Why women should quit smoking

Smoking sections in restaurants.
Cigarette ads in magazines and on T.V.
Smoking in plane cabins for international flights.

Do you remember these relics of the past?

Since the U.S. Surgeon General’s announcement in 1964 that smoking was found to cause lung disease, the United States has devoted significant resources to lowering smoking rates.¹ Overall, these measures have been successful, and smoking rates have plummeted from 42 percent of the U.S. population in 1965 to 12.5 percent in 2020.²

But although smoking rates have decreased over the past 50 years, smoking still kills more than 480,000 Americans each year.³ Smoking costs in the United States alone totaled more than $600 billion in 2018,⁴ including more than $240 billion in health care spending and nearly $372 billion in lost productivity.⁵

Smoking’s costs are physical as well as financial

Although there are negative health effects for both men and women who smoke, women are more at risk for certain health conditions that can affect quality of life and lead to increased costs for health plans and employers. Because of this, it’s important for payors to understand health disparities, promote smoking cessation efforts, and work to lower smoking rates for female members.

Women who smoke are at higher risk of developing a variety of health problems, from lung-related issues to cancer and issues with bone density. Some health issues are immediate, and others can take years to develop.

• Smoking causes most lung cancer deaths in women and men. More women die from lung cancer than any other cancer, including breast cancer. There are now more new cases of lung cancer in young women (ages 30–49) than young men.⁶
• Deaths resulting from COPD in women are higher than in men. In the late 1960s, the tobacco industry intensely targeted women. This resulted in a huge increase in women smoking. We are still seeing new cases of smoking related diseases, including COPD, as women age.⁷
• Women are more vulnerable than men to lung damage from cigarette smoke and other pollutants. Their lungs are smaller, and estrogen may play a role in worsening lung disease.⁸
• Women who smoke also have an increased risk for developing cancers of the oral cavity, pharynx, larynx (voice box), esophagus, pancreas, kidney, bladder, and uterine cervix. They also double their risk for developing coronary heart disease.⁹

Smoking can affect reproductive health

• Menopause occurs 1 to 4 years earlier in smoking women than in nonsmokers. Chemicals in cigarette smoke appear to accelerate follicular depletion and the loss of reproductive function.¹⁰
• Women who smoke more than 20 cigarettes daily face an increased risk of ectopic pregnancy compared with nonsmokers.¹¹
• Smoking also has been associated with bacterial vaginosis (which in turn is associated with second-trimester miscarriage) and with preterm labor.¹²

Lung cancer and cause of death

Lung cancer outnumbers other types of cancer as the leading cause of death for women. Although not all lung cancer deaths are related to smoking, the toll of smoking, both directly for smokers, and indirectly for those exposed to second- or third-hand smoke is significant.

Demographics and smoking use

Disparities in tobacco use, secondhand smoke exposure, related health problems, and access to treatment can occur based on where people live, the type and amount of employment and health insurance they have, and other social and demographic factors such as race, ethnicity, age, sexual orientation, disability status, level of education, income, and/or behavioral health status.

Smoking affects some racial and ethnic groups more than others. For example, the 2016 smoking rate for American Indian/Alaska Native women was 35 percent while the rate for non-Hispanic white women was 16 percent. For Hispanic women it was just 7 percent and 6 percent for Asian American women.¹³

Next steps for payors

Recognizing that women are at an increased risk of developing smoking-related health conditions, payors should continue to focus on providing smoking cessation resources and benefits. The Great American Smokeout is one such resource to share with members.

CVS Health removed tobacco products from all CVS Pharmacy locations in 2014 and is committed to helping deliver the nation’s first tobacco-free generation. We are investing in efforts to increase access to anti-smoking education, tobacco control advocacy, and healthy behavior programming. We offer key resources for students, parents, teachers, clinicians, schools, and youth organizations.