Scared Smokeless

Will New Yorkers quit smoking if you frighten them?

If it looks grim, that’s because it’s meant to. And if you don’t like that one, the New York Health Department has several other yucky pictures you’re bound to dislike just as much.

That’s the idea, anyway. Whether or not it proves successful or even useful is another matter. Yesterday, the city’s Department of Health and Mental Hygiene rolled out its new series of revolting matchbooks designed to help undercut tobacco industry marketing schemes. By focusing awareness on the graphic presentation of smoking’s worst effects, the campaign hopes to highlight the ugly side of the public health equation and reinforce this message by associating cigarettes with pictorial representations of gum disease, blackened lungs, and throat cancer.

“The tobacco industry spends $13 billion dollars each year promoting smoking by showing glamorous, healthful images,” the Health Department’s Sarah B. Perl said in a press release. “The reality of smoking is ugly and devastating. We hope these images will encourage New Yorkers to get the help they need to quit.”

Health officials are keying off several similar campaigns conducted in Canada, Australia, Brazil, Thailand, and other countries. However, in those countries, the grisly images have been placed directly on cigarette packs, rather than on matchbooks. Cigarettes sold in Canada must have warning labels that occupy at least 50% of the principal display space on the pack.

While inconspicuous text boxes with dire warnings have been mandatory on cigarette packs and other nicotine products for more than forty years in the U.S., the current warnings have not been updated since 1984, according to New York health officials.

According to the September 22 New York Times, the matchbooks will be distributed for free in the neighborhoods that have so far proven the most resistant to public anti-smoking campaigns—the heavy-smoking neighborhoods of East Harlem, the South Bronx, and Brooklyn.

In the Times article by Sewell Chan, Dr. Susan D. Karabin of the American Academy of Periodontology said: “These images are accurate: Smoking interferes with healing, with the immune system, and if you have periodontal disease—a chronic, low-grade infection—it exacerbates it, and makes the body less able to deal with that infection.” The result, said Karabin, is that smokers lose more teeth than non-smokers do. She supported the new “Eating You Alive” matchbook campaign: “Unfortunately, I think it does take scare tactics to get people to stop smoking.”

Graphic credit: NYC Health

smoking nicotine

Quitting When You're High

Active smokers underestimate rigors of withdrawal.

An alcoholic wraps his car around a tree in a drunken haze. He has "hit bottom" and vows never to drink again.

A meth tweaker gets so high he becomes unruly and disoriented and is arrested. In jail, cranked to the gills on speed, she pledges to go sober, starting right now.

A cigarette smoker stumbles to bed after a typical two-pack day, coughing, throat burning, reeking of tobacco, and swears that upon waking, his remaining cigarettes will go out with the trash and his life as a human ashtray is over.

Each of these addicts has started off on exactly the wrong foot, and will very likely fail quickly in their quitting attempts, according to recent research on smoking cessation from the University of Pittsburgh and Carnegie Mellon University. It is easy to say you're going to quit while you're high, sailing along on a comfortable level of nicotine in the bloodstream. Once that available nicotine is flushed out, you are going to have some serious second thoughts about the whole enterprise of abstinence. The smoker is likely to wake up the next morning, fumbling for a smokeable butt, muttering to himself: "What in the world was I thinking of last night? No way am I quitting today."

In a study to be published in the September issue of Psychological Science, researchers showed that cigarettes smokers who are not actively craving a cigarette when they vow to quit will likely not succeed, because they inevitably underestimate the rigors of the upcoming withdrawal, and the fierce intensity of their future desire to smoke.

According to lead investigator and professor of psychology Michael Sayette, "this lack of insight while not craving may lead them to make decisions--such as choosing to attend a party where there will be lots of smoking--that they may come to regret."

In the study, titled "Exploring the Cold-to-Hot Empathy Gap in Smokers," the researchers write: "In contrast to smokers in a hot (craving) state, those in a cold (noncraving) state underpredicted the value of smoking during a future session when they would be craving.... Failing to anticipate the motivational strength of cigarette craving, nonsmokers may not appreciate how easy it is to become addicted and how difficult it is to quit once addicted."

George Loewenstein, professor of economics and psychology at Carnegie Mellon and a co-author of the study, said that the research implications for non-smokers were crucial: "If smokers can't appreciate the intensity of their need to smoke when they aren't currently craving, what's the likelihood that people who have never smoked can do so?"

As further evidence of this psychological mismatch, the researchers cite earlier work performed by the University of Michigan’s Monitoring the Future longitudinal study of 1993, "which found that although only 15% of respondents who were occasional smokers (less than one cigarette per day) predicted that they might be smoking in 5 years, 43% of them were, in fact, smoking 5 years later."

All things considered, it's better to make the quitting decision when you're hurting, not when you're high.

Graphic Credit: Florida State University

Gates, Bloomberg Target Cigarettes

Billionaires pledge $500 million, but will it do any good?

If money were all it took, tobacco smoking would be on the run after Bill Gates and Michael Bloomberg jointly pledged last month to fight tobacco use worldwide, especially in low- and middle-income countries, through the Bill and Melinda Gates Foundation and Johns Hopkins University.

Mayor Bloomberg, who has been involved in anti-smoking campaigns for years, admitted at a joint news conference that "all the money in the world will never eradicate tobacco. But this partnership underscores how much the tide is turning against this deadly epidemic."

The program, put together by Bloomberg and Dr. Margaret Chan of the World Health Organization (WHO), is an ambitious, multi-faceted effort to be coordinated by the Bloomberg Initiative to Reduce Tobacco Use, the WHO, the World Lung Foundation, the Johns Hopkins Bloomberg School of Public Health, and the Centers for Disease Control and Prevention (CDC).

As Donald G. McNeil described the $500 million program, dubbed Mpower, in the July 24 New York Times: "It will urge governments to sharply raise tobacco taxes, prohibit smoking in publics places, outlaw advertising to children and cigarette giveaways, start antismoking advertising campaigns and offer people nicotine patches or other help quitting." The program also intends to bring "health officials, consumer advocates, journalists, tax officers and others from third world countries" to the U.S. for workshops and training.

It will not be the first such effort--far from it. Troubled by the rising tide of nicotine dependence among the common folk, Bavaria, Saxony, Zurich, and other European states outlawed tobacco at various times during the 17th Century. The Sultan Murad IV decreed the death penalty for smoking tobacco in Constantinople, and the first of the Romanoff czars decreed that the punishment for smoking was the slitting of the offender’s nostrils.

In America, the Prohibition years from 1920 to 1933 coincided with a short-lived effort to prohibit cigarettes. Leaving no stone unturned in the battle to eliminate drugs and alcohol from American life, Henry Ford and Thomas Edison joined forces to wage a public campaign against the “little white slavers.” Edison and Ford wanted to stamp out cigarette smoking in the office and the factory. Although that effort would have to wait another 75 years or so, New York City did manage to pass an ordinance prohibiting women from smoking in public. (See Siegel, Ronald K. Intoxication: Life in Pursuit of Artificial Paradise). Fourteen states eventually enacted various laws prohibiting or restricting cigarettes. By 1927, all such laws had been repealed.

Finally, Adolf Hitler himself took on the battle against cigarettes--and lost. In 1942, after letting loose a torrent of misbegotten screed about "the wrath of the Red Man against the White Man," Hitler, in one of the most aggressive anti-smoking campaigns in history, banned smoking in public places and slapped heavy taxes on tobacco. But by the mid-1950s, smoking in Germany exceeded prewar levels.

There is no evidence to suggest that any culture that has ever taken up the smoking of tobacco has ever wholly relinquished the practice voluntarily.

Photo Credit: National Health Service

The Genetics of Cigarettes

Mutations on chromosome 15 linked to lung cancer.

A variation among the genes that code for nicotine receptors in the brain has been linked with increased cigarette smoking and a heightened risk for lung cancer, according to three new studies released this week.

Two studies in Nature, and one in Nature Genetics, demonstrated that people who inherited the genetic variation, or allele, from one parent—roughly 50 percent of the population--had a 30 percent higher risk of developing lung cancer. “What’s more,” according to Michael Hopkin at Nature News, “another 10 percent of the population is likely to carry two copies of this set of mutations, raising cancer risk by as much as 80 percent relative to people with equivalent lifestyles without the cancer-linked gene variant.”

More than 35,000 Caucasian smokers in Europe and North America took part in the government-funded research. It was the strongest evidence to date of a firm link between genetics and lung cancer. It was also added evidence for the existence of biological proclivities in addicted cigarette smokers.

Earlier studies had demonstrated that having a parent or sibling with lung cancer could triple the odds of developing the disease. But teasing out the precise genes responsible has been, as always, a frustrating hunt.

Christopher Amos of the University of Texas, author of one of the studies, characterized the variant as “kind of a double whammy gene” in an Associated Press article by Seth Borenstein. Amos said of the nicotinic acetylcholine receptor gene alleles on chromosome 15: “It also makes you more likely to be dependent on smoking and less likely to quit smoking.” In the same article, psychiatry professor Dr. Laura Bierut of Washington University in St. Louis said that the three studies are “really telling us that the vulnerability to smoking and how much you smoke is clearly biologically based.”

Study author Kari Stefansson of Iceland’s deCode Genetics believes strongly that the genetic variation in question makes people more susceptible to nicotine addiction, and increases the difficulties of quitting: “In our study, we found if you have one allele you smoke about one more cigarette per day; if you have 2 alleles you average two more cigarettes per day.”

However, according to Denise Gellene of the Los Angeles Times: “The studies were divided on whether the genetic variant directly increased the risk of lung cancer or did so indirectly by predisposing people to smoking.” In a third study, Paul Brennan of the International Agency for Research on Cancer in Lyon, France noted no evidence of a link between the rogue gene and nicotine addiction itself.

It is not clear whether non-smokers with the mutation suffer an increased risk of lung cancer as well. (However, even smokers who lack the gene variant are still ten times as likely to develop lung cancer than nonsmokers).

About one million people die annually from lung cancer. According to the World Health Organization, smoking is the leading cause of preventable death worldwide.

Graphics Credit: Technology Review

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Where Can I Smoke?

An international survey of the cigarette scene.

It was a tough year for smokers. 2007 marked the onset of new restrictions on public smoking in dozens of nations around the world.

Contrary to popular belief, smoking bans are nothing new under the sun. Troubled by the rising tide of nicotine dependence among the common folk, Bavaria, Saxony, Zurich, and other European states outlawed tobacco at various times during the 17th Century. The Sultan Murad IV decreed the death penalty for smoking tobacco in Constantinople, and the first of the Romanoff czars decreed that the punishment for smoking was the slitting of the offender’s nostrils. Still, there is no evidence to suggest that any culture that has ever taken up the smoking of tobacco has ever wholly relinquished the practice voluntarily.

In order to sort things out, the BBC News Website, among others, recently compiled a chart of global changes in the climate for smokers. Herewith, a representative sampling:

In FRANCE, January 1, 2008, marked the day when cafes, bars and assorted French eateries were slated to go smoke-free, joining the existing ban on smoking in public buildings. However, in a gesture of Gallic tolerance, the government instituted a last-minute grace period, postponing the deadline 24 hours. French authorities are not expecting widespread civil disobedience among smokers and café owners--an optimism bolstered by a stiff fine of 450 euros ($660) for violations. (Most European restrictions allow for closed-off smoking sections with ventilation, something most bar and café owners say they cannot afford to build.)

GERMANY followed a similar path, when eight states, including Berlin, went smoke-free in pubs and restaurants on the 1st of January. Having passed legislation guaranteeing workers the right to a smoke-free workplace, German officials are less sanguine about the enforcement picture, according to the BBC report. German pubs bitterly fought the ban, reminding the citizenry that Hitler had wanted to ban cigarettes, too. The hard test will come in good weather, when the beer tents go up and the festivals begin.

THE UNITED KINGDOM has banned smoking in all “enclosed public spaces,” with on-the-spot fines of 50P, after a long and contentious debate on the subject of second-hand smoke.

Cafes and restaurants in FINLAND went smoke-free, along with many other European nations, on June 1, 2007. NORWAY has had a national ban on smoking in bars and restaurants in place since 2004, and SWEDEN followed in 2005. IRELAND has had strong anti-smoking laws since 2004, and the same is true of ITALY since 2005.

ESTONIA, LITHUANIA AND MONTENEGRO have smoking bans in place for bars and cafes. SPAIN made shops and offices smoke-free in 2006, but there have been boycotts, and enforcement is said to be lax. PORTUGAL observed the January 1 ban, but will let small bars continue to allow smoking if they choose.

THE NETHERLANDS—a country, like Germany, Spain and Greece, with a serious population of smokers—went all the way on January 1st, banning indoor smoking, but certain details remain unclear. How will cannabis coffee shops be required to deal with the restrictions?

INDIA has tightened smoking restrictions on public places in recent years, and has banned the sale of cigarettes to children. However, the BBC reports that a lack of money and resources mean that the smoking restrictions are only sporadically enforced. The same is true in IRAN, where restrictions on smoking in public buildings are widely ignored.

The UNITED STATES represents a confusing amalgam of state and local ordinances that vary widely and is the subject of bitter debate. New York banned smoking in bars, clubs and restaurants five years ago. California, with some of the most rigid anti-smoking legislation in the world, prohibits smoking in bars, restaurants, enclosed workplaces, within six meters of any public building, and even on public beaches. Countless local, regional, city and state regulatory agencies continue to grapple with the issue.

VENEZUELA, another nation of heavy smokers, initiated a partial ban on public smoking in 2007. Restaurants and bars in ARGENTINA must now include no-smoking areas.

AUSTRALIA, which already had rigid no-smoking rules in place, from airports to restaurants, is considering a smoking ban at Bondi Beach, the country’s most famous stretch of sand.

In CANADA, British Columbia and Alberta joined with other provinces and banned indoor smoking in public places on January 1st, 2008.

In CHINA, the nation with more smokers than any other, the government undertook small-scale test bans last year in the cities of Guangzhou (Canton) and Jiangmen. Otherwise, smoke ‘em if you got ‘em.

RUSSIA remains a smoker’s paradise as well, with a comprehensive anti-smoking package passed by the Duma, but still awaiting implementation.

MEXICO has required separate smoking and non-smoking areas since 2004. Mexico City, with some of the highest air pollution readings in the world, began battling over a smoking ban in bars and restaurants last year, and the outcome remains clouded.

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Nicotine Vaccine Doubles Quit Rate in Human Trials

NicVax still showing promise against cigarette addiction

Nabi Biopharmaceutical announced this week that an experimental vaccine it has been testing against nicotine addiction had shown itself to be effective in human trials. Volunteers were more than twice as likely to quit, compared to a control group whose members were injected with a placebo.

The company-funded study gave volunteers five injections of NicVax, Nabi’s proprietary drug, or else a placebo. In regulatory filings, the company claims that the vaccine triggers an antibody response, which prevents nicotine molecules from reaching the brain. The antibodies bind with the nicotine molecules, making nicotine too large to cross the exceedingly fine blood-brain barrier of the brain. Roughly 15 per cent of smokers who received injections of NicVax were nicotine-free after one year. For comparison, early studies of Chantix as an anti-smoking medication show a quit response rate in the range of 20 per cent for heavy smokers. Studies of NicVax undertaken last year were also positive. It is one of several nicotine vaccines currently under development, and while it is farthest along in the FDA pipeline, it is still a year or two away from any possible commercial introduction.

Vaccines for specific addictive drugs represent one of two different approaches to developing pharmaceuticals for addiction treatment. The other approach, represented by Chantix and Zyban, decreases drug craving by altering the neuroregulation of dopamine and other substances in the brain. In this respect, these two drugs, which are non-addictive, are related to nicotine gums and patches, which also attempt to diminish cravings for cigarettes.

A vaccine like NicVax, however, does not attack the craving for nicotine. It contains no nicotine and is non-addictive. Rather, the vaccine makes the attempt to assuage nicotine cravings an impossible task. And in this respect, NicVax resembles Antabuse for alcoholism--except that the vaccine does not cause the smoker to become seriously ill when he or she takes a puff. . (The company reported that side effects were “well tolerated.”) It simply (or not so simply) cancels out the nicotine high altogether, or at least that is the idea. It is unclear to what extent the antibody reaction prevents nicotine binding in other areas of the body where nicotine-type receptors are found, such as acetylcholine receptors in muscle tissue.

In addition, NicVax must be injected, while Chantix and Zyban or taken orally. “Some people prefer a shot and some people will do anything to avoid one,” Rennard said. “It’s important to have options.”

Stephen Rennard of the University of Nebraska Medical Center, one of the authors of the company’s study, which is funded by a grant from the National Institute on Drug Abuse (NIDA) and is now in midstage, said that when smokers “don’t get the hit they would normally get, it makes it easier for them to quit because smoking doesn’t really do it for them any more.”

The results were presented at the American Heart Association Scientific Sessions in Orlando, Florida. “This double-blind, placebo-controlled trial has demonstrated [that] there is a correlation between antibody level and the ability of patients to quit smoking and remain abstinent over long periods of time,” Rennard told the group. Leslie Hudson, CEO and Interim President of the company, said he was “excited and encouraged.” Nabi Biopharmaceutical, headquartered in Boca Raton, Florida, is traded on the NASDAQ stock market [NABI].

Can Obama Quit Smoking?

Does nicotine addiction matter in a president?

Presidents Eisenhower, Kennedy, Johnson, Ford, and Clinton all enjoyed their occasional cigarettes and cigars. Laura Bush as been accused of bumming a cigarette or two since entering the Oval Office.

Presidential candidate Barack Obama smokes, too, but I could not find a picture of him actually doing it--and neither can anybody else, it seems. By all accounts, Barack Obama continues to struggle mightily in his current quitting attempt, which began in the form of a campaign promise to his wife. Sources say he’s getting by—barely--with the “strenuous” use of nicotine chewing gum.

Is there any way for Obama to connect with FDR and his rakish cigarette holder? Or is a president who smokes simply out of step with a nation seemingly bent on emptying all workspaces and gathering places of tobacco smoke? In a smoke-free nation, will the next president be forced to huddle on the rear portico of the White House, with the serving staff, and fieldstrip the odd Marb?

The fact that Obama may have messed with a little weed, a little blow, back in the day, seems, at long last, to be a non-starter as a wedge issue of any consequence. If Newt Gingrich smoked pot in college, everybody smoked pot in college. Even before Obama had officially entered the race last year, Michael Currie Schaffer of the Dallas Morning News ventured to guess that “youthful coke-dabblers probably outnumber adult smokers among Mr. Obama’s fellow 1980s, Harvard law students.”

On the other hand, as Maureen Dowd cooed in the New York Times, the smoking habit made Obama “intriguingly imperfect.” Ah, that touch of the rogue. Simply irresistible. Clearly, this is meant to separate Obama as a candidate from that oh-so-perfect and impeccably smoke-free Hilary Clinton, who in point of fact was personally responsible for the first official no-smoking regulations in the White House.

Nonetheless, as Schaffer points out, nowadays smoking is “actuarially foolish and hopelessly out of fashion,” and as such, can do Obama no good, even as a humanizing gambit. Fox News called it “Obama’s dirty little secret.” The fact that Obama hasn’t officially overcome the habit means he cannot lean on any sort of triumph over adversity, any type of uplifting self-help story, as even George Bush was able to do with his former drinking.

Some anti-smoking advocates want Obama to come out of the closet and embrace his inner nicotine fiend in public. According to the New York Times, “Smoking cessation experts say they hope Mr. Obama’s example of using a nicotine gum will encourage smokers to try a nicotine replacement product to help them quit.” But for ABC News, as correspondent Jake Tapper put it, the big question is: “Will Nicorette be enough to get him through Iowa and New Hampshire? Or will he inhale?”

One of the problems with nicotine gums and lozenges, as a British health report recently made clear, is that nicotine replacement is not widely used, because it is expensive--and because it is subject to greater regulation than cigarettes themselves. Warning labels on a pack of Nicorette far exceed the side effects listed on a pack of Camels.

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Nicotine Addiction in the U.K.

Study group urges harm reduction strategy for heavy smokers

Britain's Royal College of Physicians (RCP) called upon the government to treat cigarette smoking like any other drug addiction, and faulted its members for failing to offer sufficient help to heavy smokers trying to kick the habit.

Because of that failure, the Academy called for greater access to nicotine substitution products, and the development of safer and more effective nicotine delivery systems for smokers who cannot quit.

The Academy’s report, "Harm Reduction in Nicotine Addiction: Helping People Who Can’t Quit," called for a sweeping overhaul of the country’s nicotine marketing structure "so that harm reduction strategies are in place."

The report’s principle suggestion: "Change nicotine product regulation to make it easier to produce and market medicinal nicotine products."

Jean King, Cancer Research UK's director of tobacco control, said the report highlighted the "stark fact" that cigarettes are freely available, while medicinal nicotine products are heavily regulated.

The report also calls for continued development of new forms of “user-friendly medicinal nicotine substitutes,” as well as relief from burdensome regulations that impede the marketing of new nicotine alternatives—chewing gums, nasal sprays, and patches.

“Smokers smoke because they are addicted to nicotine,” said Professor John Britton, chair of the Academy’s Tobacco Advisory group. “There are millions of smokers who can’t quit, or else are unlikely to quit, and those people need nicotine products that can satisfy their addiction without killing them.”

This methadone-style approach to nicotine addiction is sure to prove controversial. Will it save lives, or will it simply keep nicotine addicts from getting clean? Reuters reports that some British scientists are concerned that an emphasis on cigarette substitution products is at odds with a policy of helping people completely break their addiction to nicotine—which the Royal Academy maintains is still their primary focus.

Smoking in New York City

A Borough-By-Borough Survey

New York City has 240,000 fewer smokers than it did in 2002, according to a recent report released by the city’s Department of Health and Mental Hygiene. City health official Jennifer Ellis told the New York Times that the data represent the sharpest fall-off in cigarette smoking since the department began the surveys in 1993.

The report cited bans on smoking in public places, higher taxes on tobacco products, and a multi-million dollar local advertising campaign as the ingredients that helped lead to the overall reduction in the number of smokers. Based on a citywide survey of adults, Who’s Still Smoking states that as many as 800,000 smokers attempted to quit in the past year, but less than one-fifth of them succeeded.

However, quit rates over the 5-year period varied markedly from borough to borough. Staten Island proved to be the home of the city’s most stubborn and recalcitrant smokers: While the citywide smoking rate dropped by almost 20 per cent, Staten Island’s smoking rate—27 per cent, according to the survey--has remained steady since 2002. Manhattan and the Bronx ended in a virtual tie for first place, with smoking reductions of about 24 per cent, while Queens trailed slightly. Brooklyn came in second to last, with a quit rate of only 13 per cent.

On August 21, the Health Department began a nicotine-replacement giveaway program aimed specifically at Staten Islanders. The 5-week giveaway and associated media campaign will run Tuesdays through Thursdays at the Staten Island Ferry’s Whitehall Terminal.

Men still lead women in smoking, 20 per cent to 15 per cent overall, but the report claims that quit rates are similar for both sexes. Low-income adults and adults without a high school education are more likely to attempt quitting by a slight margin, but less likely to be successful per attempt. One important side note: A separate analysis of survey data showed that only 11 per cent of heavy drinkers who smoke were able to quit in the past year.

The average pack-a-day smoker now spends $2,500 a year to support his or her habit. Health officials stressed that the use of nicotine replacement, either as patches or gum, along with anti-craving medications like Zyban and Chantix, can at least double a smoker’s chances of successfully getting free.

Information in the report was gathered through a random telephone survey of 10,000 adult New Yorkers.

Image courtesy of the National Library of Medicine.

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Book Review (Part 1): "Women Under the Influence"

Women and Cigarettes: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

“Compared to boys and men, girls and women become addicted to alcohol, nicotine, and illegal and prescription drugs at lower levels of use and in shorter periods of time, develop substance-related diseases like lung cancer more quickly, suffer more severe brain damage from alcohol and drugs like Ecstasy, and often pay the ultimate price sooner. Yet 92 per cent of women in need of treatment for alcohol and drug problems do not receive it. Stigma, shame, and ignorance hide the scope of the problem and the severity of the consequences.”

--Joseph A. Califano, Jr.

“Women Under the Influence,” with a Foreword by former Health, Education and Welfare Secretary Joseph Califano, appeared in print last year, but is well worth a second look. The result of studies undertaken at Columbia University’s National Center on Addiction and Substance Abuse, and collectively written by that group, “Women Under the Influence” gathers together a decade’s worth of research on the gender differences researchers have thus far been able to identify in the addict population.

The same genetic and biological mechanisms that predispose certain men toward alcoholism and other forms of drug addiction do the same in women. Young women with family histories of alcoholism will, like Pavlov’s dogs, salivate more intensely at the sight of alcohol than women from families without addiction histories. Studies of female twins also confirm the behavioral link between major depressive disorder and substance abuse. Women who have suffered from major depression are three to six times more likely to suffer from alcoholism than those who have not. Despite these and other commonalities, however, women and men often follow different arcs of addiction on a drug-by-drug basis.

We begin with cigarettes, since it is with nicotine that women have lately shown the ability to achieve a grisly parity, or in some cases even outdo men in the damage done by nicotine. About one American woman out of five smokes. While rates of lung cancer in men have been slowly declining since 1980, the number of women with lung cancer has increased 600 percent over the past 70 years. More women now die of lung cancer than the combined fatalities from breast cancer, ovarian cancer, and uterine cancer. As Antonia C. Novella, former U.S. Surgeon General, put it: “The Virginia Slims Woman is Catching up to the Marlboro Man.”

80 per cent of female smokers began smoking before the age of 18, and women did not begin smoking in large numbers until the late 1940s, thus producing a delayed epidemic of lung cancer in women. To make matters worse, the Columbia group concluded that “At the same level of exposure to tobacco smoke, women have a greater risk of developing lung cancer than men.” Up to three times more likely, according to some studies. Moreover, women who smoke more than 20 cigarettes a day face an 80 per cent greater risk of developing breast cancer, compared to non-smoking women.

Women who smoke heavily have four times as many heart attacks as non-smoking women. Add in oral contraceptives, and the risk of heart attack increases by 1,000 percent.

Women who smoke have more respiratory disorders. Wheezing rates are consistently higher for women than for men, at all age levels. Women smokers develop more crow’s feet around the eyes than men who smoke. Female pack-a-day smokers suffer a steady accretion of bone density and a concomitant increase in rates of osteoporosis. And the fact that nicotine is an effective appetite suppressant is an open secret, as a couple of generations of chain-smoking supermodels have demonstrated.

Cigarette companies are increasingly placing their bets abroad, among a new generation of young women in countries like China, where authorities estimate that as many as 20 million Chinese women have taken up smoking over the past ten years. In “Lung cancer in U.S. women: A contemporary epidemic,” published in the Journal of the American Medical Association (JAMA 291(14):1767), J.D. Patel et. al. suggest that “Curtailing the increase in tobacco use among women in developing countries represents one of the greatest opportunities for disease prevention in the world today.”

The silver lining, if there is one, is that a majority of women still choose not to smoke.

Women Under the Influence--purchase info

End of Part One.