The Senate Governmental Affairs Subcommittee on Oversight, Government Management, and the District of Columbia held a May 14 hearing to discuss the impact of marketing by tobacco companies on women and girls. Subcommittee Chair Richard Durbin (D-IL) opening the hearing noting the rise in lung cancer deaths among women since 1950. He pointed out that rates of lung cancer, cardiovascular disease, and chronic obstructive pulmonary disease have steadily increased in women. “All of these life-threatening conditions have one thing in common—smoking.”
Sen. Durbin added that tobacco companies have specifically marketed to women and girls with campaign slogans such as “You’ve Come a Long Way, Baby” and “Find Your Voice.”
Testifying on behalf of the administration, Dr. Cristina Beato of the Department of Health and Human Services (HHS) said that the administration aims to reduce the prevalence of smoking among women to 12 percent or less and among girls to 16 percent or less. “We have seen some success,” she noted, adding that smoking among women has declined since it peaked in 1965 at 33.9 percent.
Dr. Beato stated that smoking prevalence is higher among women living below the poverty line and among women with less than 11 years of education. “Prevalence rates among racial and ethnic populations adds another dimension to our need to better understand women and smoking,” she said. “In 2000, 42 percent of American Indian or Alaska Native women, 22 percent of Caucasian women, 21 percent of African-American women, 13 percent of Hispanic women, and 8 percent of Asian/Pacific Islander women were current smokers.”
To better address smoking prevalence among diverse racial and ethnic populations, HHS is collaborating with a number of non-profit organizations who serve such populations to provide programs to prevent and reduce the use of tobacco and exposure to second-hand smoke among women and girls.
Additionally, HHS also developed the Guide to Community Preventive Services, which recommends interventions to encourage tobacco cessation. “We know that women are more likely than men to be willing to access assistance when they try to quit, and that using assistance increases the likelihood of success,” stated Dr. Beato.
Dr. Elizabeth Whelan of the American Council on Science and Health (ACSH) detailed her experiences with publishing articles about smoking in popular women’s magazines. “Given that cigarette smoking was then and is now the leading cause of preventable death in the United States, and that cigarette smoking is a major threat to a developing fetus, in my articles I necessarily focused on the dangers posed by smoking,” she said. “I was astonished that my articles were regularly edited so that pejorative references to smoking were purged.”
The ACSH has conducted several surveys examining the ratio of cigarettes ads to health articles about smoking in women’s magazines. “In 1997, ACSH found that cigarette ads outweighed anti-smoking messages by six to one, and in 1998, the ratio had nearly doubled to eleven to one,” she said. Further, in 1999-2000, articles about the health effects of tobacco made up less than one percent of the 2,414 health-related articles published in women’s magazines.
Dr. Charles King of the Harvard Business School also presented similar research he conducted last year. His study, which was published in the New England Journal of Medicine, examined magazine advertising before and after the tobacco settlement. Under the settlement, tobacco advertising that targets individuals younger than 18 is prohibited. “What we found was disheartening,” he said. “The Master Settlement Agreement appears to have had little effect on cigarette advertising in magazines and on the potential exposure of young people to these advertisements in the two years after it was signed.”
Specifically, two years after the settlement, “11 of the 15 cigarette brands studied still reached more than two-thirds of all young people,” he said. The study also found that the three brands most popular among young people “consistently devoted a significantly larger share of their magazine advertising budgets to youth-oriented magazines.”
Detailing the history of tobacco marketing, Matthew Myers of the Campaign for Tobacco-Free Kids said, “By focusing their research on how females view themselves, their aspirations and the social pressures they face, the cigarette companies have developed some of the most aggressive and sophisticated marketing campaigns in history for reaching and influencing women and girls.”
Mr. Myers said that tobacco advertising targeted at women began in the 1920s. By the late 1960s, tobacco companies “began to create specific brands of cigarettes for women to capitalize on and associate smoking with the changing role of women in society and an increased desire for independence,” he said, citing the “You’ve Come a Long Way Baby” campaign. “Sadly, these ads were powerful and successful,” he said. “Six years after the introduction of Virginia Slims and other brands aimed at the female market, the smoking initiation rate of 12-year-old girls had increased by 110 percent.” Mr. Myers also noted that tobacco companies have “violated both the spirit and the intent of the settlement’s prohibition on targeting children.”
Mr. Myers also urged Congress to expand the availability of clinically effective smoking cessation services under Medicaid and Medicare and grant the Food and Drug Administration the authority to regulate the manufacturing, marketing, and sale of tobacco products.
Dr. Diane Stover of the American College of Chest Physicians (ACCP) reported that “smoking-related disease among women truly is a ‘full blown epidemic.’” She added, “In 1999, nearly 35% of all high school girls were smoking. And why should we care? Because along life’s continuum, smoking impairs the ability of girls and women to fully realize their potential—in the classroom, as mothers, in the workforce, and at life’s end.”
Dr. Stover detailed the health-related statistics for women, saying that “females are more susceptible than males to the cancer-causing agents in tobacco, putting women at nearly twice the risk of men to develop lung cancer from smoking.” Pointing out that the effects of smoking can be see across the lifespan, Dr. Stover said that adolescent girls and young women who smoke have higher rates of asthma, wheezing and menstrual abnormalities; women of child-bearing age who smoke may reduce or delay their fertility; pregnant women who smoke are more likely to suffer from excessive bleeding, premature labor, ectopic pregnancy, and spontaneous abortion, and their babies are more likely to be born prematurely and with low birthweight; and older women who smoke are more likely to suffer from early onset of menopause and higher rates of osteoporosis.
In an effort to prevent women and girls from smoking, the ACCP established the Task Force on Women & Girls, Tobacco & Lung Cancer, which has launched several educational initiatives, including a Speaker’s Bureau and school-based educational pilot programs.
Finally, the subcommittee heard the poignant testimony of Cassandra Coleman, a woman who began smoking at the age of 11 but was able to quit with the assistance of her children. Ms. Coleman now works part-time at a smoking cessation program in Illinois. “I can’t tell you how much better I feel every day,” she said, adding that she decided to quit smoking when her nine-year-old daughter said, “Get away from me! You stink! You’re trying to kill me with cigarettes.”