Recent epidemiological studies show that tobacco consumption progressively decreases among men, but continues to increase in women

Global tobacco consumption has decreased, from reaching 32.7% of the world population over 15 years of age in the year 2000 to 22.3% in 2020. However, the reduction has occurred unevenly: policies they have been much less effective for women. Recent epidemiological studies show that while tobacco consumption progressively decreases among men, it continues to increase among women. A particularly worrying fact because tobacco affects women more seriously.

Tobacco consumption decreases… in a part of the population

The latest report from the World Health Organization (WHO) on global trends in tobacco use , published in November 2021, indicates that in 2020 the number of women smokers was 231 million. The age group with the highest prevalence of tobacco use among women is 55 to 64 years.

In Europe, 18% of women continue to smoke, a considerably higher percentage than in any other region. European women are the slowest to reduce tobacco consumption in the world. In all other WHO regions, women are on track to decrease rates by at least 30% by 2025.

From a historical perspective, it is true that women start smoking tobacco later than men, conditioned by sociocultural factors related to their incorporation into the world of work and the movement for equal rights. In fact, most epidemiological studies of the 20th century showed that diseases such as lung cancer or chronic obstructive pulmonary disease (COPD) were almost exclusive to men. But the situation has changed.

The current data from the WHO, that tobacco consumption has undergone a significant feminization process since the 1970s, progressively spreading among women of different socioeconomic levels and age groups.

The prevalence of smoking in women has increased in developed countries and this has conditioned changes in diseases. Both lung cancer and COPD, fundamentally linked to smoking, have gone from being diseases of men to having an exponential increase in women. In addition, there is still a clear gender bias in terms of diagnosis.

Impact of tobacco on women

Many doctors continue to associate both pathologies with a male pattern, without taking into account the increase in smoking in women. This is a very worrying fact, because the latest scientific studies clearly show a greater vulnerability of women in terms of the harmful effects of tobacco. The different factors linked to a greater susceptibility to the harmful effects of smoke are genetic, hormonal and anatomical.

• The genetic predisposition of women to tobacco-associated lung damage has been confirmed by studies among families of smokers and ex-smokers. In addition, the sons and daughters of mothers who smoke are more prone to respiratory problems such as asthma and COPD .
• Additionally, there are anatomical differences in the airways, narrower than those of men in proportion to the size of their lungs.
• Hormonal differences are also significant. Women who smoke may have an earlier onset of menopause . Tobacco decreases estrogen levels in the blood, which causes a worsening of the symptoms of menopause and a worsening of osteoporosis with an increased risk of fractures, especially at the level of the hip and spine.

In short, smoking prevention and diagnosis policies must improve in terms of possible gender biases. A partial and biased understanding of health problems among women must be avoided, as well as their invisibility in diseases and health problems traditionally seen as masculine, such as lung cancer and COPD.