Smoking - Women in United States

United States

Smoking cigarettes has an adverse impact on overall health. As the leading cause of preventable death in the United States, cigarette smoking is responsible for the deaths of more than 480,000 Americans every year, including 201,770 women. One study estimated the probability of female smokers living to age 80 to be 38%, compared with 70% for female nonsmokers. Smoking affects nearly every organ and can cause heart disease, stroke, diabetes, multiple types of cancer and respiratory conditions such as emphysema and chronic bronchitis.

Nonsmokers are also affected by smoking. Secondhand smoke exposure can lead to sudden infant death syndrome (SIDS), respiratory and ear infections in infants and children and heart disease and lung cancer in adults. Exposure to secondhand smoke is estimated to cause about 41,000 deaths among U.S. adults every year. 

Smoking may also affect reproductive health. Women who smoke are more likely to have reduced fertility, go through menopause at a younger age and experience adverse birth outcomes, including miscarriage and SIDS. Infants born to women who smoked during pregnancy have a higher risk of preterm birth, low birth weight and issues with lung and brain development that can last into childhood or adulthood.

In recent years, there has been an increase in the popularity of e-cigarettes, especially among youth and young adults. E-cigarettes often contain nicotine and other cancer-causing chemicals. In October 2021, the U.S. Food and Drug Administration authorized the marketing of certain tobacco-flavored e-cigarettes as a tool to help adults addicted to cigarettes smoke less and reduce their exposure to harmful chemicals.

Smoking is estimated to cost the U.S. more than $600 billion dollars annually, including more than $240 billion in healthcare spending and nearly $185 billion from lost productivity due to smoking-related illness.

According to America’s Health Rankings analysis, the prevalence of smoking is higher among:

• Women ages 35-44 compared with women ages 18-24.
• Multiracial and American Indian/Alaska Native women compared with Asian women.
• Women without a college degree compared with college graduates. 
• Women with an annual household income less than $25,000 compared with women with an income of $75,000 or more. The smoking rate increases with each decrease in income level.
• Women living in non-metropolitan areas compared with women in metropolitan areas.
• Women who have difficulty with self-care compared with women without a disability.

Quitting smoking can have profound benefits on current and long-term health, even among heavy and lifelong smokers:

• Individuals who quit smoking before age 40 live an average of 10 years longer than those who continue. 
• The risk of stroke becomes similar to that of nonsmokers five years after quitting. 
• Pregnant women who quit smoking during the first trimester give birth to infants of comparable weight and height to those of nonsmoking women. 

A variety of interventions are effective for smoking prevention and cessation. States that have expanded Medicaid coverage for tobacco cessation programs have shown declines in smoking prevalence. This is a vital area for improvement because of the high prevalence of smokers enrolled in Medicaid. Excise taxes and increased prices have been effective in preventing nonsmokers from starting, increasing cessation and decreasing smoking-related health problems. The American Lung Association highlights other policies that support measures to eliminate the tobacco industry’s targeting of women, communities of color and the LGBTQ community. 

Additional smoking prevention and cessation resources include: 

• The Centers for Disease Control and Prevention offers guidelines on and examples of successful programs for preventing and controlling tobacco use.
• County Health Rankings & Roadmaps’ What Works for Health tool provides a list of evidence-based strategies to address tobacco use. 
• Smokefree.gov provides free, accurate and evidence-based information as well as professional assistance to support the immediate and long-term needs of smokers trying to quit. There are also resources specifically for women and pregnant women. Estimates have shown that for every dollar invested in smoking cessation programs and relapse prevention for pregnant women, $3 are saved in future health care costs.

Healthy People 2030 has multiple objectives regarding adult tobacco use, including reducing current cigarette smoking and increasing past-year attempts to quit smoking.

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Shah, Reena S., and John W. Cole. “Smoking and Stroke: The More You Smoke the More You Stroke.” Expert Review of Cardiovascular Therapy 8, no. 7 (July 2010): 917–32. https://doi.org/10.1586/erc.10.56.

U.S. Department of Health and Human Services. “E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf.

U.S. Department of Health and Human Services. “The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.” Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276/.

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