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Celebrate a Smoke Free Mother's Day

Mother’s Day is a day to celebrate moms for who they are and all of the wonderful things they do. It is also a great time for moms to remember the important role they play in influencing the choices their kids make regarding tobacco use. Unfortunately, tobacco use among women remains a serious problem: more than 20 million women currently smoke, an estimated 173,000 women die every year from smoking and more than 86,000 kids have already lost their mom to smoking.[1]

 

Moms who smoke can celebrate Mother’s Day by quitting. And all moms, whether or not they smoke, can celebrate Mother’s Day by taking a number of effective actions to protect their kids from becoming another one of the tobacco industry’s addicted customers and victims. Even if they smoke, what moms say, how they act and the values they communicate through their words and actions have an enormous influence on whether or not their kids smoke.[2] All moms—smokers and nonsmokers alike—can also do a lot to protect their kids from secondhand smoke.

 

How Can Moms Keep Their Children From Smoking?

 

As a parent, you are one of the most important persons in a child’s life, especially when it comes to cigarettes.  You can make a big difference in the choices your kids make.

 

·      If you smoke, quit. If you aren’t successful at first, keep trying. Children from families who smoke are twice as likely to become smokers themselves; but parents who try to quit and talk to their kids about how addictive smoking is, why they want to quit and how important it is to never start can beat those odds.[*]

 

·      Maintain a totally smoke-free home and car (even if you smoke).

 

·      Educate your child about the dangers of cigarette smoking.

 

o     Talk about addiction and how hard it is to quit smoking.

o     Emphasize the immediate health effects, like stress, increased blood pressure and coughing.

o     Emphasize the effects of smoking on physical appearance, like face wrinkles.

o     Talk to your kids about how tobacco companies target them by trying to make tobacco use seem cool so they can addict them as life-long customers.

 

·      Listen to what your child says and does about smoking and encourage your child when he/she makes good choices.

 

·      Ask your child about his/her friends and their attitudes toward smoking. Discuss peer pressure and how to deal with it effectively.

 

·      Clear up any misunderstandings your child might have about smoking (for example: not everybody is doing it, getting hooked can happen very quickly and quitting is very difficult).

 

·      Make sure your kids’ schools have strong and well-enforced no-smoking rules for kids and staff.

 

·      Support federal, state and local tobacco-prevention efforts like higher tobacco taxes, funding for tobacco prevention programs and smoke-free laws.[3]

How Can Moms Protect Their Children from Secondhand Smoke Harms?

An estimated 22 million children aged 3 to 11 years and 18 million youth aged 12 to 19 years are exposed to secondhand smoke every year.[4] Tobacco smoke contains more than 7,000 chemicals and compounds, including hundreds that are toxic and at least 69 that cause cancer.[5] Babies exposed to secondhand smoke face a higher risk of sudden infant death syndrome (SIDS) and a range of other serious health and developmental problems; older children who are exposed have increased rates of lower respiratory infections, ear infections and asthma. Exposure to cigarette smoke during childhood may lead to the development of cancer during adulthood. It can also prolong and worsen numerous medical conditions, including pneumonia, bronchitis, croup, laryngitis, bronchiolitis, asthma, flu, ear infections, colds, sinus infections, sore throats and eye irritation, all of which can lead to increased school absenteeism, emergency room visits and hospitalizations.[6]

How can you protect your child from secondhand smoke?

 

·         If you smoke, quit smoking—or at least keep trying.[†]  Call 1-800-QUIT-NOW for free help quitting smoking. You can also call your local office of the American Lung Association or American Cancer Society, talk to your doctor or sign up for a stop-smoking course.

 

·         Don’t let anyone smoke in your home. Make sure anyone who smokes only does so outside, away from open doors and windows. If you smoke, wear a “smoking shirt” and remove it before coming into contact with your child, especially infants; and never smoke while holding, feeding or bathing your child. Remember: smoking residues in a home or car can cause harm even when smoking is no longer taking place.

 

·         Never smoke in the car, especially when your child is a passenger.

 

·         Avoid leaving your child with someone who smokes or in smoky environments. Ask about smoking and smoke-free rules and practices when choosing daycare centers or babysitters and even when leaving your kids at other people’s homes. If your child is older, try to make sure that he/she does not take a job in a restaurant or other work place that allows smoking.[7]

·         If your state or community is not already smoke-free, get involved in local efforts to support a strong smoke-free law. Talking to someone from your local office of the American Lung Association or American Cancer Society is a great place to start.

 

Campaign for Tobacco-Free Kids, May 1, 2013 / Lorna Schmidt

 

More information on women, girls, and tobacco is available at http://www.tobaccofreekids.org/facts_issues/fact_sheets/toll/populations/women_girls/



[*] For helpful information on quitting, see http://www.tobaccofreekids.org/research/factsheets/pdf/0247.pdf.

 



[1] CDC, “Current Cigarette Smoking Among Adults - United States, 2011,” MMWR 61(44) November 9, 2012, http://www.cdc.gov/mmwr/pdf/wk/mm6144.pdf.  CDC, “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses --- United States, 2000-2004,” MMWR 57(45), November 14, 2008, http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf. Leistikow, B, et al., “Estimates of Smoking-Attributable Deaths at Ages 15-54, Motherless or Fatherless Youths, and Resulting Social Security Costs in the United States in 1994,” Preventive Medicine 30(5): 353-360, May 2000.

[2] Newman, I, et al., “The influence of parental attitude and behavior on early adolescent cigarette smoking,” Journal of School Health, 59(4):150-2, April 1989.  See, also, Distefan, J, et al., “Parental influences predict adolescent smoking in the United States, 1989-1993,” Journal of Adolescent Health, 22:466-74, 1998.

[3] For more detail and cites to sources, see TFK Factsheet, How Parents Can Protect Kids From Becoming Addicted Smokers, http://www.tobaccofreekids.org/research/factsheets/pdf/0152.pdf.

[4] U.S. Department of Health and Human Services (HHS), The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2006/index.htm.

[5] U.S. Department of Health and Human Services (HHS), How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking Attributable Disease: A Report of the Surgeon General. 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, 2010.

HHS, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2006/index.htm.

[6] TFK Factsheet, Harm to Kids from Secondhand Smoke: http://tobaccofreekids.org/research/factsheets/pdf/0104.pdf.

[7] TFK Factsheet, How Parents Can Protect Kids From Becoming Addicted Smokers, http://www.tobaccofreekids.org/research/factsheets/pdf/0152.pdf.



For many kids, Mother’s Day means taking mom out to breakfast, giving her a gift or just saying thanks. On this special day for moms, we should also remember that a terrific way to celebrate Mother’s Day might be to pledge to give moms who currently smoke the kind of loving support, encouragement and information that could help them become tobacco-free before Mother’s Day next year. 

In the United States, more than 20 million adult women currently smoke, putting them at risk for heart attacks, strokes, lung cancer, emphysema and other life-threatening illnesses.  Lung cancer is the leading cancer killer among women, and smoking is attributable for 80 percent of these deaths.  Smoking also accounts for one of every five deaths from heart disease, the overall leading cause of death among women.  When women quit smoking, they improve their own health as well as the health of the people around them.  Mothers who give up smoking improve the likelihood that their children will grow-up to be tobacco-free and lead much longer and much healthier lives.

 

States

Smoking

Rate Among

Women

State Rank

Women

Smoking

(1 = low)

Number of Women Smokers

Annual Women Smoking Deaths

Pregnant Women Smoking Rate

State Rank Pregnant Smoking

(1 = low)

Pregnant Births Per Year

State Kids Who Have Already Lost Their Moms to Smoking

New Kids Who Lose Their Moms to Smoking Each Year

Taxes paid for

SSSI Payments to Kids With Moms Lost to Smoking (millions/yr)

Total State Health Costs to Treat Female Smokers (millions/year)

United States

16.5%

--

20,406,000

173,940

10.0%

--

513,000

86,000

12,100

$723.9

$37.9 bill

Alabama

21.0%

36th

403,500

2,700

12.1%

24th

7,200

1,600

230

$10.29

$538.5

Alaska

23.0%

44th

58,800

100

14.5%

31st

1,600

230

30

$1.65

$61.1

Arizona

16.9%

12th

416,200

2,700

6.3%

5th

5,600

1,500

220

$11.43

$519.8

Arkansas

25.2%

49th

289,300

1,800

16.5%

38th

6,300

1,000

140

$5.59

$298.4

California

10.1%

2nd

1,455,800

15,200

NA*

NA

NA

8,600

1,200

$82.55

$3,807.6

Colorado

15.2%

7th

296,300

1,800

8.8%

16th

5,800

1,000

150

$11.05

$540.0

Connecticut

15.4%

8th

222,300

2,100

7.0%

8th

2,700

840

110

$12.07

$731.5

Delaware

18.3%

22nd

67,100

400

12.9%

28th

1,400

250

30

$2.41

$115.7

Washington, DC

17.1%

16th

46,800

200

3.9%

1st

300

200

20

$2.16

$95.2

Florida

16.9%

12th

1,315,500

11,500

7.5%

10th

16,000

5,600

790

$34.29

$2,548.4

Georgia

18.2%

20th

690,600

3,900

6.5%

7th

8,700

2,800

400

$20.32

$833.6

Hawaii

13.9%

3rd

74,600

300

5.9%

3rd

1,100

300

40

$3.18

$104.0

Idaho

15.0%

5th

87,400

500

10.5%

23rd

2,400

360

50

$2.79

$121.6

Illinois

17.8%

18th

896,800

6,600

7.4%

9th

12,200

3,400

480

$35.56

$1,641.8

Indiana

23.8%

46th

602,000

3,800

19.1%

45th

16,000

1,800

260

$16.51

$829.4

Iowa

18.6%

25th

221,600

1,500

16.5%

38th

6,300

640

90

$7.62

$365.9

Kansas

19.5%

29th

212,900

1,500

12.7%

27th

5,100

670

90

$7.24

$358.2

Kentucky

26.6%

51st

457,900

3,000

24.4%

49th

13,600

1,400

190

$8.89

$581.0

Louisiana

22.3%

43rd

398,900

2,400

10.0%

20th

6,200

1,900

270

$8.76

$544.5

Maine

20.6%

34th

112,700

900

14.6%

32nd

1,800

320

40

$2.79

$249.1

Maryland

17.2%

17th

403,800

2,900

6.2%

4th

4,500

1,700

250

$15.24

$838.7

Massachusetts

16.9%

12th

458,100

4,000

8.1%

14th

5,800

1,400

200

$19.05

$1,584.4

Michigan

19.7%

31st

770,100

5,900

13.4%

29th

15,300

3,000

430

$29.21

$1,386.8

Minnesota

17.0%

15th

351,100

2,100

9.5%

18th

6,500

970

130

$15.24

$794.0

Mississippi

21.8%

41st

253,900

1,600

12.1%

24th

4,800

1,300

180

$5.59

$247.0

Missouri

23.6%

45th

560,800

3,700

18.2%

43rd

13,900

2,000

290

$13.97

$839.9

Montana

21.0%

36th

81,600

500

19.1%

45th

2,300

300

40

$1.91

$111.5

Nebraska

17.9%

19th

125,700

800

15.4%

34th

3,900

420

50

$4.32

$191.9

Nevada

20.2%

32nd

206,900

1,300

10.0%

20th

3,500

660

90

$4.45

$234.8

New Hampshire

18.5%

24th

98,100

700

14.0%

30th

1,800

300

40

$3.81

$244.1

New Jersey

14.6%

4th

514,300

4,800

7.8%

12th

8,500

2,200

310

$29.21

$1,382.3

New Mexico

18.2%

20th

145,000

800

7.9%

13th

2,100

670

90

$3.56

$181.2

New York

16.8%

11th

1,333,600

11,100

8.1%

14th

19,500

4,600

650

$57.15

$3,578.7

North Carolina

19.2%

28th

736,200

4,600

10.0%

20th

12,200

2,500

360

$20.32

$932.8

North Dakota

19.5%

29th

51,400

200

17.4%

42nd

1,500

150

20

$1.40

$79.6

Ohio

24.2%

47th

1,110,400

7,500

18.6%

44th

25,800

2,800

400

$27.94

$1,775.8

Oklahoma

24.3%

48th

354,000

2,400

15.7%

36th

8,300

1,300

180

$6.35

$460.6

Oregon

18.4%

23rd

282,200

2,000

12.4%

26th

5,600

1,000

140

$8.89

$464.0

Pennsylvania

21.5%

39th

1,113,600

8,100

15.6%

35th

22,200

3,200

450

$34.29

$2,110.4

Rhode Island

18.8%

26th

81,900

700

9.6%

19th

1,000

250

30

$2.92

$220.6

South Carolina

20.7%

35th

387,700

2,200

15.7%

36th

9,100

1,500

220

$9.40

$398.0

South Dakota

21.7%

40th

67,700

300

19.3%

47th

2,200

260

30

$1.65

$92.6

Tennessee

21.3%

38th

543,600

3,600

17.1%

41st

13,500

2,300

320

$13.97

$813.8

Texas

15.0%

5th

1,429,400

9,400

6.3%

5th

24,300

7,100

1,000

$45.72

$2,250.4

Utah

9.6%

1st

93,400

300

5.0%

2nd

2,600

460

60

$4.95

$106.3

Vermont

16.5%

10th

42,200

300

16.7%

40th

1,000

150

20

$1.52

$97.6

Virginia

20.5%

33rd

658,700

3,600

7.5%

10th

7,700

1,900

270

$19.05

$826.3

Washington

16.2%

9th

429,000

3,100

9.0%

17th

79,700

1,500

220

$16.51

$816.8

West Virginia

25.9%

50th

194,900

1,500

29.7%

50th

6,000

620

80

$3.68

$278.5

Wisconsin

19.1%

27th

425,500

2,800

14.9%

33rd

10,200

1,100

160

$15.24

$793.9

Wyoming

21.8%

41st

46,300

200

20.7%

48th

1,500

170

20

$1.27

$54.6

United States

16.5%

--

20,406,000

173,940

10.0%

--

513,000

86,000

12,100

$723.9

$37.9 bill

  Women = 18 years and older.  Kids = Less than 18 years old.  *No CA pregnant smoking rate data available.

Campaign for Tobacco-Free Kids, April 30, 2013 / Lorna Schmidt

Sources: State-specific smoking rates, 2011 Behavioral Risk Factor Surveillance System (BRFSS). (Note: Due to changes in CDC’s methodology, the 2011 state-specific adult women smoking rates cannot be compared to data from previous years.)  National: 2011 National Health Interview Survey (NHIS).  U.S. Bureau of Census, 2011 population estimates used to compute number of women smokers.  Annual smoking deaths from the CDC’s STATE System (average annual deaths from 2000-2004).  Pregnant women state-specific smoking rates: in regular type from 2002, CDC, “Smoking During Pregnancy – United States, 1990-2002,” MMWR 53(39) October 8, 2004 http://www.cdc.gov/mmwr/PDF/wk/mm5339.pdf; in bold type from 2005 “Trends in Smoking Before, During and After Pregnancy – Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 Sites 2000-20005,”  MMWR 58 SS-4, May 29, 2009 http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5804a1.htm.  National pregnant women smoking rate: National Center for Health Statistics, Health, United States, 2008.  Hyattsville, MD, 2009 (Data are for the 33 reporting areas that used the 1989 Revision of the U.S. Standard Certificate of Live Birth for data on smoking). http://www.cdc.gov/nchs/data/hus/hus08.pdf  Births: Hamilton, B., et al., Births: Preliminary Data for 2010, National vital statistics reports 60(2), Hyattsville, MD: National Center for Health Statistics, November 17, 2011. Leistikow, B, et al., "Estimates of Smoking-Attributable Deaths at Ages 15-54, Motherless or Fatherless Youths, and Resulting Social Security Costs in the United States in 1994," Preventive Medicine 30(5): 353-360,May 2000, and state-specific data provided by the author.  Costs: CDC, Sustaining State Programs for Tobacco Control: Data Highlights 2006, http://www.cdc.gov/tobacco/data_statistics/state_data/data_highlights/2006/index.htm.



In the United States, more than 20 million adult women and more than 1.3 million girls currently smoke cigarettes, putting them at risk for heart attacks, strokes, lung cancer, emphysema and other life-threatening illnesses.[1]  As a result, more than 170,000 women die of smoking-caused disease each year, with additional deaths caused by the use of other tobacco products such as smokeless tobacco.  Today, about one out of every six high school girls currently smoke (16.1%)[2] and 16.5 percent of women still smoke.[3]

 

Smoking harms and kills both men and women, but women face unique and even greater health risks from smoking than men.  And although death rates among female smokers were previously thought to be lower than among male smokers for lung cancer, chronic obstructive pulmonary disease and other tobacco-related diseases, new evidence shows that female death rates have increased and are now nearly identical to those of males. Researchers attribute this increase in large part to a convergence in smoking patterns among men and women since the 1960’s, with women starting to smoke earlier in adolescence and smoking more heavily. These findings confirm that “women who smoke like men die like men.”[4]

 

Mortality:

·         Each year more than 170,000 U.S. women die from smoking-caused diseases.[5]

·         Approximately four million women in the United States have died prematurely from smoking-related diseases since the release of the Surgeon General’s initial report on women and tobacco in 1980.[6]

·         About 2.1 million years of potential life of U.S women are lost prematurely each year due to smoking-related diseases.[7]

·         Smoking reduces a woman’s life expectancy by at least 10 years, on average.[8]

·         Like men, women who smoke have a death rate three times higher than those who never smoked.[9]

Cardiovascular Disease:

·         Cardiovascular diseases are the number one killers of both men and women.  Each year more than 450,000 women die of these diseases.[10]  Cardiovascular diseases caused by smoking include coronary heart disease, atherosclerosis and stroke, among others.[11]

·         Women who smoke are twice as likely to suffer a heart attack as non-smoking women.  The risk of developing coronary heart disease increases with the number of cigarettes smoked per day, the total number of smoking years and earlier age of initiation.[12]

·         Women smokers have a higher relative risk of developing cardiovascular disease than men.  The reasons for the difference are not yet known, but could be due to tobacco smoke having an adverse effect on estrogen.[13]

·         Women who smoke and use oral contraceptives are up to 40 times more likely to have a heart attack than women who neither smoke nor use birth control.[14]

·         While women smoke less than men, many nonsmoking women still suffer increased risk of heart disease from exposure to secondhand smoke because their husbands or partners smoke.[15]

 

Lung Cancer:

·         More than 66,000 U.S. women die of lung cancer each year.[16]

·         Smoking causes 80 percent of all lung cancer deaths among women.[17]

·         The risk of dying from lung cancer is 25 times higher for current women smokers compared to women who had never smoked.[18]

·         Lung cancer death rates among women increased by more than 600 percent between 1950 and 2003.  In 1987, lung cancer surpassed breast cancer to become the leading cause of cancer death among women.[19]

·         A survey from the American Legacy Foundation found that 80 percent of American women mistakenly believe that breast cancer is the primary cause of cancer death among women.[20]

·         While women smoke less than men, many nonsmoking women still suffer increased risk of lung cancer because their husbands or partners smoke.[21]

Other Cancers:

·         Smoking accounts for at least 30 percent of all cancer deaths.[22]

·         Smoking is a known cause of cancer of the lung, larynx, oral cavity, bladder, pancreas, uterus, cervix, kidney, stomach and esophagus.[23]

·         Women smokers have an increased risk of cervical cancer.[24]

·         Women smokers may have increased risks for liver and colorectal cancer.[25]

Smoking and Pregnancy:

·         Smoking reduces a woman’s fertility.  Women smokers tend to take longer to conceive than women nonsmokers, and women smokers are at a higher risk of not being able to get pregnant at all.  Furthermore, more cigarettes women smoked per day are associated with decreased fertility rates.[26]

·         Research studies have found that smoking and exposure to secondhand smoke among pregnant women is a major cause of spontaneous abortions, stillbirths, and sudden infant death syndrome (SIDS) after birth.[27]  Nevertheless, more than one in ten pregnant women smoke.[28]

·         Mothers who smoke have double the rate of premature delivery compared to nonsmoking mothers.[29] 

·         There is a clear relationship between the number of cigarettes smoked during pregnancy and low birth weight babies.[30]

·         Smoking and exposure to secondhand smoke during pregnancy directly increase the risk of health and behavioral problems including: abnormal blood pressure in infants and children, cleft palates and lips, childhood leukemia, infantile colic, childhood wheezing, respiratory disorders in childhood, eye problems during childhood, mental retardation, attention deficit disorder, behavioral problems and other learning and developmental problems.[31]

Other Health Risks for Women who Smoke:

·         Cigarette smoking is the primary cause of chronic obstructive pulmonary disease (COPD) in women.   Smoking is attributed for about 80 percent of deaths from COPD among U.S. women.  The risk of COPD is directly related to the amount and duration of cigarette use.[32]

·         Many women who smoke choose brands which are ‘low tar’ or lower nicotine brands.  There is no evidence that a smoker who chooses low tar and nicotine brands reduces the risk of myocardial infraction, chronic obstructive pulmonary disease or lung cancer.[33] In fact, a number of studies have linked low-tar cigarettes and smokers’ compensation (especially their drawing smoke from low-tar cigarettes more deeply into lungs) to increases among smokers of adenocarcinoma, a previously rare type of lung cancer that afflicts the tiniest airways of the lung.[34]

·         Women smokers have a greater risk for hip fracture than their non-smoking counterparts.[35]

·         Women who smoke are more likely to have menstrual problems including painful periods, irregular bleeding, missed periods and early onset of menopause.[36]

·         Cigarette smoking is a risk factor for osteoporosis and could become a more powerful factor among today’s youth who have begun smoking at earlier ages.  Women who are current smokers increase their risk for hip fractures and postmenopausal women who are current smokers have lower bone density versus women who never smoked.[37]

·         Male and female smokers increase their risk of death from bronchitis and emphysema by nearly 10 times.[38]

The Benefits of Quitting:

·         Women who stop smoking reduce their risk of dying prematurely.  While the benefits of quitting are greater at a younger age, quitting smoking has health benefits at any age.[39]

·         Individuals who quit smoking before the age of 40 live about 10 years longer, on average. Those who quit between 35 to 44, 45 to 54 and 55 to 64 can regain 9, 6 and 4 years of life, respectively.[40]

·         10 to 15 years after quitting, a female ex-smoker’s risk of stroke is almost equal to that of a woman who never smoked.[41]

Campaign for Tobacco-Free Kids, February 7, 2013 / Lorna Schmidt

 



[1]CDC, “Current Cigarette Smoking Among Adults - United States, 2011,” MMWR 61(44) November 9, 2012, http://www.cdc.gov/mmwr/pdf/wk/mm6144.pdf.  CDC, “Youth Risk Behavior Surveillance, United States, 2011,” MMWR 61(No. 4), June 8, 2012, http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf.

[2] CDC, “Youth Risk Behavior Surveillance, United States, 2011,” MMWR 61(No. 4), June 8, 2012, http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf

[3] CDC, “Current Cigarette Smoking Among Adults - United States, 2011,” MMWR 61(44) November 9, 2012, http://www.cdc.gov/mmwr/pdf/wk/mm6144.pdf

[4] Thun, M, et al. “50-Year Trends in Smoking-Related Mortality in the United States,” New England Journal of Medicine, 368:4, January 2013.

[5] CDC, “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 2000-2004,” MMWR 57(45), November 14, 2008, http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf.

[6] U.S. Department of Health and Human Services (HHS), Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001; CDC, “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs—United States 1995-2001,” MMWR 54(25):625-628, July 1, 2005, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htm.

[7] CDC, “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 2000-2004,” MMWR 57(45), November 14, 2008, http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf.

[8] Jha, P, et al., “21st-Century Hazards of Smoking and Benefits of Cessation in the United States,” New England Journal of Medicine, 368;4, January 2013.

[9] Thun, M, et al. “50-Year Trends in Smoking-Related Mortality in the United States,” New England Journal of Medicine, 368:4, January 2013. Jha, P, et al., “21st-Century Hazards of Smoking and Benefits of Cessation in the United States,” New England Journal of Medicine, 368;4, January 2013.

[10] CDC, “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 2000-2004,” MMWR 57(45), November 14, 2008, http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf.  See also, American Heart Association, Heart Disease and Stroke Statistics-2007 Update, http://www.heart.org/downloadable/heart/1166712318459HS_StatsInsideText.pdf.

[11] HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/index.htm

[12] HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004; See also, HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[13] Prescott, E, et al., “Smoking and risk of myocardial infarction in women and men: Longitudinal population study,” British Medical Journal (BMJ) 316:1043-7, 1998.

[14] HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[15] HHS, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006, http://www.surgeongeneral.gov/library/secondhandsmoke/report/.

[16] CDC, “Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 2000-2004,” MMWR 57(45), November 14, 2008, http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf.

[17] HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[18] Thun, M, et al. “50-Year Trends in Smoking-Related Mortality in the United States,” New England Journal of Medicine, 368:4, January 2013.

[19] US Mortality Public Use Data Tapes 1960-2003, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006.  See also, American Cancer Society, Cancer Facts and Figures, 2008, http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf

[20] American Legacy Foundation, “Women and Lung Cancer Survey,” January 2001.

[21] HHS, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006, http://www.surgeongeneral.gov/library/secondhandsmoke/report/.

[22] Doll, R, Peto, R, The Causes of Cancer, New York, NY, Oxford Press, 1981. See also, ACS, Cancer Facts and Figures 2008; HHS, Reducing the Health Consequences of Smoking: 25 Years of Progress.  A Report of the Surgeon General, Atlanta: HHS, Public Health Service, CDC, Office on Smoking and Health DHHS Publication No 89-8911, 1989b.

[23] HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

[24] HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[25] HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[26] HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

[27] HHS, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006, http://www.surgeongeneral.gov/library/secondhandsmoke/report/. On spontaneous abortions, see, e.g., Mendola, P, et al., “Risk of Recurrent Spontaneous Abortion, Cigarette Smoking, and Genetic Polymorphisms in NAT2 and GSTM1,” Epidemiology 9(6):666-668, November 1999; Shiverick, KT & Salafia, C, “Cigarette Smoking and Pregnancy I: Ovarian, Uterine and Placental Effects,” Placenta 20(4):265-272, May 1999; Ness, RB, et al., “Cocaine and Tobacco Use and the Risk of Spontaneous Abortion,” New England Journal of Medicine 340(5):333-339, February 1999; Chatenoud, L, et al., “Paternal and Maternal Smoking Habits Before Conception and During the First Trimester: Relation to Spontaneous Abortions,” Annals of Epidemiology 8(8):520-26, November 1998; Hruba, D & Kachlik, P, “Relation Between Smoking in Reproductive-Age Women and Disorders in Reproduction,” Ceska Gynekol 62(4):191-196, August 1997;  Dominquez-Rojas, V, et al., “Spontaneous Abortion in a Hospital Population: Are Tobacco and Coffee Intake Risk Factors?,” European Journal of Epidemiology 10(6):665-668, December 1994; Walsh, RA, “Effects of Maternal Smoking on Adverse Pregnancy Outcomes: Examination of the Criteria for Causation,” Human Biology 66(6):1059-1092, December 1994; Windham, GC, et al., “Parental Cigarette Smoking and the Risk of Spontaneous Abortion,” American Journal of Epidemiology 135(12):1394-403, June 1992; Armstrong, BG, et al., “Cigarette, Alcohol, and Coffee Consumption and Spontaneous Abortion,” American Journal of Public Health (AJPH) 82(1):85-87, January 1992; Pattinson, HA, et al., “The Effect of Cigarette Smoking on Ovarian Function and Early Pregnancy Outcome Of In Vitro Fertilization Treatment,” Fertility and Sterility 55(4):780-783, April 1991; Economides, D & Braithwaite, J, “Smoking, Pregnancy, and the Fetus,” Journal of the Royal Society of Health 114(4):198-201, August 1994; Fredricsson, B & Gilljam, H, “Smoking and Reproduction: Short and Long Term Effects and Benefits of Smoking Cessation,” Acta Obstetrica Gynecologica Scandinavica 71(8):580-592, December 1992.  On still births, see, e.g., Raymond, EG, et al., “Effects of Maternal Age, Parity, and Smoking on the Risk of Stillbirth,” British Journal of Obstetric Gynecology 101(4):301-306, April 1994; Ahlborg, G, Jr. & Bodin, L, “Tobacco Smoke Exposure and Pregnancy Outcome Among Working Women: A Prospective Study At Prenatal Care Centers In Orebro County, Sweden,” American Journal of Epidemiology 133(4):338-347, February 1991.  On sudden infant death syndrome, see, e.g., Cooke, RW, “Smoking, Intra-Uterine Growth Retardation and Sudden Infant Death Syndrome,” International Journal of Epidemiology 27(2):238-41, April 1998.

[28] CDC, “”Births: Final Data for 2005,” National Vital Statistics Reports, 56(6), December 5, 2007, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf.

[29] HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

[30] HHS, The Health Consequences of Smoking: A Report of the Surgeon General, Atlanta, GA: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.  On early delivery, low birth-weight babies, and growth problems after birth, see, e.g., Wiborg, K, et al., “Smoking During Pregnancy and Pre-term Birth,” British Journal of Obstetrics and Gynaecology 103(8):800-05, August 1996; Dejin-Karlsson, E, et al., “Does Passive Smoking in Early Pregnancy Increase the Risk of Small-for-Gestational-Age Infants?,” AJPH 88(1):1523-27, October 1998; Martin, TR & Bracken, MB, “Association of Low Birth Weight with Passive Smoke Exposure in Pregnancy,” American Journal of Epidemiology 124(4):633-42, October 1986. Jones, G, et al., “Maternal Smoking During Pregnancy, Growth and Bone Mass in Prepubertal Children,” Journal of Bone and Mineral Research 14(1):146-51, January 1999; Eskenazi, B & Bergmann, JJ, “Passive and Active Maternal Smoking During Pregnancy, as Measured by Serum Cotinine, and Postnatal Smoke Exposure. I. Effects on Physical Growth at 5 Years,” American Journal of Epidemiology 142(9 Supplement):S10-18, November 1995; Elwood, PC, et al., “Growth of Children from 0-5 Years: with Special Reference to Mother’s Smoking in Pregnancy,” Annals of Human Biology 14(6):543-57, 1987.

[31] On abnormal blood pressure in infants and children, see, e.g., Morley, R, et al., “Maternal Smoking and Blood Pressure in 7.5 to 8 Year Old Offspring,” Archives of Disease in Childhood 72(2):120-24, February 1995; Blake, KV, et al., “Maternal Cigarette Smoking During Pregnancy, Low Birth Weight and Subsequent Blood Pressure in Early Childhood,” Early Human Development 57:137-147, 2000. On cleft palates and lips, see Nagourney, E, “Consequences: Linking Cleft Palates and Smoking Moms,” New York Times, April 12, 2000 [citing recent study in Plastic and Reconstructive Surgery, the Journal of the American Society of Plastic Surgeons]. On childhood leukemia, see, e.g., Stjernfeldt, M, et al., “Maternal Smoking and Irradiation During Pregnancy as Risk Factors for Child Leukemia,” Cancer Detection and Prevention 16(2):129-35, 1992. On birth defects, see, e.g., Kallen, K, “Maternal Smoking During Pregnancy and Limb Reduction Malformations in Sweden,” AJPH 87(1):29-32, January 1997; Czeizel, AE, et al., “Smoking During Pregnancy and Congenital Limb Deficiency,” BMJ 308(6942):1473-76, 1994; Drews, CD, et al., “The Relationship Between Idiopathic Mental Retardation and Maternal Smoking During Pregnancy,” Pediatrics 97(4):547-53, April 1997. On colic, see Reijneveld, SA, et al., “Infantile Colic: Maternal Smoking As Potential Risk Factor,” Archives of Disease in Childhood 83:302-303, October 2000.  On wheezing and respiratory problems, see, e.g., Hu, FB, et al., “Prevalence of Asthma and Wheezing in Public Schoolchidren: Association with Maternal Smoking During Pregnancy,” Annals of Allergy, Asthma, and Immunology 79(1):80-84, July 1997; Tager, IB, et al., “Maternal Smoking During Pregnancy: Effects on Lung Function During the First 18 Months of Life,” American Journal of Respiratory and Critical Care Medicine 52(3):977-83, September 1995; Lux, AL, et al., “Wheeze Associated with Prenatal Tobacco Smoke Exposure: A Prospective, Longitudinal Study,” Archives of Disease in Childhood 83:307-12, October 2000. On eye problems, see, e.g., Hakim, RB & Tielsch, JM, “Maternal Cigarette Smoking During Pregnancy: A Risk Factor for Childhood Stabismus,” Archives of Opthalmology 110(10):1459-62, October 1992. On impaired intellectual development, see, e.g., Frydman, M, “The Smoking Addiction of Pregnant Women and the Consequences on the Offspring’s Intellectual Development,” Journal of Environmental Pathology, Toxicology and Oncology 15(2-4):169-72, 1996; Olds, DL, et al., “Intellectual Impairment in Children of Women Who Smoke During Pregnancy,” Pediatrics 93(2):221-27, 1994 [correction published in 93(6, Pt 1):973, June 1994]. On developmental and behavioral problems, including criminality, see, e.g., Milberger, S, et al., “Further Evidence of an Association Between Maternal Smoking During Pregnancy and Attention Deficit Hyperactivity Disorder: Findings from a High-Risk Sample of Siblings,” Journal of Clinical Child Psychology 27(3):352-58, October 1998; Orlebeke, JF, et al., “Child Behavior Problems Increased By Maternal Smoking During Pregnancy,” Archives of Environmental Health 54(1):15-19, 1999; Fergusson, DM & Horwood, LJ, “Prospective Childhood Predictors of Deviant Peer Affiliations in Adolescence,” Journal of Child Psychology and Psychiatry 40(4):581-92, May 1999; Orlebeke, JF, et al., “Increase in Child Behavior Problems Resulting From Maternal Smoking During Pregnancy,” Archives of Environmental Health 52(4):317-21, 1997.

[32] HHS, Women and Smoking: A Report of the Surgeon General, Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[33] Djordjevic, MV, et al., “Nicotine Regulates Smoking Patterns,” Preventive Medicine 26(4):435-40, 1997. Farrow, DC & Samet, J, “Identification of the high risk smoker,” Clinics in Chest Medicine 12(4):659-68, 1991.

[34] See, e.g., Stellman, SD, et al., “Risk of Squamous Cell Carcinoma and Adenocarcinoma of the Lung in Relation to Lifetime Filter Cigarette Smoking,” Cancer 80(3):382-88, August 1997; Russo, A, et al., “Changes in Lung Cancer Histological Types in Varese Cancer Registry,” European Journal of Cancer 33(10):1643-47, September 1997; Osann, KE, “Epidemiology of Lung Cancer,” Current Opinions in Pulmonary Medicine 4(4):198-204, July 1998; Wynder, EL & Muscat, JE, “The Changing Epidemiology of Smoking and Lung Cancer Histology,” Environmental Health Perspectives 103(Supplement 8):143-48; November 1995. See also, “Low Tar Cigarettes Linked to Cancer Upsurge,” BBC News, November 18, 1999.

[35] HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[36] HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[37] HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[38] HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[39] HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.

[40] Jha, P, et al., “21st-Century Hazards of Smoking and Benefits of Cessation in the United States,” New England Journal of Medicine, 368;4, January 2013.

[41] HHS, Women and Smoking: A Report of the Surgeon General. Washington, DC: HHS, Public Health Service, Office of the Surgeon General, 2001, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/index.htm.