Cigarette smoking, marketed as liberated and glamorous for almost 60 years, has become the single greatest threat to the health of American women, with an impact so profound that demographers say that it may eliminate the edge in lifespan women have traditionally enjoyed.
According to American Cancer Society estimates, this year, for the first time in U.S. history, lung cancer will kill more women than breast cancer, marking the first wave in a rising tide of formerly "male" diseases among female smokers.
Young women in their teens and 20s now smoke more than young men -- a trend that is especially significant because smoking creates specific threats for women and their babies: stillbirths, sudden infant deaths and miscarriages, lowered fertility, and danger of strokes and heart attacks in smokers who take birth control pills.
The history of women and cigarettes is the tale of a badge of liberation with deadly hazards for the wearer, a product linked to the American ideal of slimness that keeps female users hooked in part because they fear they will gain weight if they quit.
In the last three decades, while many men gave up the habit in the face of its frightening toll in disease and death, women have hung onto their privilege to smoke and denied that the risks applied to them. In 1935, 18 percent of American women smoked. In 1983, the figure was almost 30 percent.
The resulting health statistics are beginning to echo the words of Joseph Califano, then secretary of Health, Education and Welfare, that "women who smoke like men, die like men."
"Women have got to stop this march to death," said Estelle Ramey, professor of physiological biology at Georgetown University Medical School. Feminists Take No Stand
The women's movement has been silent on cigarettes amid mounting evidence establishing smoking as a major woman-killer. As lung cancer becomes the new "women's disease," feminist leaders are feuding over whether to attack a habit many view as a strictly personal choice. At least one tobacco company, Philip Morris Inc., has been an eager benefactor of feminist organizations. Philip Morris also sponsors the Virginia Slims women's tennis tournaments. At the National Organization for Women, a dispute flared this year over whether to continue accepting the company's advertising.
Most U.S. newspapers and magazines, including The Washington Post and Newsweek, continue to accept tobacco advertising. Such advertising is banned by law on television.
In a series of interviews with epidemiologists, public-health researchers and federal officials and an examination of the latest medical and statistical findings, the magnitude of the problem emerges:
*Smoking is changing from a male to a female preserve. More women than men will be smokers in about five years if present trends continue, according to epidemiologist Patrick L. Remington of the Centers for Disease Control.
*Lung-cancer deaths in women have increased 350 percent in the last 35 years. By the year 2000, more women than men will die of lung cancer, a reversal of the present pattern, according to Dr. Robert J. McKenna, president of the American Cancer Society.
*So strong is the addiction that despite risks of miscarriage or stillbirth, 70 to 80 percent of women who smoke continue to do so while they are pregnant.
*The workplace feeds the habit: Working women are more likely to smoke than housewives, according to American Cancer Society figures.
*Women have more trouble quitting than men -- possibly because they depend on nicotine to stay slim and to banish depression.
"Why haven't the people responsible for advising women . . . hit this No. 1 problem?" asked Surgeon General C. Everett Koop.
The tobacco industry contends that a cause-and-effect relationship has not been established between cigarettes and lung cancer, heart disease, chronic lung disease, pregnancy complications or other disorders.
"No one in the industry . . . has ever said, 'Well, cigarettes are blameless here, they are harmless, let's not worry about it . . . ' " said Walker Merryman, vice president of the Tobacco Institute. "What we are saying is . . . 'Let's find out for certain. Yes, give people information about the possible health hazards. Let people make up their own minds about whether or not they wish to be smokers . . . . And let's admit that we don't know what we don't know.' "Illegal on Fifth Avenue
Smoking by women was illegal in many public places until the 1920s, according to Virginia L. Ernster, an epidemiologist at the University of California at San Francisco. In an article in the New York State Journal of Medicine last July, Ernster provided details that trace changing American attitudes toward women's smoking.
"You can't do that on Fifth Avenue," declared a New York policeman in 1904 while arresting a woman for smoking in a car. Alice Longworth, Theodore Roosevelt's daughter, was forbidden to smoke in the White House in 1910 and threatened to smoke on the roof instead.
Female students crusaded in the 1920s for the right to smoke on campus as a symbol of equality, Ernster said.
"Smoking was made a cause celebre," she said. "The health risks just weren't known . . . . The decision by a woman to smoke was, in part, a rejection of a double standard."
Not until the end of that decade did manufacturers even dare to advertise to women -- but once they did, they portrayed the cigarette as a torch of freedom and a tool of beauty. In 1928, the makers of Lucky Strike launched a campaign with the slogan, "Reach for a Lucky Instead of a Sweet," introducing the linkage of cigarettes with slender figures that survives today in the name Virginia Slims.
A survey conducted in 1935 found that 18 percent of women smoked, compared with 52 percent of men.
World War II made smoking by women acceptable, Ernster found. Female workers appeared in magazines puffing cigarettes while they riveted battleships, and the free cigarettes distributed to soldiers swelled the ranks of smokers. By the end of the war, a third of American women smoked -- a figure that stayed almost constant through the mid-1960s and has since dropped only slightly, in sharp contrast to smoking among men, which has been declining steadily since the 1950s.
A majority of American men -- 52 percent -- were smokers in the mid-1950s when the first ominous reports linking cigarettes with lung cancer appeared in the press. A few years later, in 1964, surgeon general Dr. Luther Terry released the historic report putting the government seal on the cancer connection.Men Took Heed ----------
By 1983, the proportion of American men who smoked had fallen to 35 percent. Almost 30 percent of women were smokers in 1983 -- a drop of only 3 percentage points over 20 years.
Meanwhile, statisticians have recorded a steeply rising rate of lung cancer in women since the 1960s. The American Cancer Society predicts that in 1985 more women -- 38,600 -- will die of lung cancer than breast cancer -- 38,400. Annual totals for lung-cancer deaths in women have surpassed breast-cancer deaths in a dozen states, according to preliminary data. Studies show 75 percent to 90 percent of lung-cancer cases are caused by smoking.
Lung cancer has long been the most common fatal cancer in men, and this year, 87,000 American men will die of it. Smoking also causes one-third of all deaths from heart disease annually. Counting its toll from cancer, heart disease, strokes and lung disorders, smoking is estimated to kill 320,000 Americans each year -- more than the total American death toll from all wars fought in this century.
So enormous is the impact on health that a 1983 study in Public Health Reports predicts the difference in the life expectancy of men and women -- a difference of eight years in women's favor, according to 1979 census data -- will soon vanish because of women's smoking patterns.
The researchers found that life expectancies of nonsmoking men and women are almost identical. The higher life expectancy of women in the population at large reflects the fact that, in the past, fewer women than men were smokers, they concluded.
"When . . . women who have smoked as much as men reach the later decades of life . . . the present differences in longevity between men and women will disappear," the report predicted.
Georgetown's Ramey, a specialist on differences between the sexes, said at least half of women's greater longevity is explained by life style differences.
"There is no question that for both sexes, the major contributing factor affecting health is smoking," she said.
That conclusion is especially ominous for younger women, who are smoking in greater numbers than men their age. In this year's drug-use survey of high school seniors for the National Institute on Drug Abuse, 31.4 percent of girls had smoked in the preceding month compared with 28.2 percent of boys. More girls than boys have been smokers in every year since 1976. Young White Women
Remington said recent CDC data show a sharp increase in smoking among women in their early 20s. Young white women have the highest smoking rate -- 40 percent -- of any group in the nation. Young blacks of both sexes smoke less than whites, and Hispanics smoke less than either group, although smoking is increasing among young Hispanic women.
Remington predicted that today's young women will fall victim to heart disease, lung cancer and other smoking-related illnesses in record numbers. "You'll see them with very high rates of smoking and cigarette mortality," he said. "It will really be an epidemic in 20 years among women."
Why so many women adopt the habit, and why -- according to some studies -- women are less successful at quitting than men are matters of speculation. Experts mention several theories, among them nicotine's ability to abate hunger and depression, and the growth of cigarette advertising aimed at women.
Women have become a prime market for the tobacco industry. In 1983, cigarette companies spent almost $2.65 billion in advertising, according to a Federal Trade Commission report released last June. Several brands, including Philip Morris' Virginia Slims, R.J. Reynolds' More, Liggett Group's Eve and Lorillard's Satin, were designed to appeal exclusively to women. Advertising for such brands totaled $329 million. Targeting of women has intensified since the 1970s as manufacturers sought to maintain sales as the number of male smokers declined.
The FTC report concluded that the pitch is working. In 1983, more than 74 billion "women's" cigarettes were sold, and women's brands accounted for 12.8 percent of sales.
Tobacco industry spokesmen deny that cigarette advertising makes smokers out of nonsmokers.
"What our advertising is designed to do is competitive switching," said David Fishel, vice president for public relations of R.J. Reynolds. "The general agreement is that advertising is not going to get someone to start doing something."
Smoking researchers agree there is no proof that advertising makes people start smoking but say that it may play a role.
A key factor keeping women from quitting -- and possibly a motive for some to start -- is nicotine's ability to suppress hunger.
"It's well known that women in our society are much more weight-conscious than men," said Ellen Gritz, associate director for research in cancer control at UCLA's cancer center. "Cigarettes are used to regulate weight. People smoke instead of eating, and also use cigarettes to . . . end a meal."
Quitters not only lose the appetite suppression of nicotine, they also crave sweets, Gritz said. She said studies show that people who quit smoking do gain weight, and those who quit permanently gain more than those who quit and then go back to the habit.
Cigarette manufacturers have exploited this aspect of their product since the 1920s. "I don't think the name Virginia Slims is a mistake," said John Pinney, director of Harvard's Institute for the Study of Smoking Behavior and Policy.
Guy L. Smith, vice president for corporate affairs of Philip Morris USA, said the name was chosen to describe the shape of the product, not to suggest the shapes of its users. "The diameter of a Virginia Slim is less than the diameter of a standard cigarette -- or slimmer," he said. "There is no subliminal message." %&Regulates Mood
Another factor in addiction, speculated to be more influential in women than men, is nicotine's calming effect. "Nicotine . . . has the capacity to produce relaxation as well as stimulation," Gritz said. Many smokers rely on it for "puff-by-puff regulation of mood." Gritz suggested that, since women report depression more frequently than men, they may rely more on smoking as an emotional support.
Asked whether the industry viewed nicotine as addictive, the Tobacco Institute's Merryman said, "I think there is evidence to that effect. There is also indisputable evidence that in the past 20 years 30 million people have quit smoking. And in excess of 90 percent of them . . . have done so on their own. If that mimics addictive behavior, then I don't understand anything about addiction."
Government and private agencies are trying to reduce smoking by both men and women. Koop has called for "a smoke-free society by the year 2000," although the Reagan administration has not made this a goal.
Notably absent from the fray are most feminist organizations, which have not put women's smoking on their political agendas, although they have been active on other health fronts, such as contraceptives and toxic-shock syndrome.
"If you look at all the things they get mad about in women's health issues and add all the consequences together, you can put the damages in your left ear compared to those from women smoking," Ramey said.
Pinney, who edited the 1980 surgeon general's report on the health consequences of smoking for women, was discouraged by the failure of women's groups to react to it. "I would like to know . . . why the hell they didn't," he said. NOW Accepts Ads
Money is one suggested reason. Ernster criticized the National Organization for Women for accepting advertising from Philip Morris at its national conventions. Denise Fuge, a member of NOW's governing board, said she introduced a resolution at a board meeting this year to stop accepting ads from the tobacco industry. Ads for alcoholic beverages were added, and Fuge said it was defeated for political reasons.
"It's quite a hot issue in our organization right now," said Lois Reckitt, executive vice president of NOW. According to figures Reckitt provided, NOW received $8,750 from Philip Morris or its subsidiaries between 1979 and 1985 for advertising in its convention program books. Reckitt said NOW's annual operating budget is $5.5 million.
Philip Morris ran a full-page ad each year on either the back cover or inside front cover of the book. Miller Brewing Co. and Benson and Hedges, subsidiaries of Philip Morris, each took one full page ad during one of those years.
The 1985 Philip Morris ad, on the back cover, features a quotation from former congresswoman Shirley Chisholm and the words, " . . . Philip Morris Inc. salutes the National Organization for Women." The cigarettes and beverages manufactured by the company are listed at the bottom.
Fuge said NOW has hestitated to make smoking an issue because it is a matter of personal choice. "We have many fine women in NOW who are heavy smokers. They contribute an immense amount," she said. "We cannot deny women. We can educate them."
Other women's organizations also find smoking a difficult issue to confront. Victoria Leonard, executive director of the National Women's Health Network, said her group protested at last year's Virginia Slims tennis tournament and "is going to do more," but added, "It's the kind of thing that I just wish would go away."
She said that the new preeminence of lung cancer in women may force feminist groups to get involved. "If it [lung cancer] surpasses breast cancer, it may be the straw that broke the camel's back," she said