As the role of women in American society has evolved, so too have trends around cigarette and tobacco use. In the United States, even though female smoking is at a record low — roughly 14 percent of adult women are current smokers — smoking-related illnesses cause approximately 178,000 premature deaths among women, according to the Centers for Disease Control and Prevention.
Systematic data collection on women’s smoking did not begin in the United States until 1965, but decades-long analyses from public health officials point to a complex narrative of the rise and fall of female tobacco use. Looking back at efforts from tobacco companies and public health institutions, the connection between smoking and health literacy is evident. The following timeline depicts the past 100 years of milestones that have influenced women’s decisions to smoke.
Smoking was considered a serious taboo in the early part of the century, but as women’s desire for equality increased, smoking became an expression of female independence. Even feminist icons like Eleanor Roosevelt — the first First Lady to smoke publicly — partook, convincing tobacco companies to consider women as a profitable consumer base. They used a range of aggressive tactics to reach this new target audience.
Emboldened by the uptick, tobacco companies sought more ways to connect with women. The American Tobacco Company, for instance, appealed to calls for independence by featuring prominent women, such as Amelia Earhart, in Lucky Strike ads. Answering to women’s increasingly modern sensibilities and notions of aspirational beauty, the company also used ads to link smoking to weight loss — just one of its many purported “benefits” that contributed to a steady rise in the female smoking rate.
It would be years before medical research on the effects of smoking reached the public and countered the aggressive marketing tactics that arose during the 1920s. In 1957, The U.S. Surgeon General published a report advising against smoking, a milestone gesture that would solidify the public health community’s position on smoking. The statement marked the beginning of a decades-long effort by public health officials to educate the public about the dangers of smoking.
A Turning Point: 1965 to the 1980s
The first federal data collection on smoking habits began in 1965. That year, the U.S. Department of Health, Education, and Welfare reported that 41.9 percent of women smoked. In the same year, the Federal Cigarette Labeling and Advertising Act mandated a warning on cigarette packages that read, “Caution: Cigarette Smoking May Be Hazardous to Your Health,” and required government agencies to report tobacco advertising practices and health consequences of smoking to Congress annually.
Despite the pushback, cigarette brands were set on keeping up the demand. In 1968, Virginia Slims launched a campaign that co-opted women’s liberation language with the slogan, “You’ve come a long way, baby.” The cigarettes were designed to be longer and more feminine, and the ads depicted elegant women and a contemporary lifestyle. The campaign ran well into the 1980s, as the company’s market share grew exponentially during that time period.
When cigarette advertising was banned from television and radio, companies sought alternative ways to promote their brands — including sponsoring sporting and entertainment events. In 1973, a widely publicized tennis match dubbed “The Battle of the Sexes” featured Billie Jean King and was controversially sponsored by Virginia Slims. By 1979, less than 30 percent of women were smokers.
More Work to Be Done: 1980s to Today
Throughout the 1980s — an era of increased awareness, health literacy and prevention efforts — smoking rates among women continued to decline. More than ever, the health care community had a better understanding of the complex connection between women and smoking. The first U.S. Surgeon General’s report on the Health Consequences of Smoking for Women was released in 1980, which prompted the medical community’s dedication to gender disparities in health. Public sentiment toward smoking mirrored the developments of medical research through the 1990s; the female smoking rate had dropped to 22 percent by 1998.
The news wasn’t all good, though — particularly for young and/or marginalized populations. In 1998, reports surfaced that the R.J. Reynolds Tobacco Company had used advertising to target youth, minorities and women. In 2002, the U.S. Surgeon General reported that smoking rates were almost 40 percent higher among impoverished women. Additional studies pointed to advertising tactics that deliberately targeted poor and uneducated women, like cigarette coupons mailed with food stamps, literal advertising language and credit cards branded for specific cigarette companies.
Looking Forward: Have We Truly Come a Long Way?
Medical research has played a crucial role in reducing smoking rates, but there’s still work to be done to ensure that women of varying socioeconomic backgrounds understand the true risks of tobacco use and have the tools to avoid it. Present day data show that smoking causes 80 percent of lung cancer deaths in women and that female smokers are more likely to die from lung cancer than male smokers.
Current anti-tobacco campaigns have been helpful in preventing use among young women and girls, but these efforts require the expertise of nurse practitioners, social workers and educators who have the unique opportunity to promote health literacy on the ground. Interacting with patients, providing accurate and relevant information, and identifying the social determinants that make women vulnerable to the risks of cigarette use are all ways that a cross-sectional approach to health literacy can be a means of patient advocacy.
For more information about the history of women and tobacco, visit the Campaign for Tobacco-Free Kids, an advocacy group founded by the Robert Wood Johnson Foundation, American Cancer Society, American Heart Association, American Medical Association and others.