The role of women in the fight against smoking in Europe

A World Health Organization report highlights Europe's problematic health situation regarding female smoking. Just as the tobacco industry develops specific marketing strategies to target women, the report underscores the need for tobacco control to better address gender issues.[1].

Europe is the global region where women smoke the most, with an estimated smoking prevalence of 19%. For 13- to 15-year-olds, this proportion is one and a half times higher than the global average (12% versus 8%). In twenty years, smoking prevalence among women has declined only very modestly, from 23 to 19%. Over the same time period, the smoking rate among men has fallen considerably, from 46% to 34%. By 2025, smoking prevalence among women is expected to decline by only one further percentage point.

Smoking among women: a major European health issue

As an industrial epidemic, smoking, in its consumption levels as well as in its health effects, follows a curve, observing the following pattern: initial phase, rapid development, plateau, decline[2]. Given the long-term effects of tobacco consumption, it is estimated that there is a thirty-year delay between the tobacco consumption curve and the mortality curve associated with smoking. Thus, in France, between 1980 and 2010, the number of deaths linked to tobacco consumption among women increased sevenfold, from 2,700 to 19,000.[3]However, with peak smoking among women occurring in the late 1980s and early 1990s, the full health consequences of female smoking are yet to be seen, posing a major public health problem.

Women: “a gold mine in our garden”[4] »

The tobacco industry has deployed a protean marketing strategy to spread the tobacco epidemic among women. In particular, through product placements in films and the design of packages and cigarettes, manufacturers have sought to make cigarettes a true feminine accessory. More recently, cigarette companies have invested in digital marketing to address women, particularly through web influencer networks. While the phenomenon does not spare men, it remains overwhelmingly female: it is estimated that 85% of influencers are women. Finally, manufacturers, in the interest of public image, regularly seek to present themselves as progressive companies, allies of the women's cause, by funding various organizations (associations fighting violence against women, local associations, sports associations, etc.).

The invisibility of women in anti-smoking discourse

According to the report, tobacco control responses are not specifically targeted enough at women to be fully effective. Thus, while all cigarette packets sold throughout the European Union must feature prevention images, there are significant disparities between men and women. Indeed, 91% of the images illustrating the serious and fatal risks of smoking on packets are portrayed by men. When men are portrayed, they are overwhelmingly in the role of the sick person, the direct victim of smoking (81%). In 19% of cases, they represent a relative of the victim, or the caregiver. In contrast, when women are portrayed, they only play the sick person in 31% of cases. In 38% of cases, the women are in the role of caregiver, and in 31% are placed in situations of risk to the child or infertility.

Adapting anti-tobacco policies to gender issues

As the authors of this report point out, a number of advances can be made. First, in terms of prevention, gender-specific media campaigns could be an avenue for reflection. Given that women in Europe are more likely than men to stay at home, due to a still gendered division of domestic tasks, more proactive regulations regarding smoking bans could be beneficial for women. It is estimated that 64% of victims of passive smoking worldwide are women. Similarly, the authors highlight the importance of having more accessible and women-friendly support services for quitting. Furthermore, the report emphasizes the need for public authorities to systematically seek to involve women leaders and women's organizations in anti-smoking decisions and the implementation of control policies.

[1] World Health Organization, Through a gender lenswomen and tobacco in the WHO European region, February 2021, (in English)

[2] Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tob Control. 1994;3(3):242-247.

[3] Laureen Ribassin-Majed, Catherine Hill; Trends in tobacco-attributable mortality in France, European Journal of Public Health, Volume 25, Issue 5, 1 October 2015, Pages 824–828, https://doi.org/10.1093/eurpub/ckv078

[4] This quote comes from a statement by a tobacco company executive in 1928, when cigarette manufacturers saw the female market as a huge potential for economic development (Women, prime targets of the tobacco industry, La Croix, 05/24/2010, consulted on 02/15/2021)