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Are women at a greater health risk when it comes to smoking? Expert weighs in

Tobacco can have worse health effects on women, even in lower amounts, than men.

Unrecognizable young woman enjoying a cigarette outdoors. Focus is on the cigarette.
Tobacco researcher and expert, Lorraine Greaves, said because men began smoking in large numbers decades before women did, this resulted in a built-in bias in tobacco research. Heart disease and lung cancer were often even thought of as male diseases in earlier years because they would present it from smoking first. (Image via Getty)

Canadians are smoking less, according to a recent report from the World Health Organization (WHO).

Tobacco use in the country has dropped from 28.3 per cent of adults in 2000 to 11.4 per cent in 2022.

In the landscape of public health, the decline in smoking rates across Canada heralds a promising trend towards healthier communities; however, amidst the progressive shift, a critical narrative is often overshadowed: the unique health risks that tobacco imposes on women.

According to WHO, there is a greater prevalence of smoking among men versus women, but one Canadian researcher said smoking and second-hand smoke impact women more negatively.

Yahoo Canada spoke to Lorraine Greaves, the founding executive director of the only tobacco research program on girls and women worldwide, at the Centre of Excellence for Women’s Health in Vancouver. Here's what you need to know.


Are women at a greater health risk when it comes to smoking?

Greaves said that up until the 1990s, the only conversation around women and smoking was around pregnancy, and not actually around women's health.

According to Health Canada, serious health problems that can result from smoking tobacco include:

  • respiratory diseases

  • cardiovascular diseases (such as heart attacks or strokes)

  • lung cancer (the leading cause of death due to cancer in Canada)

  • other cancers, such as cervical cancer which women are at greater risk for when smoking

Women can be affected differently by these diseases than men, such as with chronic obstructive pulmonary disease (COPD).

"That includes things like emphysema and chronic bronchitis," Greaves said. "Women are more likely to get COPD than men, and then develop those kinds of lung diseases at a younger age than men, after less exposure to smoking."

Greaves said these effects lead researchers to question if there may be anatomical differences in women —such as their smaller airways — that can make them more vulnerable.

Women who smoke are also likelier to get breast cancer compared to the general population, according to the National Breast Cancer Foundation.

Cigarette packet
According to Health Canada, tobacco use is a known or probable cause of more than 40 debilitating and often fatal diseases of the lungs, heart, and other organs. It also increases the risk of dying from common illnesses, such as pneumonia. (Image via Getty)

Greaves said there's a lot of information that isn't in the public consciousness about smoking-related disease. As an example, she said most people think of lung cancer as the main disease resulting from smoking, when it's heart disease and stroke.

"Another one for women in particular is bone health," Greaves said, adding that women who smoke are more likely to end up with osteoporosis, or bone weakening. "And that is kind of crucial when you're older because it can lead to a lot more fractures."

When it comes to drugs, alcohol or tobacco substances overall, Greaves said there are worse health effects on women, even with lower amounts than men consume in comparison.

She added one thing that has been learned over the last couple of decades is women and men metabolize nicotine differently.

"So all of these things sort of add up and alert us about the specific and additional influences tobacco and nicotine have on women's health."


How does second-hand smoke impact women?

According to the Canadian Cancer Society, secondhand smoke, the smoke breathed out into the air by smokers, kills about 800 Canadians every year.

Greaves said most people who die from secondhand smoke across the world are women; not because they are smoking themselves but because they are breathing in smoke they are exposed to in their households by men, who are still the prevalent smokers in many parts of the world.

"There's a lot of involuntary exposure," she said. "And that's not just in the household, but also in workplaces and other places where countries don't have the policies that we have in Canada yet."


What socioeconomic issues contribute to smoking?

A woman is sitting in a very depressed mood, holding cigarette
According to the Canadian Substance Use Costs and Harms 2007-2020 report, approximately 46,000 people in Canada died from tobacco use in 2020. (Image via Getty)

Greaves is also the co-founder of the International Network of Women Against Tobacco, which leads activism, education and research on the global impact of tobacco.

As part of her research, she noticed that people who are remaining smokers or picking up smoking in Canada are those with low socioeconomic status.

"[And] have other equity-related issues that are compromising such as poverty and single motherhood for women, single parenting and mental health issues or those struggling with addictions," Greaves said.

She added that Indigenous smoking rates in Canada remain high.

Greaves also said there is an overlap between intimate partner violence and tobacco use.

"With any kind of trauma, like sexual assault or intimate partner violence, which are very gendered, there's a link to smoking because it can feel therapeutic. It's a way of coping with such issues."

With the work that Greaves does, she tries to take a holistic approach to cessation and tries to help health care practitioners also do the same, because there's no one-size-fits-all approach.

"Women have a lot of different issues that need to be recognized when asking women to quit [smoking]."

Greaves added harm reduction is always a good approach, but it also means women have to begin to face some of the other issues that contribute to their smoking, such as stress, anxiety, violence and poverty.

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