Elaine Keller, a cancer survivor and powerful advocate for tobacco harm reduction, once asked an important question: “Why is your concern about my ‘addiction’ to nicotine more important than my concern about getting lung cancer?”
As we mark Women’s History Month and International Women’s Day, gender and health should be a major focus. Combustible tobacco causes health harms like nothing else, and this is one field, among so many, where women’s rights and needs are often sidelined.
Women have been disproportionately excluded from tobacco research—and still are.
Worldwide, women are estimated to account for almost 30 percent of 8 million annual deaths from smoking. Women’s smoking rates are much lower than men’s, but that still equates to millions of women losing their lives.
Yet women have been disproportionately excluded from tobacco research—and still are—reducing our insights for a large population at risk.
In the United States, over 28 million people smoke. The smoking rate among women here is a little lower than men’s. But since the 1960s, it has declined more slowly.
Women suffer over 200,000 smoking-related deaths each year in the US. Smoking is the leading cause of preventable death and disease among women, costing us an estimated 2 million years of potential life lost annually.
Many might assume that breast cancer is the main contributor to cancer deaths among women. In fact, more women die from lung cancer. Smoking is directly responsible for 70-80 percent of lung cancer deaths among women worldwide. And there are more new cases of lung cancer in women aged 30–49 than among men in that age group.
Each year, more women than men die from COPD.
Women who smoke are also more likely than men to develop severe COPD at younger ages. Each year, more women than men die from COPD. Women over the age of 35 who smoke now have a greater risk of dying from heart disease compared to men.
I’ve encountered smoking-related harms constantly in my life, and I have known and worked with women who were experiencing COPD, shortness of breath and many other complications.
The right to health includes the right to accurate information that empowers women to make informed decisions about their own health. Tragically and unforgivably, women continue to die not only because they smoked, but because they weren’t told the truth about safer nicotine alternatives.
Annie*, an autistic woman who lives at the group home where I’m employed, is the most recent person of my acquaintance to suffer because of this. Annie’s mom wasn’t able to quit smoking. And she wouldn’t try safer nicotine products because she was led to believe they were not safer.
In 2023, she died of lung cancer. Annie is unable to comprehend death. She repeatedly asks me, “Where’s Mom?” And once again, I have to tell her, “Mom’s gone.”
The epidemic of misinformation affects everyone, but misinforming women has particularly severe consequences.
There are numerous noncombustible options that people who smoke may switch to, if they can’t or don’t wish to quit using nicotine. These include heated tobacco products, snus or nicotine pouches and vapes, which I personally used to quit smoking. Switching to any of them greatly reduces a person’s risk of smoking-related disease and death.
Yet misinformation—from junk science, media, politicians and health authorities—breeds massive misperceptions about these lifesaving alternatives. Most people believe that they are as harmful as cigarettes, or even worse.
People are constantly fed misinformation. They are told that vaping is like skydiving out of an airplane without a parachute. At the WHO’s COP10, an image of a “cancer flavor” vape was distributed, while the Truth Initiative has touted “Depression Sticks.” The FDA has used ridiculous depictions such as worms crawling under the skin of teens who vaped.
Dire warnings based on debunked myths backed by questionable science continue to make headlines, claiming people who vape nicotine will get popcorn lung, COVID, or “EVALI.” Studies full of methodological flaws portray vaping as a “gateway” to smoking. Or claim that vaping causes cancer, liver disease, myocardial infarction, COPD, and other diseases. Experts are kept busy evaluating these studies and submitting critiques of some of the most egregious papers, and their work has led to some studies being retracted.
The epidemic of misinformation affects everyone, but misinforming women has particularly severe consequences. Women are often the “chief medical officers” of their households, and 59 percent across a number of countries make health care decisions for others, as well as themselves.
Health care systems should be stepping up here. But only 65 percent of women globally, and 53 percent in the US, feel they can trust health care providers. These trust rates are lower than men’s, and when it comes to nicotine information, that’s thoroughly warranted: Large majorities of physicians around the world wrongly believe that nicotine itself causes lung cancer and other diseases.
I’ve seen the consequences of doctors misleading women.
Sherry, convinced by the doctor, begged him not to try vaping.
My husband and his best friend, John*, started smoking when they were teens. My husband quit after he was diagnosed with COPD. John continued to smoke, and was diagnosed with lung cancer.
John’s wife, Sherry*, was at his side for every treatment and cared for John, their family, and their household throughout. John recovered. But to the dismay of his doctor, he wasn’t able to quit smoking.
I talked to John about vaping. I offered to supply him with a device and liquids. I promised to make the two-hour drive to their home, show him how to use the equipment, and answer any questions.
But when John and Sherry talked it over with his doctor, the doctor told them that vaping was just as bad as smoking. John believed me and still wanted to try vaping, but Sherry, convinced by the doctor, begged him not to.
Two years later, John was sitting on the couch, a cup of coffee in one hand and a cigarette in the other. He was complaining to Sherry about the weather when he suddenly collapsed. Sherry tried to perform CPR while she called for help. By the time the medics got there, John was gone. He’d had a heart attack.
Risks from smoking may continue after cessation—even if quitting at any age has major health benefits—and we don’t know that John would have lived if he’d switched. But he’d have given himself a better chance for the rest of his life. It was heartbreaking to speak with Sherry on the phone, as she sobbed and wished she hadn’t talked him out of vaping.
My granddaughter said that vaping will give you cancer or a heart attack, that it will damage your brain and give you “popcorn lung.”
Another example of misinformation was even closer to home. Ten years ago, my 5-year-old granddaughter watched her dad curled up on the bathroom floor, clutching his chest. He was having a heart attack. I held her in my arms as she cried. I will never forget her waving at the helicopter that took my son away, and saying, “Goodbye, Daddy. I love you. Please don’t die. Please come home.”
He survived. And two weeks later, he used vapor products to quit smoking. Today, he doesn’t smoke or vape, but he quit smoking too late and will be on heart medications for the rest of his life.
In February, my now-teenage granddaughter called to wish me a happy Valentine’s Day. She then told me what she learned about vaping in school. She was fighting back tears, and I wondered if the memory of her dad on the bathroom floor had returned. She said that vaping will give you cancer or a heart attack, that it will damage your brain and give you “popcorn lung.” She worried these things would happen to me, and asked me to stop vaping.
I asked if she learned about smoking, and she said no. I asked why she thought they didn’t learn about smoking, and she said, “Because vaping is worse.”
I struggled to respond. How could I explain that what she was told was utterly wrong without destroying her trust in other vital topics she would learn about in school? Will she believe teachers when they talk about breast cancer awareness or safe sex, now that she knows they didn’t tell her the truth about vaping?
Without accurate information on which to base decisions about our health, we are not included in those decisions.
It is the smoke from smoking that is hazardous, not the nicotine. Nicotine “addiction,” as Elaine Keller referenced, is a phantom threat. Decoupled from combustible tobacco, the harms of nicotine are more similar to those of tea or coffee.
Quitting smoking is hard. Some women manage it through noncombustible products, yet find themselves stigmatized, just as they were when they smoked. Those who vape instead may be told there’s no difference. Their achievement is discredited, tossed in the trash. These attitudes prevent many women from making choices that would help them live longer, healthier lives.
The theme of 2024’s International Women’s Day is “Inspire Inclusion.” Without accurate information on which to base decisions about our health and the health of our loved ones, we are not included in those decisions. It is time we speak up for the truth.
*Names have been changed to protect privacy.