360 Chapter 10number of women decreased by only 25%.
Although rates of lung cancer have decreased
since 1984 in men, rates of lung cancer have
increased among women until leveling off
over the past few years. It is not clear whether
smoking is riskier for women or men in
terms of lung cancer. Some studies argue that
when the amount of smoking is taken into
consideration, there are no sex differences in
vulnerability to smoking, whereas other stud-
ies suggest that women are more vulnerable
to lung cancer at every level of smoking. If
women are more vulnerable, both hormonal
and genetic factors may play a role. Women
are clearly more vulnerable to lung cancer
than men among nonsmokers.Prevalence Among Adults. The most re-
cent data from the Centers for Disease Control
and Prevention (2009a) show that 21% of adults
in the United States smoke. This is down from
42% in 1965 (American Cancer Society, 2009).
As shown in Figure 10.3, men are more likely
than women to smoke across ethnic groups
in the United States, with the largest sex dif-
ferences appearing among American Indians/
Alaska Natives, Asians, and Hispanics and the
smallest sex difference occurring in Whites.
The state with the lowest rate of smoking is
Utah (10%), and the state with the highest rate
of smoking is Kentucky (26%; Centers for Dis-
ease Control and Prevention, 2009b).
Sex differences in smoking changed
over the latter half of the 20th century. In the
early part of the century, men smoked more
than women because smoking was not viewed
as socially acceptable for women. In 1955,
25% of women smoked compared to 52% of
men (Chesney & Nealey, 1996). In the 1960s
and 1970s, the health hazards of smoking be-
came publicized, but smoking also became
more socially acceptable for women. Smoking
among women increased during the women’ssuch as chronic bronchitis and osteoporosis.
Among women, smoking is related to early
menopause, decreased fertility, and compli-
cations during pregnancy.
Smoking is related to heart disease,
and this link is stronger in women than men
(Grundtvig et al., 2009; Tan, Gast, & van
der Schouw, 2010). Smoking reveals a dose-
response relation to heart disease, mean-
ing the more one smokes, the greater her or
his risk of heart disease (Rich-Edwards et al.,
1995). When people quit smoking, their risk
of heart disease decreases dramatically. Within
three to five years of quitting, their heart dis-
ease rates are similar to those of a nonsmoker.
Smoking is most strongly linked to
lung cancer. The risk of lung cancer is 23
times higher in men who smoke and 13 times
higher among women who smoke (American
Cancer Society, 2009). The risk of lung can-
cer decreases as the length of smoking ces-
sation increases (U.S. Department of Health
and Human Services, 2004). However, the
risk of lung cancer remains higher among
former smokers than nonsmokers, no mat-
ter how long the cessation period. The in-
creased rates of men smoking in the middle
of the 20th century can be directly tied to the
dramatic rise in lung cancer and heart dis-
ease among men and the subsequent widen-
ing of the sex difference in mortality at that
time (Hyams & Johnson, 2010). The in-
creased rates of smoking among women in
the 1960s and 1970s can be directly tied to the
increased rate of lung cancer that emerged
among women 20 to 30 years later. In 1987,
lung cancer surpassed breast cancer as the
leading cause of cancer death among women.
The increase in smoking among women and
the lower quit rates among women contrib-
uted to the recent narrowing of the sex gap
in longevity. Since the 1960s, the number of
male smokers decreased by about 50%; theM10_HELG0185_04_SE_C10.indd 360 6/21/11 8:54 AM