Smoking is an important womens health issue to review and learn about because smoking is the leading known cause

of preventable death and disease among women. Second hand smoke has serious health effects on others, including children. Approximately 18-20% of adult women currently smoke. Readings and Homework: 1. U.S. Surgeon Generals Report on Women and Smoking 2001, Executive Summary, available at: www.cdc.gov/tobacco/data_statistics/sgr/sgr_2001/00_pdfs/execsumm.pdf a. List the major increased risks of disease for the following body systems from smoking: respiratory, cardiovascular, reproductive, gastrointestinal, skeletal. Some studies suggest that women who smoke have an increased risk for gallbladder disease (gallstones and cholecystitis), but the evidence is inconsistent. Cardiovascular Disease 26. Smoking is a major cause of coronary heart disease among women. For women younger than 50 years, the majority of coronary heart disease is attributable to smoking. Risk increases with the number of cigarettes smoked and the duration of smoking. 27. The risk for coronary heart disease among women is substantially reduced within 1 or 2 years of smoking cessation. This immediate benefit is followed by a continuing but more gradual reduction in risk to that among nonsmokers by 10 to 15 or more years after cessation. 28. Women who use oral contraceptives have a particularly

elevated risk of coronary heart disese if they smoke. Currently, evidence is conflicting as
Surgeon Generals Report 6 Executive Summary

to whether the effect of hormone replacement therapy on coronary heart disease risk differs between smokers and nonsmokers. Reproductive Outcomes 47. Women who smoke have increased risks for conception delay and for both primary and secondary infertility. 48. Women who smoke may have a modest increase in risks for ectopic pregnancy and spontaneous abortion. 49. Smoking during pregnancy is associated with increased risks for preterm premature rupture of membranes, abruptio placentae, and placenta previa, and with a modest increase in risk for preterm delivery. 50. Women who smoke during pregnancy have a decreased risk for preeclampsia. Women who quit smoking before or during pregnancy reduce the risk for adverse reproductive outcomes, including conception delay, infertility, preterm premature rupture of membranes, preterm delivery, and low birth weight. The risk for perinatal mortalityboth stillbirth and neonatal deathsand the risk for sudden

infant death syndrome (SIDS) are incre a s e d among the offspring of women who smoke during pregnancy. 52. Infants born to women who smoke during pregnancy have a lower average birth weight and are more likely to be small for gestational age than are infants born to women who do not smoke. b. Many women start smoking and fear smoking cessation because they do not want to gain weight. List 3 statistics from the SG report discussing body weight and fat distribution with smoking. Initiation of cigarette smoking does not appear to be associated with weight loss, but smoking does appear to attenuate weight gain over time. 57. The average weight of women who are current smokers is modestly lower than that of women who have never smoked or who are long-term former smokers. 58. Smoking cessation among women typically is associated with a weight gain of about 6 to 12 pounds in the year after they quit smoking. 59. Women smokers have a more masculine pattern of body fat distribution (i.e., a higher waisttohip ratio) than do women who have never smoked. 2. The Center of Disease Control Fact Sheet on Women and Tobacco, updated Nov 2006, available at:

www.cdc.gov/tobacco/data_statistics/Factsheets/women_tobacco.htm a. How many women are killed annually by cigarette smoking and what are the 3 leading smoking-related causes of death in women? 3. U.S. Surgeon Generals Report on Women and Smoking 2004, Impact on Unborn Babies, Infants, Children, and Adolescents, available at: www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/highlights/1.htm a. Describe the negative health effects and increased risks experienced by an infant from being exposed to a mother who smokes during and after pregnancy. Readings and Homework: 1. National Institute for Health, Alcohol: A Womens Health Issue. Available at www.athealth.com/Consumer/disorders/womenalcohol.html 2. Medical College of Wisconsin, Straight Talk on Alcohol Abuse and Alcoholism, April 2002. Available at http://healthlink.mcw.edu/content/printerfriendly/article_printer_friendly?1018795126 These questions cover both readings above: a. What is considered the dietary guideline for both men and women for moderate drinking and why are they different? For women, two drinks a day is above what the Dietary Guidelines for Americans call moderate: no more than one drink a day for women and no more than two drinks a day for men As a rule, men weigh more than women. In addition, pound for pound, women have less water in their bodies than men, so a womans brain and other organs are exposed to more alcohol before it is broken down. These differences play a role in both the short and longterm effects of alcohol on women. b. What are the benefits and risks of even moderate drinking? Moderate drinking can have short and longterm health effects, both positive and negative: Drinking moderately may lower risk for coronary heart disease, mainly among women over age 55. Risks

Drinking and driving: It doesnt take much alcohol to impair driving ability. The chances of being killed in a singlevehicle crash are increased at a blood alcohol level that a 140lb. woman would reach after having one drink on an empty stomach. Medication interactions: More than 150 medications interact harmfully with alcohol. For

example, any medication that causes drowsiness or sedationfor example, many cough and cold medicationscan increase the sedative effects of alcohol. When taking any medication, read package labels and warnings carefully. Breast cancer: Research suggests that, in some women, as little as one drink per day can slightly raise the risk of breast cancer. Its not possible to know how alcohol will affect the risk of breast cancer in any one woman. But with so many new cases of breast cancer each year, even a small increase in risk can have an impact on the number of cases. Fetal Alcohol Syndrome: Drinking by a pregnant woman can harm her unborn baby. (See Fetal Alcohol Syndrome, below.)

One of the risks of drinking is that a woman may at some point abuse alcohol or become alcoholic (alcohol dependent) c. What is fetal alcohol syndrome (FAS)? What are the signs and symptoms? How can it be prevented? Alcohol can damage the baby of a mother who drinks during pregnancy, resulting in a set of birth defects called fetal alcohol syndrome (FAS). FAS is the most common known preventable cause of mental impairment. Babies with FAS have distinctive changes in their facial features and they may be born small. The brain damage that occurs with FAS can result in lifelong problems with learning, memory, attention, and problem solving. These alcoholrelated changes in the brain may be present even in babies whose appearance and growth are not affected. It is not known if there is any safe drinking level during pregnancy; nor is there any stage of pregnancy in which drinkingat any levelis known to be risk free. If a woman is pregnant, or wants to become pregnant, she should not drink alcohol. Even if she is pregnant and has already consumed alcohol, it is important to stop drinking for the rest of her pregnancy. Stopping can still reduce the chances that her child might be affected by alcohol. d. What are 4 alcohol-related organ damage diseases that women are more prone to than men when abusing alcohol? studies have found that women are more prone than men to alcoholrelated organ

damage. Health problems include the following:

Alcoholic liver disease: Women develop alcoholic liver disease more quickly and after drinking less alcohol than men. Women are more likely than men to develop alcoholic hepatitis (liver inflammation) and to die from cirrhosis. Brain disease: Most alcoholics have some loss of mental function, reduced brain size, and changes in the function of brain cells. Research suggests that women are more vulnerable than men to alcoholinduced brain damage. Cancer: Many studies report that heavy drinking increases the risk of breast cancer. Alcohol is also linked to cancers of the head and neck (the risk is especially high in smokers who also drink heavily) and the digestive tract. Heart disease: Chronic heavy drinking is a leading cause of cardiovascular disease. Among heavy drinkers, men and women have similar rates of alcoholrelated heart disease, even though women drink less alcohol over a lifetime than men.

e. Does alcohol affect women differently when they are older? If so how? Alcohol's effects do vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol's effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. Older people also tend to take more medicines than younger people. Mixing alcohol with over-the-counter or prescription medications can be very dangerous or even fatal. More than 150 medications interact harmfully with alcohol. In addition, alcohol can make many of the medical conditions common in older people such as high blood pressure and ulcers more serious. Physical changes associated with aging can make older people feel the effects of alcohol even after drinking only small amounts. So even if there is no medical reason to avoid alcohol, older men and women should limit themselves to one drink per day.

f. What is the difference between alcohol abuse and alcoholism? Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:

Craving: A strong need, or urge, to drink. Loss of control: Not being able to stop drinking once drinking has begun.

Physical dependence: Withdrawal symptoms such as nausea, sweating, shakiness and anxiety after stopping drinking. Tolerance: The need to drink greater amounts of alcohol to get "high."

3. National Institute on Drug Abuse Handouts. a. What are the short term and long term health consequences of smoking marijuana? b. List 4 specific medical complications from cocaine abuse? c. List 3 long term effects of methamphetamine abuse. d. What are the 3 classes of prescription drugs that are most commonly abused? 4. New York Presbyterian Hospital, Illegal Drug Use and Pregnancy, 2007. Available at www.nyp.org/health/drug-pregnancy.html a. What health risks does a pregnant woman have who uses illicit drugs? b. What are the 5 effects cocaine has on the fetus? c. How long can withdrawal symptoms last in a newborn?