Smoking and reproductive health

Tobacco smoking is a significant problem among women today. It is associated with a wide variety of cancers and chronic diseases, most notably respiratory and cardiovascular disorders. Women who smoke cigarettes are 12 times more likely to die from lung cancer than those who have never smoked; smoking is also responsible for 55% of the cardiovascular deaths in women less than 65 years old (1). In addition, smoking increases the risk of oral cancer, esophageal cancer, bladder cancer, pancreatic cancer, chronic obstructive pulmonary disease, and probably cervical cancer. Despite these adverse effects, 26% of reproductive age women ( 18-44 years old) smoke, with a mean of 18 cigarettes smoked per day (2). There is a higher prevalence among older women, women with less than highschool education, and black women (3). Advertising targeted at young women entering their reproductive years has successfully expanded the market for cigarettes, and the prevalence of smoking in this group is on the rise. The 1988 National Household Survey revealed that 10% of females 12-17 years old and 35% of females 18-25 years old reported smoking cigarettes in the month prior to the survey. Between 19-30% of pregnant women continue to smoke (2,4), placing themselves and their fetuses at risk for a number of adverse reproductive effects. The medical literature on smoking and reproductive health is extensive but confusing and difficult to interpret. Animal data cannot always be applied to humans. Epidemiologic studies describe associations between cigarette smoking and specific outcome but cannot prove causality. Such studies may say more about the woman who smokes than smoking itself. Prospective studies, which often rely on self-reporting of cigarette smoking, are likely to be biased. Confounding variables such as socioeconomic status, diet, life style, weight, sexually transmitted diseases, and associated habits (ie, alcohol, coffee drinking, illicit drug use) must be taken 75