OTI Online
Volume 7, 1987

WARNING: Women's Magazines Can Be Dangerous To Your Health!
by Ellen R. Gritz, Ph.D


As a result of sweeping changes in social forces during this century, cigarette smoking has become acceptable behavior for females as well as males. As a result, we are witnessing the emergence of a major national health problem.

Women's smoking has increased from 18 percent in 1935 to 33 percent in 1965 and has since decreased to 29 percent in 1983. In comparison, men's smoking decreased rather steadily from 53 percent in 1935 to 35 percent in 1983. Interestingly, these great changes in women's smoking behavior have been paralleled by an unrivalled direct-appeal campaign by cigarette advertisers, which began in the mid-to-late 1920s.

There is nothing new in the trend data describing women's smoking behavior. The news is the actualization of a national tragedy that was totally preventable - the emergence of lung cancer as the number one cause of cancer mortality among women. surpassing breast cancer. In 1985, the American Cancer Society published data reporting that lung cancer had become a major problem for women as a result of the dramatic increase in women's smoking. A disease that virtually did not exist in this country at the turn of the century is now killing more women and men annually than any other form of cancer.

Lagging behind, but paralleling changes in the smoking patterns of adult women, have been the widespread changes in teenage smoking. National survey data show that gender differences in teenage cigarette smoking have virtually disappeared, and that female smoking now exceeds that of males for most analyses.

A recent survey sponsored by the National Institute on Drug Abuse revealed a higher prevalence of smoking among girls at levels of occasional smoking - one or more cigarettes per month and one or more cigarettes per day. However, this gender difference decreased as consumption levels increased to one-half pack or more per day and one pack or more per day until approximate parity was reached at the latter consumption level, which is characteristic of adult smoking behavior.

Adolescent females have been traditionally characterized, by cognitive and emotional immaturity, hypersensitivity to peer rejection, vulnerability to impulsive behavior, and difficulty in acquiring a positive body image. This combination makes the teenage female exquisitely vulnerable to the seductive allure of smoking. Developmental models of the initiation of smoking behavior set out factors predisposing to cigarette smoking; these may be biological, environmental, and/ or psychological.

In the preparation stage, family influences predominate. Watching parents or older siblings smoke facilitates the development of a positive attitude toward smoking in the immature girl and teaches her how, when, and where smoking is appropriate. Data show a fivefold increase in likelihood (20 percent versus 4 percent) that an adolescent girl will smoke if she is in a household in which one or both parents or an older sibling smoke as compared to a non-smoking household.

During the period of initiation - trying the first cigarette - peers become most important. Almost 75 percent of all first cigarettes are smoked with another teenager. Teenage smokers stick together, as do nonsmokers. Lifestyle choices are beginning to be made at this time, and may include a variety of behaviors and value orientations into which the image of a smoker fits.

Experimental smoking is defined as smoking less than one cigarette per week. In this period of social reinforcement, the formation of a self-image is occurring. Impulsive behaviors like smoking and experimentation with alcohol and sex may occur when socially prompted. The image of a smoker, described by both personality and physical attributes, can become highly valued and identified with; teenage girls may see smoking as a way to acquire such an image. In 1984, McCarthy and Gritz demonstrated that the closer the ideal self-image of a smoker was to her/his description of a model in a cigarette advertisement, the more likely that adolescent intended to be a smoker. In this, as well as the following stage, the physical image of the female smoker portrayed in advertisements may wield substantial power.

Habituation is achieved when the adolescent is smoking at least one cigarette weekly. Dependence can begin to develop about this time. Now skilled in techniques of inhalation and nicotine/dose regulation, the teenage girl may especially learn to use cigarettes as a legal and sanctioned means of weight control, also highly valued during this period.

It is easy to see how, to a teenage girl, standards of slenderness and weight loss may be related to smoking and how cigarette advertising may capitalize on these and other descriptions of female beauty.

Feminine beauty has been equated with ultraslimness for a generation. Obsession with reducing body weight and the existence of grave eating disorders is increasingly prevalent among teenage girls and women today. Current data from the NIDA High School Senior Survey {Johnston et al. 1985) show an astounding use of nonprescription diet pills among female high school seniors.

Interestingly, in the 1984 Glamour Magazine survey of 33.000 women. 50 percent of respondents reported using diet pills sometimes or often. Analysis of the NIDA teenage data for concurrent use of reducing pills and cigarettes has not been reported, but an association might be predicted.

Cigarette smoking provides a lifestyle crutch with a physiological basis to facilitate weight control. Smoking a cigarette is said to suppress appetite; therefore, smoking serves as a means of delaying eating or reducing consumption. Cigarettes are also often used to mark the end of a meal and frequently accompany coffee and alcohol consumption. To an adolescent girl, the ritual aspects of smoking/eating/drinking may come to represent social competence along with an image of physical attractiveness.

This brings us to the putative role of cigarette advertising in female smoking, a highly debated influence with regard to the initiation of smoking. Pictorial advertising portrays smoking as fun, sophisticated, sexually adventurous, and involving risk taking. At the very least, we can say that cigarette advertising provides an indirect influence on smoking onset by supporting the image of smoking as a symbol of maturity, autonomy and attractiveness.

All of these admired traits form part of the myth surrounding the social benefits of smoking. Girls learn far earlier than puberty that beauty is a primary dimension of femininity; by adolescence, the cultivation of attractiveness has become a major task. Girls also grow up surrounded by omnipresent models of beautiful women on billboards, television, in movies and magazines, which are capable of influencing their evaluation of the importance of beauty for attaining popularity. Combined with the fact that early adolescence marks the highest degree of anxiety and greatest dissatisfaction with body image, the allure of cigarette ads targeted at women can be immense. Every psychosocial attribute and culturally relevant message valued in this age group can be found in cigarette ads which feature, in addition to those attributes mentioned earlier, athletics, dress, favorite activities, feminism and very frequently, extreme slenderness.

A 1985 Federal Trade Commission Report to Congress contains an analysis of cigarette advertising practices and expenditures for the years 1982-1983. In those years, ads directed primarily toward females featured glamorous and elegant women, and a "luxury brand" was introduced. The FTC Report summarizes the advertising approach as follows: "The cigarette marketers placed increasing emphasis on linking a particular brand with health, wealth, luxury, and achievement."

To note that cigarette manufacturers spent a total of $2.65 billion in 1983. compared to $1.2 billion in 1980. may serve to illustrate the degree of environmental flooding that is possible with a media campaign.

The three forms of media on which the greatest amounts of money were spent for advertising in 1983 were magazines, newspapers, and outdoor displays, in decreasing order. Public entertainment or special events, including sports, musical and other cultural events, received increased sponsorship. This included such sporting events as Team America Pro Soccer, the Western Rodeo series. Ski Days, the Virginia Slims Tennis Tournaments, and the Raleigh Children's Cancer Classic Celebrity Golf Tournament. Cigarette advertising and giveaways, such as T-shirts with a brand logo, were frequently prominent at such events. Examples of cultural events sponsored in whole or part by the cigarette industry were the Kool Jazz Festival and the New York City Opera Company's National tour. Obviously, many of these events are attended by adolescents, who may even come to associate such attractions with particular brand images.

K.E. Warner in the New England Journal of Medicine (1985) wrote convincingly regarding media self-censorship on the known relation between smoking and health. He cites several sources of self-censorship, the primary one being the fear of publishers that advertising will be withdrawn and thus substantial revenues lost if the health effects of smoking are openly addressed. Additionally, advertisements for anti-smoking products and services may be rejected by publishers for fear of offending the tobacco advertisers. Warner states. "Evidence ... strongly suggests that the public is fed a media diet deficient in news, comment, and commercial promotion relating to the adverse consequences of smoking."

With specific regard to women's magazines, Whelan et al (1981) reported that only eight feature articles on smoking or quitting were published in the 12 years between 1967 and 1979 in 10 leading magazines that carried cigarette advertising. Twice as many (16) such articles appeared during the same time period in two women's magazines that do not carry cigarette advertising.

Compared to the dangers of smoking, far greater attention was given to other women's health issues, such as contraception, stress, mental health, and nutrition in the magazines that accept cigarette advertising than in those that do not. Thus, there is a very clear source of bias in the amount of information about health issues in general, and about smoking in particular, that an adolescent female will encounter if she reads women's or other magazines which accept cigarette advertising. The female adolescent must somehow overcome this source of misinformation if she is to avoid habitual use of tobacco and increased risk of cancer.

To make nonsmoking appealing and counter the extremely sophisticated images presented by cigarette advertisers constitutes a major task for researchers and educators from the fields of school and public health, the medical professions, and health psychology. Prevention programs often do not address the lifestyle choices and values of those adolescent girls most likely to take up smoking - those who are disinterested in school, not college-bound, who are precocious in social and sexual behaviors, and who may especially value the images peddled by advertisements. In addition, the health risks to fetus and mother associated with smoking in pregnancy, especially low birth weight, are important to remember since low birth weight is a major problem for teenage mothers. Parental smoking also elevates risk of respiratory disease in infants. Thus, the teenage female smoker may be at risk for immediate as well as future health consequences.

We need to learn to "market" nonsmoking to this population of young women in ways they will find attractive, using role models they adulate. In light of the worrisome prevalence trends of the mid-1980's, this may be our foremost undertaking in smoking prevention for women.


Ellen R. Gritz, Ph.D.. is Director. Division of Cancer Control, Jonsson Comprehensive Cancer Center and Associate Researcher. Department of Psychiatry and Biobehavioral Sciences. UCLA School of Medicine. She is an expert in women's smoking and is currently conducting a large-scale smoking cessation intervention with a female population. Dr. Gritz has published extensively.


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