Worldwide, smoking rates continue to rise for women, while rates have peaked and are now declining for men [1]. According to data from the 2007 Canadian Tobacco Use Monitoring Survey, 16.5% of women and 20.8% of men (aged 15 and older) were current smokers. Historically, men have always smoked more than women; however a higher proportion of young women aged 18-19 smoke compared to young men (24.4% versus 22.2%, respectively). Women are also starting to smoke at a younger age [2]. It is estimated that smoking is the direct cause of lung cancer in 70% of women and 90% of men [3]. It is important to note that most smoking statistics only focus on cigarettes, ignoring other forms, such as chewing tobacco, water pipes, bidis, chutta, betel nut, and snus or snuff, which have unique patterns of use by women around the world.

Gendered patterns of tobacco use influence when and how women smoke or are exposed to smoke. Females start smoking at an earlier age and are thus exposed to tobacco for longer periods of time, which may explain why women have a harder time quitting. Adolescent girls often report that they started smoking because of curiosity or to deal with stress. Girls may be more influenced by the tobacco use of their friends and family compared to boys, likely due to the nature of close adolescent female friendships [6]. 

Adult women may be more likely to work in the service industry where they may be exposed to second hand smoke. This is even more problematic given that women are more sensitive to second-hand smoke than men and are more likely to experience illness or death due to heart disease as a result of being exposed to second-hand smoke in the workplace [7]. The Canadian Lung Association estimates that regular second-hand smoke exposure increases the risk of lung disease by 25% and heart disease by 10%.

Many women report starting to smoke in order to reduce stress, which explains why some women experience more withdrawal symptoms and are less successful when trying to quit. Women may relapse due to stress and negative emotional moods associated with a decrease in nicotine levels [8]. Lack of weight control is also a barrier for many women to stop smoking [9], as women encounter tobacco marketing which brand cigarettes as a means to achieve cultural ideals of thinness [10].

Current Canadian smokers often occupy a marginalized social position in relation to age, socioeconomic status, Aboriginal status, sexual orientation, and/or experiences, such as trauma, mental illness, and use of other substances [11]. In all of these situations, attention to specific women’s issues is warranted. Smoking is often associated with low income and low levels of education and unemployment. Low-income women report that smoking is a small escape from the stressful realities of their lives, such as childcare, household, and work responsibilities [12]. 

Tobacco use rates for the Aboriginal population over 20yrs are more than double the Canadian average [13]. Smoking among Aboriginal girls in BC is higher than Aboriginal boys [14] and the age of smoking initiation is youngest for Aboriginal girls (age 10) [15]. 

Socioeconomic status, education, and age are important factors related to smoking during pregnancy. Women who are young, living on a low-income, single mothers with a lack of social support, have a partner who smokes, and/or have a high level of nicotine dependence before becoming pregnant are more likely to smoke during pregnancy and postpartum [16]. 

While rates of smoking are decreasing among women overall, poor women, single mothers, and Aboriginal girls and women are more likely to smoke [17]. There are no large-scale surveys or surveillance initiatives focusing specifically on Canadian women’s tobacco patterns. More research is needed to accurately understand why women start and continue to smoke, in light of evidence of the harmful health effects.