In this study, we chose to examine trends in morbidity and mortality for three conditions closely linked to tobacco use that have long been considered almost exclusively male conditions: lung cancer, chronic obstructive pulmonary disease (COPD), and myocardial infarction.

It should be noted that, in absolute terms, these indicators remain largely unfavorable for men, as they smoke more than women in France; even today, there is a 6-point gap in the prevalence of daily smoking in 2017.

Regarding morbidity, between 2002 and 2012, the incidence of lung cancer increased by 72% overall among women, while it remained stable among men. For COPD, the rate of patients hospitalized for an exacerbation doubled among women between 2002 and 2015, whereas it increased by only 30% among men. Finally, for myocardial infarction, while the rate of hospitalized female patients remained generally stable over the period, it masked a very unfavorable trend among young women.

Regarding mortality, between 2000 and 2014, mortality rates from lung cancer and COPD increased by 71% and 3%, respectively, among women, whereas they decreased by 15% and 21% among men. Finally, when considering all tobacco-related diseases, the percentage of deaths attributable to tobacco among women showed a very sharp increase since 2000, with a continuous average annual growth rate of 6% between 2000 and 2014 (compared to a 1% decline for men).

The data show that increases in morbidity and mortality among women are particularly pronounced among women aged 45 to 64. This reflects a generational effect, as women born in the 1950s—who began smoking in the 1960s and 1970s—are now entering these age groups. While the downward trend among younger women is certainly an encouraging sign, it should not obscure the fact that smoking rates remain very high, particularly when compared to Anglo-Saxon countries where the prevalence of smoking among women stands at 14% in the United States and the United Kingdom. These consumption levels in France suggest a worsening of the trends observed in tobacco-related morbidity and mortality in the coming years if these women are unable to quit smoking. Furthermore, current trends in morbidity related to COPD and lung cancer reflect past smoking trends, as these conditions develop following cumulative exposure to tobacco smoke over several years. The burden of these diseases among women is therefore expected to continue to grow in the coming years, even if the prevalence of smoking declines. This trend is likely to be amplified by population aging and improved survival rates among patients with other tobacco-related conditions, such as myocardial infarction. Unlike lung cancer and COPD, for which there is a latency period between smoking and the development of the disease, a massive decrease in smoking prevalence could have a relatively short-term impact on the incidence of myocardial infarction.

Regarding smoking cessation initiatives—and more specifically media campaigns—the literature does not allow for a definitive conclusion regarding the effectiveness of campaigns specifically targeting women, as the motivations for quitting smoking are, in part, the same for both men and women. Nevertheless, a tailored media buying strategy can increase women’s exposure to smoking cessation campaigns: this is precisely what Santé publique France has been doing for several years, particularly in connection with the “Month Without Tobacco” initiative. Furthermore, beyond general public campaigns, some recent studies suggest that it might be appropriate to tailor smoking cessation support to gender at the individual level. Indeed, it is becoming increasingly clear that an approach to smoking cessation support for women must take into account differences in the processes of tobacco addiction between men and women, which result in different responses to existing treatments. This avenue remains to be explored but could lead to the promotion of differentiated care approaches in clinical practice.