The world health body says that if current trends continue, women could soon be on par with men in terms of rates of death due to smoking, creating what one expert called "a very perverse equality."
"The tobacco industry is spending heavily on seductive advertisements that target women - especially in low and middle income countries. The advertisements try to dupe women into believing that tobacco use is associated with beauty and liberation," Dr. Douglas Bettcher, Director of the WHO Tobacco Free Initiative, told a recent press briefing in Geneva. "In effect they have had to offshore their marketing strategies, look for greener pastures."
Of the world's more than one-billion smokers, only about 200 million are women - but WHO warns those numbers could change rapidly.
Experts believe the tobacco industry has made the shift towards women and young adults in order to compensate for the drop off in tobacco use from smokers who have died from cancer, emphysema, heart attacks, stroke, asthma, tuberculosis and other tobacco-related diseases. One WHO expert accused the major tobacco companies of using "predatory marketing strategies" to lure women in developing countries into taking up the smoking habit, adding that state-owned tobacco companies tend to be less aggressive than the multinationals.
Said Bettcher: "They need to always be refreshing these pools and that's why they are looking to low and middle income countries over the last decade - looking at new populations such as young women to light up and support their profit motives."
Among the venues used to lure women and young girls to tobacco are women's magazines and the fashion industry, WHO says. "The industry has studied what makes women 'tick' in the developed and developing countries," said the WHO's Peju Olukoya, adding that they use sporting and music events that draw many young people. In some countries, free cell phones and text messaging campaigns are used heavily to promote cigarettes.
In Egypt, one WHO expert said, tobacco companies are trying to lure more women by producing cigarette packages to resemble perfume boxes. In Nigeria, cigarette companies build stalls with branded umbrellas and even fund school supplies. "As a result of this, the acceptability for the use of cigarettes by women is gradually increasing., In the past cigarettes have always been associated with the red light district in town," said Olukoya, a native of Nigeria.
She added that Big Tobacco sends confusing messages in many developing countries - by promoting slimness in cultures where this is not necessarily valued and by putting forward smoking as liberating. As for messaging to young men: "It's all about the macho..a big man smokes a big cigarette."
Bettcher says the industry's marketing strategy is having its desired impact. In half of the 151 countries surveyed by WHO, about as many girls smoke as boys. "In some of the countries, in fact, even more girls smoke than boys." Countries where there are more girl smokers than boy smokers include: Uruguay, Mexico, Cook Islands, Croatia, Argentina, Senegal, Chile, Colombia and Bulgaria.
Said Bettcher of the rise of female smokers: "This is a serious red flag. It could mean that we are on the cusp of a much worse global tobacco epidemic amongst women. Girls and boys who smoke are likely to remain smokers as adults."
Bettcher said that one can expect "an explosion" in adult women's tobacco use rates in the coming years. "We simply cannot allow this trend to continue. All governments must take action to protect women from tobacco advertising and promotional sponsorship.
"We must empower women to protect themselves and their families from the harms of tobacco use."
Bettcher added that women need to be protected from second hand smoke, especially in countries where women feel powerless. Smoke-free areas in restaurants and help to cope with addiction are among the steps recommended.
Of the 430,00 adults who die from second-hand smoke each year, well over half - 64 percent - are women. And of the more than 5 million people who die from tobacco use each year, about 1.5 million are women. "Most of these tobacco-related deaths occur in low and middle income countries, which can least afford such dreadful losses," said Bettcher.
By 2030, there could be as many as 8 million people who die from tobacco, of which 2.5 million will be amongst women.
In the Asia-Pacific region, more than 8 per cent of girls between 13 and 15, or around 4.7 million girls, are using tobacco products, said WHO.
Betcher called the new trends - where women became as likely as men to die of smoke-related reasons - a "very perverse equality."
WHO chose as the theme for the recent World No Tobacco Day 2010 as "Gender and Tobacco With an Emphasis on Marketing to Women." WHO recommends that tobacco advertising and sponsorship should be completely banned. In the US alone, 11 percent of advertising and promotional expenditures in 1996 came from the tobacco industry; in 2005 $13.11 billion was spent on tobacco advertising and promotions.
In 2006, only 17 countries in the world had comprehensive bans against tobacco advertising, and Bettcher said some wealthy countries "dont do very well" in terms of enforcing bans. In response to bans, tobacco companies have become more sophisticated, turning to such tactics as product placement in movies and sponsorships of popular events.
That tobacco companies are tailoring their marketing strategies increasingly towards women in developing countries is nothing new. In 2003, the American Cancer Society flagged the issue as very serious. "The tobacco industry has intensified its marketing strategies -- especially those targeting women -- in developing countries,” said Michael J. Thun, vice president of epidemiology and surveillance research for the American Cancer Society. “International measures such as the WHO Framework Convention on Tobacco Control are essential to help countries protect themselves.”