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Tobacco and women's health
  1. Ontario Tobacco Research Unit
  2. University of Toronto
  3. 33 Russell Street
  4. Toronto, Ontario M5S 2S1
  5. Canada;
  6. roberta.ferrence{at}

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    Tobacco and women's health. Hannu Vierola. Helsinki Finland: Art House Oy, ISBN 951-884-236-1.

    This book contains everything you want to know about tobacco and women's health. Vierola has put together a readable, comprehensive volume that goes far beyond what one might expect from a medical specialist, or from a book on tobacco and women's health. Only the exceptional emphasis on the benefits of hormone replacement therapy betrays the author's primary specialisation in obstetrics and gynaecology. The author covers health effects, but also includes advice on quitting, policy initiatives, and issues in developing countries.

    Despite considerable referencing of the scientific literature,Tobacco and women's health is very much a popular book. Open it anywhere and there is something that grabs your attention. It is an easy read and does not suffer from the kind of pedantry that often characterises the academic literature. But it is also directive and delivers advice as the doctor ordered, a feature that might put off some readers looking for a more impartial account.

    With an introduction by Margaretha Haglund that focuses on the history of advertising and women's smoking, Vierola launches into a whirlwind tour of the topic. Chapter 1, for example, is titled “Smoking frequency among women”, but also includes the effect of advertising and women's magazines on women's smoking, how lung cancer became an “equal opportunity” disease, a discussion of the relative importance of price and education strategies, and a section on World Health Organization and US anti-smoking campaigns. This is punctuated by boxed quotes on a number of different topics.

    There are nine chapters on the effects of smoking on various diseases and body systems, as well as chapters on initiation, cessation, and the role of health care professionals. A final chapter provides relevant web addresses for those seeking further information. The book is also indexed. It includes a sprinkling of cartoons, photos, and maxims for smokers (“When you can't breathe, nothing else matters”—American Lung Association).

    The book is remarkably broad, including both detailed medical advice and clear thinking on policy, but there are inaccuracies and unsupported statements. The section on cigarettes as a gateway drug draws unwarranted conclusions, as does the section on the effects of advertising bans. At one point, the author says there are no risks of nicotine replacement therapy to the fetus, but we know that nicotine has a detrimental effect on prenatal neurological development. There is also a heavy reliance on single studies, leaving the reader to wonder about the generalisability of the findings. Readers should be cautioned that an accurate account of what is currently accepted might require consulting various surgeon general's reports.

    Referencing is inconsistent. While two Finnish studies on light cigarettes are cited, Kozlowski's filter blocking studies in the same paragraph are unacknowledged. Much of the information is not well digested, and many sections hop from topic to topic. A good editor would have made a difference here. While this is generally not desirable in a book, it may serve to keep the channel flipping reader involved.

    Despite these drawbacks, Vierola's book is generally solid and could be recommended for the non-academic reader seeking understanding of tobacco and women's health and the larger context of smoking for both women and men. It may well pique the interest of the casual reader and lead to a more in depth search of the growing literature on tobacco control.