The latest surgeon general's report gives dire new meaning to that old cigarette ad, "You've come a long way, baby." The Surgeon General Talks About Female Smokers Women now account for 39 percent of smoking-related deaths, a proportion that has more than doubled since 1965. Worse, more teenage girls are smoking, and increased tobacco industry marketing threatens to derail recent progress in fighting the killer habit, concludes Surgeon General David Satcher in a report released Tuesday. "What starts out as a simple puff is turning into a death sentence," said Tommy Thompson, Health and Human Services Secretary, pledging to use his office as a bully pulpit as he travels the country to expound on the "evils of smoking." The surgeon general's report urges a new push to fight female smoking, and Thompson said that his office will develop strategies to do just that. But the last big federal attempt to curb smoking -- Food and Drug Administration tobacco regulation to prevent cigarette companies from targeting minors -- failed a Supreme Court challenge. "Speaking only for myself, I think tobacco should be regulated," Thompson told reporters Tuesday. But because of the court action, "It's up to Congress to pass legislation." Legislation to reopen FDA regulation has been introduced. While he wouldn't endorse a specific bill, Thompson said curbing tobacco marketing that encourages teens to smoke will be key -- because 80 percent of smokers, women and men, start as teens. States, however, can fight tobacco without awaiting federal action. Satcher's report cites a California program that cut lung cancer among women even as it rose across the rest of the country, and a Florida program that has reduced smoking by middle-school girls by 40 percent in just two years. Smoking is the nation's leading cause of preventable death, claiming more than 400,000 lives a year. Smoking has killed nearly 3 million women since the surgeon general last investigated female smoking in 1980, the new report says. It can cut short a woman's life by an average of 14 years. Lung cancer is smoking's top harm. Once rare among women, it's now the top female cancer killer, claiming 27,000 more lives each year than does the breast cancer that so many women dread. Smoking also causes numerous other cancers, heart disease and other lung diseases in male and female smokers alike. But women face some unique additional risks, the nation's top doctor stressed: dangerous blood clots among users of birth control pills; menstrual irregularities and earlier menopause; infertility; bone-thinning osteoporosis; cervical cancer. That's in addition to the dangers of smoking during pregnancy, which include low-birth-weight babies, stillbirths, miscarriages. About one in five women smokes, a rate that hasn't changed much in the last decade. In a government survey last year, 30 percent of high school senior girls said they had smoked in the previous month, an increase from the early 1990s. Studies show that tobacco ads do influence people's decision to smoke -- and tobacco companies for decades have specially targeted women, starting with the 1960s' Virginia Slims' "you've come a long way, baby" campaign. The newest promotion to draw the surgeon general's ire: R.J. Reynolds matchbooks that say, "Until I find a real man, I'll take a real smoke." Reynolds declined comment. But the government complained that cigarette companies spent $8.2 billion on overall advertising in 1999, a 22 percent increase -- and one that comes after the industry's $252 billion settlement of state anti-tobacco lawsuits in 1998, a settlement in which companies also pledged not to market to teen-agers. There are solutions, Satcher said. He pointed to California, where a statewide program that includes major advertising about tobacco's deadliness found lung cancer declined by 4.8 percent among California women in the last decade -- even as it rose in other regions. A Florida anti-smoking program reduced smoking by middle-school girls from 18.1 percent in 1998 to 10.9 percent last year, he said. Additional Resources:

• Surgeon General's Report
• Federal Information On Women's Smoking Cessation