Today, we have all gathered on the occasion of World No Tobacco Day to address the serious and growing problem of tobacco use by women and girls.

Females comprise about 20% of the world's more than 1 billion smokers, and these figures are rising. Use of other forms of tobacco, such as shisha and smokeless tobacco is also increasing among females in many countries, particularly in the Eastern Mediterranean Region. In recent years, tobacco use has reached as high as 10% among females over 18 years of age and 30% among females under 18 years of age in some countries of the Region.

The spread of tobacco use by women and girls is directly linked to tobacco company marketing activities that increasingly target this group, particularly in low-income and middle-income countries. Tobacco marketing promotes the belief that smoking is fashionable and keeps women and girls slim and beautiful, and that it is a symbol of vitality, sophistication, emancipation and independence.

Although the majority (80%) of the world's smokers are currently males, the change in cultural norms at global and regional levels has led to tobacco use by females becoming more socially acceptable, which has put them at great risk. Females become more easily addicted to nicotine than males and find it harder to quit. We therefore have a responsibility to prevent the tobacco epidemic from becoming as bad among females as it already is among males.

Second-hand smoke poses another immense problem. Smokers affect others, especially women and children, with their second-hand smoke. Worldwide, second-hand smoke causes an estimated 600 000 premature deaths a year, the majority (64%) among women. In the Eastern Mediterranean Region, many women and young people live in homes that are not smoke-free and are also exposed to second-hand smoke in public places, both of which increase their risk of smoking-related illnesses.

There is no safe level of tobacco use or exposure to second-hand smoke. Women and children need to be protected from exposure to second-hand smoke at home and in public places. However, women often do not have the power to negotiate smoke-free spaces, even within their own homes.

We must therefore protect them through measures called for by the WHO Framework Convention on Tobacco Control, such as education, bans on tobacco advertising, protection against second-hand smoke and support for quitting. Otherwise, millions of preventable deaths will occur.

These facts are well documented by data that we have been collecting for the past ten years on young people from all countries of the Region. These data clearly show that the major issues with female tobacco use can be summarized as follows:

The gap between boys and girls is becoming narrower than the gap between men and women.

The gap between adult women and young girls is also becoming less than we have seen in the past.

Exposure to second-hand smoke is high.

The growing use of other forms of tobacco, such as shisha and smokeless tobacco, is due to tobacco company marketing activities.

Unless we all work together now to face the challenges of women's tobacco use, we might face a real disaster in another 10 years time if the current trends persist. We are all catalysts in one massive chain. Women whose partners smoke are at health risk. Parents who smoke place their children at risk. Adults who smoke encourage children to smoke by example. And we as health workers and advocates must intercept this chain to create change for tobacco control.

On this World No Tobacco Day, we are not only trying to highlight the challenges we are facing with women and tobacco use. We also want to empower women and girls to take a leading role in fighting this epidemic, and to encourage our male population, young and old, to assume a greater responsibility when it comes to tobacco control, for better health for all.