If you were a visitor from Mars and turned to the leading women's magazines to find how you could reduce your chances of premature disease and death, you'd receive a distorted view of what really poses a threat to health.

The five months' worth of magazines I reviewed (the May to September l996 issues of Woman's Day, Family Circle, Redbook, Glamour, Mademoisselle, Elle, Cosmopolitan, Harper's Bazaar, Vogue, Self, New Woman, McCalls and Ladies Home Journal) tended to emphasize nonexistent or trivial health risks while largely overlooking major causes of disease, particularly cigarette smoking.

Epidemiologists estimate that approximately two million deaths occur each year in the United States and that about half of those, or 1 million, are preventable in the sense that they can be postponed. The leading cause of premature death is cigarette smoking, accounting for about half of those one million preventable deaths.

Alcohol abuse or misuse accounts for an additional 100,000 deaths (although unlike cigarette smoking, there is a proven safe level of alcohol use that actually conveys some health benefits, particularly in reducing the risk of heart disease). A smaller but still significant number of premature deaths can be linked with failure to wear seatbelts or use smoke detectors or wear helmets while biking or roller blading, and failure to take advantage of early screening techniques to identify a treatable disease (cervical, breast and colon cancer, high blood pressure, for example). Our undertanding of the role of diet in causing early death is still evolving, but there's increasing agreement that a lower fat intake and increased consumption of fruits and vegetables may help extend life and good health.

How did the magazines do in reporting health facts, specifically those related to cigarettes?

The magazines dedicated a substantial portion of editorial content to disease-prevention advice, some of which was quite good. For example, nearly all of the magtazines we reviewed offered sound advice on the importance of early detection for breast, cervical, colon and ovarian cancers. All stressed the role of excessive sunlight exposure in causing various forms of skin cancer. They frequently mentioned the role of high blood pressure in causing heart disease, the need for women of reproductive age to consume adequate amounts of folic acid ito minimize the risk of birth defects and the desirability of cutting fat intake and eating more fruits and vegetables.

But there's a striking omission in this extensive health coverage: During this five-month period, no magazine carried a feature story on preventing lung cancer (now the leading cause of cancer death in women) or on smoking's role in causing cervical, pancreatic, bladder and other malignancies, or on the prominent role of smoking as a cause of heart disease.

In fairness, this scanty coverage of smoking is nevertheless a great improvement over the way magazines dealt with the issue a decade ago. At that time, our magazine surveys found no references whatsoever to the dangers of smoking. Now, at least, several magazines did offer some strong statements about smoking's unparalleled hazards.

For example, McCalls carried a warning about the risks of second hand smoke; Ladies Home Journal mentioned the role of cigarette smoking in discussing the causes of colon cancer — a proven link that has not been widely covered in the popular media; Elle lamented that physicians frequently fail to inquire about women's smoking habits; Woman's Day highlighted the importance of quitting as a way to reduce stroke risk; Glamour, in commenting on groups claiming a connection between abortion and increased breast cancer risk, asked: "Why don't these groups tell women how dangerous it is to smoke?"

But such references to cigarettes represent only a fraction of the total heath coverage of these magazines. Hard-hitting discussions of the issue were few and far between, and many articles that mentioned smoking failed to put its health risks in perspective. For example, a Woman's Day article on "the worst health mistakes women make..."ranked "putting off Pap smears" and "not excercising" high on the list and "still lighting up" low down. A Self article detailing things a woman should care about in the l996 election put a clean environment, abortion rights, and education well before "Must women die of lung cancer?" And an article on "How to live to be 100" in Woman's Day ranked "avoiding cigarettes" as less important than "thrive on hard work" and "be self-disciplined."

While de-emphasizing the risks from smoking, the magazines at the same time were playing up risks that were trivial or nonexistent. Readers were warned, for example, of the dangers of cheese addiction, the toxic effect of displaced anger, dioxin in tampons, grilled meat and "deadly" Red Dye #3. An undue amount of attention was also spent on topics only slightly more important, including how to protect against snake bites, the dangers of allergens in biotech foods, cystitis and Mad Cow disease (which has never occurred in the U.S.)

Some articles that cried out for a discussion of smoking left it out entirely — omissions so blatant that censors seemed to be at work. Woman's Day's "Every woman 's medical must list" mentioned breast and rectal exams and Pap tests along with monitoring blood pressure and cholesterol, but it had nothing on smoking's health effects or tips on quitting. Incredibly, Family Circle's "4l Ways to Live Longer" omitted smoking from the list, aside from a passing mention under one of the 41 more important "ways." And Glamour's article on the causes of infertility speculated about hot tubs, marijuana and drinking excessively — but made no mention of smoking's proven threat to both male and female fertility.

Even worse than the omissions was the blatant promotion of smoking in some magazines. Mademoiselle commented that "smoking is hardly a crime"; and some publications ran photos of smoking models and film stars — most egregiously Vogue's September "Fall Fashion" issue, which featured Kate Moss, TĪa Leoni and Cameron Diaz with cigarettes in hand.

Why do magazines downplay the risks of smoking — and in some cases even promote the habit? Perhaps editors don't want to appear as "health nanny" to readers. Or maybe the feel that harping on the hazards of smoking is a downer or rationalize that most of their readers don't smoke and don't need to be reminded of its hazards. But in all likelihood, the main reason a discussion of smoking hazards remains largely outside the purview of these magazines is because of what's inside — namely, a lot of cigarette ads. All the publications in our study carried them, for a total of nearly 300 cigarette ads in five months' worth of magazines we analyzed. These ads account for a substantial portion of total advertising revenue, so it's understandable that magazine editors are reluctant to tell the truth about tobacco.

We have an absurd situation: Magazines purporting to be valuable sources of health information for women carry ads that portray smoking — the No. 1 killer of women — as sexy, feminine and glamorous. Can anything be done?

President Clinton proposes that cigarette advertising be banned or restricted in magazines read primarily by young people — which would apply to many of the ones in our survey. But an examination of the May issue of Elle shows why this solution won't work.The issue carried an ad for an Elle cigarette case "to carry your favorite brand."

Is this a cigarette ad? No. But it's a surrogate for one. This sort of merchandising has arisen in other countries where ad restricitions have gone into place, and there's every reason to expect that ad restrictions would have the same effect here. Virginia Slims clothing, Camel candles, Malboro hats — the possiblities are endless.

The only real solution is to hold magazines that carry cigarette ads accountable for the misinformation and distortion they offer. And that means consumers should refuse to buy these magazines until their editors decide to reject cigarette advertising.

(From Priorities Vol. 8, No. 3, 1996)

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