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Lung cancer deaths are rising among women born after 1950 in the South and Midwest, according to a new study. Cigarette advertising aimed at women in the 1960s and 1970s may have contributed to the increase, the researchers say. Overall, lung cancer deaths in the United States have been decreasing, according to HealthDay.

Women who were adolescents and young adults in the 1960s and 1970s were encouraged to smoke through Virginia Slims ads that told them, “You’ve come a long way, baby.” These ads indicated that smoking was a way to signal their liberation from traditional roles, the article notes.

“In the 60s and 70s, there was a sharp increase in the number of girls, not boys, who started to smoke,” study author Ahmedin Jemal of the American Cancer Society told HealthDay. “These women are now in their 50s, and already we’re seeing a sharp rise in deaths from lung cancer in this group.”

The researchers found that in Alabama, the lung cancer death rate for women born after 1950 was more than double the rate for those born in 1933. Similar trends were found in Kentucky, Louisiana, Tennessee and South Carolina. In contrast, in California, lung cancer death rates declined in all age groups younger than 75, starting in the 1990s.

Jemal said higher death rates in certain states are likely due to the states’ cultural attitudes about smoking, as well as weak anti-smoking efforts, such as few anti-smoking laws and low cigarette taxes.

The study only included white women, because lung cancer rates vary by ethnicity, and many states did not have complete data for other ethnicities, the researchers explained.

The study appears in the Journal of Clinical Oncology.

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