Smoking is and has been a staple of free cultures throughout history. It has been a long established element of what was once thought of as the art of being a well-rounded gentleman, especially in the 19th and 20th centuries. In the 1800's, it was not uncommon for a young gentleman to hire a smoking tutor of sorts to teach him the art of smoking, with the course considered a success when the student was able to blow smoke rings. Most gentlemens' clubs were a haven for smokers of all ranks, be it pipes, cigars, or cigarettes. Many clubs featured their own humidours, as well as a nice variety of smoking jackets to choose from.
As to ill health effects, one must keep in mind that the tobaccos of the 1800's and earlier 1900's were not sprayed with the poisonous toxins more modern tobaccos are. Nor were cigarette tobaccos doused in dangerous chemicals as they are now, in order to give the leaf a longer shelf life (not to mention the fillers which have also come into play). The modern anti-smoking studies were more political than they were factual, with the methods and models being geared to achieve results which had already been decided upon. Many factors were blatantly ignored. For example, the addition of chemicals I just mentioned were not considered in analysing the effects of tobacco. Nor were unseen (non-tobacco related) airborn particulates and toxins. The occupational hazards of many test subjects (such as those working in construction or plants where heavy pollutants and chemicals were present) were not taken into consideration nor differentiated from those who were not exposed to such things. And the fact that, regardless of the cavalier approach to these studies, pipe smokers were found-- statistically-- to outlive non-smokers by two to three years was ignored, if not suppressed. Many studies showed so-called "secondhand smoke" to be of a negligible threat, and far less a health risk than the pollution and particulates one breathes on a daily trek through a city, or even when mowing the lawn or firing up charcoal in a grill.
I'm not saying smoking is the healthiest choice in the world, nor am I saying it's without some risk to one's health, depending on the choice of pipes, cigars, or cigarettes and the frequency with which one partakes of their tobacco. But as one who works in the field of healthcare, I can say it is not the "evil" ogre the anti-tobacco forces would have us believe. One must keep in mind smoking is an easy target and a perfect control for behaviour modification efforts.
I've actually known several lady pipe smokers. One of the most famous historically was Rachel Jackson, Andrew Jackson's wife. According to the story, she found one of his pipes lying around one day when he was off to war and decided to try it.
I think a lot of it is simply a matter of preference and perception.
Smoking a pipe or really enjoying a quality cigar requires patience, time, and an ability to relax. Cigarettes are far easier to pop in one's mouth and light up on the go, and they're a lot faster than the alternative.
Then there's the notion that pipes and cigars are more of a masculine element. Even in today's "progressive" society, most folks don't think of pipe and cigar smoking as something women would prefer, yet the few women who are independently minded enough to give them a try find they're just as good at it as we men are. And bear in mind it wasn't that long ago that cigarettes were also thought of as decidedly masculine, and few women dared light one up in public.
I think, had it not been for the radical anti-tobacco pogrom our government decided to undertake, we might now see a lot more women joining the ranks of the more traditional pipe/cigar smoker, which ironically is a far healthier choice than cigarettes. My supervisor is every bit the feminine lady, yet she regularly enjoys a good cigar and a glass of bourbon. In time we may see more women moving away from cigarettes and into the ranks of pipe and cigar afficionados, but with all the hype and misinformation (as well as the manufactured stigma associated with smoking in general) about tobacco, who knows what the future holds?