Quitting Smoking Harder for Women than for Men
Review of Research Finds Variety of Reasons for Why It Is Harder for Women to Break Free of Nicotine Addiction

A review of numerous research studies focusing on smoking cessation has concluded that while women may suffer greater relative risks of smoking-related diseases than do men, they tend to have less success than men in quitting smoking. Dr. Kenneth A. Perkins from the University of Pittsburgh School of Medicine who conducted the review offers several reasons for this disparity in a paper published in the May 2001 issue of CNS Drugs.

These research-based findings include:

• Nicotine replacement therapy may not be as effective for women.
• Women smokers are more fearful than men of gaining a lot of weight if they quit.
• Medications to aid smoking cesstion are not currently recommended for pregnant women.
• A woman's menstrual cycle affects tobacco withdrawal symptoms, and responses to anti-smoking drugs may vary by cycle phase.
• Husbands may provide less effective support to women who are trying to quit smoking than wives give to husbands.
• Women may be more susceptible than men to environmental cues to smoking, such as smoking with specific friends or smoking associated with specific moods.
• Many women may enjoy the feeling of control associated with smoking a cigarette.

"According to the recent report on women and smoking by the Surgeon General, three million women have died from smoking-related diseases since 1980. Currently, women suffer 39 percent of all smoking related deaths," says NIDA Director Dr. Alan I. Leshner. "Given the greater relative risk of women to incur smoking-related diseases, it is clear that we must find better approaches to help women break their nicotine addiction."

Dr. Perkins says that one of the intriguing observations that emerged from his review is that some forms of nicotine replacement therapy may not be as effective in women as in men. In some of the studies he reviewed, women had less treatment success using nicotine gum or nicotine patches than did men.

In contrast, other stop-smoking medications may more effective in women than men. Because negative mood is more likely to precipitate smoking relapse in women than in men, Dr. Perkins suggests that use of antidepressant medications for smoking cessation could be more effective in women than men.

Dr. Perkins concludes that developing smoking cessation interventions that address the gender-specific concerns of women smokers could increase the success rate among women who are trying to stop smoking.

The health risks associated with smoking for both men and women are well known, and include a two-fold increase in risks of heart disease and of cancers of the bladder, stomach, and pancreas, a 10-20 fold increase in lung cancer, and a 10-fold increase in chronic obstructive pulmonary disease. Smoking also significantly increases risks of stroke and pneumonia.

But women may suffer greater relative risks of smoking-related diseases than do men. For example, in one study cited by Dr. Perkins in his review, women who smoked had almost double the risk of myocardial infarction than did men. The increased risks of heart attack and stroke due to smoking are further exacerbated in women who also use oral contraceptives. Some studies have also pointed to the conclusion that women also may have nearly double the risk of lung cancer as men.

There is also some evidence that breast cancer risk may be increased among women who smoke. Smoking is associated with greater menstrual bleeding and duration of dysmenorrhea, as well as greater variability in menstrual cycle length. Women who smoke have a more difficult time becoming pregnant, and reach menopause on average a year or two younger than women who do not smoke.

Most health risks associated with smoking are reduced or eventually eliminated when smoking abstinence is maintained.

Note to Reporters: This paper is being published in CNS Drugs (Perkins KA. Smoking Cessation in Women: Special Considerations. CNS Drugs 2001; 15 (5): 391-411). It is available online at http://www.Ingenta.com/.

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