Smoking Cessation Harder For Women Than Men

Women may suffer greater smoking-related health problems and have a harder time stubbing out that last cigarette than do men, according to a review of recent research.

Kenneth Perkins, Ph.D., a professor of psychiatry at Western Psychiatric Institute and Clinic in Pittsburgh, reviewed more than 100 studies on smoking cessation and found that women appear to suffer greater risks of smoking-related diseases than men and tend to have less success than men when they try to quit smoking. The study appears in the May issue of CNS Drugs.

In regard to smoking-related health risks, one study showed that women had almost twice the risk of myocardial infarction than did men. Other studies pointed to greater risk of heart attack and stroke in women smokers who use oral contraceptives.

In addition, outcome studies on lung cancer led Perkins to conclude that, controlling for the amount of smoke exposure, women may have nearly double the risk of lung cancer as men. Recent research has identified a role for estrogen in increasing the lung cancer risk, according to Perkins.

Perkins also found some evidence that breast cancer risk may be increased among women who smoke, although he acknowledged that more studies are needed to replicate that finding.

Thus, smoking is especially dangerous for women, and the imperative to quit couldn’t be clearer. But it’s not that easy—especially for women, according to Perkins. “Treatment isn’t one size fits all,” he told Psychiatric News. “We can’t just say, ‘Here is a nicotine patch, now go and use it.’ Women have unique obstacles facing them.”

The research that Perkins reviewed suggests that women have more concerns about weight gain after they quit and greater susceptibility to falling back into old habits when faced with certain cues that trigger smoking, such as being around certain friends or experiencing specific moods.

Perkins also noted that men tended to benefit more from nicotine replacement therapy.

One study by Joel Killen, Ph.D., of Stanford University found that using nicotine gum resulted in abstinence from smoking twice as often in men as did using a placebo. For women, however, the nicotine gum didn’t help them to abstain from smoking.

Yet another study found similar results with the nicotine patch, where 17 percent of women but 24 percent of men were able to abstain from smoking with the treatment.

But women had a more positive response than men when it came to certain antidepressant medications. Perhaps due to the fact that depressed mood more often precipitates a smoking relapse in women, they are more likely to benefit from medications such as bupropion than are men, according to Perkins. Medications used to assist smoking cessation, such as clonidine and naltrexone, are also more effective for women, according to outcome studies.

Pregnant women, however, cannot take these medications since there is a significant risk to the developing fetus.

Finally, researchers are developing anti-smoking strategies that are tailored to women.

Perkins is currently involved in a counseling approach for women who are trying to quit smoking. Researchers at Western Psychiatric Institute and Clinic are using cognitive-behavioral therapy with women to reduce their concerns about weight gain.

The researchers are also using bupropion to see if it boosts the effects of therapy compared with placebo.

Smoking has resulted in the deaths of 3 million women since 1980, according to the Surgeon General’s recent report on women and smoking. It is also expected to cause 3 million more deaths per year among women by 2020.

“My message is not only for the smokers themselves but also for health care providers that there are many obstacles that crop up when people are trying to quit smoking,” said Perkins, who added that smokers should identify ways to cope with these obstacles before they emerge. “Often, people are faced with the situation that made them smoke, and they don’t have a coping mechanism in place,” he pointed out. ▪