Women appear to have a tougher time quitting smoking than men, according to researchers at Women's Health Research at Yale. • While the percentage of men who have given up cigarettes between 1965 and 2006 was 54.5 percent, the rate of decline among women was less steep, at 47.5 percent. • Consequently, the gap in the percentages of male and female smokers has narrowed. In 1965, slightly more than half of all men smoked, while about a third of women did. Today, 23.3 percent of men smoke, compared with 18.6 percent of women. • We talked to Carolyn Mazure, a professor of psychiatry and director of the research program, about why women are not kicking the habit at the same rate as men.
What does the research show?
Well, the first thing I want to say is that smoking remains a serious public health issue. Smoking is the leading cause of preventable death and illness in the United States. Those deaths and morbid occurrences are from cancers, respiratory illness, cardiovascular disease.
Why is it harder for women to quit smoking?
It appears as though when men quit smoking, the most prominent symptoms of withdrawal are biological symptoms of craving.
However, we find women are more likely to use cigarettes to manage moods, to deal with stress and to control weight. In other words, women are smoking for different reasons, and if you're not helping with those particular reasons for smoking in your cessation treatment, you wouldn't necessarily expect your treatment to work.
A good example is the nicotine patch, which often is considered the first line of treatment for smoking. The research data on the nicotine patch suggest that women do less well quitting smoking when using the patch than men do, probably because it targets symptoms of craving rather than the symptoms that are more prominent for women.
So this begins to make an argument for gender-specific approaches to smoking cessation. . . . With the medication Zyban (the generic is bupropion), it appears that women do as well in quitting when using this treatment as men do. . . . Zyban can help with mood symptoms. It was originally developed as an antidepressant drug, Wellbutrin. That's an important part of the story in that we do think there is a relationship between depressed mood and smoking.
Are women moodier than men or less good at managing stress?
I wouldn't say that at all, but we clearly know that the rates of depression are higher in women than in men, not only in this country but in the world.
We find stress a pathway to depression in both men and women, although stress appears to be a more potent predictor of depression in women than men. Knowing that, we can understand how women would be attempting to use a variety of strategies to handle stress, including smoking.
Cigarette smoking does affect weight, right?
Yes, it can. When people quit smoking, it's not uncommon to gain a few pounds. Often this is a deterrent, particularly among women.
You have to deal with the fact that you may gain some weight and prepare for that and really factor that into whatever cessation program you undertake. . . . The main concept is to include some form of exercise and support. And the exercise should be something that is manageable and really fits into your day.
Does the menstrual cycle have any effect on attempts to quit smoking?
We tell women to think about the time within their menstrual cycle that is most difficult personally and advise them not to quit during that time because you are likely to have a harder time resisting cigarettes during that time. In addition, before you quit, prepare for that time in your cycle. What are you going to do when you feel badly? Call a (quit-smoking hotline), take a walk, you have to have a plan.