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Kicking the Habit Tougher for Women

Different smoke-cessation therapies are needed, research shows

THURSDAY, May 3 (HealthScout) -- Women have a tougher time kicking the habit than men do, and smoking cessation therapies need to factor in such gender differences, research says.

Nicotine patches and gum seem to be less effective in women, the research says. And since depression is a greater obstacle for women when they attempt to quit, antidepressant medicine might prove more effective, it adds.

"Women have a harder time quitting and it may be that there are additional burdens they may face that men do not," says author Kenneth Perkins, a professor of psychiatry at the University of Pittsburgh.

"Fear of weight gain is something women are more concerned about than men, and depression is another issue. Women are more likely to suffer the disorder of major depression, and depression and mood change is a predictor of failure during smoking cessation therapy."

Perkins, who has been studying why women and men react differently to smoking, was asked by the National Institute on Drug Abuse (NIDA) to look at all available research "to see what factors may be more important for the treatment of nicotine addiction specific to women," he says.

"I focused on the research that compared the differences men and women had in response to medications, since the major thrust of treatment today is the use of nicotine replacement therapies like the nicotine patch or nicotine gum," he adds.

Perkin's findings show that:

  • Women smokers are more fearful than men that quitting smoking means gaining weight;
  • Antismoking drugs are not recommended for pregnant women;
  • A woman's menstrual cycle affects tobacco withdrawal symptoms and reactions to antismoking drugs may vary by cycle phase;
  • Husbands may offer less effective support to wives trying to quit than the other way around;
  • And women are more susceptible than men to such environmental cues as smoking after a meal, or smoking because they're nervous.

It's not clear why women react differently to nicotine than men, Perkins says. "I think it's probably some slight difference of sensitivity to nicotine in the brain," he says. "While there is no conclusive research, a woman's hormones can temporarily change nicotine receptors, which makes some sense in terms of the menstrual cycle."

His findings were published in the May issue of CNS Drugs.

According to NIDA, it is clear that women are more at risk from smoking-related diseases.

A Surgeon General's report released in March shows that smoking-related deaths among women have more than doubled since 1965 and women now account for 39 percent of all smoking-related death in the United States. Since 1980, about 3 million women have died from smoking-related disease.

Women who smoke have almost double the risk of heart attack than men, Perkins reports. Their risk of breast cancer risk may also be greater, he adds, and they also have greater difficulty in getting pregnant.

"For all drugs of abuse, men and women have different reactions," says NIDA Director Alan Leshner. "The situation with nicotine for women is not very different than alcohol, heroin or cocaine, where women appear to have more dramatic consequences than men."

"Given the greater relative risk of women to incur smoking-related disease, it is clear that we must find better approaches to help women break their nicotine addiction," Leshner adds.

"The medical community and women need to understand that combined treatment is best," he says. "When women want to stop smoking, they need to understand that behavioral counseling tied to medication is by far the better approach."

What To Do

Perkins says women who smoke need to plan their attempts to quit. "I think they should really try to recognize all the hurdles they face," he says. "They should not go blindly or quickly into a quit attempt. And they need to recognize that they are more susceptible to environmental cues, like smoking with friends or smoking after a meal. And behavioral therapy and support is essential."

For more on women and smoking, see the Centers for Disease Control and Prevention, which also has resources on how to quit.

You may also want to read these other HealthScout stories on women and smoking.

SOURCES: Interviews with Kenneth Perkins, Ph.D., professor of psychiatry, University of Pittsburgh, Pa.; Alan Leshner, Ph.D., director, National Institute on Drug Abuse, Bethesda, Md.; May 2001 CNS Drugs
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