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Stop-smoking

Updated 31 October 2019

Why it may be even tougher for women to quit smoking than men

Depression and other mood disorders need to be addressed in women who smoke, especially those with heart disease and stroke, according to a new study.

Smoking is a notoriously tough habit to quit, but a new study suggests it is far harder for women to stop than it is for men.

Why? The researchers point to a higher prevalence of anxiety and depression in women, which might interfere with even the best intentions to kick the habit. And one expert noted that prior evidence has shown that women's brains react differently to nicotine.

No one-size-fits-all

In the latest study, involving more than 200 patients at St. Michael's Hospital in Toronto, the prevalence of anxiety or depression was 41% in women while it was only 21% in men.

Depression and other mood disorders need to be addressed in women who smoke, especially those with heart disease and stroke, said senior study author Dr Beth Abramson, an associate professor of medicine at the University of Toronto.

"Smoking cessation is the most significant modifiable risk factor to prevent heart disease in women, but there is no one-size-fits-all," Abramson noted.

In the study, the average age of participants was 56, and almost one-third were women. Patients reported smoking an average of 18 cigarettes daily for 37 years. Two-thirds had lipid abnormalities such as dyslipidemia, in which blood levels of lipids (triglycerides and cholesterol) hit the roof. Nearly two-thirds had high blood pressure, close to half reported heart disease, and more than a quarter had depression or anxiety.

After six months, 58 (25%) participants stopped smoking, while 68 (29%) cut back on the number of cigarettes smoked by more than half. The total number of clinic visits, use of prescription medications such as Chantix (varenicline) to treat smoking addiction, gender and the ability to afford treatment all influenced the chances of success. While using Chantix more than doubled the odds of success, women were roughly 50% less likely to quit smoking than men.

Female brain reacts differently

Tobacco smoking is the number one cause of preventable death worldwide, and accounts for 480 000 deaths annually in the United States alone. About 12% of all American women aged 18 and older smoke tobacco, according to the US Centers for Disease Control and Prevention. Programmes to stop smoking have shown varying degrees of success.

Although some studies haven't seen a difference between men and women when it comes to quitting smoking, other studies have suggested that the female brain reacts differently to nicotine, said Patricia Folan, director at the Center for Tobacco Control at Northwell Health, in Great Neck, New York.

"Because of this difference, women may not be as successful in quitting when using nicotine-replacement products," said Folan, though they may succeed if they take Chantix or Wellbutrin (bupropion).

Folan added that "some women have a fear of weight gain after cessation." That's why it's important to counsel women that after quitting cigarettes, food may taste and smell better, and some weight gain is expected.

"Stocking up on healthy foods, particularly fruits and vegetables, and keeping hydrated with plenty of water will be helpful in avoiding weight gain," she said. Also, women will most likely have more energy and stamina for exercise when they quit, which can help offset potential weight gain and help with stress relief.

Patient-specific counselling

Women also tend to use cigarettes to deal with stress in their lives, Folan added. So, combining drug treatment with behavioural change can help women quit smoking.

"Quit smoking apps, like the HelpMeQuit app developed by the New York City Department of Health and Mental Hygiene, are freely available and can track progress, offer support, provide distractions during cravings, and help keep individuals motivated," Folan said.

However, women smoke and stop smoking for different reasons than men. For instance, "some women stop smoking during pregnancy," Abramson said. So a larger study of women with patient-focused treatments and tailored therapies, including patient-specific counselling, is needed to address the different biological and social factors involved.

The findings were presented recently at the Canadian Cardiovascular Congress in Montreal. Such research is considered preliminary until published in a peer-reviewed journal.

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