Women Smokers: Effects Deadlier, Quitting Tougher

(WOMENSENEWS)–New evidence shows gender disparities in the effects of smoking on men and women, with women at possibly higher risk of developing diseases as a result of smoking, but also recovering more lung function than men after quitting.

Women saw greater improvement in lung function after quitting smoking than did men in a study sponsored by the National Heart, Lung, and Blood Institute, of the Washington-Based National Institutes of Health, recently published in the American Journal of Epidemiology.

Dr. Sherry Marts, physiologist and scientific director of the nonprofit Society for Women’s Health Research in Washington, D.C., said in a phone interview the new findings suggest it’s never too late to quit and that “finding the biological basis” for this gender difference is the next scientific step.

Women’s Death Rate Rising From Lung Cancer

The Canadian Cancer Society reported in April that lung cancer deaths in men had dropped 17 percent since 1988 but women’s deaths had increased 46 percent. The Society’s director attributed the increased deaths to a ‘disease lag’ linked to the years before the 1980s, when more and more women started smoking, according to an April Canadian Press report. The U.S. Surgeon General had issued similar findings in 2001.

“Women began smoking in large numbers in the 1930s, 1940s and 1950s and so now we’re seeing the dramatic increases in those diseases,” said Corrine Husten, M.D., chief of epidemiology at the U.S. Centers for Disease Control and Prevention’s Office on Smoking and Health, in Atlanta. “Lung cancer death rates are starting to come down in men, but in women are still going up.”

“You have so much lung function and with age there’s a gradual, normal decline in lung function. If you smoke, the smoking destroys lung tissue, so you have an accelerated decline,” added Husten. Smoking damage may lead to emphysema, chronic bronchitis and lung cancer.

Once addicted to smoking, research indicates that women may be more vulnerable to the diseases it causes.

“In one of the best studies I’ve seen, when they controlled for the amount of smoke exposure, women seemed more likely to develop lung cancer than men,” Marts added.

Of studies listed on the Society for Women’s Health Research Web site, one found that nicotine may heighten aggressive moods in men, but calms feelings of stress in women.

Husten added that the new findings highlight the Centers for Disease Control and Prevention’s message to all female smokers that “it is absolutely critical for smokers to quit and that the earlier one quits, the better.”

Quitting Could Be Harder for Women

That may be easier said than done.

“A lot of studies have shown women have a more difficult time quitting smoking,” said Marts, citing a study by Dr. Sakire Pogun, published in 2001 in the International Journal of Psychophysiology indicating that women experience more severe withdrawal symptoms than men when quitting smoking and that women are less likely than men to benefit from nicotine-replacement remedies. Marts said other, similar findings have been reported by the American Lung Association on its Web site’s fact sheet on women and smoking.

The best advice for women who are having a hard time quitting seems to be for them to understand the serious and physical nature of their addiction, not to try going it alone and to try medications that can help.

“The nicotine patches seem to work a bit better for men. Women seem to be more addicted to the physical habit and sensation of smoke,” said Marts. Some studies found that the brain’s pleasure centers of women lit up to the smell or taste of cigarette smoke; the men needed the nicotine hit to get that response, she said, referring to the pleasure center study recently published by the National Institute on Drug Abuse. Fortunately, Marts said, the medication buproprion seems to benefit women as well as men, according to a study by David Gonzales and others published 2002 in the American Journal of Preventive Medicine. Buproprion is marketed both as the antidepressant Welbutrin and for smoking cessation as Zyban. The drug is approved for both uses by the U.S. Food and Drug Administration.

Husten said quitting usually takes several attempts, and insurance coverage for medication and counseling is often inadequate. “Most people should probably be on some medication because this is an addictive drug. I would say, go get it even if you have to pay for it.”

Nicotine-replacement therapies (nicotine gum, patch, lozenge are over-the-counter; nicotine inhaler and nasal spray are by prescription only) provide a low but steady dose of nicotine, dampening withdrawal symptoms and buying time to create new routines and habits.

“Women want to quit,” said Husten. “This is the leading cancer killer of women, the leading preventable cause of death for women, and I would tell women: ‘You improve your chances of being successful by getting help.'”

If at first you don’t succeed, Huston cautions against taking it as a personal failure. “Addiction of any kind is a brain disease,” she said. “Once you’re actually addicted to a substance, your brain chemistry changes. To treat a relapse of addiction as a failure of will is self-defeating.”

Marts said social and environmental cues–such as meeting friends in a lunchroom, driving the car, the sofa where one smokes–are more crucial in women’s addiction, as reported by the study “Smoking and gender,” by Centemeri Bolego and others published 2002 in Cardiovascular Research; a study by KA Perkins and others published 2001 in the journal CNS Drugs (dedicated to the information about the central nervous system); a study by S. Zhu and others published 2000 in the American Journal of Preventive Medicine and three other studies listed at the Society for Women’s Health Research Web site.

Marts offered her mother’s quitting as an example of a strong environmental association. After her grandchildren taught Marts’ mother to play videogames, Marts’ mother often smoked while playing “Hedgehog” alone at home. To quit, Marts said, her mother had to put the Sega video machine in the closet and play only with the grandkids.

“One-on-one group support is helpful to women, some kind of human support in quitting,” added Marts.

Suzanne Batchelor has written also for the national science series “Earth and Sky” and on health and medicine for Medscape, CBS Healthwatch and the Texas Medical Association’s “Healthline Texas.”