Women and Smoking

While smoking is declining for Americans, it is not decreasing as rapidly among women as among men. Almost 23 percent of adult American women smoke, and that translates into about 22.6 million women.

Since the 1920s, the tobacco industry has targeted women with advertisements portraying smoking as liberating, glamorous, sexy, slenderizing and feminine. “Women’s cigarettes” were developed in the 1960s and 1970s, and large advertising and promotional campaigns coincided with sharp increases in the number of girls between the ages of 12 and 17 who began smoking. The sales of women’s cigarettes were high, and the smoking rate more than doubled among 12-year-old girls from 1967 to 1973. In 1987, lung cancer surpassed breast cancer as the leading cause of cancer deaths among women in the United States. Smoking is directly responsible for 87 percent of all lung cancer cases in the United States.

There are many speculations about the reasons for this much slower decline. Women may be affected differently than men by their nicotine addiction. Women may be reluctant to give up an effective weight management tool for fear that they will gain weight. Nicotine is a drug that is quite effective in weight management because it increases metabolism and suppresses appetite. The behavior and rituals of smoking can provide an effective substitute for the hand-to-mouth behavior of eating.

Teen-age girls often start to smoke to avoid weight gain or for weight loss, and they also want to feel more independent and glamorous. Most teens greatly underestimate the risk to become addicted to nicotine, and to develop a tobacco-related illness when they start smoking. Women also tend to exercise less than men, so they may be less “body conscious” than men about the effects of their smoking on their health and stamina.

We have learned a great deal about women and smoking, but there still is a lot that we do not know about how nicotine and smoking may affect women differently than men. If our research insights for other drugs, particularly alcohol, hold true for tobacco, there are important differences in the effects of nicotine, the use of the drug, the progress of the addiction to the drug, and the effects of long-term use of the drug in women. One of the reasons for this lack of information is that, until recently, women were not included as research subjects for fear of potential harm to their offspring. Only in the past decade has the federal government required women in the subject pool in most alcohol and drug research. Hence, we are sorely lacking in much specific information about how nicotine, tobacco and smoking affect women in different and similar ways to men.

We are beginning to get an early picture of some of these differences and similarities between women and men. The greatest appeals of tobacco use for women are friendship, weight management, image, and feeling management. Both men and women smoke when they are angry or stressed, but women smoke in response to even milder feelings than men do. Women also smoke more often when they are happy, and may be responding more to external social cues than to the medicinal effect of smoking. There is some evidence that women, and not men, smoke to regulate negative moods, like depression or anxiety. Women also seem to benefit more from social support for their quitting efforts than men. Women who want to quit smoking need to include special strategies, such as social support, stress management and feeling management, in their quitting plan.

As with alcohol, women metabolize nicotine slower than men do, which means that they can have higher concentrations of the drug than men per cigarette smoked. This could mean that women become more drug dependent, or dependent more quickly, than men do. This also means that they may have more intense nicotine withdrawal symptoms when they quit. Recent studies also show that nicotine withdrawal symptoms are worse in the latter part of the menstrual cycle and during menses. If women plan to quit at the beginning of their menstrual cycle, they can experience less intense withdrawal symptoms.

Because nicotine replacement therapies may not work as well for women as for men, women should plan alternative ways to cope with nicotine withdrawal symptoms and their cravings to smoke.

Our Tackling Tobacco center can help women identify stress management and feeling management strategies to include in their plans to quit their tobacco use. And our weekly chats and message boards can provide motivation and support for their efforts. In the coming weeks, we will look at the effects of smoking on pregnancy and children.

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