Women's Unique Smoking Cessation Needs

There are no buts, but plenty of butts, about it: Quitting smoking is difficult, especially for women.

A variety of gender-specific factors make it difficult for women to quit, according to Dr. Kenneth Perkins, professor of psychiatry at the University of Pittsburgh Medical School. They include:

Nicotine replacement therapy may not be as effective for women.

Women smokers are more fearful than men of gaining weight.

A woman's menstrual cycle may affect withdrawal symptoms.

Husbands may be less supportive to women trying to quit than wives are of husbands.

So what's a woman to do?

Don't give up, say experts.

You Can Quit

Half of all people (including women) who have ever smoked have quit — not necessarily after the first time they tried — but eventually, according to Dr. Michele Bloch, medical officer in the Tobacco Control Research Branch of the National Cancer Institute.

While 90 percent of women (and men) try to quit without help from professionals, the success rate can triple when they get some sort of counseling or medical intervention.

Without help, only 5 percent to 10 percent of people will stop smoking for a year. With help, the rate goes up to 20 percent to 30 percent.

Some data suggest women may have more difficulty quitting than men, according to David Wetter, associate professor of behavioral science at the University of Texas' M.D. Anderson Cancer Center in Houston.

Behavioral Modification and Medical Intervention

Women should seek professional advice when they decide to quit because it improves the likelihood they will successfully stop.

The most effective methods to quit smoking include behavioral change, counseling/social support and drug treatment, such as nicotine replacement and the antidepressant buproprion, according to a U.S. surgeon general's report issued last June after extensive research.

Counseling and social support can include asking a family member or friend to be there for you when you feel an urge to smoke, calling state telephone quit lines (several states offer counseling services on the phone to help people quit), joining groups or seeing a health-care professional or smoking cessation specialist for more intensive therapy.

What is important in the behavioral aspect of quitting is planning and preparing, says Glen Morgan, program director of the Tobacco Control Research Branch in the NCI's Behavioral Research Program.

About a month before quitting, a smoker should monitor how many cigarettes she smokes and the times and circumstances that lead to the behavior, such as being on the phone, when angry or at a bar. Then she can begin to understand the triggers for smoking, Morgan says.

Research suggests that a woman's emotional state may influence her smoking more than a man's, so women should pay attention to their feelings when trying to cut back.

Slowly, a woman can begin to reduce her smoking under trigger circumstances and replace cigarettes with other activities, such as cooking, exercise or even knitting, he says.

During this preparatory time, the woman should also start planning what she will do when she has stopped smoking and has cravings. Some people may want to buy a special candy for those times or take a long walk, he says.

"All this preparation makes it easier when the day comes to throw out the cigarettes and ashtrays and stop completely," Morgan says.

But women should not be discouraged if they relapse after the big quit day. Each time a woman quits, she can learn about what pushed her to start again. If it's alcohol, perhaps she needs to stay away from bars for a while or have a contract with a friend to take away her cigarette, Morgan says.

Women’s Special Needs

Research seems to show that women may benefit more than men by taking buproprion to help them quit, says Dr. Michael Fiore, chairman of the panel that issued the surgeon general's report. Fiore is also professor of medicine at the University of Wisconsin Medical School in Madison.

The drug, he says, may help address the higher rate of depression women experience when they try to quit.

Although women are concerned about gaining weight when they quit, the NCI's Bloch says dieting is not recommended. Instead of dieting, which can be stressful, women should try to exercise.

Women need to reassess what makes them attractive should they gain the average five pounds to 10 pounds that often show up during quitting, Bloch suggests.

"Nicer teeth and cleaner hair are benefits of not smoking," Bloch says. "After a woman successfully stops smoking, she can then lose the extra weight."

A key time to reach women about quitting smoking is when they are trying to get pregnant, experts say. Women may be more motivated to stop at this time because of the damage smoking can do to the developing fetus and the impact secondhand smoke has on children.

Women who are thinking about getting pregnant or who are pregnant should tell their doctors if they are using nicotine patches or gums, which are available without a prescription, because as with other drugs, doctors should be kept in the loop about what medications the women is taking, says Dr. Richard Hurt, director of the Mayo Clinic Nicotine Dependence Clinic.

Although manufacturers tell pregnant women to seek medical attention when taking these products, Hurt has performed research with pregnant women in their third trimester who used the patch and found the nicotine had no effect on the developing fetus.

Pregnant women, however, may not be apt to tell their doctors about their smoking or quitting behavior, Bloch says, because there is a lot of shame associated with pregnancy and smoking. She warns doctors should not be judgmental and try to help women quit.

"We still have a long way to go to understand the gender differences when it comes to quitting smoking," says Bloch. "But we have some clues now."

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