Women who smoke...

and why it's harder to quit

From M, fall 2003

Compared to men, women tend to smoke fewer cigarettes each day, choose brands with lower nicotine levels, and be less likely to inhale deeply. But Dorothy Hatsukami, University of Minnesota psychiatry professor, reports that relapse rates for women who quit smoking are higher than for men. So what makes it harder for women to quit smoking?

When people withdraw from nicotine, they feel anxious, depressed, restless, and irritable. For some reason, women feel those withdrawal symptoms more intensely than men, according to research by University associate professor of behavioral medicine Mustaf al'Absi. Sharon Allen, University professor in family practice and community health, found that these symptoms may be particularly pronounced during the premenstrual phase of the menstrual cycle. That increased vulnerability makes women want to smoke to feel better and makes it more difficult for them to quit and to not relapse.

Considering quitting?

Dr. Hatsukami has some tips for women:

Find help to manage your negative emotions when you quit and healthy substitutes to make up for the lost pleasure of smoking.

Address concerns about gaining weight.

Take your menstrual cycle into account and consider a time for quitting other than premenstrually.

Think about taking tobacco-addiction medications that will help relieve withdrawal and help with cessation.

Although women are less sensitive to the effects of nicotine than men, they're more sensitive to the sensory aspects of smoking. In other words, it's not just the nicotine--or so much the nicotine--that women crave, it's the actual sensory pleasure of smoking. That makes quitting harder. And when they do quit, women gain more weight than men.

Unfortunately, if women don't quit smoking, their health can suffer more than men's. A recent study, led by John Connett, head of biostatistics in the School of Public Health, confirmed findings that women are more susceptible to the effects of tobacco smoke--like chronic obstructive pulmonary disease (COPD). The fourth leading cause of death in the United States, COPD kills women at twice the rate it did 20 years ago. Why tobacco smoke harms women more than men remains unknown, but the study speculates that it may be because women's lungs tend to be smaller and smoke concentrates more easily in the airways.

But there's good news for women, too. Dr. Connett's study, published in the June American Journal of Epidemiology, also found that among smokers with mild to moderate lung function impairment, women tended to have greater improvement when they stopped smoking than men did. Women in the category of sustained quitters "gained a striking percentage of lung function over the course of the study compared with men, whose lung function remained unchanged," but "even women categorized as intermittent quitters lost less lung function than their male counterparts."