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Smoking cessation & women: it took Colleen Cayton, 65, seven tries and a total body detoxification before she finally quit smoking for good.

For Jacquie Bossert, 72, a diagnosis of chronic pulmonary disease (COPD) and a course of the prescription medication Zyban (bupropion) finally helped her say good-bye to tobacco, her "friend" of 50 years.

Because, bottom line, quitting smoking is hard. And no wonder: Nicotine is one of the most addictive drugs we know of, possibly more addictive than alcohol or heroine. In the brain it increases levels of dopamine, a neurotransmitter related to pleasure and reward. (15)

OK, that explains why it's so hard to quit smoking and gives women like Ms. Cayton and Ms. Bossert, who began smoking before we knew just how bad it was, an "out." But what about the 14 million women of reproductive age who smoke today? They started smoking even while knowing the health risks. Why does the National Survey on Drug Use and Health estimate that more than 4,000 people under 18 try their first cigarette every day? Why are women under 23 among the fastest-growing segment of new smokers? And why do 23 percent of teenage girls now smoke--the same percentage as teenaged boys? (16,17,18,19)

"This is the sixty-four-thousand-dollar question," says David M. Mannino, MD, who directs the Pulmonary Epidemiology Research Laboratory at the University of Kentucky School of Medicine. "I think there is no easy answer. But it relates to the threads of addiction, habituation, genetic makeup, early life exposures, response to stressors and other factors that are woven into the tapestry of a cigarette-addicted person." The strands of cigarette addiction are so complex that Dr. Mannino now views tobacco addiction as a chronic illness, similar to diabetes or hypertension--with a subsequent need for primary, secondary and tertiary prevention opportunities.

Unfortunately, prevention is difficult in a world in which cigarette companies continue to market heavily to children and women. Just think of the cigarette brands targeted at women: Virginia Slims, Eve, Misty and Capri. "I quit once for seven years," says Ms. Bossert, "but then Phillip Morris came out with the flowered Eve cigarettes, and I thought they were so great looking, and I was sure I could just smoke five a day." She couldn't, of course.

Cigarette manufacturers also advertise in women's magazines, which researchers find are less likely to publish articles critical of smoking than magazines that don't accept such advertising. (20)

It also appears that women have a tougher time quitting than men, in part because many rely on smoking to help control their weight, says Dr. Mannino. Women also report more intense withdrawal symptoms when they try to quit and more difficulty in quitting. (17) And at least one study found that nicotine replacement therapy may be less effective in women. (21)

Dr. Mannino also thinks the stress in women's lives makes quitting harder. Ms. Bossert agrees: "It's hard enough to break the habit," she says. "But when you have all the emotional stuff on the side to deal with, it's overwhelming. No wonder people quit and start again--or aren't able to quit at all."


15 National Center on Addiction and Substance Abuse at Columbia University. Women Under the Influence. Baltimore: Johns Hopkins University Press; 2006.

16 Tobacco Industry's Targeting of Youth, Minorities and Women. American Heart Association. Available at: Accessed Feb 22, 2007.

17 Marketing cigarettes to women: A Fact Sheet. Centers For Disease Control and Prevention. Available at: Accessed Feb 22, 2007.

18 Centers for Disease Control and Prevention. Cigarette use among high school students--United States, 1991-2005. MMWR. 2006:55(26);724-726. Available at: Accessed: Feb 22, 2007.

19 Christen AG, Christen JA. The female smoker: from addiction to recovery. Am J Med Sci. 2003 Oct;326(4):231-4.

20 Warner KE. Cigarette advertising and media coverage of smoking and health. N Engl J Med. 1985 Feb 7;312(6):384-8.

21 Women and Smoking: A report of the Surgeon General. 2001. Available at: Accessed Feb 22, 2007.


Although no one knows for sure what impels a 17-year-old young woman to light her first cigarette, researchers have found that girls who smoke are more likely to:

* Have parents or friends who smoke

* Have weaker social attachments to peers

* Be inclined toward rebelliousness, rejection of conventional values and risk taking

* Perceive smoking as a way to control their weight and moods (17)

Meanwhile, adult women are more likely to smoke to:

* Control their weight

* Reduce stress

* Find relief from depression, anxieties and tension

* Receive ongoing stimulation and social support
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Publication:National Women's Health Report
Date:Feb 1, 2007
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