Smoking cessation in women - Special considerations

Women may be at relatively greater risk of smoking-related diseases than me n but tend to have less success than men in quitting smoking. The failure o f most outcome studies to report results by gender and the lack of statisti cal power for detecting significant gender differences currently do not all ow for many firm conclusions to be drawn about smoking cessation rates in w omen, but several trends warrant attention and further study. First, the difference in cessation rates for women versus men may be even g reater in trials of nicotine replacement therapies (NRT). This suggests tha t women benefit less from NRT relative to men, although this difference may depend on the particular form of NRT (e.g. inhaler versus gum). On the oth er hand, some non-NRT medications may reverse the poorer outcome of women, producing quit rates in women comparable with those in men. Gender differen ces in outcome, as well as overall success rates, with NRT and some of the non-NRT medications appear to be enhanced when treatment includes substanti al behavioural counselling. However, while several of the non-NRT medicatio ns may be particularly appropriate to consider for treating women trying to quit smoking, adverse effects may limit widespread use of some of these dr ugs, such as clonidine and naltrexone. Thus, even if the gender differences in outcome with NRT versus non-NRT drugs are confirmed in further research , such findings do not necessarily justify limiting NRT use in women, becau se such treatment is clearly effective and is likely to be safer and more r eadily available than non-NRT medications. Nevertheless, study of the mecha nisms by which some non-NRT drugs are effective in women may aid our unders tanding of factors that are more influential in smoking behaviour in women than in men. Secondly, smoking cessation treatment for women must address several other issues that often emerge, and these are most likely to require behavioural counselling that is tailored to these problems. These issues include concer n about bodyweight gain, restrictions on medication use in pregnant smokers , variability in mood and withdrawal as a function of menstrual cycle phase , harnessing social support to foster abstinence, and the possibility that smoking-associated environmental cues may be more influential in smoking be haviour in women than men. Greater attention to gender differences in clinical trial outcomes and to a ddressing concerns of women smokers may aid in the development of substanti ally improved smoking cessation interventions for women.