Smoking cessation strategies targeting stress reduction may be more successful in women
It may be the case that men have a better shot than women at quitting smoking if they take part in a nicotine replacement therapy. According to the results of a new study, women are 31 percent less likely to quit smoking successfully in such cases, and that those female smokers participating in such programs said they experienced more stress and cravings for cigarettes than men after viewing cellphone-delivered stress-inducing images.
Although all smokers making a cessation attempt would likely benefit from interventions to reduce stress, these findings suggest that women could receive particular benefit.
According to the National Institute of Drug Abuse, women crave cigarettes more when they experience stress even though that finding has not been clearly replicated in a real-world setting. In an article published online by Nicotine & Tobacco Research, researchers at the Medical University of South Carolina (MUSC) report the findings of a real-world study in 177 smokers. The females responded negatively to certain cues -- cues are images that induce stress, similar to news images of violence or war.
However, researchers said that no gender differences in craving were noted after viewing cellphone-delivered smoking cues. Smoking cues are images that suggest smoking behavior, such as a photograph of a cigarette or a person smoking.
“These findings suggest that improving quit outcomes in women may require gender-specific cessation strategies,” researchers said.
“We know that not all existing treatments are equally effective for men and women," says Rachel L. Tomko, Ph.D., assistant professor in the Department of Psychiatry and Behavioral Sciences at MUSC and first author on the article. “That could be because they find different aspects of smoking rewarding and relieving, and there are different things that maintain their smoking. Our findings suggest that stress may be one thing that maintains smoking more for women than for men.”
Research suggests that, if smoking were about nothing but nicotine, everyone would respond “beautifully” to nicotine replacement therapy, but MUSC researchers think things are more nuanced and complex than that.
Participants in the real-world study viewed eight images each day (four sets of two) for two weeks, including smoking cues, stress cues and neutral images. Each time they received a pair of images, they completed a form assessing their stress, negative emotion and craving levels before viewing the images (their baseline value) and after viewing each image. They also tracked the number of cigarettes they smoked each day.
Because women smoke more in response to stress and environmental triggers, their smoking patterns could be expected to vary more than men's. However, the MUSC team found no difference in the number of cigarettes smoked per day for male and female smokers.
"Fortunately, showing smokers stress and smoking cues did not result in an overall increase in cigarettes smoked," says Tomko. "This is likely because smokers are already exposed to similar images on a daily basis. However, it is surprising that women did not have more day-to-day fluctuations in their number of cigarettes than men. It is possible that minor, everyday stressors result in women smoking a cigarette a bit sooner than they would have otherwise but does not impact the overall rate of smoking. We hope to test this in future research."
More broadly, they will continue to map out the gender and other differences that affect how smokers respond to treatment and use that knowledge to better craft cessation therapies.
