A recent JAMA Viewpoint highlights the fact that women, compared to men, are at greater risk for adverse health outcomes from tobacco smoking, become dependent more rapidly, have a more difficult time quitting and maintaining tobacco abstinence, and are targeted differently in tobacco advertising. Women and men also smoke for different reasons. Men smoke largely for the direct effects of nicotine, while evidence shows women, in addition to nicotine effects, smoke to manage stress, mood, and weight gain, and men smoke largely for the direct effects of nicotine. However, these important differences are largely overlooked in deciding how to regulate tobacco products beyond issues involving reproductive health.

The authors, Danielle R. Davis, PhD, assistant professor of psychiatry, Suchitra Krishnan-Sarin, PhD, Albert E. Kent Professor of Psychiatry, and Carolyn M. Mazure, PhD, the Norma Weinberg Spungen and Joan Lebson Bildner Professor in Women’s Health Research, professor of psychiatry and of psychology, and director of Women’s Health Research at Yale, highlight specific policies under consideration by the FDA and offer approaches to how the impact of sex and gender can be integrated into regulatory policies for tobacco.

For example, one proposed policy currently under review by the FDA would require the removal of menthol and other characterizing flavors from cigarettes and cigars. This product change would affect women preferentially because women have a higher prevalence of menthol use than men and have been directly targeted by menthol cigarette advertising. Consequently, the removal of menthol may have a greater impact on women by causing women who use this flavor to stop smoking, or they could potentially shift use to another tobacco product.

The authors, anticipating these outcomes, assert that FDA policy should include public messaging and guidance regarding sex and gender-specific interventions that reduce switching from menthol to other cigarettes, such as stress and weight management, especially for women. The authors also note the additional benefits in considering flavor policy in relation to sex and gender. Namely, it offers the opportunity to uncover subgroups – such as gender, race, or ethnicity – at even higher risk for using flavored products which can inform a more comprehensive plan for implementation.

By considering scenarios such as these and increasing current and future research in this area on sex and gender, the article shows how the FDA can create policies with a more complete understanding of the biological and social determinants of tobacco use – leading to more precision-based treatment and prevention interventions, and a healthier nation.