The Science Behind Quitting Smoking
The percentage of adult smokers in the United States has dropped steadily over the last five decades, from 42 percent in 1965 to 17 percent in 2013.
That’s the good news.
But even as fewer adults and high school students smoke today than at previous peaks, smoking remains the leading cause of preventable death and illness in the country. Every year, 480,000 Americans die of smoking-related diseases.
And not all smokers are the same.
While fewer women than men smoke, studies have shown that women are more susceptible to tobacco-related health conditions such as cardiovascular disease, respiratory disease, and stroke. Women who smoke also experience increased risks of cervical cancer, lower bone density, estrogen deficiency disorders, menstrual cycle disorders, conception delay, infertility, and pregnancy complications. Since 1987, lung cancer has surpassed breast cancer as the number one cause of cancer death for women.
“For women and men, smoking continues to disrupt and shorten lives,” said Dr. Sherry McKee, Director of the Yale Specialized Center of Research (SCOR) developing gender-sensitive treatments for tobacco dependence. “But women also face more difficulty when trying to quit.”
At the Yale-SCOR, Dr. McKee and her team have added to a substantial collection of evidence showing that first-line smoking cessation medications using nicotine replacement, such as the nicotine patch, do not appear to work as well for women as for men.
“While men might smoke to satisfy a craving for nicotine, women smoke more to manage their moods,” McKee said. “And the relationship between stress and smoking appears to be stronger in women than men, leaving women less able to quit or more likely to restart smoking after stressful events such as a financial setback.”
Nicotine replacement treatments such as the patch can help men satisfy their craving for nicotine and ease biological symptoms of withdrawal from nicotine dependency. But for women, just treating nicotine withdrawal does not help reduce negative moods, enhance positive moods, or manage stress, appetite, and weight.
At a basic level, women often smoke for different reasons than men.
“People with depression are more likely to smoke, and depression affects twice as many women as men,” said Women’s Health Research at Yale Director Carolyn M. Mazure, Ph.D. “Women may also be more vulnerable to depression following an attempt to quit smoking.”
In addition, women are more likely to smoke or to restart smoking after a quit attempt when facing stress. Because smoking suppresses appetite, women also often smoke to control their weight. And because women are more likely to be concerned about gaining weight if they quit, they are often less motivated to quit and more likely to relapse after a quit attempt.
Thankfully for women, the Yale-SCOR has conducted the first-ever demonstration that women have a preferential response to a specific smoking cessation medication.
In a study published in 2015 by the journal Nicotine and Tobacco Research, the Yale-SCOR showed that the prescription medication varenicline, marketed as Chantix, was more effective earlier in women though equally effective for women and men after one year. The medication does not contain nicotine but works by blocking the pleasurable effects of nicotine in the brain.
Because women are more likely to relapse after a quit attempt, and because relapses tend to occur soon after the beginning of a quit attempt, the earlier effectiveness of varenicline in women can help women get over that hump toward successfully quitting.
Other advice for women seeking to throw out their cigarettes for good include finding other ways to manage negative moods, accepting that maybe gaining a few pounds will be worth the health benefits of not smoking, enlisting the support of family and friends, and limiting coffee and alcoholic beverages, which can increase cigarette cravings when quitting.
Researchers have demonstrated tremendous benefits of quitting.
Regardless of a smoker’s age, the risk of heart disease and stroke decreases up to 50 percent in the first year after quitting. By 15 years, the risk of coronary heart disease is the same as a non-smoker.
By quitting before turning 40, a smoker can reduce the chance of dying early from smoke-related diseases by about 90 percent. Quitting between the ages of 45 and 54 reduces premature smoke-related death by about 66 percent.
In addition, quitting smoking reduces the risk of developing and dying from cancer. Even if a smoker already has cancer, quitting can improve the effectiveness of treatments, lower the risk of further tumors, and increase rates of survival.