Treating tobacco dependence in women

Tobacco dependence poses unique health risks for women (e.g., obstetrical and perinatal complications, cervical cancer), and compared with men, the rate of lung cancer among women has been steadily increasing over the past 50 years. However, the rate of decline in smoking rates in the United States over the past decade has been far slower for women than for men. Unfortunately, less than two thirds of physicians who care exclusively for women provide formal assistance to patients who smoke. Barriers to smoking cessation that are unique to women include concerns about weight gain and negative emotional reactions following cessation. Recent data suggest that timing in the menstrual cycle may influence quitting success. Outcomes may be poorer for women than for men treated with nicotine replacement therapies (NRT), possibly because women experience more severe withdrawal symptoms, report poorer compliance with NRT, and exhibit greater sensitivity to nonnicotine factors, such as the sight, smell, and sensations of smoking, compared with men. There is also evidence suggesting that women have significantly higher rates of nicotine metabolism than men, particularly when using oral contraceptives. In contrast, data suggest that nonnicotine pharmacotherapies, such as bupropion and varenicline, have equivalent efficacy for women and men, and behavioral treatments that focus on postcessation weight reduction and negative mood management may be particularly beneficial for women. Overall, additional research is needed to examine the potential effectiveness and safety of pharmacotherapies for pregnant women who smoke. Greater attention to the unique needs of female smokers may allow healthcare providers to optimize delivery of pharmacotherapy and behavioral counseling to aid their female patients to quit smoking.