Health Problems and Financial Setbacks Risk Factors for Women and Smoking

Women are affected more than men by certain stressful life events, a factor that can contribute to their inability to quit smoking or their decision to resume smoking, according to a new study from Yale researchers.

Health problems and financial setbacks are particular risk factors when it comes to women and smoking, the study says.

The study, “Sex differences in the effects of stressful life events on changes in smoking status,” published in this month’s issue of Addiction, the journal of the Society for the Study of Addiction to Alcohol and Other Drugs, says that health care providers and smoking cessation programs should consider this information as they deal with women smokers, particularly those who have quit or are trying to quit.

“Stressful life events do have an impact. It’s important to outline these stressful events, so women know to be prepared for them,” said Sherry A. McKee, an assistant professor in the department of psychiatry at the Yale School of Medicine and the lead author of the study.

The study says that women are more likely than men to take up smoking again when faced by a negative financial event. Negative financial events also made it harder for women to quit, according to the study. “Women respond differently to financial stressors than men,” said McKee. “Also, women were more likely to experience personal financial problems than men.”

Women were also less likely than men to quit in response to an adverse health event, perhaps due to gender bias in health care referral patterns. McKee said, “In some cases, women are less likely to be referred on for additional testing or treatment after experiencing a major health event, like a heart attack. Some studies also have shown that doctors are less likely to provide smoking cessation advice to women,” she said.

McKee said the new study reinforces past research that has shown women have a harder time quitting than men and that men and women may respond to different cessation techniques and advice. “Not only is the percentage of quitting higher with men, women have a harder time staying abstinent once they quit,” McKee said. “It’s important to factor in gender when it comes to tobacco studies.”

“These investigations ultimately will yield new practical applications for treating female smokers,” McKee said. “Health care providers should consider focusing on techniques for coping with stressful life events and preventing relapse in the face of such events. Also, health care providers may want to ask female patients who are former smokers about recent stressful events and provide advice to them to help them maintain their abstinence.”

McKee is an investigator for the Transdisciplinary Tobacco Use Research Center at Yale (TTURC), which is part of the Center for Nicotine and Tobacco Use Research at Yale (CENTURY). She also is affiliated with Women’s Health Research at Yale, an interdisciplinary program designed to advance health research on women. The program is the largest of its kind in the country.

“Stress has an effect on how we feel and behave. However, this research systematically shows how stressful events affect a crucially important health behavior, quitting smoking. Importantly, it also shows how stress differentially affects women and men. This has enormous implications for treatment and preventative interventions,” said Carolyn M. Mazure, director of CENTURY’s sex-specific factors core and the director of Women’s Health Research at Yale. Mazure, a co-author of the study, also is a professor of psychiatry at Yale School of Medicine.

Tracy Falba, an associate research scientist with the Yale School of Medicine’s Department of Epidemiology and Public Health at Yale, and Paul Maciejewski, an associate research scientist in psychiatry and director of the statistical core for Women’s Health Research at Yale, were co-authors on the study.

The study was a pilot project for TTURC. Funding for TTURC and CENTURY comes from the National Institute on Drug Abuse, the National Cancer Institute and the Robert Wood Johnson Foundation. The mission of CENTURY and TTURC is to conduct research to understand better why some tobacco users have difficulty quitting and how to help them quit.

Yale TTURC focuses on tobacco research projects conducted by a multidisciplinary team of scientists. It is one of seven centers around the country conducting a variety of tobacco-related research. One of the goals of the initiative is to support research that integrates theories and methods from different disciplines. To attract and train new investigators to tobacco research, the center offers career development activities and funding for pilot research projects. To find out more about CENTURY and TTURC, please see http://info.med.yale.edu/century/. To find out more about Women’s Health Research at Yale, please see: http://www.YaleWHR.org