Gaining approval from opposite-sex peers seems to be a more potent factor in smoking initiation for girls than for boys. Although peer pressure is an important factor, only a subsection of early smokers go on to become regular smokers.

Existing research has only begun to tease out social & biological contributors to long-term smoking. Suggestive findings include: adolescent girls are five times as likely to smoke if one or both parents or an older sibling in the household smokes; smokers consistently score higher than nonsmokers on scales designed to measure the (presumably inherited) trait of novelty-seeking or sensation-seeking; young girls who start to smoke have been described as more socially aggressive, sexually precocious,self-confident, rebellious, and rejecting of authority than their male peers.

The tobacco industry has been strong in promoting weight-related advantages through decades of associating smoking to female independence, sophistication, attractiveness, youth, health, and success. These promotion and advertising approaches have been the foundation of multi-billion dollar annual campaigns by the tobacco industry. A typical strategy is to target a population with low prevalence, such as Hispanic women in this decade. In countries where prevalence among women is lower that among men (e.g., in Japan and China), it is among women that increased consumption is most likely to occur. Analyses of ad campaigns in these countries reveal an increased preponderance of promotional and advertising materials with female smokers.

Hormonal Effects

Premenstrual women achieved lower smoking reduction rates than mid-cycle or male abstainers. Interestingly, a striking similarity has been reported between symptoms of tobacco withdrawal and symptoms of menstrual discomfort. However, inconsistencies have been found regarding the effect of smoking on dysmenorrhea. Some research has found heavy smokers to report more menstrual problems than light or nonsmokers; contrasting with other reports of less severe dysmenorrhea in smokers, suggesting that smoking may relieve menstrual distress.

Investigations into the stress-modulating effects of oral contraceptives are consistent with the position that they also decrease nicotine withdrawal symptoms. In addition, it has been suggested that gender differences in the effects of smoking may be related to pre menopause versus post menopause and the presence or absence of estrogen replacement therapy in post menopausal women.

Weight Management

Smoking depresses body weight and there for represents a potential tool for weight control; On average, smokers weigh 3-5 pounds less than nonsmokers of the same age and gender;Women have greater expectations of weight gain after quitting.

Women gain more weight than men after quitting. The usefulness of smoking as a weight control strategy appear to influence its initiation and maintenance into adulthood. After age 12, more smokers than nonsmokers believe that smoking helps control weight. Overweight women are more likely than other groups to report desire to control weight as a motivating factor in initiation. Moreover, women smokers are consistently more likely than men smokers to state that fear of weight gain reduces motivation to quit.

Although overall withdrawal symptoms do not differ markedly between men and women, women report wanting to eat more following quitting and greater weight gain, as well as more concern about weight gain. Women's greater tendency to gain weight may reflect gender-related biological differences in response to nicotine. Although weight concerns don't appear to actually interfere with cessation efforts, once the commitment is made, but they do discourage women smokers from making quit attempts.

Interestingly enough, several studies indicate that weight gain during cessation is positively associated with continued abstinence, demonstrating gaining weight does not necessarily lead to relapse.These studies may be biased in terms of sampling successful quitters, since smokers incapable of tolerating post cessation weight gain may relapse and be excluded from such statistics.

Nicotine Dependence & Emotional Regulation

A definitive statement cannot be made at this time regarding gender-related vulnerability to nicotine products. Women smokers trying to quit are more likely to describe themselves as"hooked" than men.Women in cessation programs report being more tentative and less committed to quitting than men. Women are less likely to give up smoking permanently. Women are less successful than men in maintaining long-term cessation in spite of the fact that they are just as likely to try quitting. Women seem to be particularly responsive to nicotine's ability to reduce anxiety. Women believe more that men that it would be hard to go out with friends who smoke after quitting.

In addition, women are more prone to smoking in high anxiety rather than low anxiety situations; to smoke when experiencing high job stress; and to smoke when experiencing negative emotions. Degree of nicotine dependence in women is associated with the harm-avoidance trait and stress-inducing circumstances. Some research has even suggested that women are more sensitive to external stimuli, making them more apt to find the distraction-filtering effects of nicotine more useful than men do. Female smokers seem to show greater psychological reactivity to smoking than do male smokers. Women report the reduction of negative affect as a primary motive for smoking, whereas men are more often report sensorimotor stimulation and enhanced concentration. Despite reports of women using nicotine to decrease negative affect, studies looking into reports of negative affect after quitting do not show a gender difference. However, this inconsistency may be an artifact of the lack of adequate studies to clearly identify the effects of menstrual cycle phase and gender-specific biases toward certain personalities, occupations, and other sample selection issues.

There also seems to be a strong relationship between smoking and depression; and a milder relationship between smoking and panic disorder. The data on the latter are less conclusive, however. Overall, these findings may be of particular importance to women because both depressive and anxiety disorders occur in women twice as often as in men. Additionally, there may be an increased biological sensitivity to nicotine in people smoke into adulthood.

Continued in Part 2

5/29/98

Marlene M. Maheu, Ph.D. is the founding Director of the Nicotine Recovery Institute. She is the designer of the Nicotine Freedom System, and specializes in the treatment of nicotine-related disorders. Such disorders include underlying depression and anxiety. She has worked extensively with smokers and tobacco chewers in hospital, industrial, and private settings, and is available for individualized consultation and program design. Her program and materials have been developed after completion of her doctoral dissertation in smoking cessation, and following a decade of work with thousands of smokers. Through colorations with SelfhelpMagazine, she offers telephone based services for individuals and groups seeking freedom from nicotine in any form. For more information on this convenient application of her program, email her directly.