Currently over 1 billion people smoke worldwide (1/3 world population) 5 million die per year (11,000 per day) 20% (200 million) of these are women 1 million women will die per year By 2030, 1.7 billion people will be smoking worldwide 8 million will die per year 2.5 million are expected to be women Worldwide men smoke nearly 5x as much as women but the ratios of female-to-male smoking prevalence rates vary dramatically across countries
In high-income countries, including Australia, Canada, the United States of America and most countries of western Europe, women smoke at nearly the same rate as men American and European regions – 1.6-2x differences However, in many low- and middle-income countries women smoke much less than men. SE Asia and Western Pacific – 9.3 -11.4x differences Tobacco use by women is becoming more socially acceptable in many countries as cultural norms change.
A side comment – one of the reasons you hardly ever see a table of this sort is because comparing percentages across countries can be misleading if you do not take into consideration the total population. (show actual numbers for China, India and France). What we should make note of when looking at these type of tables is that the low rates among women in certain countries is gradually rising as the acceptable social norms change . This can be seen in the rising rates among teens.
1.1 billion = 1/3 global population 5 million = 11,000 per day
ANTIESTROGENIC Effect – effects of smoking on hormone-related events seems to be more common among post-menopausal women than among premenopausal women Deficiency disorders – such as osteoperosis (which mainly occurs in postmenopausal women) Dependent disorders – such as endometrial cancer (which occurs mostly in postmenopausal women, rather than pre-menopausal)
10.7% of women continue to smoke during pregnancy 17.8% among Alaskan Natives/American Indian 13.9% among Hispanic white women 8.5% among white women 16.6% of those aged 15-19 smoke 18.6% of those aged 20-24 smoke
Smoking during pregnancy accounts for 20 to 30 percent of low-birth weight babies, up to 14 percent of preterm deliveries about 10 percent of all infant deaths. Maternal smoking has also been linked to asthma among infants and young children. The odds of developing asthma are 2X as high among children whose mothers smoke more than 10 cigarettes a day. If you stop smoking during pregnancy you can reduce the risk for many of the adverse reproductive outcomes: Conception delay, infertility, preterm premature rupture of membranes preterm delivery and lower birth weight
(? self medication? or common genetic factors between those who smoke and those who are prone to depression?) Although mechanisms for these associations are not known, we do wonder if smoking is a way in which these individuals manage their symptoms. For these individuals, smoking cessation may lead to manifestation/emergence of depression or other dysphoric mood states.
In addition, other illnesses not specific to females, but should also be noted. 90 percent of chronic obstructive pulmonary disease (COPD), 13 times more likely to die from COPD (emphysema and chronic bronchitis) Women who smoke also double their risk for developing coronary heart disease
Other cancers not specific to females, but should also be noted include: 80 percent of lung cancer deaths increased risk for developing cancers of the oral cavity, pharynx, larynx (voice box), esophagus, pancreas, kidney, bladder, and uterine cervix
Women and Smoking -- Ivana Croghan, Ph.D., Mayo Clinic
Smoking Among Women: An Update Ivana T. Croghan, Ph.D. Associate Professor in Medicine Mayo Clinic Nicotine Research Program Global Bridges Webinar 08 March 2012
The Coming Epidemic Rise in Smokers Worldwide 2 1.7 Billions of smokers 1.5 1.1 1 0.5 0 2000 2030http://tobacco.who.int/en/treatment/index.html
Current SmokingCountry Region Male Female Youth Adult Youth AdultNigeria* Africa 5.6 9.0 1.3 0.2Argentina Americas 21.1 32.4 27.3 22.4Mexico Americas 26.3 24.8 27.1 7.8USA Americas 9.7 31.2 7.9 23.0Egypt Eastern Mediterranean 15.5 37.6 2.8 0.5France Europe 13 33.3 16 26.5 17,317,750Italy Europe 19.4 29.5 21.6 17.0Ukraine Europe 27 50.0 12 11.3India* Southeast Asia 5.8 24.3 2.4 2.9 35,095,609Thailand Southeast Asia 20.1 45.6 3.8 3.1China Western Pacific 2.7 52.9 0.8 2.4 32,153,396Japan Western Pacific 2.1 38.2 1.8 10.9 More countries: http://www.who.int/tobacco/surveillance/policy/country_profile/en/
Global Trends http://www.who.int/tobacco/global_data/country_profiles/en/
Profile of a Female TobaccoUser Have role models who use tobacco Have weaker attachment to parents/family Have weaker commitment to school/religion Stronger attachment to peers and friends Perceive tobacco use prevalence to be higher then what it really is Less knowledge of adverse consequences of tobacco use & nicotine addiction Believe tobacco use can control weight, negative mood and stress Have positive image of tobacco users Are risk takers Rebellious
Hormones, Menstruation,Reproduction Antiestrogenic effect ↑ estrogen-deficiency disorder – e.g. osteoporosis ↓ estrogen-dependent disorder – e.g. endometrial cancer ↓ risk for uterine fibroids Alters menstrual function ↑ risk for dysmenorrhea (painful menstruation) ↑ secondary amenorrhea (lack of menses) ↑ menstrual irregularity Earlier age of natural menopause More severe menopausal symptoms ↑ risk for conception delay (primary & secondary infertility)
Pregnancy 1 out of 10 (10.7%) female smokers continue smoking through pregnancy (can change based on race, ethnicity and age) Of those who stop smoking during pregnancy, 2 out of 3 (67%) relapse at end of pregnancy In the US, yearly cost of maternal smoking is $366 million per year for neonatal care $740 per maternal smoker
Pregnancy ↑ risk of in utero: Premature birth Placenta previa Abruptio placenta Ectopic pregnancy Spontaneous abortion Preterm premature rupture of membranes ↑ intrauterine growth retardation ↓ physical stature ↓ intellectual development in children ↓ lung function ↑ risk of perinatal and infant death ↑ risk of SIDS through loss of neonatal hypoxia tolerance
Body Weight and FatDistribution Tobacco use initiation is NOT associated with weight loss Continued tobacco use DOES attenuate weight gain over time Average weight of tobacco users is MODESTLY lower than non-users Tobacco cessation CAN be associated with weight gain (6-12 pounds) Female tobacco users have a more masculine pattern of body fat distribution (higher waist-to-hip ratio)
Psychiatric Disorders Female tobacco users are more likely to be depressed ↑ prevalence of tobacco use in people with: Anxiety disorders Bulimia Attention deficit disorders Alcoholism Schizophrenia ↓ Parkinson’s ↑ ↓ Alzheimer’s
Other Affects glucose regulation & related metabolic processes ↓ Bone density (↑ risk of hip fracture) ↑ risk of Graves’ ophthalmopathy (thyroid-related disease) ↑ age-related macular degeneration ↑ risk for rheumatoid arthritis ↑ risk for osteoarthritis ↑ cataracts ↑ facial wrinkling
Female ↑ ovarian Cancers cancer↓ endometrial ↑ cervical cancer cancer ↑ smoking ↑ breast ↑ vulvar cancer risk cancer
Benefits of Quitting Overall: Women who quit smoking reduce their risk of infertility Pregnant women who quit early in their pregnancy reduce the risk of the baby being born too early and with an abnormally low weight Quitting smoking dramatically reduces the risk of developing an illness caused by smoking Reduces the risk of fractures that would be caused by smoking in old age For women who have already developed cancer: Quitting smoking helps the body to heal and respond to cancer treatment Quitting reduces the risk of developing a second cancer
Benefits of Quitting (cont.) Within a few hours: The level of carbon monoxide in the blood begins to decline The former smokers heart rate and blood pressure, which were abnormally high while smoking, begin to return to normal Within a few weeks: Women who quit smoking have improved circulation Don’t produce as much phlegm Don’t cough or wheeze as often Significant improvements in lung function within several months of quitting Within 1-2 years: The risk of death from heart disease is substantially reduced 5 years after quitting: The risk of death from lung cancer and other lung diseases declines steadily
Studies Review Study In study Quit Rates (%) Men Women Men women *Bjornson et al (NG) 2448 1475 29 25 *Gourlay et al (NP) 823 658 25 18 *Glassman et al (Clonidine) 132 161 31 34 *Hall et al(Nortiptyline) 89 110 31 18 *Covey et al (naltrexone) 24 44 58 39 Dale et al (Bupropion 300) 77 79 51 38 Piper et al (Placebo) 78 111 23 21 Piper et al (Bupropion) 223 297 34 30 Piper et al (NL) 228 293 44 26 Piper et al (NP) 232 311 35 34 Piper et al (Bup+NL) 224 306 36 31 Piper et al (NP+NL) 235 311 42 38Perkins et al CNS Drugs 15:391+, 2001;Dale et al CHEST 119:1357+, 2001;Piper et al NTR 12:647+, 2010
Why Do Females Have Lower Stopping Rates& Higher Relapse Rates? Negative mood during menstrual cycle phase Women react more to triggers involving negative emotions (conflict, stress) vs. men, who react more to triggers involving positive situations (social events) Women use more palliative coping strategies (men use more active coping strategies) Women have better outcomes in programs that emphasize social support (men do better in self-management and control groups)
Barriers to Tobacco Cessationin Women Intense withdrawal symptoms and cravings Depression Irritability Anxiety Lethargy Tension Weight changes Lower mental concentration Hormone influences Phase of the menstrual cycle High levels of emotional & physical dependence on cigarettes < high school education Lack of social support Lower self-efficacy Living with a tobacco user
Barriers to Tobacco Cessationin Women (cont) Situations involving negative effects or stress Lessened expectations about ability to quit Cognitively less ready to stop smoking Less confident in resisting temptation to smoke <6 months of abstinence in past attempts Previous failed cessation attempts Depression Weight gain concerns Lower socioeconomic status
Smoking Cessation InterventionMen and women have equal number of previous quit attempts BUTWomen are less successful in sustaining abstinence more than 1 week
Interventions: What Do We Know? Self-help manuals are more popular and least effective among women Telephone quitlines are effective for females who are homebound Females have greater success when receiving proactive calls Brief physician advice is more effective in females (39% vs. 35%) Tailored feedback by health care provider More females visit doctors than males Females are more responsive to personal interaction More females than males use assisted methods for smoking cessation More females have greater success in gradual approaches Females who reduce gradually by scheduled smoking at regular intervals have better success rates than those who self-taper or quit cold turkey
Multicomponent Intervention Cognitive behavioral therapy incorporates strategies to prepare and motivate smokers to stop smoking Combining behavioral therapy with pharmacotherapeutics Multiple sessions, which provide long-term support Cognitive behavioral approach Prepare and motivate Provide social support (e.g., “buddy system”) Problem solving
Nicotine Dependence Center:Treatment Program Data 3,398 patients (January 2004 – December 2005) Ambulatory 1,156 females 983 males Hospitalized 512 females 747 malesCroghan IT, Ebbert JO, Hurt RD, Hays JT, Dale LC, Warner N, Schroeder DR. Genderdifferences among smokers receiving tobacco use interventions. Addictive Behaviors 34(2009) 61-67.
Females vs. Males Statistically significant differences Males smoked more Males more likely to be married Males more likely to be more highly educated Males more likely to have a history of alcoholism Females more likely to have a history of depression Tobacco abstinence outcome at 6 months: After controlling for above variables – no difference Croghan IT, Ebbert JO, Hurt RD, Hays JT, Dale LC, Warner N, Schroeder DR. Gender differences among smokers receiving tobacco use interventions. Addictive Behaviors 34 (2009) 61-67.
Abstinence Rates: Females vs. Males Observed differences in tobacco abstinence outcomes between female and male smokers may not be due to inherent differences between genders, but rather may be explained by other characteristics. Individual assessment by tobacco treatment specialists allows for the elicitation of these factors as potential barriers to the achievement or maintenance of smoking abstinence. With this knowledge, the skilled tobacco treatment specialist can develop an individualized treatment plan. Clinical treatment programs may be more adept at addressing the needs of individual patients compared to the protocolized interventions used in clinical trials.Croghan IT, Ebbert JO, Hurt RD, Hays JT, Dale LC, Warner N, Schroeder DR. Genderdifferences among smokers receiving tobacco use interventions. Addictive Behaviors 34(2009) 61-67.
CONCLUSION:Best smoking cessation program for female smokers is MULTICOMPONENT Behavioral support Long-term follow-up Pharmacotherapy
ContactMayo Clinic Nicotine Dependence Center Research Program 200 First St. SW Rochester, MN 55905 Phone: 800-848-7853 Fax: 507-266-7900 http://ndc.mayo.edu/ firstname.lastname@example.org