A more inclusive approach to smoking cessation for women

Is quitting smoking on your 2019 list of goals? There are a variety of factors that influence someone’s ability to quit smoking long-term.

For women, the messaging and research around smoking cessation has focused largely on women and pregnancy, rather than supporting the overall health of women and considering other social factors at play in their addiction, according to Natalie Hemsing, MA, a research associate at the Centre of Excellence for Women’s Health (CEWH) in Vancouver, British Columbia. Further research she says is needed to guide success in smoking cessation while supporting the overall health of women.

The CEWH research demonstrates that we need to approach smoking cessation for women differently than we approach smoking cessation for men because the challenges women face when trying to quit, and their reasons for smoking in the first place, are different than men.

While there are sex-based factors that play a role in a woman’s decision to start (and quit) smoking, such as hormonal fluctuation, genetics, and the quality to metabolize nicotine quicker than men, there are also social and cultural factors related to gender that are to be considered.

Women are most likely to smoke to cope with mood, emotion, and stress. Mothers may smoke to temporarily escape the day-to-day stressors of motherhood. Marketing campaigns have linked smoking with female empowerment. Women are likely to continue smoking due to a fear of weight gain which typically results when women quit.

There are other intersectional factors which cause women to smoke, such as coping with violence, trauma, discrimination based on race or sexual orientation, and social disadvantage such as living in poverty. Additionally, Indigenous men and women are three times more likely to smoke, due to cultural factors such as pro-smoking environments, and trauma.

A program manager for the Ottawa Model for Smoking Cessation, Dr. Kerri-Anne Mullen says there are differences in smoking-related health risks which affect men and women.

“The risk of death from heart disease is actually higher for women who smoke, compared to men who smoke,” Dr. Mullen says. “Women are more likely to try to quit smoking, but they are also more likely to relapse as they tend to experience higher levels of nicotine withdrawal and crave more when they are feeling stressed.”

The question is then, how should clinicians better approach smoking cessation for women?

“Healthcare providers should consider additional factors in a women’s life that may limit their ability to give up smoking,” says Hemsing. “A holistic and inclusive approach may be the key to success in smoking cessation for women.”

Hemsing shared four components for clinicians, which may help women quit for good:

1. Women-centred approaches to recognize sex and gender-related influences on tobacco use and cessation.
2. Trauma-informed approaches to recognize the need for physical and emotional safety in patients dealing with trauma.
3. Harm-reducing approaches to recognize the importance of providing support to women who do not have immediate goals for cessation.
4. Equity-informed approaches to recognize how factors such as poverty, racism, social isolation, violence and trauma, gender inequity, and other social inequalities affect vulnerability to tobacco-related health problems. Smoking cessation support should be more affordable to vulnerable populations.

Hemsing believes additional research into intervention development is needed, and there is potential for her current literature review to lead to just that.

At the Ottawa Model for Smoking Cessation, Dr. Mullen recommends using a cessation medication in combination with Nicotine Replacement Therapy (NRT) to aid in the success of quitting smoking for women.

“While we recommend that all patients who smoke should quit with the help of an approved smoking cessation medication, it is particularly important that we advise female smokers to use medications in order to prevent relapse by reducing withdrawal and to aid in stressful situations.”

- Dr. Kerri-Anne Mullen

Natalie Hemsing presented the CEWH research on women and tobacco at the 11th Annual Ottawa Conference: State of the Art Clinical Approaches to Smoking Cessation by the Ottawa Model for Smoking Cessation.