1. CHAPTER 6: Women and Smoking

2. Introduction Tobacco use among women has increased in the United States and globally. Tobacco control among women is a public health priority.

3. Public Health Priorities 1. Decrease tobacco use initiation among girls. 2. Reduce smoking and secondhand smoke exposure (SHSe) among pregnant women. 3. Reduce children’s SHSe. 4. Combat tobacco industry advertising targeting females. 5. Improve cessation rates among women across the lifespan.

4. Significance and Current Trends 17% to 22% of American women smoke. Use of specific types of tobacco products varies across cultures and customs. More than 350,000 children under age 18 begin smoking annually in the United States.

5. Tobacco-Related Morbidity and Mortality Cancer – Lung, breast, cervical Respiratory and Cardiovascular diseases – Women are more susceptible to chronic obstructive pulmonary disease (COPD) and myocardial infection (MI).

6. Tobacco-Related Morbidity and Mortality Reproductive Health and Smoking – Smoking is related to irregular menstrual cycles, cramps, infertility, early menopause. – Smoking increases risk for miscarriage and ectopic pregnancies. Smoking During Pregnancy and Postpartum – Negatively affects child’s health

7. Tobacco-Related Morbidity and Mortality Secondhand Smoke Exposure and Nonsmoking Women’s Health – Increased risk of cancer and cardovasicular disease(CVD). Health Disparities and High-Risk Groups – Greater tobacco-related morbidity and mortality in underserved, minority populations – Influence of menthol cigarettes

8. Psychosocial Correlates of Tobacco Use Initiation Media Influence – Marketing campaigns are intended to exploit women’s attitudes and insecurities. Parents and Peers – Parent support and active engagement mitigate peer pressure to smoke.

9. Psychosocial Correlates of Tobacco Use Initiation Psychological Factors and Initiation – Weight concerns – Depressive symptoms – “Gateway hypothesis”

10. Factors Associated With Nicotine Dependence Negative Affect Weight Concerns Race and Socioeconomic Factors Molecular Genetics and Smoking

11. Cessation and Relapse: Intervention Issues Unique to Women Nicotine Replacement Therapy – Delivers nicotine via routes of administration with slower and/or steadier absorption rates than smoking Nicotine Withdrawal Medications – Antidepressants, Varenicline

12. Cessation and Relapse: Intervention Issues Unique to Women Behavioral Interventions: – Enhance motivation. – Promote urge, stress, mood management skills. – Enable problem solving. – Facilitate social support. – Expand range of reinforcing activities to replace smoking. – Generalize smoking behavior across contexts.

13. Cessation and Relapse: Intervention Issues Unique to Women Unique Challenges and Barriers to Smoking Cessation for Women – Menstrual cycle and hormones – Negative affect and depression – Weight concerns

14. Cessation and Relapse: Intervention Issues Unique to Women Pregnancy and Smoking Cessation – CBT interventions are most widely used. Postpartum and Smoking Cessation – Two thirds of women who stop smoking during pregnancy relapse in postpartum. Sociocultural Factors – Standard cessation programs are not culturally relevant or sensitive.

15. Public Health Priorities and Future Directions Future work should address: Effectiveness of prevention and cessation treatments Benefits of treatment matching Influence of behavioral science