Chemical Dependency Treatment

Center
126 N. Franklin Street, Hempstead, New York 11550
(516)486-7200 • Fax: (516)486-7291
Email: familyandchildrens.org

• Facts on Tobacco

Gender Differences and Tobacco

Compilation by Jorge Yeshayahu Gonzales-Lara1
Tobacco
Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Between 1964
and 2004, cigarette smoking caused an estimated 12 million deaths, including 4.1 million deaths from cancer, 5.5
million deaths from cardiovascular diseases, 1.1 million deaths from respiratory diseases, and 94,000 infant deaths
related to mothers smoking during pregnancy. According to the Centers for Disease Control and Prevention (CDC),
cigarette smoking results in more than 400,000 premature deaths in the United States each year—about 1 in every 5
U.S. deaths.

.a Cigarette smoking kills an estimated 440,000 U.S. citizens each year.

• Since 1964, more than 12 million Americans have died prematurely from smoking, and another 25
million U.S. smokers alive today will most likely die of a smoking-related illness.
• Smoking accounts for about one-third of all cancer deaths.
• It causes lung diseases such as chronic bronchitis and emphysema, and it has been found to exacerbate
asthma symptoms in adults and children.
• Smoking substantially increases the risk of heart disease, including stroke, heart attack, vascular
disease, and aneurysm.
• Passive or secondary smoke also increases the risk for many diseases– approximately 3,000 lung
cancer deaths and 46,000 deaths from coronary heart disease per year among nonsmokers.

1
Jorge Yeshayahu Gonzales-Lara Sociologist, MA Latin American Studies, BIA accredited,
Graduate Federal Immigration Academy, Student OTI-CASAC, Intern-Family & Children
Association

a community of caring
How Does Tobacco Affect the Brain?
Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the
addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed,
inhaled, or smoked. A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is
lit. Thus, a person who smokes about 1 1/2 packs (30 cigarettes) daily gets 300 “hits” of nicotine each day.

Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone
epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure,
respiration, and heart rate. Glucose is released into the blood while nicotine suppresses insulin output from the
pancreas, which means that smokers have chronically elevated blood sugar levels.

Like cocaine, heroin, and marijuana, nicotine increases levels of the neurotransmitter dopamine, which affects the
brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by
continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of
negative consequences. Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may
enhance nicotine’s effects on the brain. A number of studies indicate that adolescents are especially vulnerable to
these effects and may be more likely than adults to develop an addiction to tobacco.

When an addicted user tries to quit, he or she experiences withdrawal symptoms including powerful cravings for
tobacco, irritability, difficulty paying attention, sleep disturbances, and increased appetite. Treatments can help
smokers manage these symptoms and improve the likelihood of successfully quitting.

Are there gender differences in tobacco smoking?

Several avenues of research now indicate that men and women differ in their smoking behavior and that differences
in nicotine sensitivity may be the root cause. Studies of smoking behavior seem to indicate that women smoke fewer
cigarettes per day, tend to use cigarettes with lower nicotine content, and do not inhale as deeply as men. Whether
this is because of differences in sensitivity to nicotine is an important research question. Some researchers are
finding that women may be more affected by factors other than nicotine, such as the sensory aspects of the smoke or
social factors, than they are by nicotine itself.
The number of smokers in the United States declined in the 1970s and 1980s, but has been relatively stable
throughout the 1990s. Because this decline of smoking was greater among men than women, the prevalence of
smoking is only slightly higher for men today than it is for women. Several factors appear to be contributing to this
trend, including increased initiation of smoking among female teens and, more critically, women being less likely
than men to quit smoking.

Large-scale smoking-cessation trials show that women are less likely to initiate quitting and may be more likely to
relapse if they do quit. In cessation programs using nicotine replacement methods, such as the patch or gum, the
nicotine does not seem to reduce craving as effectively for women as for men. Other factors that may contribute to
women's difficulty with quitting are that the withdrawal syndrome may be more intense for women and that they
appear more likely than men to gain weight upon quitting. It is important for women entering smoking cessation
programs to be aware that standard treatment regimens may have to be adjusted to compensate for gender
differences in nicotine sensitivity.

.2 Gender Difference: A Meaningful Distinction

Both sex and gender are relevant for tobacco control. While sex refers to the biological differences between women
and men, gender refers to the array of socially constructed roles and relationships, personality traits, attitudes,
behaviors, values, relative power and influence that society ascribes to the two sexes on a differential basis. Men and
women are affected differently by tobacco use and tobacco messaging, and smoking rates alone differ between men
and women.

.3 Gender & Tobacco

Gender differences are apparent in the way men and women are affected by tobacco and influenced by tobacco
messaging. Some studies have indicated the following results:

2
F a m i l y a n d C h i l d r e n ' s A s s o c i a t i o n • page
 • Girls and women are more likely to fear weight gain than boys, and to initiate and continue smoking for
weight control.

• Women gain more weight after quitting than men.

• Women and girls tend to smoke as a “buffer” against negative feelings, while men smoke more from habit
or to enhance positive sensations.

• Low-income mothers in Western countries used smoking as a “time out” from the demands of caring for
young children.

• Some females in the Philippines expressed emotional dependence on tobacco in the midst of life
difficulties, while young urban Vietnamese women said they might start smoking if they become “very
unhappy”.

• Female addiction may be reinforced more by the sensory and social context of smoking, rather than by
nicotine, suggesting that patches may not be so effective an aid.

• Women quit less easily than men due to their different responses to nicotine as well as a lack of social
support, fear of weight gain, depression and hormones.

• Relapse rates in women are higher, and it may take a number of attempts before the achieve success.

.4 The Impact on Health

When it comes to health, tobacco poses specific threats for men and women. Men risk declines in fertility and sexual
potency, and female smokers risk increased cardiovascular disease, in particular while using oral contraceptives, and
higher rates of infertility, premature labor, low birth weight infants, cervical cancer, early menopause, and bone
fractures.

Smoking during pregnancy adversely affects fetal development. Female non-smokers are more likely to be exposed
to environmental tobacco smoke, which elevates the risks of lung cancer and heart disease.

Diseases that are more prevalent or manifest differently in women include cardiovascular disease, substance abuse
and addiction, and lung diseases such as cancer and asthma.

Read the American Medical Association report Women's Health: Sex- and Gender-Based Differences in Health
and Disease.

.a Gender Differences with Lung Cancer & Smoking

Other research indicates differences in the risk between men and women when it comes to lung cancer. A study by
the Journal of the National Cancer Institute confirms findings that the occurrence rates for major lung cancer types
are consistently higher for women than for men at every level of exposure to cigarette smoke – a difference likely
due to the higher susceptibility to tobacco carcinogens in women.

.5 Exploiting Gender Differences to Promote Tobacco

Through comprehensive social research, the tobacco industry understands popular culture and psycho-social
aspirations, and it incorporates this knowledge into its massive promotional efforts as it seeks new markets and
sustains existing ones. Prevailing gender norms are a key feature within promotion for both sexes. When users
realize how they are targeted, it is a significant step toward reducing vulnerability.

• Smoking is portrayed as a manly habit linked to happiness, fitness, wealth, power and sexual success, while
in reality it brings premature death and sexual problems.

3
F a m i l y a n d C h i l d r e n ' s A s s o c i a t i o n • page
 • The tobacco industry deliberately targets women with new products and glamorous, sexy, and independent
themed advertising.

• Tobacco is promoted to women as a buffer for negative feelings, a time-out from stress, and as way to
control weight.

• The greatest growth of tobacco advertising aimed at women followed the introduction of Virginia Slims in
1968 with its slogan “You’ve Come a Long Way, Baby!” Since then, there have been an increasing number
of cigarette brands and advertising campaigns targeted toward women, including women-targeted brands
and promotions.

.6 Quitting
Researchers have found a significant difference in quitting success between men and women, as well as between
men (when compared to other men) and between women (when compared to other women). Past attempts at
quitting smoking, adherence to Bupropion medication, body mass index, stress, depression, and education are all
factors that have an impact on a person’s chances of quitting smoking successfully. Some factors make more of a
difference for a woman’s chance of success while other factors matter more to men.
Racial, ethnic, and gender differences in smoking cessation associated with employment and joblessness
through young adulthood in the US

Smoking is one of the most important behavioral determinants of poor health, disability and premature death. As
young adults progress into midlife, employment and joblessness can affect tobacco use through access to health
resources, exposure to health-related behavioral norms and psycho-social strain. This study seeks to determine
whether trends in labor force participation can be correlated with corresponding trends in tobacco use, which is
now most prevalent among individuals with the lowest incomes and educational levels. Previous research has
explored the relative roles of exposure, vulnerability and reactivity to health challenges in explaining gender
differences in health. The authors extend those frameworks to consider differences by race and ethnicity as well
as by gender. Using data from the U.S. Bureau of Labor Statistics, National Longitudinal Survey of Labor Market
Experience, Youth Survey 1979-1998, they analyzed yearly surveys of a cohort of 4,050 daily smokers, 1,912 of
whom quit smoking in the course of the study. They used a discrete-time hazards model to assess the relationship
between employment and the likelihood of smoking cessation.

Key Findings:

• Joblessness is more strongly associated with persistent daily smoking among women than among men.

• Fewer social and economic resources among unemployed women in all ethnic groups studied explain
their lower cessation rates.

• For American women, the reduction in the odds of cessation associated with unemployment remains
large and significant even after the indicators for these resources are addressed.

THE FACTS ABOUT CHILDREN AND TOBACCO USE

Here are some facts about tobacco use among youth:

1. More than 3 million kids age 12-17 are current smokers.

4
F a m i l y a n d C h i l d r e n ' s A s s o c i a t i o n • page
Source: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and
HumanServices (HHS), Summary findings from the 1999 National Household Survey on Drug Abuse (2000).

2. More than 5 million children under age 18 alive today will eventually die from smoking-related
disease, unless current rates are reversed.

Source: U.S. Centers for Disease Control and Prevention (CDC), .Projected Smoking-Related Deaths Among
Youth. United States,. Morbidity and Mortality Weekly Report (MMWR) 45:44 (November 8, 1996).

3. Almost 90 percent of adult smokers began at or before age 18.

Source: National Household Surveys on Drug Abuse (1998), unpublished data. See, also, HHS, .Preventing
Tobacco. Use Among Young People: A Report of The Surgeon General" (1994).

4. More than a third of all kids who ever try smoking a cigarette become regular, daily smokers before
leaving high school.

Source: CDC, "Selected Cigarette Smoking Initiation and Quitting Behaviors Among High School Students –
United States, 1997," MMWR (May 22, 1998).

5. 86 percent of youth (12-17) smokers prefer Marlboro, Camel and Newport.the three most heavily
advertised brands. Marlboro, the most heavily advertised brand, constitutes almost 55 percent of the
youth market but only about 35 percent of smokers over age 25.

Source: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human
Services (HHS), Summary findings from the 1999 National Household Survey on Drug Abuse (2000).

6. Youths age 12-17 who smoke are more than 11 times as likely to use illicit drugs and 16 times as
likely to drink heavily as youths who do not smoke.

Source: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and
HumanServices, Summary of Findings from the 1998 National Household Survey on Drug Abuse (August
1999),www.health.org/pubs/nhsda/.

7. Cigarettes kill more than 400,000 Americans every year. This figure represents more deaths than
from AIDS, alcohol, car accidents, murders, suicides, drugs, and fires.combined.

Source: Lynch, B., & Bonnie, R., eds, Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and
Youths, Institute of Medicine, 1994.

8. Long-term health risks associated with tobacco use include heart attacks, strokes, cancers (lung,
larynx, oral cavity, pharynx, esophagus, pancreas, bladder, cervix, leukemia) and chronic obstructive
pulmonary diseases (chronic bronchitis and emphysema).

9. Short-term health risks of tobacco include shortness of breath, increases heart rate, exacerbation of
asthma, impotence, infertility, and increased carbon monoxide blood levels.

• It is a common belief among kids that the effects of smoking (heart disease, lung cancer, and other
cancers) do not appear for many years, but many health consequences can occur quite quickly. For

5
F a m i l y a n d C h i l d r e n ' s A s s o c i a t i o n • page
 example: Smoking causes bad breath and makes smokers’ homes and clothes stink and, perhaps
fortunately for smokers, it also reduces their sense of smell.

• Beyond smoke- or nicotine-stained teeth, smokers are also more likely to suffer from periodontal
disease and to have more serious periodontal disease, including tooth loss. Chronic coughing,
increased phlegm, emphysema, and bronchitis have been well-established products of smoking for
decades; smokers are also more susceptible to influenza and more likely to experience severe
symptoms when they get the flu. Smoking causes mild airway obstruction, reduced lung function,
and slowed growth of lung function among adolescents.

• Teenage smokers suffer from shortness of breath almost three times more often than teens who
don’t smoke, and produce phlegm more than twice as often as teens who don’t smoke. Not
surprisingly, smoking also hurts young people’s physical fitness in terms of both performance and
endurance even among young people trained in competitive running.

• The resting heart rates of young adult smokers are two to three beats per minute faster than
nonsmokers; studies have shown that early signs of heart disease and stroke can be found in
adolescents who smoke.

• Smoking is also associated with hearing loss, vision problems, and increased headaches. While
many smokers believe that smoking relieves stress, it is actually a major cause.

• Smoking only appears to reduce stress because it lessens the irritability and tension caused by the
underlying nicotine addiction. High school seniors who are regular smokers and began smoking
by grade nine are more than twice as likely than their nonsmoking peers to report poorer overall
health; roughly two and a half times more likely to report cough with phlegm or blood, shortness
of breath when not exercising, and wheezing or gasping; and three times more likely.

Are There Effective Treatments for Tobacco Addiction?

Tobacco addiction is a chronic disease that often requires multiple attempts to quit. Although some smokers are able
to quit without help, many others need assistance. Generally, rates of relapse for smoking cessation are highest in the
first few weeks and months and diminish considerably after about 3 months. Both behavioral interventions
(counseling) and medication can help smokers quit; the combination of medication with counseling is more effective
than either alone.

Behavioral Treatments

Behavioral treatments employ a variety of methods to assist smokers in quitting, ranging from self-help materials to
individual counseling. These interventions teach individuals to recognize high-risk situations and develop coping
strategies to deal with them. The U.S. Department of Health and Human Services’ (HHS) national toll-free quitline,
800-QUIT-NOW, is an access point for any smoker seeking information and assistance in quitting.

Nicotine Replacement Treatments

Nicotine replacement therapies (NRTs), such as nicotine gum and the nicotine patch, were the first pharmacological
treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. NRTs
deliver a controlled dose of nicotine to a smoker in order to relieve withdrawal symptoms during the smoking
cessation process. They are most successful when used in combination with behavioral treatments. FDA-approved
NRT products include nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers, and lozenges.

6
F a m i l y a n d C h i l d r e n ' s A s s o c i a t i o n • page
Other Medications

Bupropion and varenicline are two FDA-approved non-nicotine medications that effectively increase rates of long-
term abstinence from smoking. Bupropion, a medication that goes by the trade name Zyban, was approved by the
FDA in 1997 for use in smoking cessation. Varenicline tartrate (trade name: Chantix) targets nicotine receptors in
the brain, easing withdrawal symptoms and blocking the effects of nicotine if people resume smoking.

Current Treatment Research

Scientists are currently pursuing many other avenues of research to develop new tobacco cessation therapies. One
promising intervention is a vaccine that targets nicotine, blocking the drug’s access to the brain and preventing its
reinforcing effects. Preliminary trials of this vaccine have yielded promising results.

How Widespread Is Tobacco Use?

Monitoring the Future Survey

Current smoking rates among high school students reached an all-time low in 2008. According to the Monitoring the
Future survey, 6.8 percent of 8th-graders, 12.3 percent of 10th-graders, and 20.4 percent of 12th-graders reported
that they had used cigarettes in the previous month.* Although unacceptably high numbers of youth continue to
smoke, these numbers represent a significant decrease from peaks reached in the late 1990s.

The decrease in smoking rates among young Americans corresponds to several years in which increased proportions
of teens said they believe there is a “great” health risk associated with cigarette smoking and expressed disapproval
of smoking one or more packs of cigarettes per day. Students’ personal disapproval of smoking has risen for some
years: in the past 10 years, for example, the percentage of 12th-graders disapproving of smoking one or more packs
of cigarettes per day increased significantly, from 68.8 percent in 1998 to 80.5 percent in 2008. During the same
period, the number of 8th-graders who said it was “very easy” or “fairly easy” to get cigarettes declined from 73.6
percent in 1998 to 57.4 percent in 2008.

Current use of smokeless tobacco among 10th- and 12th-graders also reached an all-time low in 2008: 5 percent of
10th-graders and 6.5 percent of 12th-graders reported that they had used smokeless tobacco in the previous month.
Current use for 8th-graders (3.5 percent) did not change significantly from the all-time low reached in 2007.

National Survey on Drug Use and Health (NSDUH)

In 2007, 28.6 percent of the U.S. population 12 and older (70.9 million people) used a tobacco product at least once
in the month prior to being interviewed. This figure includes 3.1 million young people aged 12 to 17 (12.4 percent of
this age group). In addition, 60 million Americans (24.2 percent of the population) were current cigarette smokers;
13.3 million smoked cigars; 8.1 million used smokeless tobacco; and 2 million smoked tobacco in pipes.

Between 2002 and 2007, past-month cigarette use among persons 12 or older decreased from 26 percent to 24.2
percent. Cigarette use in the past month among 12- to 17-year-olds declined from 13 percent in 2002 to 9.8 percent
in 2007.

New Opportunities for Clinicians

• If it is true that women have less success in quitting, more complex approaches may be needed to achieve
better outcomes. Intensive counseling would address the circumstances that create obstacles to cessation.

• Awareness and advocacy are also needed. Investigative journalism offers scope for mass exposure about
gender and tobacco. Community and school-based discussion of the health impacts of gender expectations
for both males and females would foster greater self-awareness and, thus, resistance to gender-based
advertising and harmful social norms.

7
F a m i l y a n d C h i l d r e n ' s A s s o c i a t i o n • page
 • Revising cessation treatments for women and tailoring therapy to increase behavioral support and less
reliance of nicotine replacement.

• Increased attention should be devoted to reduction in preventable risk factors for chronic disease such as
tobacco, alcohol, and other drug use, which in women are increasing rather than decreasing.

• Increased attention on the part of both physicians and patients to modifiable risk factors for cardiovascular
disease remains important given its predominant contribution to morbidity and mortality in older women.
References:

Are there gender differences in tobacco smoking http://psy.rin.ru/eng/article/202-101.html

Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA.
http://www.tobaccofreemaine.org/channels/providers/gender_differences.php.
Margaret M Weden, Nan M Astone, and David Bishai, Racial, ethnic, and gender differences in smoking cessation associated with
employment and joblessness through young adulthood in the US.Population Health Sciences, University of Wisconsin-Madison, 610 N.
Walnut St., 1007 WARF Office Bldg., Madison, WI 53726 US. Population & Family Health Sciences, Johns Hopkins University Bloomberg
School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 US.
1 U.S. Department of Health and Human Services. The Health Consequences of Smoking: What It Means to You. U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on
Smoking and Health, 2004. Available at:
http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/whatitmeanstoyou.pdf.

2 Centers for Disease Control and Prevention. Smoking and Tobacco Use—Fact Sheet: Health Effects of Cigarette Smoking. Updated January
2008. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/.

3 Belluzzi JD, Wang R, Leslie FM. Acetaldehyde enhances acquisition of nicotine self-administration in adolescent rats.
Neuropsychopharmacology 30:705–712, 2005.

4 Buka SL, Shenassa ED, Niaura R. Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: A 30-year
prospective study. Am J Psychiatry 160:1978–1984, 2003.

5 Centers for Disease Control and Prevention. Smoking and Tobacco Use—Fact Sheet: Secondhand Smoke Causes Heart Disease. Updated May
2007. Available at:
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/heart_disease/.

6 U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. U.S.
Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion, Office on Smoking and Health, 1990. Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T/.

8
F a m i l y a n d C h i l d r e n ' s A s s o c i a t i o n • page