Women & Smoking

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Overview

Cigarette smoking is the largest preventable cause of death among women. Since 1980, smoking-related illnesses, including cancer, have claimed the lives of about 3 million women. Of the more than 4000 chemicals found in tobacco smoke, more than 40 are known carcinogens (cancer-causing substances).

Addiction
While people become dependent on cigarettes for a number of reasons, addiction to the nicotine contained in cigarettes is the primary factor in smoking dependency. Its most immediate effect is a physiological "rush," an increase in blood pressure, respiration, and heart rate caused by stimulation of the adrenal glands to release epinephrine (adrenaline). Nicotine can also have a sedative effect. It leads to addiction primarily because of its effect on the neurotransmitter dopamine (chemical that activates the areas of the brain, called reward centers that control pleasure). Nicotine increases the levels of dopamine in the reward centers of the brain, similar to the action of other addictive substances, such as cocaine and heroine.

Nicotine in tobacco is a particularly powerful and effective drug delivery system, and "hooks" the smoker quickly. The nicotine within a single puff of cigarette smoke reaches the brain within 10 seconds of inhalation. While the effects of the substance are experienced quickly, they fade within minutes, which leads the user to dose frequently with cigarettes. It is estimated that a person who smokes about 1 1/2 packs a day receives 300 doses of nicotine daily. This high-frequency dosing reinforces the addictive quality of the drug.

In two studies funded by the National Institute of Drug Abuse, research indicates that dependence on cigarettes is not the result of nicotine alone. Women, teenagers, and Caucasians experience more symptoms of tobacco dependence than other groups, even while using the same number, or fewer, cigarettes. According to a 2001 review of available research on women and smoking, nicotine replacement therapy is less effective for women. Together, these findings may indicate that women's dependence on smoking is based in part on something in addition to nicotine.

Withdrawal Symptoms
As with other addictive drugs, withdrawal can be extremely unpleasant, making it difficult for the smoker to quit. Withdrawal symptoms include:

• Craving
• Difficulty thinking and concentrating
• Increased appetite
• Irritability
• Sleep disturbances

Symptoms may begin within a few hours after the last cigarette, peak within a few days, and last from a few weeks to 6 months or more.

Incidence and Prevalence
According to a 1998 study by the Centers for Disease Control and Prevention, 22 million women 18 years and older in the United States smoke cigarettes. Another 1.5 million adolescent girls are cigarette smokers.

Smoking rates vary among women when classified by ethnicity:

• Native American – 35%
• Caucasian – 24%
• African American – 24%
• Hispanic – 15%
• Asian/Pacific Islander – 4%

It is more prevalent among women living below the poverty level and is generally higher among women with mental health disorders, such as anxiety disorders, depression, bulimia, attention deficit disorder, schizophrenia, and alcoholism.

While smoking rates in general are declining, the number of women smoking cigarettes is not declining as rapidly as the number of men who smoke. Between 1965 and 1993, the percentage of men who smoke dropped 24%, while the number of women who smoke dropped only 11%.

In addition, women are beginning to smoke at a younger age. Smoking rates among female high school seniors increased from 17.9% in 1991 to 23.6% in 1997. If the trend continues, women smokers will soon outnumber men smokers.

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