On March 8, 2012, Global Bridges presented the webinar "Women and Smoking," which featured Ivana Croghan, Ph.D., coordinator of the Mayo Clinic Nicotine Dependence Center's Research Program.
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Women and Smoking -- Ivana Croghan, Ph.D., Mayo Clinic
1. 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
2. The Coming Epidemic
Rise in Smokers Worldwide
2 1.7
Billions of smokers
1.5
1.1
1
0.5
0
2000 2030
http://tobacco.who.int/en/treatment/index.html
3.
4. Current Smoking
Country Region Male Female
Youth Adult Youth Adult
Nigeria* Africa 5.6 9.0 1.3 0.2
Argentina Americas 21.1 32.4 27.3 22.4
Mexico Americas 26.3 24.8 27.1 7.8
USA Americas 9.7 31.2 7.9 23.0
Egypt Eastern Mediterranean 15.5 37.6 2.8 0.5
France Europe 13 33.3 16 26.5 17,317,750
Italy Europe 19.4 29.5 21.6 17.0
Ukraine Europe 27 50.0 12 11.3
India* Southeast Asia 5.8 24.3 2.4 2.9 35,095,609
Thailand Southeast Asia 20.1 45.6 3.8 3.1
China Western Pacific 2.7 52.9 0.8 2.4 32,153,396
Japan Western Pacific 2.1 38.2 1.8 10.9
More countries: http://www.who.int/tobacco/surveillance/policy/country_profile/en/
7. Profile of a Female Tobacco
User
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
8. 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)
9. 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
10. 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
11. Body Weight and Fat
Distribution
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)
12. 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
13. 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
14. Female ↑ ovarian
Cancers cancer
↓ endometrial ↑ cervical
cancer cancer
↑ smoking
↑ breast ↑ vulvar
cancer risk cancer
15. 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
16. Benefits of Quitting (cont.)
Within a few hours:
The level of carbon monoxide in the blood begins to decline
The former smoker's 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
17. 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 38
Perkins et al CNS Drugs 15:391+, 2001;
Dale et al CHEST 119:1357+, 2001;
Piper et al NTR 12:647+, 2010
18. 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)
19. Barriers to Tobacco Cessation
in 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
20. Barriers to Tobacco Cessation
in 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
21. Smoking Cessation Intervention
Men and women have equal
number of previous quit
attempts
BUT
Women are less successful in
sustaining abstinence more
than 1 week
22. 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
23. 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
24. Nicotine Dependence Center:
Treatment Program Data
3,398 patients (January 2004 – December 2005)
Ambulatory
1,156 females
983 males
Hospitalized
512 females
747 males
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.
25. 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.
26. 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. Gender
differences among smokers receiving tobacco use interventions. Addictive Behaviors 34
(2009) 61-67.
27. CONCLUSION:
Best smoking cessation program for female smokers is
MULTICOMPONENT
Behavioral support
Long-term follow-up
Pharmacotherapy
28. Contact
Mayo 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/
nicotineresearch@mayo.edu
Hinweis der Redaktion
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