Women and smoking cessation: Disparities in tobacco dependence treatment outcomes

Smoking is the leading cause of preventable death and disease among women. More women die of lung cancer than breast cancer, uterine cancer, and ovarian cancer combined. Women experience unique risks from smoking (i.e., breast cancer, reproductive health) and are more likely to develop heart disease from smoking than men. Cessation provides remarkable health benefits, but women are sometimes less successful with cessation after treatment for tobacco dependence. Most states provide free tobacco dependence treatment. Although more women than men utilize these services, it is unknown whether women benefit equally from these programs. We examined differences between women (n=6,325) and men (n=3,040) who attended the same evidence-based treatment for tobacco dependence. We modeled the effect of sex/gender on 6-month abstinence rates, accounting for sex/gender differences among demographic, clinical, environmental, and treatment utilization factors. Women were of lower socioeconomic status, smoked fewer cigarettes per day, started smoking later in life, and smoked for fewer years than men. Although women attended the same number treatment sessions, they covered less treatment content and were less likely to complete treatment than men. Women were more likely to use the free nicotine patches and use telephone treatment than men. With all the sex/gender differences accounted for, men were more likely to achieve long-term abstinence than women (17.9% versus 15.0%, p< .05, OR 1.16, CI: 1.02, 1.32). More research is needed to understand why women are less successful with cessation after treatment and how treatment can more fully meet the needs of women who smoke.