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Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
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E-mail: tobaccoinfo@cdc.gov
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2001 Surgeon General's Report—Women and Smoking
Efforts to Reduce Tobacco Use Among Women and Girls
Disclaimer
Highlights
- There are numerous effective smoking cessation methods available
in the United States. The methods range from self-help materials, to
intensive clinical approaches, to broad community-based programs. Minimal
clinical assistance; intensive clinical assistance; and individual,
group, or telephone counseling have shown few differences in effectiveness
between men and women.
- Studies show no major or consistent differences between women’s
and men’s motivation to quit, readiness to quit, general awareness of
the harmful health effects of smoking, or the effectiveness of intervention
programs for tobacco use.
- Based on national surveys, the probability of attempting to quit
smoking and to succeed has been equally high among women and men since the
late 1970s or early 1980s.
- The majority of smokers who try to stop using tobacco reported doing
so on their own, even though this is the least effective method. This
pattern has changed somewhat in recent years with increased use of pharmacologic
aids.
- The likelihood of having been counseled to stop smoking was slightly
higher for women (39%) than for men (35%); women report more physician
visits than men, which allows more opportunity for counseling.
- Intensive clinical interventions involve individual, group, or telephone
counseling for multiple sessions. The most successful treatments are
multi-component cognitive behavioral programs that incorporate strategies
to prepare and motivate smokers to stop smoking.
- Women are somewhat more likely than men to use intensive treatment
programs. Similarly, women have a stronger interest than men in smoking
cessation groups that offer mutual support through a buddy system and
in treatment meetings over a long period.
- A number of effective pharmacotherapies for nicotine addiction have
emerged in the past decade—nicotine gum and nicotine patch (approved
for over-the-counter use), nicotine nasal spray, oral nicotine inhaler,
and Bupropion (available by prescription). Two other pharmacotherapies,
Clonidine and the antidepressant Nortiptyline, have been recommended
as second-line pharmacotherapies, but have not yet been approved by
the Food and Drug Administration for this indication—smoking cessation.
- Pharmacologic approaches to smoking cessation raise a number of
issues specific to women. Nevertheless, nicotine replacement has been
shown to be more effective than placebo among women smokers and, thus,
remains recommended for use.
- More research is needed to determine the effects of nicotine replacement
therapy on pregnant women and their offspring.
- Studies have identified numerous gender-related factors that should
be studied as predictors for smoking cessation as well as factors for
continued smoking or relapse after quitting. These factors include hormonal
influences, pregnancy, fear of weight gain, lack of social support,
and depression.
- Women stop smoking more often during pregnancy—both spontaneously
and with assistance—than at any other time in their lives. However,
most women return to smoking after pregnancy: up to 67% are smoking
again by 12 months after delivery.
- Pregnancy-specific programs benefit both maternal and infant health
and are cost-effective. If the national prevalence of smoking before
or during the first trimester of pregnancy were reduced by one percentage
point annually, it would prevent 1,300 babies from being born at low
birth weight and save $21 million (in 1995 dollars) in direct medical
costs in the first year alone. Prenatal smoking cessation interventions
can be of economic benefit to healthcare insurers.
- More women than men fear weight gain if they quit smoking; however,
few studies have found a relationship between weight gain concerns and
smoking cessation among either women or men. Further, actual weight
gain during cessation efforts does not predict relapse to smoking.
- Smoking cessation treatment and social support derived from family
and friends improve cessation rates. Whether there are gender differences
in the role of social support on long-term smoking cessation is inconclusive.
- Women of low socioeconomic status (SES) have lower rates of smoking
cessation than do women of higher SES. Studies that analyze the effects
of mass media campaigns suggest that smokers of low SES, especially
women, are more likely than smokers of high SES to watch and obtain
cessation information from television.
- Women of low SES enrolled in intensive cessation intervention programs
(stress management, self-esteem enhancement, group support, and other
activities that improve quality of life) have 20%–25% successful cessation
rates. Unfortunately, only a small proportion of women of low SES appear
to take advantage of these programs.
- In general, African-American, Hispanic, and American-Indian or Alaska-Native
women want to stop smoking at rates similar to those of white women,
but there is little research on smoking cessation among women in racial/ethnic
minority populations.
- There is strong scientific evidence that shows increases in state
and federal excise taxes on tobacco products reduce consumption and
increase the number of people who stop using tobacco. Price increases
reduce consumption of tobacco products by adults, young adults, adolescents,
and children.
- Mass-media campaigns implemented in combination with other interventions,
such as excise tax increases and community education programs, are effective
in reducing tobacco consumption and motivating tobacco product users
to quit.
- There are a number of effective interventions to help tobacco users
in their efforts to quit, such as behavioral programs offering counseling
in individual or group settings and the use of a number of pharmacotherapies,
including nicotine replacement. One way to increase the use of effective
treatments is to lower the cost for people who wish to use these treatments.
Scientific evidence shows that interventions that reduce smokers’ costs
(such as programs that reduce or eliminate the insured’s copayment)
increase the number of people who stop using tobacco products.
- There is no Medicare coverage for tobacco use dependence except
in a few states that will participate in a demonstration project starting
in April 2001.
- Six states provide Medicaid coverage for counseling, and four states
cover all prescription drugs and over-the-counter nicotine replacement
products.
- Under private insurance, 42% of managed care organizations (MCOs)
cover counseling, 16% cover indemnity counseling, 38% cover drugs, and
25% cover indemnity drugs.
Disclaimer: Data and findings provided on this page reflect the content of
this particular Surgeon General's Report. More recent information may exist
elsewhere on the Smoking & Tobacco Use Web site (for example, in fact sheets,
frequently asked questions, or other materials that are reviewed on a regular
basis and updated accordingly).
Page last updated March 27, 2001