ESC 2021: Despite Smoking Less, Women Find it Harder to Quit Than Men

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Women smoke fewer cigarettes than men but are less likely to quit, according to a new study of over 35 000 smokers being presented at the European Society of Cardiology (ESC) Congress 2021, held virtually between August 27-30, 2021.

“In our study, women who used smoking cessation services had higher rates of overweight or obesity, depression, and anxiety compared to men and kicked the habit less often. Our findings highlight the need to provide smoking cessation interventions tailored to the needs of women,” said study author Ingrid Allagbe, PhD student, University of Burgundy, Dijon, France, in an ESC press release.

The cardiovascular (CV) risk attributable to smoking is more than 4-times higher in women than men, but there is limited epidemiological data available on smoking in women with CV risks. To help fill this research gap, Allagbe and colleagues aimed to measure abstinence rates among female smokers with CV diseases and/or CV risks.

Researchers compared characteristics and abstinence rates of men and women who visited smoking cessation services between 2001 and 2018 in France. Data were obtained from the nationwide database CDT-net.

Researchers enrolled smokers aged ≥18 years with at least 1 additional CV risk factor: overweight/obese (body mass index ≥25 kg/m²), hypercholesterolemia, diabetes, hypertension, and a history of stroke, myocardial infarction, or angina pectoris.

Smoking abstinence (≥28 consecutive days) was self-reported and confirmed by measurement of exhaled carbon monoxide <10 parts per million (ppm). A nicotine dependence scale was used to classify participants as having mild, moderate, or severe dependence.

Participants provided information on their age, education level, other conditions including diabetes and respiratory illness, and number of cigarettes smoked each day. Participants were classified as having anxiety or depression symptoms or not according to their medical history, use of anxiety medication or antidepressants, and the Hospital Anxiety and Depression Scale.

Overall, 37 949 smokers met inclusion criteria and were included in the study, of whom 16 492 (43.5%) were women. The median age of the female participants was 48 years compared to 51 years for men (p<.001). Also, more women (55%) reported a bachelor’s degree level of education or higher compared to men (45%; p<.001).

Results

Researchers found that the burden of CV risk factors was high in both women and men. Hypercholesterolemia was more common in men (33%) than women (30%; p<.001), as was hypertension (26% vs 23%; p<.001) and diabetes (13% vs 10%; p<.001).

A greater proportion of women (27%) were overweight or obese compared to men (20%; p<.001), and women were more likely to have symptoms of anxiety or depression than men (37.5% vs 26.5%; p<.001). Also, chronic obstructive pulmonary disease was more common in women than men (24% vs 21%; p<.001) as was asthma (16% vs 9%, p<.001).

The average number of cigarettes smoked per day was 23 in women and 27 in men. Although women (56%) were less nicotine dependent than men (60%; p<.001), their abstinence rate was lower (52% vs 55%, p<.001).

“The findings suggest that despite smoking fewer cigarettes and being less nicotine dependent than men, women find it more difficult to quit. Possible contributors could be the higher prevalence of anxiety, depression and overweight or obesity among women,” said Allagbe in the press release. “It has previously been reported that women may face different barriers to smoking cessation related to fear of weight gain, sex hormones, and mood.”

“The results indicate that comprehensive smoking cessation programmes are needed for women that offer a multidisciplinary approach involving a psychologist, dietitian, and physical activity specialist,” concluded Allagbe.

Reference: Allagbe I, Thomas D, Airagnes G, et al. Specific risk factors profile and abstinence rate of female smokers at high cardiovascular risk from the nationwide smoking cessation services cohort CDT-net. Abstract presented at: ESC Congress 2021; August 25, 2021.