Population considerations:

  • Body image. Some women feel that smoking will help them control their weight (McKee, 2006). Women tend to have greater response to the weight-reducing effects of nicotine and tend to gain more weight than men after quitting. Weight gain is a significant issue among women, since weight gain may be an important factor that presents and obstacle for cessation attempts. This issue may be of particular concern among women with eating disorders or symptoms of eating disorders (Hatsukami, 1999).
  • Tobacco advertising. Over the past two decades tobacco advertising has been linked to smoking with the women’s liberation movement, portraying smoking as empowering, sophisticated, and a sign of independence. Advertising also has focused on the topic of body image by promoting “light” and “slims” cigarette brands to women (MoALPHA, 2009).
  • Increased enjoyment. Although less sensitive to the effects of nicotine, women may be more sensitive to the sensory aspects of smoking and may have greater pleasurable effects from smoking cigarettes. If the sensory aspects of smoking are reduced, then women report a greater reduction in the strength of cigarettes compared to men (Hatsukami, 1999).
  • Access to resources. Women are less likely to receive prescriptions for cessation medications (Steinberg, 2006).  
  • Age. Young, single women are more likely to smoke during pregnancy (Seamark, 1998; Coleman, 2004).
  • Previous pregnancies. Women who have had previous pregnancies and used tobacco may be less likely to quit smoking because there were not any evident adverse affects previously. They may be harder to convince that smoking has negative effects on a baby’s health (Raatikainen, 2007).
  • Relapse. Many women who quit smoking during pregnancy relapse right after giving birth (Coleman, 2004). They view quitting during pregnancy as temporarily abstaining rather than quitting completely. Providers often do not continue to counsel them on smoking cessation after birth.
  • Low education level. Women of lower educational achievement are more likely to continue to smoke during pregnancy (Coleman, 2004).
  • Presence of smoking partner. Women with partners who smoke are more likely to continue to smoke during pregnancy (Coleman, 2004).

  Strategies to address these considerations:

  • Mobilize special interest groups. Strategies that mobilize women’s group and organizations may be helpful in combating the glamorization of smoking in women. These groups may be effective in calling public attention to the problem of smoking in women and promote interventions or policies that target this specific population.
  • Emphasize negative consequences of smoking. Strategies that call attention to the effects of smoking and how they specifically affect women may be helpful.
  • Include weight management. Since body image and weight gain are barriers for smoking cessation, cessation and prevention strategies that include a weight management component may be particularly effective. Nicotine gum has been found to be effective in reducing weight gain in women (Hatsukami, 1999).
  • Incorporate sensory focus. Treatment of women may require more emphasis on how to deal with the sensory aspects of smoking (Hatsukami, 1999). Women experience more severe withdrawal symptoms, report poorer compliance with nicotine replacement therapies and exhibit greater sensitivity to non-nicotine factors such as the sight, smell and sensations of smoking, compared with men (Schnoll, 2007).
  • Incorporate provider counseling. Health care providers need to strongly reinforce the health risks associated with smoking and pregnancy. They should also emphasize the postpartum benefits to both the mother and child of smoking cessation.
  • Encourage supportive home atmosphere. Partner support and influence might aid in creating a successful smoking cessation intervention. Strategies that include a component that promotes partner social support for quitting may be effective.
  • Continue support. Postpartum relapse prevention interventions may benefit by utilizing a quitter’s stage of change when tailoring an intervention.
  • Tailor messages. Women who continue to smoke during pregnancy tend to hold rather different views about smoking than those who give it up. Therefore, it is important for health professionals to tailor their message to the perceptions and beliefs of smokers in different stages of pregnancy (Coleman, 2004).
  • Choose appropriate therapy. The highest cessation rates are associated with counseling and behavioral interventions (Crawford, 2008). Nicotine replacement therapy is the agent of choice for smoking cessation in pregnancy as the safety of other pharmacotherapies in pregnancy has yet to be proven (Rore, 2008).
  • Encourage pro-activity. Patients requesting treatment are more likely to receive prescriptions for cessation medications (Steinberg, 2006).
  • Educate. Some interventions have used warnings and educational material to deter individuals from smoking in public places. More comprehensive efforts to reduce environmental tobacco smoke include educational campaigns for employees and managers, posting signs about the smoking policy, and providing smoking cessation assistance for those who smoke (Barbeau, 2004).
  • Smoke-free environments. “No smoking” policies are the most common method to reduce environmental tobacco smoke in public places (Barbeau, 2004).

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