Smoking cessation and gender: the influence of physiological, psychological, and behavioral factors.

While gender differences in smoking cessation do exist, it is unclear whether these differences affect smoking cessation outcomes. Large population-based surveys have shown few gender differences in the ability to quit or to stay quit; conflicting reports continue to emerge from individual studies, however. Existing evidence evaluating possible gender differences related to physiological, psychological, and behavioral factors is reviewed in this paper. Physiological factors affecting women include: differential sensitivity and tolerance to nicotine, greater withdrawal symptoms, and the importance of timing quit attempts in relation to the menstrual cycle. Behavioral and psychological factors include the following: fear of weight gain, need for social support, depression and negative affect smoking, self-efficacy (confidence in ability to quit), and stage of change (readiness to quit smoking). The majority of studies report gender-pooled data and lack the power to identify differential trends. Gender should be used as a stratification variable in the design of smoking cessation studies whenever feasible. To justify gender-specific interventions, more prospective, randomized studies need to be undertaken.