Perkins KA, Scott J. Sex differences in long-term smoking cessation rates due to nicotine patch. Nicotine Tob Res 10: 1245-1251

Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Nicotine & Tobacco Research (Impact Factor: 3.3). 07/2008; 10(7):1245-50. DOI: 10.1080/14622200802097506
Source: PubMed


Compared to men, women may be at greater risk for smoking-related diseases and have greater difficulty quitting smoking. Sex differences in medication response could guide treatment for smoking cessation to improve women's quit rates. We conducted a meta-analysis of the 14 placebo-controlled nicotine patch trials (N = 6,250) for which long-term (6 months) clinical outcome results could be determined separately by sex. This analysis updated a meta-analysis of 11 of these trials that found no significant sex differences due to nicotine patch. The increase in quitting due to the nicotine vs. placebo patch was only about half as large in women as in men. Pooled absolute quit rates at 6 months for nicotine and placebo patch, respectively, were 20.1% and 10.8% in men, and 14.7% and 10.1% in women. The odds ratio for quitting due to nicotine vs. placebo patch was lower in women (OR = 1.61) than in men (OR = 2.20), with an interaction odds ratio of 1.40 (95% CI = 1.02-1.93, p = .04). This sex difference did not vary significantly by whether or not formal counseling was provided. Poorer outcomes in women vs. men treated with nicotine patch suggests that increasing the quit rates of women smokers may require supplementing patch treatment or use of other medications.

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    • "Women face higher risks of smoking-related diseases and may also have greater difficulty quitting compared to men (Allen, Oncken, & Hatsukami, 2014; Perkins & Scott, 2008). Ovarian hormones potentially affect a woman's ability to quit. "
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    ABSTRACT: Although an estimated 25% of premenopausal smokers report using oral contraceptives (OC), little is known about how OC use may influence smoking cessation. The purpose of this study was to examine the difference in smoking-related symptomatology during acute smoking abstinence between women on a standardized combination OC (Tri-Sprintec™) compared to women not on OCs (no-OC).Participants were women aged 18-40 who smoked ≥. 5 cigarettes/day and reported regular menstrual cycles. Using a controlled cross-over design, participants completed two six-day testing weeks: Low Progesterone Week (LPW; Follicular (F) phase in no-OC or 1st week of pills in OC) and High Progesterone Week (HPW; Luteal (L) phase in no-OC or 3rd week of pills in OC). Each testing week included daily assessment of symptomatology and biochemical confirmation of smoking status. During smoking abstinence, the OC group (n. =. 14) reported significantly lower levels of positive affect (21.56. ±. 7.12 vs. 24.57. ±. 6.46; β. =. 3.63, p. =. 0.0323) than the no-OC group (n. =. 28). Further significant interactions between group and testing week were observed as follows: Smoking satisfaction was higher during LPW in the OC group (LPW: 4.29. ±. 1.30 vs. HPW: 4.10. ±. 1.37) but higher during HPW in the no-OC group (LPW: 3.91. ±. 1.30 vs. HPW: 4.23. ±. 1.30; β. =. -. 0.5499, p. <. 0.0001). Similar interactions were noted in negative affect and psychological reward of smoking. These results suggest that women on OCs may have different patterns of smoking-related symptomatology during short-term smoking abstinence as compared to women not on OCs. Additional work is needed to examine how this may affect smoking cessation efforts.
    Addictive Behaviors 02/2015; 41. DOI:10.1016/j.addbeh.2014.10.018 · 2.76 Impact Factor
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    • "For example, women consume more tobacco products relative to men (Hammond, 2009; Oh et al., 2010). Women also exhibit higher relapse rates and are less likely to benefit from nicotine replacement therapy (NRT) than men (Perkins, 2001; Cepeda-Benito et al., 2004; Schnoll et al., 2007; Perkins and Scott, 2008; Piper et al., 2010). During abstinence from tobacco, women also report more intense symptoms of withdrawal than men (Heishman et al., 2010; Nakajima and al’Absi, 2012; Perkins et al., 2013). "
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    ABSTRACT: Stress is a major factor that promotes tobacco use and relapse during withdrawal. Although women are more vulnerable to tobacco use than men, the manner in which stress contributes to tobacco use in women versus men is unclear. Thus, the goal of this study was to compare behavioral and biological indices of stress in male and female rats during nicotine withdrawal. Since the effects of nicotine withdrawal are age-dependent, this study also included adolescent rats. An initial study was conducted to provide comparable nicotine doses across age and sex during nicotine exposure and withdrawal. Rats received sham surgery or an osmotic pump that delivered nicotine. After 14 days of nicotine, the pumps were removed and controls received a sham surgery. Twenty-four hours later, anxiety-like behavior and plasma corticosterone were assessed. The nucleus accumbens (NAcc), amygdala, and hypothalamus were examined for changes in corticotropin-releasing factor (CRF) gene expression. In order to differentiate the effects of nicotine withdrawal from exposure to nicotine, a cohort of rats did not have their pumps removed. The major finding is that during nicotine withdrawal, adult females display higher levels of anxiety-like behavior, plasma corticosterone, and CRF mRNA expression in the NAcc relative to adult males. However, during nicotine exposure, adult males exhibited higher levels of corticosterone and CRF mRNA in the amygdala relative to females. Adolescents displayed less nicotine withdrawal than adults. Moreover, adolescent males displayed an increase in anxiety-like behavior and an up-regulation of CRF mRNA in the amygdala during nicotine exposure and withdrawal. These findings are likely related to stress produced by the high doses of nicotine that were administered to adolescents to produce equivalent levels of cotinine as adults. In conclusion, these findings suggest that intense stress produced by nicotine withdrawal may contribute to tobacco use in women.
    Frontiers in Psychiatry 05/2013; 4:38. DOI:10.3389/fpsyt.2013.00038
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    • "Although smoking rates have declined over the past 40 years, the rate of decline among women has been less than the rate of decline among men (20% compared to 30%, respectively; [2]). The mechanisms underlying why women have lower rates of cessation than men remain unknown; however, some research suggests that sex differences in responses to nicotine and non-nicotine factors may influence smoking cessation outcomes [3,4]. "
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    ABSTRACT: Background Anecdotal and clinical theories purport that females are more responsive to smoking cues, yet few objective, neurophysiological examinations of these theories have been conducted. The current study examines the impact of sex on brain responses to smoking cues. Methods Fifty-one (31 males) cigarette-dependent sated smokers underwent pseudo-continuous arterial spin-labeled perfusion functional magnetic resonance imaging during exposure to visual smoking cues and non-smoking cues. Brain responses to smoking cues relative to non-smoking cues were examined within males and females separately and then compared between males and females. Cigarettes smoked per day was included in analyses as a covariate. Results Both males and females showed increased responses to smoking cues compared to non-smoking cues with males exhibiting increased medial orbitofrontal cortex and ventral striatum/ventral pallidum responses, and females showing increased medial orbitofrontal cortex responses. Direct comparisons between male and female brain responses revealed that males showed greater bilateral hippocampal/amygdala activation to smoking cues relative to non-smoking cues. Conclusions Males and females exhibit similar responses to smoking cues relative to non-smoking cues in a priori reward-related regions; however, direct comparisons between sexes indicate that smoking cues evoke greater bilateral hippocampal/amygdalar activation among males. Given the current literature on sex differences in smoking cue neural activity is sparse and incomplete, these results contribute to our knowledge of the neurobiological underpinnings of drug cue reactivity.
    Biology of Sex Differences 04/2013; 4(1):9. DOI:10.1186/2042-6410-4-9 · 4.84 Impact Factor
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