UT PSY 394q - Gender Differences in Smoking Cessation (12 pages)

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Gender Differences in Smoking Cessation



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Gender Differences in Smoking Cessation

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Pages:
12
School:
University of Texas at Austin
Course:
Psy 394q - Seminars
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Page 1 of 12 Journal of Consulting and Clinical Psychology August 1999 Vol 67 No 4 555 562 1999 by the American Psychological Association For personal use only not for distribution Gender Differences in Smoking Cessation David W Wetter Department of Behavioral Science University of Texas M D Anderson Cancer Center Susan L Kenford Center for Tobacco Research and Intervention University of Wisconsin Madison Stevens S Smith Center for Tobacco Research and Intervention University of Wisconsin Madison Michael C Fiore Center for Tobacco Research and Intervention University of Wisconsin Madison Douglas E Jorenby Center for Tobacco Research and Intervention University of Wisconsin Madison Timothy B Baker Center for Tobacco Research and Intervention University of Wisconsin Madison ABSTRACT Gender differences in smoking quit rates are frequently reported and are the subject of much speculation This study examined the generalizability of gender differences in abstinence across study sites treatments and time of relapse as well as potential mediators and moderators of gender effects Participants were smokers who participated in 3 randomized clinical trials of the nicotine patch N 632 Men had higher cessation rates than women at all follow ups The impact of gender on abstinence was unaffected by controlling for study site treatment or time of relapse There was little evidence for mediation or moderation of this relation by any of a host of predictor variables The magnitude and consistency of the gender differential coupled with an inability to account for it highlights a compelling need for additional research specifically aimed at elucidating the relation between gender and abstinence This study was supported by a research grant from Elan Pharmaceutical Research Corporation Gainesville Georgia and Athlone Ireland Correspondence may be addressed to David W Wetter Center for Health Studies Group Health Cooperative 1730 Minor Avenue Suite 1600 Seattle Washington 98101 1448 Electronic mail may be sent to wetter d ghc org Received May 11 1998 Revised September 21 1998 Accepted October 27 1998 Research on gender differences in smoking quit rates has suggested that men are more likely than women to successfully quit smoking Population based data indicate that the quit ratio former smokers to ever smokers is consistently higher for men 52 than for women 47 Centers for Disease Control and Prevention 1994 and smoking prevalence curves within comparable birth cohorts show less quitting for http spider apa org ftdocs ccp 1999 august ccp674555 html 8 30 2000 Page 2 of 12 women than for men Escobedo Peddicord 1996 Recent data from two large community intervention trials also suggest that women have lower rates of quitting than men Bjornson et al 1995 Community Intervention Trial for Smoking Cessation Research Group 1995 Finally our own research on smokers seeking treatment reveals that men have higher cessation rates than do women Fiore et al 1994 Wetter et al 1994 These results are consistent with conclusions made almost 20 years ago in the Surgeon General s report that women have more difficulty giving up smoking than men U S Department of Health and Human Services 1980 p 307 However gender by itself is not a theoretically or clinically meaningful explanatory factor Identifying the mechanisms through which gender influences smoking relapse or identifying subgroups of men or women at particularly high risk for relapse requires examining the association of gender and abstinence in conjunction with other variables Mediator variables typically explain how or why a predictor variable influences an outcome variable Baron Kenny 1986 That is a mediator represents a mechanism through which gender influences abstinence and provides a potential target of intervention Moderator variables influence the strength or direction of the association between the predictor and dependent variable i e there is an interaction between gender and the moderator variable when predicting abstinence Baron Kenny 1986 Moderator variables are useful in identifying subgroups that might be particularly vulnerable to relapse Gender differences in abstinence have been attributed to numerous factors e g depression nicotine dependence withdrawal and demographics Perhaps the most common hypotheses concern the notion that negative affect stress and depression are especially determinant of outcomes among women Borrelli Bock King Pinto Marcus 1996 Depression is associated with a decreased likelihood of quitting smoking Glassman et al 1990 and is more prevalent among women than among men Angst 1992 Therefore women may be less successful than men at quitting smoking because of the mediating effect of depression on cessation Similar arguments have been advanced for negative affect and stress Alternatively depression negative affect and stress may moderate the relation of gender with abstinence presumably by exerting a more pronounced effect among women than among men Borrelli et al 1996 However there is little research that explores how affective variables influence the relation of gender and outcome and to the extent that such data exist they are inconsistent sometimes appearing to be a more important risk factor for men Glassman et al 1990 and other times for women Covey Hughes Glassman Blazer George 1994 Therefore at present it is unclear whether the investigation of affective and stress variables can elucidate gender differences in cessation outcomes Gender differences in abstinence have also been ascribed to nicotine related variables Grunberg Winders Wewers 1991 For example nicotine withdrawal and dependence measures predict abstinence and there is some evidence that withdrawal severity may be greater among women Hatsukami Skoog Allen Bliss 1995 or may interact with gender such that it is more strongly related to relapse among women than among men Gunn 1986 With respect to nicotine dependence women often display lower levels of dependence on both self report and biochemical measures than do men see Perkins 1996 Thus it is unlikely that nicotine dependence mediates the effects of gender on abstinence However in at least one study dependence functioned as a moderator variable such that its effects on abstinence were stronger among women than among men Jackson Stapleton Russell Merriman 1986 Perkins 1996 has posited specific mechanisms that might underlie gender differences in treatment response He has argued that nicotine replacement therapies


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