Women, smoking and vulnerability factors
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Spanish Association Against Cancer, Spain
Publication date: 2023-04-25
Tob. Prev. Cessation 2023;9(Supplement):A174
The number of women tobacco users in 2018 was 244 million. By 2025, there should be 32 million fewer women using tobacco, mainly in low- and middle-income countries. European women are the slowest to reduce tobacco use in the world (WHO, 2019). Smoking is one of today's major global public health problems and the leading cause of preventable death. In Spain, the national health survey shows a progressive and significant decline in tobacco consumption in men since the 1990s, but much slower in women where consumption increased until 2001 and has subsequently experienced a very slight decline (Higes & Ramos, 2013). According to the 2020 European Health Survey in Spain, 16.4 % of women and 23.3 % of men smoke daily. The highest percentage in men corresponds to the age group 25-34 years, and in women to the age group 45-54 years. It seems of particular importance to pay attention to gender differences in perceptions of smoking, motivations for quitting, the role of mental health and weight control. Among the reasons for quitting smoking for women, physical and psychological health reasons were more frequent, while health problems were more common in men. Women have a stronger relationship between risk, pre-treatment motivation and treatment outcome (McKee et al.,2005), confirming the importance of motivation in the success of treatment for women. Another factor favouring smoking cessation in women is that women are more likely than men to seek help, self-help, or treatment to quit smoking (Zhu, et al., 2005). Regarding the link between mental health and tobacco use, there is evidence that stress, depression, trauma, and negative emotions in general are closely linked to female smoking, a trend that may be exacerbated among the most disadvantaged social groups (Hemsing et al., 2015).

The main objective of this study is to identify female determinants of tobacco use in terms of patterns of initiation, progression, and cessation.

Material and Methods:
A sample of 98 women with an average age of 47 years, attending multicomponent treatment in the form of group therapy, combined (medical-psychological), in the smoking cessation unit of the Spanish Association Against Cancer in Burgos in 2019. Treatment consisting of 13 intervention sessions: an initial psychological assessment, seven psychological intervention sessions, two medical sessions and three follow-ups.

The study variables were: Age: 12% are under 35 years old, 46% are under 50 years old and 42% are between 51 and 73 years old. Education level: 43% have basic education, 25% have intermediate vocational education and 32% have university education. Marital status: 54% are married/partnered, 26% are single, 14% are divorced or separated and 6% are widowed. Number of children: 33% have no children, 19% have one child, 38% have two children, 9% have three children and 1% have four or more children. Smoking environment: 24% report living with a smoker. Support: 52% report feeling supported to quit. Consumption rates: 9% smoke less than ten cigarettes a day, 78% smoke between ten and twenty, 12.2% smoke more than twenty cigarettes a day. 55% smoke blond tobacco. Age of onset: 45% reported having started smoking between 12 and 15 years of age, 42% between 16 and 19 years of age and 13% between 20 and 23 years of age. Level of addiction as measured by the Fagerström test: 18% had less than 4 (low dependence), 52% between 4 and 6 (moderate dependence) and 29% had rates higher than 7 (high or very high level of dependence), Pharmacological treatment for smoking: 20% treated with Bupropion, 20% with nicotine replacement therapy, 42% with varenicline and 17% with no treatment. Comorbid psychiatric pathology: 23% report being currently under psychiatric or psychological treatment. Cannabis: 2.5% reported dual use with cannabis. Regarding expectations of success: 11.6% less than 5, 20.9% between 6 and 8 and 44.8% between 9 and 10. Current stress: 27% do not consider themselves to be going through a difficult or stressful time compared to 73% who do. The following variables are significant with abstinence six months after starting treatment: marital status, perceived current stress, level of education, current psychiatric treatment and levels of addiction. The following variables are not significant with abstinence at six months: age, children, age of onset, number of cigarettes, tobacco consumption, years of smoking, type of pharmacological treatment, perception of support, having a smoker at home and initial expectations of success.

Smoking treatment needs to be redesigned and adapted to take into account the structural and intermediate determinants of social inequalities in health. In order to analyze smoking from a gender perspective, it is necessary to have data that allow not only to describe gender differences, but also to analyze the determinants in order to apply them to prevention and treatment programmes aimed at specific or vulnerable groups, such as women of low socio-economic status, women with psychiatric pathology, pregnant women or younger women.

The authors declare that they have no conflict of interest with the tobacco industry.
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