Perkins K A
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
CNS Drugs. 2001;15(5):391-411. doi: 10.2165/00023210-200115050-00005.
Women may be at relatively greater risk of smoking-related diseases than men but tend to have less success than men in quitting smoking. The failure of most outcome studies to report results by gender and the lack of statistical power for detecting significant gender differences currently do not allow for many firm conclusions to be drawn about smoking cessation rates in women, but several trends warrant attention and further study. First, the difference in cessation rates for women versus men may be even greater in trials of nicotine replacement therapies (NRT). This suggests that women benefit less from NRT relative to men, although this difference may depend on the particular form of NRT (e.g. inhaler versus gum). On the other hand, some non-NRT medications may reverse the poorer outcome of women, producing quit rates in women comparable with those in men. Gender differences in outcome, as well as overall success rates, with NRT and some of the non-NRT medications appear to be enhanced when treatment includes substantial behavioural counselling. However, while several of the non-NRT medications may be particularly appropriate to consider for treating women trying to quit smoking, adverse effects may limit widespread use of some of these drugs, such as clonidine and naltrexone. Thus, even if the gender differences in outcome with NRT versus non-NRT drugs are confirmed in further research, such findings do not necessarily justify limiting NRT use in women, because such treatment is clearly effective and is likely to be safer and more readily available than non-NRT medications. Nevertheless, study of the mechanisms by which some non-NRT drugs are effective in women may aid our understanding of factors that are more influential in smoking behaviour in women than in men. Secondly, smoking cessation treatment for women must address several other issues that often emerge, and these are most likely to require behavioural counselling that is tailored to these problems. These issues include concern about bodyweight gain, restrictions on medication use in pregnant smokers, variability in mood and withdrawal as a function of menstrual cycle phase, harnessing social support to foster abstinence, and the possibility that smoking-associated environmental cues may be more influential in smoking behaviour in women than men. Greater attention to gender differences in clinical trial outcomes and to addressing concerns of women smokers may aid in the development of substantially improved smoking cessation interventions for women.
与男性相比，女性可能因吸烟相关疾病面临相对更大的风险，但在戒烟方面往往比男性更难成功。大多数结果研究未能按性别报告结果，而且目前缺乏检测显著性别差异的统计效力，因此无法就女性的戒烟率得出许多确凿结论，但有几个趋势值得关注和进一步研究。首先，在尼古丁替代疗法（NRT）试验中，女性与男性的戒烟率差异可能更大。这表明相对于男性，女性从NRT中获益更少，尽管这种差异可能取决于NRT的具体形式（例如吸入器与口香糖）。另一方面，一些非NRT药物可能会扭转女性较差的戒烟结果，使女性的戒烟率与男性相当。当治疗包括大量行为咨询时，NRT和一些非NRT药物在结果以及总体成功率方面的性别差异似乎会加大。然而，虽然几种非NRT药物可能特别适合考虑用于治疗试图戒烟的女性，但副作用可能会限制其中一些药物（如可乐定和纳曲酮）的广泛使用。因此，即使在进一步研究中证实了NRT与非NRT药物在结果上的性别差异，这样的发现也不一定证明限制女性使用NRT是合理的，因为这种治疗显然是有效的，而且可能比非NRT药物更安全、更容易获得。尽管如此，研究一些非NRT药物对女性有效的机制，可能有助于我们理解在女性吸烟行为中比在男性中更具影响力的因素。其次，针对女性的戒烟治疗必须解决经常出现的其他几个问题，而这些问题很可能需要针对这些问题量身定制的行为咨询。这些问题包括对体重增加的担忧、对怀孕吸烟者用药限制、情绪和戒断症状随月经周期阶段的变化、利用社会支持促进戒烟，以及与吸烟相关的环境线索在女性吸烟行为中可能比在男性中更具影响力的可能性。在临床试验结果中更多地关注性别差异以及解决女性吸烟者的担忧，可能有助于开发出大幅改进的女性戒烟干预措施。
