Why? Weight, moods prompt women to puff

Caren Chesler, 40, is no dummy. She's well aware of the health risks associated with smoking: She even lost her father to a form of esophageal cancer thought to be linked to cigarettes. Yet she continues to light up– sometimes smoking as many as 35 cigarettes a day.

"I think about my father's death, and the increased probability that I'll get cancer," she says. "Does it make me stop?" she asks. "No."

Like Caren, most female smokers can practically recite the statistics in their sleep:

*They run up to six times the risk of heart attack that nonsmoking women do.

*Lung cancer is the leading cause of cancer death among women and will kill an estimated 68,800 women this year (about 29,000 more than will die of breast cancer).

*Smoking-related illnesses, such as lung cancer and heart disease, will kill close to 178,000 women each year.

*Women who smoke have an increased risk of cervical cancer and difficulty conceiving.

Despite these sobering statistics, a quarter of all American women in their 30s smoke, the highest percentage of any age group. (Twenty-one percent of women smoke overall.)

What's behind our predilection to puff?

Experts say there are a number of factors that can make it extra tough for women to kick the habit. In fact, women are one-third less likely to be successful at stopping than men, according to Saul Shiffman, director of the Smoking Research Group and the Clinical Psychology Center at the University of Pittsburgh. Why do women find it so challenging to give butts the boot? Is it possible for a woman to become a quitter for life? Read on.

"I'm afraid I'll pile on pounds"

A significant number of female smokers say they want to quit but are afraid they'll gain weight if they do. (One of the reasons teen girls start smoking in the first place is to avoid gaining weight.) They're right to be concerned. Smokers tend to have diets low in fruits and vegetables and high in fat, according to Nancy Betts, professor of nutrition and health sciences in the College of Education and Human Sciences at the University of Nebraska, Lincoln. Plus, nicotine speeds up your metabolism, so when you quit, your body slows down the rate at which it burns calories. Smoking may also affect levels of serotonin, the feel-good hormone that regulates mood and appetite (in fact, smoking itself may act as a mild antidepressant).

When you come off cigarettes, it's tempting to reach for sweets and carbs in an attempt to improve your mood. It all adds up to a possible weight gain of 5 to 15 pounds, according to Robert Klesges, lead author of the book How Women Can Finally Stop Smoking.

It's no surprise that women who try to quit often consider starting a diet at the same time, but experts say this double-barreled approach will probably fail. "Women need to focus all their energies on quitting smoking first and worry about the weight gain later," says Klesges. "In fact, I tell them not even to step on the scale for six weeks."

"I'll become a total crab"

Men who quit smoking get cranky, too, but women seem to be hit with an extra whammy. The mood-elevating properties of nicotine are stronger for women, making their pre-quit highs higher and post-quit lows lower. Plus, the side effects of stopping– lowered concentration, heightened anxiety, depression, and irritability– often mimic the symptoms of premenstrual syndrome (PMS) and, in a cigarette catch-22, PMS often makes those symptoms worse.

About 60 percent of relapses occur during the first 14 days after someone has kicked the habit, according to Klesges. "Women should quit smoking a few days after their period ends so they're not hit with PMS at the same time," he says.

Even so, a woman trying to quit may feel extra vulnerable to remarks from others during the first two weeks after she stops. While a man might brush it off when a friend says, "You're so grouchy now that you've quit," statements like that can cause some women to ditch their efforts. Instead, women should say: "The first few weeks are the hardest, so I hope you'll understand if I'm stressed."

"I've tried to quit– and I can't"

Stress reduction is often cited as one of the biggest benefits of smoking. A fight with a friend, a harried day, or an unexpected traffic jam become reasons to light up. Indeed, a deep drag can help a smoker chill out, concentrate better, and feel more energetic when she's tired.

Once nicotine enters the brain, it results in a temporary change in chemistry that the smoker experiences as enhanced pleasure, decreased anxiety, and a state of calm alertness. "It goes straight into the brain in a very immediate, sharp spike," says Dr. Corinne Husten, medical officer of the Centers for Disease Control's (CDC) Office of Smoking and Health. "It's much more reinforcing than other drugs, such as heroin, that have a slower delivery to the brain."

"My friends all smoke"

A strong sense of connection often comes with smoking. While tobacco company ads 30 years ago emphasized the independent woman ("You've come a long way, baby!"), today's product pitches feature groups of gregarious friends chatting, laughing, and bonding over cigarettes. For many women, kicking the smoking habit often means limiting contact with or moving away from those relationships– a decision that may be as tough as actually giving up cigarettes.

Although having pals who smoke can make it more difficult to quit, it's not impossible, says Steve Wood, a therapist who counsels patients at the live-in nicotine addiction program at St. Helena Center for Health in Napa Valley California. "Ask your friends to work with you by not smoking around you and by certainly not offering you a cigarette," he advises. "As you continue to succeed, you'll get a lot of reinforcement from others wanting what you have."


"Smoking is my identity"

"Women almost always start smoking in their teen years because they want to be cool or sexy," says Wood. In fact, many women in their 30s who light up started as teenagers. And the rebellion that played a part in the first puff remains decades later, but with a slightly different face.

"The young rebel is closely connected to a strength I see in successful adult women who smoke: They are highly independent decision makers in both career and family" Wood explains. "The rebel transforms over time and becomes the modern woman managing life in the early 21st century– career, mother, wife, often divorced, and on her own or never married."

Smoking is a constant for these women. So while they might change their romantic relationships or move or get a new job, cigarettes remain, literally, as pocketsize friends. "The one companion for these women throughout the years is their cigarettes," says Wood. "They are, in some ways, more dependable than these other aspects of their lives."



 Quitting is tough, no doubt about it. The typical long-term rates for those who rely on nothing but their own willpower are a dismal five to eight percent. But the good news is, experts say you get better, not worse, at kicking the habit each time you try because you learn what pushed you to begin again.

Before you try to quit (whether for the fourth or fortieth time), it's crucial that you prepare. "Often it takes a glimpse of reality for a smoker to be ready to take that step," says Shiffman, who has studied smoking addiction for more than 30 years. "It could be that they see someone get cancer or heart disease, or they run for a bus and realize how winded they are."

Once you're ready, the best approach is to use several of the strategies below, not just one:

1. Buddy up. Tell one or more friends, family members or co-workers you're quitting and ask them for help. Often, simply sharing your intention to quit can make you more committed. Choose people who can sympathize with your situation. "A nonsupportive partner who continues to smoke is one of the most difficult problems to overcome," says Marc Manley, executive director of the Center for Tobacco Reduction and Health Improvement at Blue Cross and Blue Shield of Minnesota. If your husband won't quit, says Dr. Manley, at least suggest that he smoke away from the house.

2. Go to a pro. "Whether one-on-one with a doctor or through a support group, counseling is key" says Dr. Husten of the CDC. "Together you'll develop a plan that includes practical strategies for quitting."

One of the newest-and best-twists on professional counseling is telephone quit lines. Thirty-three states have them, and Blue Cross and Blue Shield of Minnesota has set up system-wide phone programs for its members. Callers to the Blue Cross and Blue Shield program are immediately connected with someone who will help them create a plan of attack, with tailored homework plus follow-up appointments. Most telephone quit programs are free, and a study of smokers who called a California-based line showed that telephone counseling roughly doubled abstinence rates even 12 months after the smokers had given up cigarettes. (The American Legacy Foundation's Circle of Friends Web site, join-the-circle.org, has a list of state telephone quit lines, as well as lists of other national quitting resources.)

Computer-based counseling programs are becoming more prevalent. The American Lung Association's (ALA) Freedom From Smoking online cessation clinic (ffsonline.org) is free 24 hours a day. Another online effort, Committed Quitters (committedquitters.com), is a personalized support program available free to purchasers of certain nicotinereplacement products (you must enter a code from the inside of the product box). It creates a targeted plan based on your responses to a series of questions, ranging from readiness to quit to the number of cigarettes smoked per day.

3. Don't dismiss meds. Quit rates using any one of the six available medications to help people stop smoking are around 25 percent. These meds fall into two categories: nicotine replacements (patches, inhalers, gums and nasal sprays) and medication (the antidepressant bupropion hydrochloride, marketed as Zyban). "Pick one based on your preference and on your previous usage and failure patterns," says Dr. Husten. For example, if you're prone to depression when quitting, Zyban may be your best bet.

There's also evidence that combining different medications-a patch with nicotine gum, for example-can be particularly effective. "The patch provides a low, steady amount of nicotine, to reduce withdrawal symptoms. Nicotine gum can then provide more nicotine when needed," explains Dr. Husten.

4. Track your triggers. Many smokers associate a cigarette with a morning cup of coffee, the drive to work or an afternoon break at the office-routines that, when repeated day in and day out, can make lighting up a kneejerk reaction. Similarly, certain situations, like drinking alcohol or socializing in a smoky bar, can prompt you to reach for a pack.

"You need to change the routines that might lead you back to cigarettes," warns Shiffman. "Be vigilant. Ask yourself, `Are there any triggers coming up, such as a stressful meeting with my boss?' and have a plan in place for dealing with them." For example, you might chew a stick of nicotine gum before the meeting.

5. Try. . . and try again. No matter which methods you choose, it's crucial to stick with them-and to try again if you fail. Experts say it can take between five and 11 attempts before a person's efforts to stop smoking finally stick.

It's well worth it. Quit now and your body will begin to repair part of the damage almost immediately-some benefits, such as lowered blood pressure and pulse rate, appear in as little as 20 minutes after your last cigarette. After about 15 years without cigarettes, an ex-smoker's risk of getting lung cancer is only slightly greater than that of someone who's never puffed. Now that's news that can help you breathe easy.

Jennifer Pirtle writes about health, fitness, nutrition and other lifestyles topics for Self, Health, Lifetime, Martha Stewart Living, Fitness, Cosmopolitan, and Lifetime Magazine where this article originally appeared.