Dear Dr. Garner,
I caught my 17-year-old daughter smoking with her friends the other day. I was very upset, as we have always taught her about the harms of cigarette smoking. It seems that the smoking problem is more prevalent in girls. Could you please address this issue? We could then use the column as a means to bring up the subject with her.
Concerned Mother in Maspeth
 
Dear Concerned Mother,
I was just talking about this problem with my good friend and noted pulmonologist, Dr. Tony Saleh.

Unfortunately, cigarette smoking among young girls is on the rise. This is due in part to the tobacco industry advertising campaign that has successfully targeted this group. They have equated cigarette smoking with being slim, popular, and calm. Girls see it as an opportunity to lose weight as well.

Once someone has started smoking it is very difficult to stop.

Smoking is a deadly habit, with more than 400,000 people in the U.S. expected to die as a result. About twice as many women will die from lung cancer as from breast cancer.

Women face unique health effects from smoking. One difference involves the hormone estrogen, which is found in much larger quantities in women than in men. Estrogen has a combined effect with nicotine to make it more potent in its ability to create addiction. In addition, the blood vessels in women are smaller and also more prone to have irritation of the lining. This predisposes to blood clots, which can cause heart attacks and strokes.

Below are some of the key differences in the effects of tobacco on women:

• Women are more susceptible to the damaging effects of chronic cigarette smoking.

• Girls are more susceptible to advertising.

• Females are more sensitive to second-hand smoke, and the largest group of lung cancer cases in non-smokers is female.

• Women are more susceptible to tobacco’s cancer-producing particles than men.

There are over 60 different cancer-producing elements in cigarette smoke.

• Women, ages 35-52, who smoke 20 cigarettes per day have a six-fold increased risk of heart attacks, almost double that of men.

• Smoking increases the levels of LDL (bad cholesterol) in women more than men.

• Smoking lowers the levels of estrogen in women, predisposing to osteoporosis.

• Nicotine causes a calming effect in women, which helps to perpetuate cigarette use.

• Nicotine enhances the effects of alcohol in women.

• Women experience more severe withdrawal symptoms than men when quitting.

• Women who quit smoking relapse for different reasons than men — the two main causes are fear of weight gain and stress.
 
How can women use this information in regard to cigarette smoking?

1. The first and foremost advice is not to start. We know that the rate of smoking is lowest in the most educated groups. We have to target those at low educational levels. This education should start early on, even in kindergarten, as the age that many start to smoke is as early as 12 years old. There has to be greater control over advertising. Even though it has been banned in radio and television, it is still out there.

It is known that smoking is more prevalent in white populations than in African-Americans or Hispanics, and this segment should be targeted as well.

2. Families — Girls are twice as likely to smart smoking in families where parents smoke. Mothers should absolutely stop smoking, if not for themselves, then for their children’s benefit.

3. The majority of women continue to smoke through their pregnancy. This is a major cause of stillborns, premature babies and babies who suffer from respiratory problems and SIDS.

Nicotine patches do not work well in women. Actually, studies show that quitting cold turkey is actually slightly more effective, with both having about a 10% success rate.

A strategy to quit smoking must be targeted to women.

• Stress reduction needs to be addressed. This can be done with exercise, yoga, hypnosis, or perhaps even a short course of medication.

• Weight gain fears – the use of an antidepressant, Zyban, can help to stop smoking as well as reduce weight gain.

• Varenicline – helps to block the area of the brain responsible for nicotine craving. This new pill has had a success rate of about 20% at two years.

• Education – children should be taken on field trips to talk with smokers who have developed emphysema and other lung diseases. Class trips could be arranged with local hospitals.

• We need to cut out all advertising for tobacco. There should be stricter government regulation.

• Cessation groups – These are excellent, providing positive reinforcement for members. A word of caution is to avoid any group or plan that promises immediate control and stopping of smoking. There is no magic pill or cure.

• Addiction to smoking is very similar to alcohol addiction – It is a lifelong process that will require frequent fine-tuning and reinforcement. There may be relapses, but what is critical is to immediately get back to the plan and start the process of cessation once again.

• Exercise is a key part of the plan. It helps improve the mood as well as the weight loss. It also takes one’s mind off of cigarette smoking.
 
I hope your daughter realizes that the longer and the more she smokes, the harder it will be to stop. Looking ahead, she is putting her future family and children in jeopardy, both from second-hand smoke, and the decrease in life expectancy and disease that she will experience.

If you like, I could take her and some of her friends to meet some chronic smokers so they could get a first-hand account of what she has to look forward to if she continues smoking. Dr. Mascatello and I were discussing this approach, and feel it is one of the best forms of education.

I thank you for your question, and please call on me if I can be of further help.

See you on the next live edition of “Ask the Doctor” on The Prayer Channel.

Dr. Steven Garner, MD, is a Fidelis Care provider. He is affiliated with the New York Methodist Hospital, Park Slope. He hosts the popular “Ask the Doctor” cable TV show seen on The Prayer Channel.