Sex Differences in Health: Evidence and Explanations 363Sussman et al., 1998). The Fagerstrom Toler-
ance Questionnaire, shown in Table 10.7, is
a widely used measure of physiological ad-
diction to nicotine (Heatherton et al., 1991).
If you have friends who smoke, conduct
Do Gender 10.3 to see who is more strongly
addicted to smoking. Also see Sidebar 10.2 for
a discussion of how methodology affects re-
porting of withdrawal symptoms.
Perkins (2009), however, has argued
that women arelesslikely than men to be
physiologically addicted to nicotine. This
argument is based on research that shows
nicotine replacement therapies are less ef-
fective for women. A meta-analytic review
of the literature showed that women re-
ceive about half the benefit of men from the
nicotine patch (Perkins & Scott, 2008). One
illustrative study showed that nicotine re-
placement therapy influenced a physiologi-
cal recording of sleep quality—an objective
measure of withdrawal symptoms—among
men but not women (Wetter et al., 1999a).
Men and women who had quit smoking
were randomly assigned to receive a nico-
tine patch or a placebo patch, and their sleep
quality was measured physiologically. Men
who received the nicotine patch had better
sleep quality, as indicated by physiological
recordings of sleep duration and sleep awak-
enings, than men who did not receive the
patch. The patch did not influence women’s
sleep quality. Thus, the nicotine patch was
effective in helping men sleep but had no ef-
fect on women’s sleep quality. This research
suggests that men are more physiologically
addicted to nicotine.
If women are not as physiologically ad-
dicted to nicotine, what is the basis of wom-
en’s addiction? Perkins (2009) suggests that
smoking is more of a sensory experience for
women than for men. Women enjoy the vi-
sual and olfactory experiences of smoking
more than men do.are more likely than men to be depressed.
People with a history of depression or anxi-
ety disorders are more likely to smoke than
are people without such histories (Morrell,
Cohen, & McChargue, 2010). Even depressed
adolescent females are more likely to start
smoking than their male counterparts (Whit-
beck et al., 2009). And, the relation of smoking
to depression is stronger among women than
men (Husky et al., 2008; Massak & Graham,
2008; Morrell et al., 2010). Women smokers,
in particular, are likely to believe that smok-
ing enhances their mood and helps them to
cope with stress (Hazen, Mannino, & Clayton,
2008; Reid et al., 2009). It also turns out that
quitting smoking is associated with an in-
crease in negative mood—and more so for
women than men (Morrell et al., 2010). One
study of smokers showed that anxiety and
hostility increased when smokers abstained,
and the increase was greater among women
than men (Xu et al., 2008). In addition, when
participants were allowed to resume smoking,
women experienced more relief from anxi-
ety than men. To recap, one reason women
are less able to quit smoking than men is that
depression interferes with cessation, women
are more likely than men to be depressed,
and smoking is more strongly associated with
mood enhancement in women than men.
Another theory as to why women have
more difficulty quitting smoking is that
women are more likely to be physiologically
addicted to smoking. Women become ad-
dicted to smoking at lower nicotine levels
and with fewer cigarettes compared to men
(Tuchman, 2010). Female smokers are more
likely than male smokers to report behaviors
indicative of physiological addiction, includ-
ing smoking a cigarette within 10 minutes of
waking, smoking when sick, being upset about
having to go a whole day without a cigarette,
and reporting “not feeling right” if one goes
too long without smoking (Royce et al., 1997;M10_HELG0185_04_SE_C10.indd 363 6/21/11 8:54 AM