The Psychology of Gender 4th Edition

Sex Differences in Health: Evidence and Explanations 365

SIDEBAR 10.2:How Methodology Affects Self-Report of Withdrawal Symptoms

One way physiological addiction is measured is by self-reports of withdrawal symptoms when

quitting smoking. Withdrawal symptoms include depressed mood, insomnia, irritability, anxi-

ety, difficulty concentrating, restlessness, decreased heart rate, and increased appetite (American

Psychiatric Association, 2000). It is not clear whether women or men report more withdrawal

symptoms. The methodology of a study appears to influence whether sex differences in with-

drawal symptoms emerge. Prospective studies (conducted during cessation) show no sex differ-

ences, whereas retrospective studies (conducted after cessation) show that women recall more

symptoms than men. What is the source of this discrepancy? Is it that women recall more symp-

toms than they actually experience or that men recall fewer symptoms? The latter seems to be

the case. Pomerleau and colleagues (1994) compared prospective and retrospective reports of

withdrawal symptoms. They asked men and women first to recall their experience of four com-

mon withdrawal symptoms (anxiety, anger/irritation, difficulty in concentrating, hunger) from

previous attempts to quit smoking and then to report prospectively their experience of these

symptoms over the first few days that they quit smoking. Men recalled fewer symptoms in the

past than they actually experienced during their present attempt; in other words, men’s recall of

symptoms underestimated the extent to which they actually experienced symptoms. For exam-

ple, only 5% of men said they experienced difficulty concentrating during past attempts to quit

smoking, but 58% reported this symptom during the present attempt. Women’s retrospective

reports of difficulty concentrating were more similar to their prospective reports (40% vs. 56%).

There were no sex differences in any of the prospective reports of symptoms. Thus, retrospective

methodologies may suggest that women experience more withdrawal symptoms due to men’s

tendency to recall fewer symptoms than they actually experienced. According to self-reports

of current withdrawal symptoms, women and men experience similar withdrawal symptoms,

which means similar levels of physiological addiction.

associated with smoking cessation is far less

hazardous to health than the hazards associ-

ated with smoking.

One motivator for women to quit

smoking is pregnancy. Between 23% and 43%

of women quit smoking when they become

pregnant in the United States (Schneider

et al., 2010). Women who are of a lower SES,

have partners who smoke, are more addicted,

and have more children are less likely to quit

smoking while pregnant. However, most

women who quit when they become pregnant

subsequently resume smoking after child-

birth. Half of women resume smoking within

six months of delivery and over two-thirds

resume smoking by one year (Centers for

Disease Control and Prevention, 2007b).

Thus, various theories have been put

forth to explain why women have more diffi-

culty than men when they try to quit smoking.

One theory is that women are more depressed

and depression interferes with smoking ces-

sation. Some evidence supports this. Another

theory is that women are more physiologi-

cally addicted to smoking, but the evidence

in support of this theory is completely con-

tradictory. On some self-report measures of

physiological addiction, women appear more

dependent than men on nicotine; yet another

group of investigators suggests men are more

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