Gender differences in smoking cessation among FEP patients

MedWire News: Gender is significantly associated with smoking cessation rates in first episode psychosis (FEP) patients, with women significantly less likely to quit the habit than men, researchers have found.

“Schizophrenia and bipolar disorder are associated worldwide with higher rates of current and ever smoking than those observed in the general population or in patients with other severe mental illnesses,” observe Ana González-Pinto (University of the Basque Country, Vitoria, Spain) and colleagues.

They explain that “in order to design useful treatments to help psychotic patients with smoking cessation, it is important to identify factors associated with lower smoking cessation in psychotic patients.”

However, they add that, to date, “no prospective studies of first psychotic episodes have explored sex differences in smoking cessation.”



To address this, the researchers studied 112 FEP patients (48% women), aged 15-65 years, with a diagnosis of schizophrenia, bipolar disorder, or other associated condition. Of these, 79% of men and 84% of women were current smokers at baseline.

Smoking cessation rates over an 8-year follow-up period were recorded, and logistic regression analysis was used to identify factors associated with smoking cessation by gender.

After 8 years, just 25% of the men were still current smokers compared with 58% of the women, and men also quit the habit significantly earlier than women.

Overall, women were significantly less likely to quit smoking than men, at an adjusted odds ratio (aOR) of 0.30, and those who used typical antipsychotics were less likely to quit the habit than those who did not, at an aOR of 0.30.

Among the 44 patients with history of cannabis use, continuous cannabis use was not significantly associated with smoking cessation. However, gender significantly influenced this association, with women who continued to use cannabis being less likely to stop smoking than men.

Changes in negative symptom or functioning scores between baseline and year 8 were not significantly associated with smoking cessation, and their interaction with gender was not significant.

However, although change in positive symptom scores over time was not significantly associated with smoking cessation, the interaction with gender was significant, in that among patients who quit smoking, women tended to have lower positive symptom scores than men.

González-Pinto and team conclude in the journal Psychiatry Research: “Women were less prone to quit smoking than men during long-term follow-up after the development of psychosis. Factors that have usually been considered mediators of the difficulties in smoking cessation, such as cannabis use and positive symptoms, were linked to continued tobacco use in women but not in men.”

They add: “If our results are replicated by other studies this would indicate sex difference for the treatment of nicotine dependence in psychotic patients. Treatment for psychotic women who want to quit smoking should probably be more supportive and intensive than that for men.”

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