Psychology explains why it might be harder for women to quit smoking than men

Quitting smoking is often described as one of the hardest habits to break. Many people expect the toughest challenge to come weeks or months into the journey. But what if the biggest hurdle arrives within the very first 24 hours? A cross-national study suggests that this critical first day may be especially difficult for women, offering new insight into the psychology of smoking cessation.

Researchers found that women in 12 low- and middle-income countries (LMICs) were more likely than men to relapse on the first day of a quit attempt, a period already known to play a major role in determining long-term success.

The first day may be the hardest for women

Published in the May 2022 edition of Addictive Behaviors, the study was led by João M. Castaldelli-Maia and an international team of researchers, including experts from Columbia University Mailman School of Public Health. Using data from the Global Adult Tobacco Survey (2008–2012), the researchers examined 16,576 smokers across 12 low- and middle-income countries who had attempted to quit smoking at least once in the previous 12 months to understand what happens during the crucial first day of abstinence.

Researchers reported that the odds of relapsing within the first day were significantly higher for women than men in six of the countries studied. In the remaining six countries, no significant sex differences were found. Even after accounting for national tobacco consumption and tobacco-control policies, the overall finding remained consistent.

The researchers noted that maintaining abstinence during the first 24 hours is one of the strongest predictors of long-term smoking cessation, making this early period particularly important.

What the study found

According to the researchers:

• Women had higher odds of relapsing on the first day of a quit attempt than men across the overall analysis.
• The finding remained significant even when countries with relatively high or low rates of female smoking were excluded from the analysis.
• Larger health warning labels on cigarette packs were associated with lower odds of first-day relapse among women.

Why the first 24 hours matter

The study highlights that the first day without smoking is not just another milestone; it is one of the most important stages of quitting.

Researchers cited previous evidence showing that successfully remaining smoke-free for the first 24 hours is strongly associated with sustained abstinence months later. The study also notes that many smokers experience withdrawal symptoms during this period, including cravings, negative mood, and hunger.

What the researchers concluded

The researchers concluded that the first day of a quit attempt appears to be more challenging for women than men in the LMICs included in the study.

They suggest that smoking-cessation efforts should consider this early abstinence period when designing support strategies. The authors also noted that tailored interventions, alongside national tobacco-control policies, counseling, and pharmacotherapy, could play an important role in helping women during the initial phase of quitting smoking.

Why might women find it harder to quit smoking?

While the featured study found that women were more likely than men to relapse during the first day of a quit attempt, it did not investigate the reasons behind the difference. However, a 2016 review published in Preventive Medicine examined evidence from 190 studies and found that women generally have more difficulty maintaining long-term abstinence from smoking than men.

The review cautioned that there is no single explanation for this difference. Instead, the authors concluded that women's greater difficulty in quitting smoking is likely influenced by multiple biological, psychological, and social factors that interact with one another.

A complex mix of factors

Rather than pointing to one cause, the researchers argued that smoking cessation should be viewed through a bio-psycho-social lens, meaning that physical, emotional, and social influences all play a role in a person's ability to quit. The authors wrote that women appear to have more difficulty achieving long-term abstinence than men "based on the influence of multi-level bio-psycho-social factors."