Gender differences in age of smoking initiation and its association with health

Abstract

Background: It is generally accepted that smoking starts in adolescence and earlier initiation is associated with more negative health outcomes. Some research suggests that women initiate smoking at later ages and have more negative health outcomes than men. The purpose of this study was to examine gender differences in age of initiation and its association with health.

Methods: The sample included men (n = 8506) and women (n = 8479) with a history of smoking from the 2001–2002 National Epidemiological Survey of Alcohol Related Conditions. Logistic regression was used to examine gender differences in the effect of late smoking initiation on physical and mental health status after adjusting for covariates.

Results: At mostly all ages after 16, women exceeded men in rates of smoking initiation (59.8% versus 50.3%, p < 0.001). Among late initiators (≥16), women were more likely than men to have hypertension (OR: 1.24, CI: 1.09–1.41), heart disease (OR: 1.20, CI: 1.00–1.45), major depressive disorder (OR: 2.54, CI: 2.22–2.92), and generalized anxiety disorder (OR: 2.34, CI: 1.84–2.99). Among early initiators (<16), women were more likely than men to have major depressive disorder (OR: 2.42, CI: 2.11–2.77) and generalized anxiety disorder (OR: 2.01, CI: 1.59–2.54) but there were no gender differences in the likelihood of having hypertension (OR: 1.04, CI: 0.89–1.22) and heart disease (OR: 1.11, CI: 0.90–1.36).

Conclusions: In late adolescence and adulthood, women exceed men in smoking initiation. Late initiation was associated with more significant physical health risks for women than men. Our findings raise questions about generally accepted notions on the age at which smoking initiation occurs and its association with health.

• Age of onset
• cardiovascular disease
• depression
• hypertension
• tobacco use
• women's health

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

This work was supported by the Building Interdisciplinary Research Careers in Women's Health (BIRCWH) Program (Carolyn Mazure, PI), National Institute on Drug Abuse (NIDA), Office of Research on Women's Health (ORWH), Office of the Director, National Institutes of Health (OD) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (NIH K12DA031050) [ABT] and the ORWH and NIDA (NIH P50DA033945) [SAM].