Why Female Smokers Have Poorer Long-Term Health Outcomes than Male Smokers: The Role of Cigarette Smoking During Pregnancy

Li Yang; Yunchun Zhou; Mingyan Jiang; Wendy Wen; Yanfang Guo; Smita Pakhale; Shi Wu Wen

doi:10.3389/phrs.2024.1605579

Why Female Smokers Have Poorer Long-Term Health Outcomes than Male Smokers: The Role of Cigarette Smoking During Pregnancy

Public Health Rev. 2024 Feb 29:45:1605579. doi: 10.3389/phrs.2024.1605579. eCollection 2024.

Authors

Li Yang^#^{1

2}, Yunchun Zhou^#^{2

3}, Mingyan Jiang¹, Wendy Wen⁴, Yanfang Guo^{2

5}, Smita Pakhale^{2

6

4}, Shi Wu Wen^{2

4

7}

Affiliations

¹ Respiratory Medicine Department of Xiangtan Central Hospital of Hunan Province, Xiangtan, Hunan, China.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ Department of Pulmonary and Critical Care Medicine of Yuxi People's Hospital of Yunnan Province, Yuxi, Yunnan, China.
⁴ School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.
⁵ BORN (Better Outcome Registry Network) Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
⁶ Division of Respiratory, The Ottawa Hospital, Ottawa, ON, Canada.
⁷ Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.

^# Contributed equally.

Abstract

Objectives: Women's health status is better than men but the opposite is true for female smokers who usually have poorer long-health outcomes than male smokers. The objectives of this study were to thoroughly reviewed and analyzed relevant literature and to propose a hypothesis that may explain this paradox phenomenon. Methods: We conducted a search of literature from three English databases (EMBASE, MEDLINE, and Google Scholar) from inception to 13 November 2023. A combination of key words and/or subject headings in English was applied, including relevant terms for cigarette smoking, sex/gender, pregnancy, and health indicators. We then performed analysis of the searched literature. Results: Based on this review/analysis of literature, we proposed a hypothesis that may explain this paradox phenomenon: female smokers have worse long-term health outcomes than male smokers because some of them smoke during pregnancy, and the adverse effects of cigarette smoking during pregnancy is much stronger than cigarette smoking during non-pregnancy periods. Conclusion: Approval of our pregnancy-amplification theory could provide additional evidence on the adverse effect on women's long-term health outcomes for cigarette smoking during pregnancy.

Keywords: cigarette smoking; female; health effect; sex; tobacco dependence.

Publication types

Review

Grants and funding

This study was supported in part by Canadian Institutes for Health Research (FND-148438) and Natural Science Foundation of Hunan Province of China [No. 2 (2022) 2022JJ80031].