Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr;17(4):382-9.
doi: 10.1093/ntr/ntu340.

Sex differences in hormonal responses to stress and smoking relapse: a prospective examination

Mustafa al'Absi  1 , Motohiro Nakajima  2 , Sharon Allen  3 , Andrine Lemieux  2 , Dorothy Hatsukami  4
Affiliations

Sex differences in hormonal responses to stress and smoking relapse: a prospective examination

Mustafa al'Absi et al. Nicotine Tob Res. 2015 Apr.

Abstract

Introduction: Dysregulation in the hypothalamic-pituitary-adrenal axis has been shown to be associated with smoking relapse. No study has directly examined the role of sex differences in this relationship.

Methods: Nicotine dependent men (n = 52) and women (n = 46) interested in cessation completed 2 laboratory stress sessions during ad libitum smoking and after 48 hr of abstinence. The laboratory session included baseline, stress, and recovery periods. Blood and saliva samples were collected at the end of each period for the measurement of cortisol and adrenocorticotropic hormone. Self-report measures of craving and withdrawal symptoms were also collected. Participants attended 4 weekly follow-up sessions for counseling where they provided biological samples and self-report measures including smoking status. Relapse was defined by smoking cigarettes for 7 consecutive days post-cessation.

Results: Results showed that 60 participants relapsed during the 4-week period. Cox regression models from the abstinence session showed that cortisol levels regardless of source were predictive of relapse but the direction of prediction was sex dependent (Sex × Hormone, all ps < .05). Follow-up analyses further revealed that lower cortisol levels predicted relapse in men whereas greater cortisol levels predicted relapse in women (ps < .05). Enhanced craving predicted early smoking relapse in men but not in women (ps < .05). Data from the ad libitum session showed no differences in predicting relapse.

Conclusion: These findings highlight that sex differences in the hormonal response to stress and subjective craving during nicotine withdrawal are critical predictors of risk for understanding early relapse.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Graphic representation of the study.
Figure 2.
Figure 2.
Cox regression plots are shown depicting sex × predictor interactions controlling for site and order of task. The three predictors shown include (a) salivary cortisol and (b) craving. Area under the curve (salivary cortisol) and average across session ratings (craving) during the 48-hr abstinence lab were uses for the analysis. Plot (a) demonstrates the salivary cortisol interaction that reveals higher cortisol predicts longer days to relapse for men (p = .05) but earlier relapse for women (p < .05). Plot (b) depicts the observation that greater craving predicted early relapse in men (p < .001) but not women (p > .10).
Figure 2.
Figure 2.
Cox regression plots are shown depicting sex × predictor interactions controlling for site and order of task. The three predictors shown include (a) salivary cortisol and (b) craving. Area under the curve (salivary cortisol) and average across session ratings (craving) during the 48-hr abstinence lab were uses for the analysis. Plot (a) demonstrates the salivary cortisol interaction that reveals higher cortisol predicts longer days to relapse for men (p = .05) but earlier relapse for women (p < .05). Plot (b) depicts the observation that greater craving predicted early relapse in men (p < .001) but not women (p > .10).
See this image and copyright information in PMC

References

    1. al’Absi M. Hypothalamic-pituitary-adrenocortical responses to psychological stress and risk for smoking relapse. Int J Psychophysiol. 2006;59:218–227. - PubMed
    1. Shiffman S, Hickcox M, Paty JA, Gnys M, Kassel JD, Richards TJ. Progression from a smoking lapse to relapse: prediction from abstinence violation effects, nicotine dependence, and lapse characteristics. J Consult Clin Psychol. 1996;64:993–1002. - PubMed
    1. Slopen N, Kontos EZ, Ryff CD, Ayanian JZ, Albert MA, Williams DR. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9-10 years: a prospective study of middle-aged adults in the United States. Cancer Causes Control. 2013;24:1849–1863. - PMC - PubMed
    1. Webb MS, Carey MP. Tobacco smoking among low-income Black women: demographic and psychosocial correlates in a community sample. Nicotine Tob Res. 2008;10:219–229. - PubMed
    1. Cohen S, Lichtenstein E. Perceived stress, quitting smoking, and smoking relapse. Health Psychol. 1990;9:466–478. - PubMed

Publication types