- 1. Health Psychology Smoking Chapter 7 PY470 - Hudiburg
2. Who Smokes? F 7.1, p. 215 3. Who Smokes?
- 20.9 % of American adults about 45.1 million (CDC 2005) slight
decline since 2003 (21.6%).
- Rates higher in Males (23.9%) than Females (18.1%), highest in
American Indian (32.0%) White (21.9%), African Americans (21.5%),
Hispanic Americans (16.2%) and Asian Americans (13.3%).
- Rate drop since mid 1960s (42.4%) but rate has dropped slightly
since 1990 (25.5%).
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- Which state has the highest rate and which state has the lowest
rate? Where is Alabama, Tennessee, and Mississippi?
- Smoking related to education and SES F 7.2, p. 216
- 1.3 million quit each year
- 3,000 teens start each day, 70% of adult smokers started in
adolescence Johnston et al. (1998), but use decreasing
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- 8 thgrade (9.3%), 10 thgrade (14.9%), and 12 grade (23.2%) -
2005
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- 8 thgrade (19.1%), 10 thgrade (27.9%), and 12 grade (33.5%) -
1995
- There are more ex-smokers (52.4%) than current smokers
(20.9%).
4. Prevalence of adults (18 and older) smoking in U.S. 2004
& 2006 CDC MMWR report 5. Health Effects of Smoking
- Lung disease COPD, asthma
- Vascular disease - impotence
6. What are the health consequences of smoking?
- Leading cause of preventable mortality
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- Smoking related illnesses cause 440,000 deaths per year, CDC
(2003)
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- These deaths occur 12 years earlier than would be expected, so
the aggregate annual loss exceeds 5 million life-years.
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- Linked to numerous types of cancer cause by smoking 155,000
deaths per year among smokers
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- The majority of cancers of the lung, trachea, bronchus, larynx,
pharynx, oral cavity, nasal cavity, and esophagus from tobacco
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- linked to increase risk of developing heart disease and
strokes
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- linked to other major illnesses
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- linked to numerous pregnancy complications
7. What are the health consequences of smoking? (cont.)
- What causes the health consequences of smoking?
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- increases heart rate and blood pressure
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- hardens the arteries (arteriosclerosis)
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- disrupts the ability of the cilia to clear lungs
8. TOBACCO KILLS 9. Healthy lungSmokers lung 10. Oral Cancer
Squamous cell & Leukoplakia 90% are squamous cell carcinomas
buccal mucosa of heavy smoker buccal mucosasmoker of 2 packs/day
11. Erythroplakia
- Patient has long history of chronic white and red lesions of
soft palate
- more likely for malignant transformation than white
patches
12. Smoking changes: BLACK HAIRY TONGUE
- Overgrowth of filiform papillae
- canbe black, brown or yellow.
- will disappear on cessation of smoking
13. 14. Smoking concerns
- Smoking and pregnant women lower birth weight of
child,miscarriage,rates of ADHD, hyperactivity, and SIDS MacDorman
et al. (1997)
- Passive smoking (second-hand smoke) is a serious problem
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- Effects on children & infants respiratory problems CDC
report
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- Almost 60 percent of U.S. children aged 311 yearsor almost 22
million childrenare exposed to secondhand smoke.
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- About 25 percent of children aged 3-11 years live with at least
one smoker, as compared to only about 7 percent of nonsmoking
adults.
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- Secondhand smoke exposure is responsible for an estimated
150,000300,000 new cases of bronchitis and pneumonia in children
aged less than 18 months, resulting in 7,50015,000
hospitalizations.
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- The California Environmental Protection Agency estimates that
secondhand smoke exposure causes approximately 3,400 lung cancer
deaths and 22,70069,600 heart disease deaths annually among adult
nonsmokers in the United States.
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- Maternal smoking 700 SIDS cases each year in U.S. Grunberg at
al. (1997)
15. Chemistry of tobacco smoke
- Cigarette smoke is composed of volatile and particulate
phases.
- Contains some 500 gaseous compounds including nitrogen, carbon
monoxide (CO), carbon dioxide, ammonia, hydrogen cyanide and
benzene.
- There are about 3,500 different compounds in the particulate
phase, of which the major one is the alkaloidnicotine.
- The particulate matter without its alkaloid and water content
is calledtar .
- Many potential cancer inducing substances have been identified
in cigarette tar.
16. Nicotine
- Nicotine is an amine consisting of two rings (pyridine and
pyrrolidine)
- Two stereoisomers of nicotine
- (S)-nicotineis the active isomer which binds to nicotinic
cholinergic receptors and is found in tobacco.
17. Absorption of nicotine from tobacco products
- Small droplets of tar containing nicotine are inhaled and
deposited in the small airways and alveoli of the lungs.
- Nicotine is a weak base & absorption across cell membranes
depends on the pH
- When nicotine reaches the small airways and the alveoli of the
lung, it is buffered to physiological pH
- Absorbed into the pulmonary alveolar capillary and venous
circulation
- Nicotine is distributed quickly throughout the body.
18. Nicotine dosage delivery forms
- Speed of delivery of nicotine from cigarettes is fast,
providing nicotine 'hits' to the brain within 10 -19 seconds of
smoke delivery to the lung
- Cigarettes are designed to ensure the delivery of nicotine to
maximises the addictive effect
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http://www.washingtonpost.com/wp-dyn/content/article/2006/08/30/AR2006083001418.html
- Cigarettes can readily deliver approximately 1-3 mg of
nicotine, as desired by smokers
- The smoker can manipulate the intake of nicotine from different
cigarettes to achieve and maintain the desired level of
nicotine
- http://home.att.net/~rdavis2/cigra.html
- nicotine, tar, carbon monoxide by brands (U.S.)
19. Stop smoking?
- Two-thirds of smokers would like to quit
- 30-33% try to quit in any year, 2/3 smoke in two days, 97% in 6
months
- Relapse rate lower in smoking cessation programs with 20-30%
success in long-term abstinence Cohen et al. (1989)
- Over 40% continue to smoke after laryngectomy, more 50% after a
heart attack
- Smokers make repeated attempts with a period of abstinence
followed by relapse
20. How do psychological factors lead to the initiation of
smoking?
- To try out a new identity - adolescents
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- glamorous, older and more mature grades 5 to 7, need of role
models
- Distinct personality types Burt et al (2000)
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- risk-takers (sex, drugs, etc.), extraverted
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- higher rates of depression Windle & Windle (2001)
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- weight concerns (for women in particular) 7 to 10 graders smoke
with weight issues
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- modeling and peer pressure, more likely if a friend smokes
Mittelmark et al. (1987)
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- Smokers get more offers of cigarettes (4.22/week) v.
non-smokers (.16/week) Ary & Biglan (1988)
21. How do psychological factors lead to the initiation of
smoking?
- Family history of smoking 26.6 % (smokers) v. 12.6%
(nonsmokers) as adults Chassin et al. (1998)
- NASCAR changes: Winston Cup to Nextel
- Media influences movies and product placement
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- JAMA study of 50 G rated films, 56% had tobacco use and all
films during 1996 to 1997
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- http://smokingsides.com/asfs/m/
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- Joe Camel study Grunberg et al. (1997)
22. What constitutes addiction?
- Addictive drugs exhibit two important characteristics
- They cause effects within the brain which are pleasant or
rewarding, and which reinforce self-administration of the drug in
both experimental animals and human beings
- Following a period of chronic exposure, withdrawal of the drug
may cause an abstinence syndrome which an addict may also seek to
avoid by continuing to take the drug.
23. Does nicotine use through smoking meet diagnostic criteria
for addiction?
- A strong desire to take the drug.
- Difficulty in controlling use.
- Continued use despite harmful effects
- Tolerance need larger dose 2/4 cigarettes initially but need
20/40 cigarettes after long term smoking
- Substance taken in larger amounts or longer than intended
- A higher priority given to drug use than to other activities
and obligations
- A great deal of time is spent in obtaining, using or recovering
from effects of substance
24. Ranking of nicotine in relation to other drugs in terms of
addiction Dependence among usersnicotine
>heroin>cocaine>alcohol>caffeine Difficulty achieving
abstinence(alcohol=cocaine=heroin= nicotine )>caffeine
Tolerance(alcohol=heroin= nicotine )>cocaine>caffeine
Physical withdrawal severityalcohol>heroin> nicotine
>cocaine>caffeine Deathsnicotine
>alcohol>(cocaine=heroin)>caffeineImportance in user's
daily life( alcohol=cocaine=heroin= nicotine )>caffeine
Prevalencecaffeine> nicotine >alcohol>(cocaine=heroin )
25. Markers and measures of dependence in smokers
- Daily cigarette consumption
- Time to first cigarette of the day
- Smoking more in the morning
- Difficulty not smoking in no smoking areas
- Which cigarette would hate to give up?
- Those who smoke more cigarettes per day are less likely to be
able to stop
26. Consequences of nicotine addiction
- Morbidity and mortality caused by active and passive
smoking
- Smoking prevalence is higher and nicotine use heavier among
poorer smokers.
- This difference in smokingbehavioraccounts for about two-thirds
of the excess premature mortality associated with deprivation.
- Nicotine addiction is therefore responsible for significant
health inequalities
27. Tobacco and nicotine addiction
- The unique selling point of tobacco is its nicotine
content.
- Tobacco products without nicotine are not commercially
viable.
- Nicotine is an addictive drug.
- The purpose of smoking tobacco is to deliver a dose of nicotine
rapidly the brain.
28. Nicotine withdrawal
- Withdrawal syndrome is a collection of signs and symptoms
caused by abstinence.
- Nicotine or cigarette withdrawal?
- Nicotine replacement reduces severity of withdrawal
symptoms.
29. Nicotine-based models
- Nicotine fixed-effect model
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- nicotine has many reinforcing physiological effects
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- smoking feels good, so people continue to smoke
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- F 7.4, p. 223 Schachter et al. (1977) heavy smokers more low
nicotine cigarettes in 2 week period; when High smokers given low
nicotine cigarettes were more irritable and anxious
- Nicotine regulation model
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- smoking is rewarding only when level of nicotine is above a
set-point
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- smokers must smoke to maintain a certain level of nicotine to
feel good
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- based on these models, quitting should be easy
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- ignores environmental pressures
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- nicotine replacement methods are not 100% effective
30. Affect-regulation model
- Developed by Tomkins (1966, 1968)
- Smoke to attain positive affect or to avoid negative
affect
- Box 7.3, p. 226 studied stress on smoking
- Leventhal & Avis (1976) dipped cigarettes in vinegar
persons motivated by pleasure smoked significantly less than usual;
personsnotmotivated by pleasure smoked a the same level
- Relaxation and coping with anxiety
- Depression and smoking: 40% less likely to quit as compared to
non depressed
- Schachter et al. (1977) found more stressed students smoked
more cigarettes and puffed more; the difference was profound for
heavy smokers.
31. Combined models
- Psychological/physiological factors combined
- Predicts that smoking initially used to regulate emotions and
over time links how smokers feel in how much nicotine they have in
the their blood
- Can be paired with both positive and negative emotional
states
- Biobehavioral model Pomerleau & Pomerleau (1989)
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- Both psychological and physiological factors lead people to
continue to smoke; makes them feel good physiological effect
dependence (psychological & physiological) to use nicotine to
experience positive emotions
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- nostalgia for smoking: estimated 8.5 month half-life -- cause
of relapse over 1st year
32. What are some strategies for preventing smoking?
- Targeting adolescents many studies
- The message is not relevant they will quit before long-term
consequence
- If at risksmokers focus on short-term benefits
- Social influence programs Flay (1987)
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- Short-term effectsmore effective in altering the attitudes
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- Types of persons who smoke: duped by advertisers; saying
noindependent and self-reliant
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- Overestimates of norms in adolescent smoking by
adolescents
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- Best et al. (1989) 6 thgraders who received social influence
training less likely to smoke in the 8 thgrade
33. What are some strategies for preventing smoking?
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- Assumption is that lack of self-esteem and
self-confidenceincrease smoking
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- Smoking to feel better about themselves
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- Training enhances self-esteem
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- Batvin et al (1984) gave 15 life skills sessions to 7
thgraders, this group smoked less after 1 year (10 %)v.22 % for no
training group
34. What are some strategies for preventing smoking?
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- Problems with continuing effects increase levels of smoking as
students progress through grades need of booster sessions in
HS
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- Mass media approaches are least effective Box 7.4, p. 231 adds
run at low viewer times
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- U.S. tobacco companies spend $7.12/person for ads but only
$.50/person for prevention
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- Government programs are not very effective
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- Cigarettes are easy to get but increase cost (10%) might lead
to decrease use Tavas et al. (2001)
35. Benefits after quitting
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- cough, DOE resolve in weeks
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- exercise tolerance improves rapidly
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- bladder cancer: 50% reduction in 5 years
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- lung cancer: 50% reduction in 10 years
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- heart disease: 50% reduction in 1 year!
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- No excess risk of heart disease by 10-15 years
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- vascular disease: 50% reduction in 5 years
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- mortality - same as never smokers by 10-15 yrs
36. Smoking cessation
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- Level of use: < 1 pack/day have many attribute that might
lead to successful cessation
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- > 1 pack/day more difficult to quit
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- Motivation, social support and advice
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- Weight gain concerns 1/3 gain 5 8 lbs. - Jeffery et al. (2000)
those not concern 21 % cessation v. 13.1 % for those concerned with
weight gain
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- Gradual reduction less nicotine in cigarettes 49 % success v.
22 % cold turkey
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- Treatment products such as NRT, bupropion the patch and gum
-Box 7.6, p. 234 235 chain chewer
37. NRT & Bupropion (Zyban)
- Stop or reduce the symptoms of nicotine withdrawal.
- Assist in stopping smoking, but without having unpleasant
withdrawal symptoms.
- Do not 'make' the client want to stop smoking.
- Still need to address the psychological issues combine with
counseling
- Still need motivation and determination to succeed in breaking
the smoking habit.
38. NRT & Bupropion
- Inhalator - 10mg cartridges
- Gum - 4mg, 2mg mint, original or fruit
- Patch - 16hr = 15mg, 10mg, 5mg and
- Lozenge (2 types) - 1mg, 2mg, 4mg
- Nasal Spray - 0.5mg per spray
39. Smoking cessation
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- Rapid-smoking method take a puff every 6 seconds creating an
aversive stimulus
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- Electric shock pairing -rates of cessation Welter et al.
(1998)
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- Self-management stimulus control of situations for smoking or
not smoking
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- Stimulus substitution taking a walk after dinner, chewing
gum
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- Contingency-contracting give money to someone who give it back
if cessation goal is reached
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- Large scale programs varying success may initially reduce
smoking but usually returns Gomel et al. (1993)