TOBACCO AND SMOKING

Chapter 8 TOBACCO AND SMOKING D.F.Marks*, M.Murray*, B.Evans, C.Willig, C.Woodall & C.M. Sykes* (2005) Health Psychology: Theory, Research & Practice (2nd edition). London: Sage. *Starred authors feature in videoclips TOBACCO AND SMOKING         Introduction Health effects of smoking Tobacco promotion and the social and economic context of smoking Theories of smoking Starting smoking Smoking cessation Psychological therapy for smokers Summary INTRODUCTION    About 25% of adults in most western societies smoke. The prevalence rates in developing countries are higher than this and are increasing. The prevalence of smoking varies according to sex, social class, and ethnicity. HEALTH EFFECTS OF SMOKING    The heath effects of smoking have been studied for over 100 years. Smoking has been linked with cancer, heart disease, and respiratory disease on both active and passive smokers. There is hardly a single organ in the body that is not deleteriously influenced by tobacco smoking. How did Van Gogh know? The painting is called 'Skull with Burning Cigarette', painted in Antwerp, Winter 1885/86. (Oil on canvas, 32x24.5 cm.) It's in the Rijksmuseum Vincent van Gogh in Amsterdam. According to Metzger, R. & Walther I.F. (1999) in 'Van Gogh', published by Taschen in Koeln, the story is that van Gogh was mocking procedure in drawing classes where a skeleton invariably served as the basis of anatomical studies… "The lifelessness of the skeleton represented the very opposite of what van Gogh wanted a picture to express" (p. 62). The picture could also be seen as a cynical self-portrait, a comment on his unkempt and unattractive appearance. So, this painting had nothing to do with the dangers of smoking. TOBACCO PROMOTION AND THE SOCIAL AND ECONOMIC CONTEXT OF SMOKING  While van Gogh may not have known about the shocking health consequences of smoking, but the tobacco industry certainly does. Yet it spends billions worldwide in promoting tobacco products to one and all, including children. A new concept: the ‘Chinese Smoking Cowboy’. Exporting death to Asia, and making it look cool to the Chinese. But how cool is it, really?   Given increase in mortality and morbidity rates caused by smoking, serious arguments have arisen concerning the abolition of tobacco advertising. But the tobacco industry hold a lot of sway with the most powerful of governments. Tobacco advertising The tobacco industry spends more than $12.4 billion per year over $34.1 million a day - marketing its deadly products in the U.S. alone, much of this reaching kids. This tobacco industry calendar from the Phillipines features the Virgin Mary smiling serenely over cigarettes (1994) Source:http://www.tobaccofreeki ds.org/adgallery/ Footnote: Emee Estacio, co-designed of this website, a Phillipino, actually recalls this poster being on display at home on the kitchen wall. „Cool‟ candy flavoured cigarettes for children and teenagers  The US tobacco industry recently introduced candy-flavored cigarettes and smokeless tobacco R.J. Reynolds - the company that once marketed cigarettes to kids with a cartoon character, Joe Camel - has launched a series of flavoured cigarettes, including a pineapple and coconut-flavored cigarette called "Kauai Kolada" and a citrusflavored cigarette called "Twista Lime." In November 2004, they introduced Camel "Winter Blends" in flavors including "Winter Warm Toffee" and "Winter MochaMint”. Brown & Williamson has introduced flavored versions of its Kool cigarettes with names like "Caribbean Chill," "Midnight Berry," "Mocha Taboo" and "Mintrigue.” The U.S. Smokeless Tobacco Company is marketing spit tobacco with flavors including berry blend, mint, wintergreen, apple blend, vanilla and cherry    Source:http://www.tobaccofreekids.org/reports/targeting/ „Cool‟ candy flavoured cigarettes for children and teenagers . R.J. REYNOLDS:Lived and died from tobacco “Founded the tobacco company in 1875, began manufacturing Camel cigarettes in 1913. He died in 1918, of cancer of the pancreas, after a lifetime of chewing tobacco -- ironically, the same product which established his fortune, and earlier, his father's, in the tobacco business. Studies have linked cancer of the pancreas to chewing tobacco. He married at age 53, and died at age 67, when his eldest son, R.J. Reynolds, Jr., was just 12. As a result, R.J. Jr. would never spend much time working in the tobacco business, nor would any of R.J. Jr.'s 6 sons.” Source: info@adbusters.org SIGN OF THE TIMES: Patrick Reynolds, grandson of R.J. Reynolds, leading anti-smoking campaigner Photo: Hara Photo. THEORIES OF SMOKING    Biological theories Psychological theories Social theories Biological Theories of Smoking   Revolves around the addictive nature of cigarettes, especially the role of nicotine dependence. Nicotine is a substance that if taken in large quantities can be toxic. However, delivered in small amounts via cigarette smoke it has a range of psychophysiological effects: – – – – – Tranquillization Weight loss Decreased irritability Increased alertness Improved cognitive functioning Biological Theories of Smoking  Over time the smoker seems to develop a physical dependence on nicotine – – – The addictive nature of nicotine Twin studies Evolutionary approaches to addiction Nicotine paradox - the apparent conflict between the stimulant physiological effect of nicotine and reports of relaxation (Nesbitt, 1973) Psychological Theories of Smoking   People become smokers because of the positive reinforcement they obtain from smoking. Other psychological theories include the possible role of the following: – – – – Sensation seeking Extraversion Stress Other personality characteristics Social Theories of Smoking     Smoking is a social activity. Smoking has different meanings in different settings. It is not only embedded in the immediate material circumstances in which the smoker lives, but also in wider social and cultural contexts. Tobacco promotion and advertising creates an environment in which smoking is projected as „cool‟, something that all adolescents crave. STARTING SMOKING    Biological factors Psychological factors Social factors STARTING SMOKING: Biological Factors  There is evidence that pharmacologic factors play a role in the establishment of regular smoking from an early stage. STARTING SMOKING: Psychological Factors  This domain includes a range of more psychological, interpersonal and behavioural factors The Theory of Reasoned Action and the Theory of Planned Behaviour – smoking is predicted by behavioural intention that is predicted by attitudes, social norms, and perceived self-efficacy. STARTING SMOKING: Social Factors    Social learning Social bonding Social environment SMOKING CESSATION    Biological aspects Psychological aspects Social aspects SMOKING CESSATION: Biological Aspects  Pharmacologic products have been used to aid smoking cessation: – – – Nicotine chewing gum Transdermal patch Nasal spray/inhaler SMOKING CESSATION: Psychological Aspects   Transtheoretical Model of Change (TTM)* The following are the most important components of the model: – – – – Processes of change Stages of change Decisional balance Self-efficacy * DiClemente & Prochaska (1982) Stages of behaviour change (DiClemente and Velicer, 1997)    Precontemplation - not intending to take action in the foreseeable future Contemplation - intending to change Preparation - intending to take action in the immediate future and have developed a plan of action The real Marlboro Country Smokers are finding that restrictions are being increasingly placed on smoking at work and in public places. Stages of behaviour change (DiClemente and Velicer, 1997)    Action - have made specific overt modifications Maintenance - working to prevent relapse but do not apply change processes as frequently as in the Action stage Termination - behaviour change successful and individuals have zero temptation and 100% self-efficacy SMOKING CESSATION: Social Aspects    Smoking activities are deeply embedded in everyday social activities and a society where cigarettes are widely promoted. Smoking efforts need to provide not only social support but also attempt to enhance the sense of control and mastery of the individual by changing their social conditions. Cessation attempts must take these aspects into consideration, including the increasing social gradient in smoking prevalence. PSYCHOLOGICAL THERAPY FOR SMOKERS   In order to achieve effective smoking cessation, it is necessary for an intervention to help smokers to control both their physical and psychological dependency on smoking. There has been increasing interest in the development of cognitive behaviour therapy (CBT) for the control of smoking and other health-related behaviours. PSYCHOLOGICAL THERAPY FOR SMOKERS    An example of a brief intervention using CBT is the QUIT FOR LIFE (QFL) Programme (Marks, 2005) QFL encourages a steady reduction of cigarette consumption over seven to 10 days followed by complete abstinence. The QFL programme is delivered in several alternative ways: – – – Group therapy of 10 sessions Self-help programme following a single, one-hour group therapy session Internet Using anti-smoking art to educate children: “Joe Camel‟s last words” (Source: http://www.anti-smoking.org/children.htm) Art by Adbusters  The Truth About Tobacco  “Joe is lying down, sick from smoking! He's got a needle in his arm to get the chemotherapy medicine, whose purpose is to cure, or at least slow down, his cancer. It made his hair fall out! His friends are all gone, he's all alone, and his days as an athlete are over. And he's in terrible, awful pain, and knows he's going to die”. “Joe might be saying, "I wish I hadn't smoked. I conned a lot of kids into thinking smoking was cool, and I'm sorry! And I'm sorry I smoked. I'm dying of cancer. Just look at me now! Please — whatever you do, don't smoke!" HEALTH PROMOTION WITH CHILDREN E.G. New York City Project ARTS 2004 Following are the top 3 posters chosen from a pool of entries in the "Kick Butts Day" AntiSmoking Poster Contest sponsored by the Campaign for Tobacco-Free Kids and the New York City Department of Education. Source:www.nyc.gov/html/doh/gif/smoke/projectarts20 04 . . . . Summary l l l 1 About 25% of adults in most western societies smoke, while prevalence rates in the developing world are higher than this and are increasing. The prevalence of smoking varies according to sex, social class and ethnicity. 2 Biological, psychological and social factors contribute to the continued popularity of smoking. 3 The uptake of smoking occurs largely in adolescence and appears to be associated with parental and peer smoking. Various social and psychological factors are of prime importance in understanding the recruitment of teenagers to smoking. Summary (continued) 4 Most smokers report difficulty in quitting the habit. The transtheoretical model describes the process of quitting as progressing through several stages. 5 Social, biological and psychological factors are involved in the process of smoking cessation. Brief psychological therapies for smoking cessation based on cognitive behavioural therapy are showing considerable promise. 6 The final solution to tobacco control will require a multilevel approach consisting of economic, political, social and psychological interventions.