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					    Smoking

       Role of Psychologists

       Disease Management Model

       Prevention

       Single greatest cause of preventable death

       USA – accounts for about 1 in 5 deaths

       Smokers, compared to nonsmokers are
         
   Generally less health-conscious (drink, sedentary)
         
   More likely to engage in other unhealthy behaviors


          Drinking cues             Smoking
    Smoking


     30% of all Americans

     Low SES (income/education)

     Pediatric disease

     3000 children/teens per day

     1/5 at the end of High School

     1 in 5 adults die each year from tobacco use

     Approx 450,000 premature deaths each year
Smoking and Health Problems
20 year lag for smoking and lung
cancer deaths
 Maternal Smoking
Pincock “Smoking Damages Placenta, Stunts Fetal Growth” 1,650 pregnant women
    and, after the full-term births of their infants, conducted physical
    examinations of the infants.
     
   smokers who quit when they became pregnant and
     
   smokers who continued smoking throughout the pregnancy.



   Women who smoked throughout had smaller babies, a well-documented result.
    But also found a reduced uterine artery blood flow as well as damage to the
    placenta. There were lower levels of IGF (insulin-like growth factors) which is
    essential for fetal growth. Correlation between the reduction of IGF in the
    umbilical cord blood and cigarettes smoked by the mother.


   Helped when women stopped smoking after learning pregnant. Placental
    function, IGF levels and the size of the neonates were all normal for those
    wome
    Smoking

   Smokers: risks and costs
   
   CHD and 30% of all cancer deaths (4 x risk of breast c)
   
   Bronchitis, emphysemia, asthma, etc
   
   Low birth weight infants & retarded fetal development
   
   More accidents and injuries at work
   
   Take off more sick time
   
   Use more health benefits

   Studies of secondhand smoke reveal that family
    members and coworkers are at risk for a variety
    of health disorders.
      Costs

   Direct medical cost
    estimated >50 billion/year

   $2.00 every pack sold US

   Life time medical costs (more medical problems,
    dental, medications, co-pays) higher for smokers, even
    they die young

   Life insurance, health insurance, home owners, and
    car insurance higher

   Loss in home and car resale, earn less money, some
    employers refuse to hire smokers (ACLU 6,000
    employers)

   Curtailing teen smoking is the cheapest and easiest
    way to slash health care costs

   Readily reach kids and teens in public schools
BENEFITS OF QUITTING
Research results show that just 20 minutes after
you’ve smoked that last cigarette, your body begins an
ongoing series of beneficial changes:

> 20 MINUTES
o Blood pressure drops to normal
o Pulse rate drops to normal
o Temperature of hands and feet increases to normal

> 8 HOURS
o Carbon-monoxide level in blood drops to normal
o Nerve endings start regrowing
o Ability to smell and taste is enhanced
o Walking becomes easier

> 2 - 12 WEEKS
o Circulation improves
o Lung function increases up to 30%

> 1 - 9 MONTHS
o Coughing, sinus congestion, fatigue, shortness of breath
o Decrease Cilia regrow in lungs, increasing ability to handle mucus
o Clean the lungs, reduce infection

> 1 YEAR
o Risk of coronary heart disease is half that of a smoker
  Smoking: Synergistic Effects

   Smoking enhances the impact of other risk
    factors in compromising health
   
   Nicotine stimulates release of free fatty acids, in
       turn decreases HDL
   
   Nicotine increases men’s reactivity to stress
   
   Increases BP in women, risk of CHD and stroke

   Smokers engage in less physical activity

   Smoking is considered a potential cause of
    depression, especially among youth

   Smoking is related to an increase in anxiety
    among adolescents
     Smoking: A Brief History


   A sophisticated habit of the male gentry until
    WWII

   1940s
   
   Large numbers of women smoke
   
   Advertised as symbol of feminine sophistication

   1964
   
   First U.S. Surgeon General’s warning is issued
   
   Male smoking declines, female smoking increases

   1994
   
   Female teen smokers, 22.9%
   
   Male teen smokers, 28.8%
  Smoking: Why Do People Smoke?


  Smoking begins early (adolescence)

  15% of teens smoke regularly
  
   Initial experimentation
  
   Tries out cigarettes
  
   Experiences peer pressure to smoke
  
   Develops attitudes about smokers

  Only some become heavy smokers
  Smoking: Why Do People Smoke?


  Peer influence
  
   70% of all cigarettes smoked by teens are
    smoked in the presence of a peer

  Adolescents are more likely to start
   smoking if
  
   Their parents smoke
  
   They are lower-class
  
   They feel social pressure to smoke
  
   There has been a major family stressor
  Smoking: Why Do People Smoke?


  Chippers: term used to describe light
   smokers
  
   High value placed on academic success
  
   Supportive relationships at home
  
   Little smoking among parents and peers

  Number of “chippers” has increased

  Surprising trend given addictive nature
   of smoking
  Smoking: Why Do People Smoke?


  To preadolescents, the image of a
   smoker
  
   Rebellious
  
   Tough
  
   Mature

  Smoking cigarettes may help convey
   the image that an insecure teen longs
   to display
  Smoking: Why Do People Smoke?


   Smoking is clearly an addiction
   
   It is reported to be harder to stop than heroin
         addiction or alcoholism
   
     The exact mechanisms of nicotine addiction are
         not known
   
     Nicotine may be a way of regulating performance
         and affect
   
     Smoking is also maintained by social learning
   
     Smoking is paired with rewarding experiences
  Smoking:
  Interventions to reduce smoking

   Media campaigns have helped instill
    antismoking attitudes among the general
    public
  
   Even adolescents view smoking as addictive

   Changes in social norms (from largely
    positive to strongly negative) have motivated
    many people to quit

   BUT attitude-change campaigns by
    themselves don’t help smokers quit
  Smoking:
  Interventions to reduce smoking
Nicotine-Replacement Therapy

  Nicotine gum is disliked because the
   nicotine is absorbed very slowly

  Transdermal nicotine patches release
   nicotine in steady doses

  Nicotine-replacement therapy
   produces significant smoking cessation
Nicotine Patch
     Smoking:
     Interventions to reduce smoking
 Multimodal Interventions
 
   Specific interventions are geared to the stage
     of readiness with respect to smoking
Precontemplation Contemplation to       Action Phase
to Contemplation       Action
    Focus is on  Smoker develops
    attitudes.     a timetable to       Cognitive-
   Emphasis on       quit and a         behavioral
 adverse health   program of how        techniques
  consequences     to go about it       will be used
    Smoking:
    Interventions to reduce smoking

   Social Support and Stress Management
  
   Would-be ex-smokers enlist support from others in
      their efforts to stop
  
   A strong image of oneself as a “nonsmoker” helps
      treatment effectiveness

   Maintenance and Relapse Prevention
  
   Many people relapse on the road to quitting
  
   A single lapse reduces perceptions of self-efficacy
  
   When self-efficacy wanes, vulnerability to relapse is
    high
     Smoking: Who is best able to induce
     people to stop smoking?
                   
  Physician
                      recommendations
                     
   Especially effective
  Recall the             for pregnant
  concept of             smokers
the teachable        
   Patients with
   moment                symptoms of CHD
                         more likely to stop
                   
  Hospitalized
                      patients
  Smoking:
  Why is smoking so hard to change?

   Deeply entrenched behavior that may be
    influenced by
  
   Addiction that makes it difficult to stop
  
   Mood, since it elevates mood
  
   Weight control, it keeps body weight down

   But more than 45 million Americans have
    successfully quit
  
   Those who quit on their own have good self-
    control skills, self-confidence in their ability to
    stop, and a belief that the benefits to quitting
    are substantial
Smoking Cessation

   Patch alone is not enough, since
    smoking is more complex than just the
    physical addiction.

   Psychological factors such as stress that
    can trigger a desire to smoke. Social and
    environmental factors (e.g., group of
    friends, meal, type of gathering) that
    make a contribution, too.

   Treating the physical addiction doesn't
    address these psychological influences,
    which can trigger a relapse to smoking
    months or years after a person has quit.
 Hall, S.M., et al. Extended nortriptyline and
 psychological treatment for cigarette smoking.
 American J of Psychiatry 161(11):2100-2107, 2004.

   Assigned 160 trial participants to one of four conditions.

   All the participants received nicotine replacement therapy
    (transdermal patch) and took part in five group counseling
    sessions during the first 12 weeks of the study. 90-minute
    sessions concentrated on understanding health issues
    associated with smoking and quitting, developing personalized
    quit strategies, and avoiding relapse.

   Half received placebo and half nortriptyline, an antidepressant
    that helps smokers to quit. Adjusting doses to maintain blood
    concentrations of 50 to 150 ng/L.

   At the end of 12 weeks, treatment ended for half of the
    participants.

   The remaining half continued their regimens of nortriptyline
    (40) or placebo (41) for 40 more weeks. Continued to
    participate in monthly 30-minute group counseling sessions and
    were contacted by phone 2 weeks after each session to
    reinforce counseling lessons.
  Extended combination treatment

   At weeks 24, 36, and 52, far fewer of the
    participants in extended treatment were smoking
    than were participants whose treatment ended after
    12 weeks.

   At the end of 1 year, 50 percent of patients who
    had received nortriptyline and counseling
    throughout were abstinent, compared with 18
    percent who got this treatment for only 12 weeks.

   Forty-two percent of patients who received
    extended counseling and placebo were abstinent at
    1 year, compared with 30 percent of those who got
    them for 12 weeks.
FINDINGS
  Extended combination treatment

   "The highest success rate was with nortriptyline and
    counseling for 52 weeks," Dr. Hall says. "Extended
    treatment with placebo and counseling came in a
    very close second, suggesting that prolonged
    psychological support and counseling are important
    components in improved treatment outcomes."

   "Simply treating the physical addiction doesn't
    address these psychological influences, which can
    trigger a relapse to smoking months or years after a
    person has quit."

   Findings show that combination treatment provided
    over an extended period improves smoking cessation
    rates.
Smoking Prevention
  Smoking:
  Prevention

  Social Influence Intervention
  (Richard Evans/Houston School District)
Two Theoretical Principles:

  Model “High Status” nonsmokers

  Behavioral inoculation
  
   expose students to a weak version of a
    persuasive message so they can resist the
    message in its stronger form
  Smoking:
  Prevention

  Social Influence Intervention Program
  
   Information about negative effects of
      smoking (appealing to adolescents)
  
   Image of nonsmoker is presented as
      independent and self-reliant
     
   But   a smoker falls for advertising gimmicks!
  
   Peer group is used to facilitate non
    smoking rather than smoking
    Smoking:
    Prevention

Life-Skills-Training Approach

   Rationale: If adolescents are trained in self-
    esteem enhancement, then they will not feel
    the need to bolster self-image by smoking
Social Engineering and Smoking

   Liability litigation

   FDA Regulation of tobacco as a drug

   Heavy taxation

				
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