Health Psychology Chapter 13: Smoking Tobacco Mansfield University Dr. Craig, Instructor

Tobacco Use and Mortality 400,000 death’s yearly 20% of deaths directly related to Tobacco Use 3 leading causes of death Heart Disease 180,000 attributable to smoking nicotine effect on CV physiology & atherosclerotic effects Cancer 150K/annually, 120K from lung cancer all cancers, especially lung, strongly related to smoking COPD 85,000 deaths annually; 80% from smoking Other Bad Stuff: facial wrinkling, impotence, gum disease, macular degeneration

Effects of Passive Smoking Passive Smoking a/k/a Environmental Tobacco Smoke (ETS) Second Hand Smoke Side Stream Smoke Lung Cancer- elevates risk between 20-30% Breast Cancer- almost as strong as active smoking!! a “strong” dose-response relationship 2 hours a day for 25 years, tripled risk even stronger relationship if exposed as a child Heart Disease- increases risk of CHD 20-30%, of 30-60,000 ETS related deaths annually, 75% from Heart Disease

Passive Smoking and Children’s Health 1700 infant mortalities through ETS annually dose-response relationship between SIDS risk and number of cigarettes smoked by mother Other effects low-birth weight babies Smoking around children less than 2 years: bronchitis, pneumonia, asthma, childhood cancers & lower respiratory tract infections.

Breathing and Defending Against Particles Nasal Passage > Pharynx > Larynx > Trachea > Bronchi > Bronchioles > to Alveoli (CO2-O2 exchanged here) All prior of alveoli- work to cleanse, warm, and humidify inspiration Sneezing, coughing, swallowing all defensive physiology against airborne particles Mucociliatory Escalator (MCE)- cilia transport mucous and engulfed particle out of lungs/nasopharynx to be coughed up/swallowed. Smoking effects physiological processes by obstructing pulmonary (lung) function

Smoking and COPD Chronic Bronchitis Emphysema smoking increases mucous secretion > MSE activity decreased> excess mucous collection > coughing reflex leads to intense coughing fits > permanent damage/scarring of cilia and respiratory tissue. Emphysema scar tissue in bronchioles obstructs expiration O2 oxidizes alveoli walls and obstructs capillaries delivering blood to alveoli. CO2 not exchanged for O2, reduced physical functioning.

“What you been smokin’?” 4000 chemical compound in a burning cigarette Nicotine- 30-40 minute half-life (between cigarettes) Stimulates CNS receptors in pleasure areas of brain leads to endorphin and opiate release underlying addictive component Stimulates SNS and general metabolism Tars carcinogens varying directly with nicotine content (low tar/low nicotine)- low tar cigarettes and compensating smoking behavior

Who smokes? Part I Percent smoker, former, non-smoker 1965-1995

Who Smokes? Part II Smoking and Education 1966-1994

Who Smokes? Part III Smoking in Males and Females Males smoke a little more than women, but rate of decline much greater among men… may be smaller within 10 years or so Adolescent Smoking--- the new challenge rates have markedly increased in the past 10 years 10% for women, 25% for men 40% of white adolescents! Characteristics- social/health risk takers dissatisfaction with education, low grade depression, cluster with unhealthy behaviors

The Key Questions for Scientists, Part I 1. Why do adolescents start especially when the hazards of smoking are generally understood? Optimistic bias regarding health and difficulty quitting Present threats are more salient Leventhal & Cleary- 3 reasons tension control (stress/relaxation/pleasure) rebellion social pressure- situational factors appear particularly strong also sibling, parents body image needs, weight concerns Risk of Addiction- 100 lifetime or 15 a day.

The Key Questions for Scientists, Part II Why do people continue to smoke? Tomkins and Smoking Behavior Habitual Smoker- a matter of habit, little attention or thought to smoking Positive/Negative Affect Smoker (Pleasure/Taste)- increase relaxation and/or decrease feeling of anxiety or stress etc. Addicted Smoker- keenly aware of when they are NOT smoking… can tell you how long since last and prepare so they are never without Also- “environmentally cued smoking”

Why continue to smoke Nicotine Addiction Model- suggest that people continue to smoke to maintain basic level of nicotine to prevent withdrawal support- double-blind studies with high and low nicotine cigarettes. Smokers adjusted behavior despite not knowing nicotine content. More and deeper “puffs” from low nicotine cigarettes Can’t explain why people start though or why nicotine delivery products (patch) don’t work with everyone and is still hard for those who succeed. Nicotine plays a role, but not the only factor!!

Starting and Continuing to Smoke- SLM Social Learning Model of Smoking people learn patterns of behavior that are social reinforced by other we deem to be important The first cigarette, often not pleasant experience how is this often negative experience overcome? Both positive and negative social reinforcement in action

Deterring Smoking information on its own is not a deterrent More success: buffering or “innoculation” programs taught about situations that pressure to smoke might be high role model refusal/counter social pressure particularly effective when peer-led and combined with community anti-smoking campaigns

Quitting Smoking Cognitive barriers and Addictive Barriers refusal to recognize risks refusal to personalize risks combined addictions: Smoking and Alcohol More people quit on their own than through programs (“cold turkey”)- 60% success rate no difference in success rates between light/heavy smokers Programs- eventually, about 60%, lower initially Quitting rates should not be based on programs numbers tend to attract those w/o success on own tendency to fail 1 or 2 times, but succeed by third

Quitting Smoking Nicotine Replacement Therapy gum: 15% to 9% in placebo control tends to maintain weight better than the patch patch 22% to 9% in placebo control w/ bupropion increases to 35% success after 1 year Effectiveness increased when combined with drugs and psychological interventions Psychological Interventions- deal with affect/ cognitive/social element that reinforce smoking improving self-efficacy- point out previous successive, note likelihood of success sensitizes to environmental cues to smoke stress management techniques

Increasing the Odds & Relapse Control Married/Supportive S.O. particularly if supported by spouse/so Previous attempts Longer quit attempts Reducing smokers in social network Reduce alcohol consumption Heart disease diagnosis (not cancer though!) Increase self-efficacy- personal control over smoking RELAPSE CONTROL identify relapse factors, addresses and control, quit again. Phone follow-ups, social encouragement

What about weight gain? My a** is already fat! Research Fact: There is a tendency to gain on average of 9 lbs. for men and 11 lbs. for women while quitting if sedentary in the first year Research Fact: Non-smokers and smokers tend to gain more than 5 lbs. a year Research Fact: After 2 years of abstinence, weight of quitters and matched-smokers is the same on average. Research Fact: Moderate exercise with quitting will minimize weight gain and increases the metabolism making weight hard to put on. Research Fact: Gain in life expectancy (5-8 years) and reduce disease risks far outweigh risk associated with weight gain during quitting.

Health and Bodily Effects of Quitting Overall Mortality Figure 13.7 Light Smokers after 16 years have same risk as never smokers for cancer & CHD, stroke Heavy Smokers dramatically cut HD risk, stroke, less so for lung cancer