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

2. 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

3. 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

4. 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.

5. 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

6. 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.

7. “What you been smokin’?”
4000 chemical compound in a burning cigarette
Nicotine 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

8. Who smokes? Part I
Percent smoker, former, non-smoker

9. Who Smokes? Part II
Smoking and Education

10. 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

11. 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.

12. 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”

13. 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!!

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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.

20. 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