health psychology smoking chapter 7

1. Health Psychology Smoking Chapter 7 PY470 - Hudiburg

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%).

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

8 thgrade (9.3%), 10 thgrade (14.9%), and 12 grade (23.2%) - 2005

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%).

Heart disease

Lung disease COPD, asthma

Cancer

Lung, ENT, pancreas

Cervix, colorectal

Skin (squamous cell)

Vascular disease - impotence

Stroke

Cataracts

Gum disease

Dementia

Early menopause

Osteoporosis

Wound healing

Anxiety

Miscarriage

Hearing loss

Rheumatoid arthritis

Macular degeneration

Tooth decay

Depression

Multiple sclerosis

Leading cause of preventable mortality

Smoking related illnesses cause 440,000 deaths per year, CDC (2003)

These deaths occur 12 years earlier than would be expected, so the aggregate annual loss exceeds 5 million life-years.

Linked to numerous types of cancer cause by smoking 155,000 deaths per year among smokers

The majority of cancers of the lung, trachea, bronchus, larynx, pharynx, oral cavity, nasal cavity, and esophagus from tobacco

linked to increase risk of developing heart disease and strokes

linked to other major illnesses

linked to numerous pregnancy complications

What causes the health consequences of smoking?

constricts blood vessels

increases heart rate and blood pressure

increases cardiac output

hardens the arteries (arteriosclerosis)

disrupts the ability of the cilia to clear lungs

Patient has long history of chronic white and red lesions of soft palate

more likely for malignant transformation than white patches

BLACK HAIRY TONGUE

Overgrowth of filiform papillae

canbe black, brown or yellow.

will disappear on cessation of smoking

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

Effects on children & infants respiratory problems CDC report

Almost 60 percent of U.S. children aged 311 yearsor almost 22 million childrenare exposed to secondhand smoke.

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.

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.

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.

Maternal smoking 700 SIDS cases each year in U.S. Grunberg at al. (1997)

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.

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.

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.

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

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.)

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

Only about 2% succeed

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

To try out a new identity - adolescents

glamorous, older and more mature grades 5 to 7, need of role models

Distinct personality types Burt et al (2000)

risk-takers (sex, drugs, etc.), extraverted

higher rates of depression Windle & Windle (2001)

weight concerns (for women in particular) 7 to 10 graders smoke with weight issues

Social factors

modeling and peer pressure, more likely if a friend smokes Mittelmark et al. (1987)

Smokers get more offers of cigarettes (4.22/week) v. non-smokers (.16/week) Ary & Biglan (1988)

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

Box 7.2, p. 220-221

JAMA study of 50 G rated films, 56% had tobacco use and all films during 1996 to 1997

http://scenesmoking.org/

http://smokingsides.com/asfs/m/

Joe Camel study Grunberg et al. (1997)

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.

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

Withdrawal

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

Daily cigarette consumption

Time to first cigarette of the day

Smoking even when ill

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

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

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.

Withdrawal syndrome is a collection of signs and symptoms caused by abstinence.

Nicotine or cigarette withdrawal?

Nicotine replacement reduces severity of withdrawal symptoms.

Nicotine fixed-effect model

nicotine has many reinforcing physiological effects

smoking feels good, so people continue to smoke

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

smoking is rewarding only when level of nicotine is above a set-point

smokers must smoke to maintain a certain level of nicotine to feel good

Limitations

based on these models, quitting should be easy

ignores environmental pressures

nicotine replacement methods are not 100% effective

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.

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)

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

nostalgia for smoking: estimated 8.5 month half-life -- cause of relapse over 1st year

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)

Short-term effectsmore effective in altering the attitudes

Types of persons who smoke: duped by advertisers; saying noindependent and self-reliant

Overestimates of norms in adolescent smoking by adolescents

Best et al. (1989) 6 thgraders who received social influence training less likely to smoke in the 8 thgrade

Life Skills training

Assumption is that lack of self-esteem and self-confidenceincrease smoking

Smoking to feel better about themselves

Training enhances self-esteem

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

Problems

Problems with continuing effects increase levels of smoking as students progress through grades need of booster sessions in HS

Mass media approaches are least effective Box 7.4, p. 231 adds run at low viewer times

U.S. tobacco companies spend $7.12/person for ads but only $.50/person for prevention

Government programs are not very effective

Cigarettes are easy to get but increase cost (10%) might lead to decrease use Tavas et al. (2001)

Health benefits

cough, DOE resolve in weeks

exercise tolerance improves rapidly

bladder cancer: 50% reduction in 5 years

lung cancer: 50% reduction in 10 years

heart disease: 50% reduction in 1 year!

No excess risk of heart disease by 10-15 years

vascular disease: 50% reduction in 5 years

mortality - same as never smokers by 10-15 yrs

Non Health benefits

COST!!!

inconvenience

self-esteem

role model

Treatment options:

Level of use: < 1 pack/day have many attribute that might lead to successful cessation

> 1 pack/day more difficult to quit

Motivation, social support and advice

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

Gradual reduction less nicotine in cigarettes 49 % success v. 22 % cold turkey

Treatment products such as NRT, bupropion the patch and gum -Box 7.6, p. 234 235 chain chewer

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.

Inhalator - 10mg cartridges

Gum - 4mg, 2mg mint, original or fruit

Patch - 16hr = 15mg, 10mg, 5mg and

24hr = 21mg, 14mg, 7mg

Microtab - 2mg

Lozenge (2 types) - 1mg, 2mg, 4mg

Nasal Spray - 0.5mg per spray

Bupropion (Zyban)

150mg per tablet

Treatment options:

Aversion strategies

Rapid-smoking method take a puff every 6 seconds creating an aversive stimulus

Electric shock pairing -rates of cessation Welter et al. (1998)

Self-management stimulus control of situations for smoking or not smoking

Stimulus substitution taking a walk after dinner, chewing gum

Contingency-contracting give money to someone who give it back if cessation goal is reached

Large scale programs varying success may initially reduce smoking but usually returns Gomel et al. (1993)

health psychology smoking chapter 7

Documents

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smoking concerns smoking

smoking changes

older smoking

maternal smoking

cessation of smoking

health consequences

absorption of nicotine