SMOKING AND OBESITY. THE BEHAVIORAL RAMIFICAT ONS

Richard St Pierre, Ed D Carrie Lee Warren, Ed D

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Richad St. Pierre, EdD., Assistant Professor of Health Education, Department of Health Education, Pennsylvania State University, State College Pennsylvania and Carrie Lee Warren, EdD., Associate Professor of Health Education, Department of Pmfessioml Studies, University of Houston at Clear Lake City, Houston, Texas.

INTRODUCTION Two major health concerns today center around

the high incidence of cigarette smoking and its relationehip to chronic disease conditions and the increasing prevalence of obesity and its physical and psychological impact on the individual. Although statistics on the scope of these two problems vary considerably, they generally indicate problems of severe magnitude.

Each year as many as one million teenagers become smokers. At one time or another 75 percent of the male population and 46 percent of the female population in the United States smoked cigarettes regularly.

Mayer (1974) has reported that in some cases the prevalence of obesity is as high as 20 percent in certain high schools. Even more startling is his statement that one third of the male population and almost one half of the female population in the age group 50 to 69 could be determined obese.

Other statistias could be stated to support the rationale for this paper, but the best evidence is visual. Simply look around and the incidence of these conditions becomes apparent.

Both health concerns mentioned provide a considerable amount of content material in health education classes. These topics might surface in a variety of class discussions centered on such diverse areas as drugs, mental health, nutrition, chronic disease, and consumer health.

It would be a rare health educator who, following class discussion, has not been confronted by a perplexed student desiring information on how to control excessive smoking behavior or seeking ways to reduce unwanted poundage. Often health educators are not prepared to offer such advice.

Though aware of the dangers and hazards of such conditions, offering assistance to change behavior patterns presents an entirely different picture. There is difficulty in shifting from the cognitive domain to the elusive, but essential, problems related to attitudes and actions.

BEHAVIORAL NATURE OF SMOKING AND OVEREATING

Both obesity and smoking have several behavioral characteristics in common. Each can be considered a learned behavior. It is well known that the first cigarette the young adolescent experiments with is not always pleasurable. He must “learn” how to smoke, how to handle the cigarette, and how to gain satisfaction from the act.

The learning mechanism is even more apparent with regard to eating. We quickly gain preferences for certain foods, get hungry a t certain times of the day and like our foods prepared a specific way. Everyone has “learned” to like certain foods. The first taste of caviar to the young socialite is probably repugnant but after repeated exposure, it is considered a delicacy.

Both smoking and eating can reduce tension. The adolescent girl who was not invited to the prom might find some relief from the frustration by overeating. Likewise, the student taking his final exam might reduce his tension by smoking.

In addition to tension reduction, both smoking and eating are reinforcing in other similar ways. Both can increase social interaction and peer acceptance. Smoking can be a sign of adult status while eating (at least properly) invokes parental approval.

When one considers that smoking and eating are learned forms of behavior that often provide tension reduction and other forms of immediate reinforcement, the difficulty in controlling the ex- cesses of these behaviors becomes apparent.

Before the health educator provides guidance to an individual seeking assistance in reducing smoking levels or losing weight, he should be aware of some conditions that make success in these areas somewhat tenuous.

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To begin with, both behaviors are socially approved. Even though smoking has been linked to cancer and obesity to heart attacks, there are still few restrictions on these behaviors. A person is free to eat and smoke without breaking any laws or heing considered abnormal, though to the nonsmoker or person of average weight, smoking und overeating might appear to represent weakness in character and a lack of self control.

Both behaviors are subject to strong peer pressure. The relationship between peer influence and smoking is well documented. Since most of the adolescent’s leisure time activity centers around group activities of a social nature, food and eating must be considered integral. In fact in some areas, gathering a t a soda shop or hamburger stand may be a major leisure time activity.

Another aspect that presents problems in dealing with these two conditions is the fact that the major health related consequences are long term in nature. The 21-year-old college student has trouble accepting the idea that smoking will reduce the chances that he will live to be 72 or that his obesity increases his risk of heart diseases during middle age. In other words, if excessive smoking or overeating are serving as immediate reinforcers, it is unlikely that concern about the long range consequences will provide sufficient motivation to reduce either behavior.

Constantly hearing only the negative effects of smoking or obesity can actually increase the severity of either condition. Again, if we view both behaviors as forms of tension relievers, the worry or concern over the negative effects can have a reactive affect on the behavior (Watts, 1967). Generally, the control or reduction of these behaviors is attempted via the negative approach. Seldom is the condition handled with positive techniques.

Related to this is the fact that positive gains or improvements are slow in emerging when a person attempts to modify either behavior. Anyone who has attempted to lose weight or reduce his level of smoking can attest to this fact. As a result, rewards or reinforcement via succeea is difficult during the early stages of behavior control. This is one reason why success in controlling behavior in either area is ,so minimal; the immediate reinforcement is not sufficient to maintain the behavior.

Further compounding the problem is the fact that a variety of environmental situations can initiate the smoking or eating response. We are bombarded by cues encouraging either behavior: friends’awhb smoke, advertisements about food, situations conducive to smoking or eating, and the reinforcement we gain from indulging. Also, as the

habit of eating or smoking intensifies, a chain of events can lead to the behavior. Walking by the stove can encourage the impulse to eat or seeing an unused lighter could initiate the chain of events to smoke.

Finally, success in reducing either behavior is limited due to little supportive assistance. Few friends or resources are available to help carry out the program necessary to reduce the behaviors in light of the pitfalls identified above. I t is a t this point that the health educator can play a vital role.

THE HEALTH EDUCATOR’S ROLE

The health educator can suggest that the student conduct a behavioral interpretation of the problem. Situations, individuals, or environmental stimuli most conducive to smoking or overeating should be identified. How frequently the behavior occurs, under what conditions i t occurs and the end result of engaging in the behavior should be included in such an analysis. With this information in hand the student can be more objective in developing a plan of action. It is imperative that negative or adverse rationale for altering the behavior be minimized. Emphasis should be on positive or immediate benefits of behavior change. Self-directed modification of the environment and awareness of cues that encourage smoking and eating are essential. Behavioral changes resulting from conscious effort have the potential of improving self- concept and encouraging continuation of satisfying new behaviors. Conversely, guilt, shame, and a sense of failure evolve from the inability to begin or maintain model behaviors. The student should be encouraged to seek support of friends or the health educator throughout his efforts to reduce the daily number of cigarettes smoked or the amount of food consumed. Emphasis should be placed on self- control and the development of alternative behaviors which assist self-control.

Since success in either area, smoking or overeating, is limited a t first, efforts should be made to reinforce even minimal achievement. The key to success centers around a thorough evaluation of the behavior itself coupled with support and reinforcement from concerned individuals.

It is most important that the health educator have a sufficient pool of resources and referral suggestions a t hand. Providing students with sources of information relating to behavior change and encouraging the assistance of trained personnel can often be the major service rendered by the health educator.

THE JOURNAL OF SCHOOL HEALTH 407

REFERENCES Fear-arousing Communications. (Doctoral dissertation, Bryn Mawr College) Ann Arbor, Michigan. University Microfilms, 1967, No. 68-04699:

Abramson EE: A review of behavioral approaches to

Mayer J: Health. New York, D. Van Nostrand Company,

Stuart RB, Davis B: Slim Chance in a Fat World,

Watts JD: The Role of Vulnerability in Resistance to

weight oontrol. Behav Res "her 11:547-556, 1973.

1974. The corresponding author of this article is Carrie Lee Warren, EdD., Associate Professor of Health Education,

Champaign, Illinoh, M a r c h Press, 1972. Department of Professional Studies, University of Houston at Clear Lake City, Houston, TX 77058.

PATIENTS NEEDED FOR STUDY OF ANOREXIA NERVOSA

An NIMH-sponsored study on treatment effectiveness in anorexia nervosa is soliciting suitable cases. If selected for study, a patient will be treated free of charge in one of three collaborating institutions: the University of Iowa, the Illinois State Psychiatric Institute, and the University of Minnesota. Duration of hospital treatment is about 45 days.

Anorexia nervosa is characterized by extreme emaciation, a high degree of physical activity, unusual eating habits, an abnormally high value placed on thinness, and failure to recognize or denial that a problem exists. The disorder primarily afflicts girls of high school and college age but may go as low as 10 and as high as 30 years. Although the disorder is rare, the mortality rate is high for untreated cases.

Readers who are aware of possible study cases are encouraged to phone (collect) or to write to one of the following study collaborators for further information:

Solomon C. Goldberg, Ph.D. Asst. Chief, Psychopharmacology Research Branch, NIMH 5600 Fishers Lane, Room 9-105 Rockville, Maryland 20852 Area Code 301-443-3524

John M. Davis, M.D. Ill. State Psychiatric Institute 1601 West Taylor Street Chicago, Illinois 60612 Area Code 312-341-6302

Katherine A. Halmi, M.D. Department of Psychiatry University of Iowa Iowa City, Iowa 52240 Area Code 319-353-3960

Elke D. Eckert, M.D. Department of Psychiatry Box 393 Mayo University of Minnesota Minneapolis, Minnesota 55455 Area Code 612-373-8856

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