Essay/Term paper: Smoking

Essay, term paper, research paper:  Alcohol and Drugs

Smoking


The first article for review is titled Self-efficacy, Health Locus of
Control, and Smoking. This article studies how the participants confidence
levels and health locus prior to entering treatment predicts results of the
quitting program. The program is called "Fresh Start" and was conducted in
Victoria, Australia. It consisted of three groups:
(A) those who made an attempt (Stop for one day),
(B) those who met criteria in A, and did not smoke for duration
of program,
(C) those who abstained for six months.

Confidence was tested by questionnaires (post, during and at 6-month
period). Health Locus is defined by how the participant attributed health
outcomes (internal, external or by chance). The results of this experiment
showed that those individuals across the three groups who had high levels of
self-efficacy was related not to the number of attempts to quit, but the success
of the attempts, while "the role of Health Locus of Control [was found to be]
complex needing further investigation" (Stuart, Borland, & McMurray, 1994, p. 1).
The second article for review is titled, Sensation Seeking, Nicotine
Dependence, and Smoking Motivation in Female and Male Smokers. This study was
conducted using a sample of French smokers (36 F, 60 M) and non-smokers (23 F,
45 M). The goal of the experiment was to study "the relationship between
sensation seeking and smoking" (p. 221). The objectives of the study was (a) to
see if smokers are higher in sensation seeking than their non-smoking
counterparts, (b) to see if there are any gender forces in smoking and sensation
seeking, and (c) to examine "in each sex, the nature of the relationship between
sensation seeking and smoking" (p. 221).
These three items were measured on four sub-scales, they are:
1) The Disinhibition subscale (DIS) - shows desire to be
socially open, extroverted
2) The Thrill and Adventure Seeking subscale (TAS) - shows
desire, extreme physical activities.
3) The Experience Seeking subscale (ES) - shows search for
new and exciting life experiences.
4) The Boredom Susceptibility subscale (BS)

After the evaluation of multiple questionnaires was completed, results
of the subscale analysis was as follows:

(a) Smokers score higher in sensation seeking regardless of
sex, than non- smokers.

(b) Women scored higher scores than men in the ES subscale
(trend).

(c) Men scored higher on AIS and TAS scale than women.

(d) ES and BS subscales had a significant main effect for
smoking status.

This study concludes by showing "that smokers score higher on measures
of sensation seeking than do non-smokers" (p. 224). This aids the belief that
sensation seekers may be more open to become dependant on smoking, as opposed to
those who score low on sensation seeking activities. Finally, women scoring
higher on the ES subscale, was attributed to mass media and emerging cultural
trends that have lured more women to be independent and more experience seeking
than in the past.
The next article in the subject of smoking is titled Measuring Readiness
and Motivation to Quit Smoking Among Women in Public Health Clinics. This study
was a pilot program to test as an instrument in the stage readiness and
motivation of 495 women of lower socioeconomic class in Chicago. Since this
segment of the smoking population has not declined when other have, it reveals
the reasoning behind the study and therefore it is necessary to "develop and
validate an instrument to measure progress across all stages of readiness" (p.
497) to aid motivation.
The instrument spoke of is a questionnaire by Diclemente, et al., (1991)
and Prochaska, et al. (1992), modified to meet the literacy level of female
subjects of the lower socioeconomic level. The questionnaire was given to
smokers "in prenatal, family planning, and well-child health clinics" (p. 498).
The stages of Prochaska and Diclemente's were expanded to ensure sensitivity
because most of the women of low SES fell into the first category;
precontemplation (no intent to quit smoking in the next 6 months). The
experimenters, therefore, "were interested in measuring movement within the
early stages of change" (p. 498). Through the use of Biener and Abrams (1991)
contemplation ladder, the experimenters were able to make this expansion. The
experiment also evaluated other variables, they were: "smoking status, age,
education level, pregnancy status, and type of clinic" (p. 501). Results of
this newly formed instrument to detect finer movement across the
precontemplation stage of readiness yielded the following:
(a) "Readiness was higher for women who were pregnant" (p. 505).

(b) Higher readiness equalled higher motivation, confidence, and
action.

(c) Stages unrelated to other variables (age, education, stress, or
race).

(d) Stages of readiness to quit was negatively related to habitation
factors (p. 506). This experiment concludes by stating there instrument meets
the low literacy needs of low SES women and that the instrument has shown
sensitivity and reliability "to track the movement of motivation and readiness
to quit in such a group" (p. 506).
The fourth article for summary is Cigarette Smoking: Effects Upon Self-
Rated Stress and Arousal Over the Day. This experiment dealt with the
"typology" of smokers. Its main objective was to find evidence that contradicts
the arousal modulation theory of smoking. Subjects were divided into two
groups; smokers that smoked for arousal and those who smoked for sedative
reasons. The experiment was done over the course of one day, which was divided
into four time blocks; first cigarette = first time block, while last cigarette
of the day was the fourth time block (rest of the day was divided into blocks 2
and 3). Subjects made self reports before and after each cigarette for that day.

For subjects in the stress group, stress was high before each cigarette
and decreased afterward, increasing again prior to the next cigarette (cyclicle
pattern). Subjects in the arousal group over the day yielded an increase in
arousal in block one, that increased gradually until high in later afternoon,
then decreasing at night. These outcomes lend support to the theory that the
main problem with the arousal modulation theory "is the linkage of stress and
arousal" (p. 394). This study provided "an alternative viewpoint: that stress
control and arousal control are separate and orthogonal" (p. 395), and research
into sub-groups of smokers is needed.
Attributional Correlates of Cessation Self-Efficacy Among Smokers was an
experiment designed to examine the association of past failed attempts at
quitting smoking, with Self- Attribution and Self-efficacy.
One hundred and twenty-one male and female subjects who were seen
smoking at a small campus or mall were asked to complete an open-ended
questionnaire concerning the subject at hand. The questionnaire was designed to
elicit information for the following categories:
(1) Demographic and historical data.
(2) Attributional statement and dimensional ratings.
(3) Composite attributional indices.
(4) Cessation self-efficacy.
Results from the open-ended attribution questionnaire found "three main
categories: personal factors, situational factors, and combined personal and
situational factors" (p. 315). Analysis of these categories and sub-categories
suggest "that attributional processes are related to cessation among smokers" (p.
317). Smokers who were confident in future quit attempts, attributed past
failures to unstable and/or controllable factors; while those with low
confidence, attributed past failure to stable and/or uncontrollable factors.
The main factors to help explain failed attempts at cessation were self-blame,
perceived ideas concerning past failures and having family/friends who smoke.
The experimenters conclude by suggesting that therapists should "focus
on the similarities" (p. 319) of different models of attribution to create
therapies that aid in helping clients to "[attribute] abstinence failures to
changeable, controllable factors" (p. 319) which based on their findings
increase the self-efficacy of smokers.
The last article is a study of self quitters by H.J. Garney, et al. that
followed 235 people who quit smoking on self intuitive alone, for a period of
twelve months. The project was run through to determine what factors caused the
participants to fail in their attempt to quit smoking. More importantly, the
study looks at the post-quitting period, not as a single entity, but as several
critical time frames of said post-quitting period.
The number of people who relapse is quite high among those who used
self-quitting techniques is why this study is important. It sheds light in the
areas of the scientific study of the addictive habit of cigarette smoking and it
provides many useful and helpful hints to those who have previously failed in
their attempts to stop smoking.
The purpose of this study, as stated by its authors is as follows: "to
provide prospective information on predictors of early and later relapse for
smokers who made a self-initiated quite attempt" (p. 365). From 251 subjects,
235 were chosen and each initiated their quit attempt four days after a baseline
was taken. Each subject, whether they were successful in their attempt or fell
prey to relapse, were kept in contact with the experimenters through telephone
or personal interviews to monitor the subjects status and to ask questions
concerning their difficulties.
The study's baseline measured the subjects on many variables, such as;
level of motivation, confidence, and psychological stress. It also observed
personal variables like, the smoker's history, demographics, environment and
lifestyle. An interview schedule in conjunction with various tests (ex.,
Smoking Test Patterns, Russel, et al., 1974) and electronic equipment to measure
carbonmonoxide levels were used to generate the baseline accurately.
Follow up measures included getting information from subjects concerning
their productivity after quitting smoking, at the one month mark. If they
relapsed at all, or if they had abstained from smoking how their attitudes were
on psychological stress, confidence to remain abstinent, as well as frequency
and strength of temptations to smoke. These follow up measures were used again
at the 3 month mark, and at the 12 months mark for those who were still able to
abstain. Carbonmonoxcide levels and saliva samples were tested to verify
subject's claims of abstinence. The projects definition of "relapse" is an
important note here, it is as follows: "relapse was defined as 7 or more
consecutive days of smoking, or 7 or more consecutive episodes of smoking" (p.
369).
At the 12-month follow up only 12.8% of the sample population of 235
subjects managed not to fall into relapse. For those who relapsed, results
indicate that the greatest amount of relapse occurred by the first two weeks of
post-self-quitting. The percentages of relapses in the first two weeks are:
13% - day 1
32% - by day 3
49% - by week 1
62% - by week 2
The relapses increase to 76% at the end of month one, and then levels
off finally at 87.2% between months one and twelve. From the results obtained
an analysis was done to find which baseline predictors had the strongest effect
on relapse. The relapse times were divided into four categories: Abstains
during: a) 0-7 days; b) 8-30 days; c) 31-364 days and d) at 365 days (* groups A,
B and C did not make it to 365 days abstinence). Outcomes revealed the
following: (most significant at the top of the list and decreasing effect as the
list goes down).
(a) not quitting as long as you did the last time you tried to quit.
(b) lower motivation to quit.
(c) lower confidence to quit for 3 months.
(d) have a spouse/significant other who smokes.
(e) greater alcohol consumption than baseline.
Multivariant results compared groups A, B, and C individuals with group
D (those who abstained for 365 days). The most significant baseline predictors
in descending strength are:
(a) short term confidence in maintain abstinence.
(b) not equalling prior longest quit time.
(c) started smoking to maintain weight. In comparison, between group
A and D, a person with one standard deviation higher in confidence is half as
likely to start smoking again. The odds are the same for someone who does not
meet or surpass their longest prior quitting duration. The weight motive
differed for gender type. Women are more likely not to relapse, and men were
more likely to they use the weight motive. While results for comparing groups B
and C with group D have basically the same predictors of relapse; less short-
term confidence and baseline alcohol consumption.
This study has found that relapse in the first early weeks of cessation
are higher than recent literature suggests, compared to those who attend stop
smoking type clinics.
Example: Self-quitters Clinic
62% vs 10%
(past 2 weeks)
76% vs 20% (to
1 month)

The other conclusions the study has made are:

1) It is the "length" of the prior longest quit duration and the number of
times one has tried to quit is important. (If the person doesn't match longest
time frame, he/she is more likely to quite due to motivation and confidence
factors).

2) Attitude prior to quitting: The level of commitment, motivation and
confidence are directly related to relapse. Therefore, higher levels of factors
yield longer quitting times and vice versa.

3) Baseline Alcohol consumption: If a person had high levels of alcohol
consumption during baseline, the person is likely to continue this practice and
therefore be exposed in social settings which provide cues to smoke and he/she
will be more likely to succumb to the temptation of smoking.

4) Any Smoking during cessation: Any smoking whatsoever by a person during
the cessation period dramatically increases the chances of relapse. For example
in this study, out of 215 who did smoke any amount at all, only 10 went on to
abstain, 205 went into full relapse.
In addition, the study revealed that neither age, gender,
education, amount smoked, social support or increased psychological stress
levels at the one month mark did not have a significant effect on relapse. And
finally, clinical implication are to advise potential patients with the four
main conclusions mentioned here.

 DIARY OF AN ATTEMPT AT SMOKING CESSATION FOR ONE DAY
(Thursday, December 7, 1995)

Biological Factors

- Felt generally tired all day.
- Teeth and gums ached.
- Tension throughout the day in shoulders and abdominals.
- Nostrils and mouth dry.
- Eyes dry and very "head drowsy".

Behaviours Recorded

- Couldn't sit still (as I usually could, eg., watching T.V.).
- Excessive snacking (calorie intake estimated by roommates at
7000 cal.).
- I was observed pacing a lot in mid-afternoon and continually
looking into the fridge but taking nothing out.
- Roommates say I was "hyper-sensitive" to any type of comments,
remarks, criticisms directed towards me.
- I was overly critical of everything I watched on T.V. (programs
and commercials).
- Tried to counteract biological factors (ex., splashed cold water
on face, had 3-20 minute periods of exercise [walking], brushed teeth more, had
rest periods).
- Smoked 4 cigarettes throughout the day.

Urges

- I had urges to eat and snack all day.
- Urges to do "something" but didn't know what to do.
- Urges and craving to smoke (mentally to calm me down, physically
to eliminate withdrawal symptoms).

Variations in Arousal

Though I was generally tired all day, there were peak times when I was
particularly more tired; these times were at 11:00 am, 3:30 pm and between 7:00-
8:00 pm. At these times there was a duality between being on the verge of sleep
and at the same time being really alert and somewhat excitable. Because it is
during exam time, I knew if I didn't smoke, I would get nothing done at all for
this day. So, I allowed myself 4 cigarettes for this day (a decrease from
25/day) to allow some type of productivity to take place. As a result of
attempting to quit smoking I was only able to read two chapters for one course,
on a day that there was not classes and I did not have to work, this production
level was very low. It was at these three time periods of heightened duality
mentioned above (and once prior to going to bed as a reward and a relaxant) that
I smoked. During these times, I could not make myself do anything, I could not
focus on any one thing, my attention was popping from one thing to the next,
which led me to ruminate excessively. In turn this led me to smoke in order to
relieve the frustration caused by ruminating. After smoking, I would be calm.
Smoking relieved my stress and anxiety, and increased the awareness and focus
relating to the tasks that I wanted to accomplish. This cycle repeated itself
four main times throughout that day.

References Carton, S., Jouvent, R., Widlöcher (1994). "Sensation Seeking,
Nicotine Dependence, and Smoking Motivation in Female and Male Smokers"
in Addictive Behaviors, 19(3), (p. 219- 227). Pergaman Press Ltd., Oxford,
England.

Crittendens, K.S., Manfredi, C., Lacey, L., Warnecke, R., & Parsons, J. (1994).
"Measuring Readiness and Motivation to Quit Smoking among Women in Public
Health Clinics" in Addictive Behaviors, 19(5), (p. 497-507). Pergaman Press
Ltd., Oxford, England.

Garvey, A.J., Hitchcock, J.L., Heinold, J.W., Rosner, B. (1992). Addictive
Behaviors, 17, (p. 367-377). Pergamon Press Ltd., Oxford, England.

Grove, R.J. (1993). "Attributional Correlates of Cessation Self-Efficacy Among
Smokers" in Addictive Behaviors, 18(3), (p. 311-320). Pergaman Press Ltd.,
Oxford, England.

Parrott, A.C. (1993). "Cigarette Smoking: Effects Upon Self-Rated Stress and
Arousal over the Day", in Addictive Behaviors, 18(4), (p. 389-395).
Pergaman Press Ltd., Oxford, England.

Stuart, K., Borland, R., McMurray, N. (1994). "Self-Efficacy, Health Locus of
Control, and Smoking Cessation" in Addictive Behaviors, 19(1) (p. 1-12).
Pergaman Press Ltd., Oxford, England.