Who Smokes and Why

1
Who Smokes and Why
2
Prevalence

• Current estimates for US 25 of adults smoke.
  High was 41 in 1965.
• 25.2 million men (26.7 percent)
• 23.2 million women (22.8 percent)
• Estimated 4.1 million teenagers aged 12 through
  17 years are smokers.

3
Prevalence by Race

• African Americans over 18 years of age have the
  highest amount of smokers
• African American 25.1
• Whites 22.9
• Hispanic 21.2
• Asian 14.4

4
Prevalence by Education

• People with less formal education tend to smoke
  more
• Less than 12 years 29.1
• More than 12 years 18
• Smoking prevalence was highest among men who had
  dropped out of school
  (41.9).

5
Prevalence by Age

• Nationwide, 70.2 of high school students have
  tried cigarette smoking. More than one-third
  (36.4) of high school students were current
  cigarette smokers, i.e., smoked at least one
  cigarette in the past 30 days. White students
  (19.9) were more likely than African-American
  (7.2) or Hispanic (10.9) students to smoke
  frequently.

6
Prevalence by State

• Nevada has the highest number of adult smokers
  (30.3)
• Utah has the lowest number of adult smokers
  (15.1)

7
Prevalence and Taxes

• States with highest cigarette taxes Washington
  State, Washington D.C., Hawaii, Arizona,
  Massachusetts Connecticut and Minnesota, have
  lower rates of adult smokers
• States with lowest cigarette taxes Virginia,
  Kentucky, N. Carolina, S. Carolina, Wyoming,
  Tennessee, Indiana and W. Virginia, have higher
  rates of adult smokers

8
Prevalence by Country

• In developed countries, 41 of men and 21 of
  women regularly smoke cigarettes.
• In developing countries, 50 of men smoke, and 8
  of women.

9
Why People Smoke

• Why do you smoke?
• Why do you think people smoke?
• Is smoking cool?
• How could it be viewed as cool or sexy?
• What does someone get out of smoking?

10
Starting Smoking

• Reasons for starting
• Tension Control
• Rebelliousness
• Social Pressure
• Weight Control
• Parental Modeling

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College Students Reasons

• Dissatisfaction w/Education
• Being Unhappy
• Living in a Coed Dorm
• Valuing Parties
• Marijuana
• Binge Drinking
• Multiple Sex Partners
• Negative View of Religion

12
Why People Continue

• Habit
• Increase Positive Affect
• Decrease Negative Affect
• Addiction Nicotine Addiction Model

13
Ultimate Reason for Continued Heavy Smoking

• Nicotine is an addictive drug, which reaches the
  brain faster than drugs that enter the body
  intravenously. Smokers become not only physically
  addicted to nicotine, but develop the habit of
  smoking.
• Smokers also link smoking with many social
  activities, making smoking a difficult habit to
  break.

14

• Identified only as "Debi," the woman smokes
  through a hole in her throat, telling the
  audience she tried to quit when she became aware
  of dangers to her health, but couldn't.

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Quitting Smoking
16
Starting to Stop

• In 1994, an estimated 46 million adults were
  former smokers. Of the current smokers, 33.2
  million persons reported they wanted to quit
  smoking completely.
• An estimated 30 of smokers make at least one
  quit attempt per year.
• 81 fail within the first month.

17
Quitting smoking

• In 1995, an estimated 68.2 of current smokers
  reported that they wanted to quit smoking
  completely.
• Quit attempts, abstaining from smoking for at
  least one day during the preceding 12 months,
  were made by about 45.8 of current every-day
  smokers.

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Quitting Smoking

• About 23.3 of US adults (25 million men and 19.3
  million women) were former smokers in 1995

19
How People Quit
20
How People Quit

• Self-Help
• Nicotine Replacement
• Antidepressants
• Psychosocial Interventions

21
Self-help

• Of smokers using the self-help approach, about
  20 remain tobacco-free for about 1 year.
• In the U.S., about 90 of successful quitters
  have used some form of self-help method either
  alone or with other methods.

22
Self-help

• The most successful self-help materials address
  the physical, psychological, and social
  components of nicotine addiction and smoking
  behavior.
• Information includes topics like quitting, diet,
  exercise, relaxation, and relapse prevention.

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Group Help

• Some organizations, like the American Cancer
  Society, also offer highly structured group
  support programs
• The groups try to aid in the adjustment to a
  non-smoking lifestyle.
• Of smokers participating in group programs,
  about 33 are successful at 1 year.

24
Nicotine Gum

• Contains nicotine but less than that in
  cigarettes (about 2mg per stick instead of the
  6-8mg in a single cigarette).
• Nicotine is slowly released when chewed (90 of
  the nicotine is released in 20-30 minutes).
• Used properly, this gum helps to slowly wean
  from cigarettes by first substituting the gum and
  then chewing less and less of the gum.

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Nicotine Gum

• Most patients are advised to use the gum for 3-6
  months.
• Side effects of the gum may include nausea,
  dizziness, or overdoses.
• Studies have suggested that the gum is effective
  in decreasing the amount of symptoms experienced
  with the withdrawal syndrome.

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Nicotine Gum

• There have been reports that use of the gum with
  behavioral treatments has provided success at 1
  year in up to 37.
• Without counseling and a physician's
  instructions, success is low.

27
Nicotine Patches

• The patches have been found to significantly
  decrease the craving for nicotine.
• Initial studies suggest the 1 year quit rate
  with the patch to be up to 20.

28
Nicotine Inhaler

• Designed to help w/habit aspect.
• New, so there isnt much data.

29
Anti-Depressants

• Recent studies of bupropion (Zyban) have shown
  that this drug may be useful in heavily addicted
  smokers when used in combination with behavioral
  methods of quitting.

30
Anti-Depressants

• There appears to be an increased quit rate and a
  decreased relapse rate with bupropion as compared
  to control subjects.
• It is thought that bupropion may work by
  decreasing the withdrawal symptoms associated
  with nicotine addiction.

31
Psychosocial Interventions

• Three types of counseling and behavioral
  therapies were found to be especially effective
  and should be used often in combo with
  pharmacotherapy
•  Provision of practical counseling (problem
  solving/skills training).
• Provision of social support as part of treatment
  (intra-treatment social support).
• Help in securing social support outside of
  treatment (extra-treatment social support).

32
Relapse Prevention

• Abstinence Violation Effect
• Triggers
• Slippery Situations
• Behavior Chain Analysis

33
Treatment Outcome

• There is a strong dose-response relation between
  the intensity of tobacco dependence counseling
  and its effectiveness.
• Treatments involving person-to-person contact
  (via individual, group, or proactive telephone
  counseling) are consistently effective, and their
  effectiveness increases with treatment intensity
  (e.g., minutes of contact).

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Treatment Outcome

• Women more willing to make quit attempt
• Women less successful in first 24-hours
• Equal in avoiding relapse once quit

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In Sum

• Tobacco dependence is a chronic condition that
  often requires repeated intervention.
• However, effective treatments exist that can
  produce long-term or even permanent abstinence.
• Tobacco dependence treatments are both clinically
  effective and cost-effective relative to other
  medical and disease prevention interventions.

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Effects of Quitting

• Possible 9-11 pound weight gain
• Decreased risk for all cause mortality
• Light smokers return to normal after about 15
  years.
• Heavy Smokers take longer
• Lung cancer rate risk lower but remains