Why do people smoke

Why do People Smoke?

By Ruth P. Wachter The impact of smoking on mental health is difficult to ascertaine. An analyse based on the biopsychosocial model.

A closer look at the physical process of smoking indicates a cycle time from lung inhalation until the nicotine reaches the brain of 10-16 seconds (Javis, 2004). Thereof just 7.5 seconds are needed for the distribution between lung and brain. This is much faster than e.g. an intravenous injection of diacetylmorphine (more commonly known as „Heroin“) that needs almost 14 seconds to reach its final destination after injection (Warburton, 1985). The elimination half-life (EHL) of nicotine (which is the stimulant drug contained in cigarette smoke) is 15-20 minutes.

However, the EHL of diacetylmorphine is 0.8-7 hours. Due to the short EHL of nicotine, smokers are required to have their regular cigarettes to avoid a drop-off of their blood nicotine concentration.

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Before concentrating on the application of the biopsychosocial model, I want to say a few brief words about smoking behaviour in general. According to Simonich (1991), the approaches of regarding the question „why people smoke“ can be divided into two categories. The first category includes the noncognitive approaches (e.i. nicotine addiction).

The second category contains the cognitive approaches (e.i. help to relax, feel more comfortable at parties, help to keep weight down). In the course of time, the debate between the opinion that smoking is a choice (cognitive) or addiciton (noncognitive) has become more and more important.

Fernander, Shavers & Hammons (2007), in a study of tobaccorealated health disparities among racially classified social groups, explain that 3 million humans die annually because of smoking. The morbidity rate per country caused by smoking behaviour varies significantly. They argue that the cultural differences in smoking behaviour (e.i. number of cigarettes per day, type of cigarette, etc.) are the

reasons why e.g. American females risk suffering from cancer is significantly higher than the risk for European females.

Biological aspect. You often hear that smoking damage the health.

We all know smoking incurs the risk to suffer from lung cancer, mouth cancer, peripheral arterial disease or paradontitis. Tobacco companies are already obliged to print warning labels on cigarette boxes. Nevertheless, people still smoke. The question must be asked, therefore, whether or not smoking can have also positive effects in case of the biological aspect. Grehoff, Aston-Jones & Svensson (1986) show that nicotine results in a higher release of noradrenaline and acetylcholine which may improve the cognitive performance.

Levin, Wilson, Rose & McEvoy (1996) agree with this approach and apply the effects of haloperidol and nicotine on cognitive performance on a group of schizophrenics.

The authors illustrate the possibility of nicotine in combination with haloperidol for reducing cognitive deficits.

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Psychological aspect. According to Scheerer & Vogt, the regular consumption of nicotine to avoid a drop-off of their blood nicotine concentration has a positive effect on human‘s reward system. But, they argue as well that the noncognitive trigger goes every time in combination with the cognitive trigger. Similar findings were published by Orleans & Slade (1993).

They confirm that smoking behaviour is a blend of cognitive and noncognitive elements. Take, for example, the study of Weiser et al. below. This study illustrates how cognitive effects (feel comfortable and secured) and noncognitive effects (nicotine addition) work together. Moreover it shows the premise of the benefit (feel comfortable and secured and activation of the renewal system) weighted to costs (lower IQ due to nicotine addiction).

The Telegrapher (Collins, 2010) has published on 3. April 2010: „Smokers have lower IQs: A cigarette dangling lazily from the mouth was once the telltale sign of an intellectual, but new evidence suggests it may have signalled quite the opposite.“ Collin‘s argument is based on Weiser et al. (2010). The

authors point out that smoking affects cognitive test scores. From the article, it is clear that smokers have a lower score than nonsmokers and former smokers have a better score than present smokers. It would be interesting to know their author‘s thoughts on how much time smokers need to recover after their smoking cessation. The authors‘s assumption that adolescents with poor IQ scores can be solved by attending prevent-from-smoking programmes is debatable. The study fails to address the questions about the cultural differences and the social background. Weiser et al.‘s prospective study is based on 20 221 Israeli soldiers, without taking into consideration the increased stress level due to the participation in sorties. There is no reference to the neuroscientific methods or/and research. The smoking status is based on selfreported. information only without taking into consideration another possible hypothesis: Humans with lower IQ are more likely addicted to cigarettes than humans with a higher IQ. Harte, Proctor & Vasterling (2014) make an additional, useful distinction between deploy-

ered and non-deployered soldiers.

This is reflected in their findings that acute and/or chronic stress is a trigger for tobacco use without taking into consideration the link to IQ. Social aspect. Day after day we see groups of persons standing together while smoking a cigarette.

This image belongs to our Western culture in business as well as in bars and discotheques. It seems that it is a kind of „belonging to a group“. Either you stay inside for working or having a glass of wine, or you join this kind of social group outside (the office building, restaurant, bar). I personally belong to the group of people that stay inside because I am a self-confessed non-smoker. Regardless of the fact that I have the feeling that it is the right conviction, I have sometimes the feeling that I miss important discussions and/or decisions due to this behaviour. Why this is so?

According to Huismann (2014), there is no influence of friend‘s smoking behaviour and the reason why people start smoking. It is precisely the opposite: People select their friends (social group) based on the collective attitude on

Pull out box Smoking behaviour and success of the respective smoking cessation depend on the socioeconomic status, level of eduction and individual drivers (e.i. fatphobia, less self- awareness, stress, etc.).

This study has shown that promising approaches for smoking cessation are there, if the smoker decides for himself to stop smoking.

If the smoker e.g. suffer from mental disease like schizophrenia or depression it is important to consult a doctor before starting the smoking cessation.

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smoking behaviour. It is curious that De Vries, Engels, Kremers, Wetzels & Mudde (2003) supports a different approach. According to their study, the smoking behaviour of our best friend impacts, but a small one. However, for the authors the smoking behaviour of the parents is much more important.

The study of Schuck, Otten, Engels, Barker & Kleinjan (2012) shed light on this affair. They argue that the influence between parents and child is bidirectional, while the influence between siblings or partners is unidirectional. Although much work has been carried out on the influence of the smoking behaviour (i.e. decision to smoke, amount of cigarettes per day, etc.), a number of questions remain. The study fails in answering the question e.g. „Who is affected when and by what?“. In general, however, the study supports my assumption that adults freely decide which social groups (smokers or nonsmokers) they want to belong.

lack of scientific substance. For the purpose of this paper, I will confine the discussion of behaviour methods for smoking cessation. In addition to the behavioural methods, which among to biopsychological interventions, a number of pharmacologic (biological) interventions. In light of the social aspect analysis above, I set aside the purely socialeconomical interventions. I must add, however, that the support of parents or partners is important for long-term abstinence (Fisher et al., 1993).

Smoking cessation. For some time, now the situation has been changed. Before the rethinking of human health has started, it was widely believed that smoking among young people as "cool". In the UK, more than 41 thousand people were diagnosed with lung cancer in the year 2009. By contrast, in the year 2010 the number of deaths caused by lung cancer was about 35 thousand in the UK. The question must be asked.

Therefore which method of smoking cessation helps if people want to stop their behaviour. It is also worthy of note that the risk of heart attack falls to about 50% of that of a smoker after 1 year after smoking cessation. The equivalent figure will appear for lung cancer only after 10 years.

A number of methods for smoking cessation are offered for those smoker who really want to stop smoking. Despite the fact that it would be interesting to examine also the pseudoscientific techniques I have excluded them from the scope of this paper, due to the University of Liverpool

Behavioural methods. Hiscock, Bauld, Amos, Fidler & Munafo (2012) explain that 5.4 million humans annually die from smokingrelated behaviour. The most interesting finding related to their study is that humans with a low socioeconomic status (SES) are less likely to quit smoking than humans with a high SES. The reason for this is their reduced social support for quitting, lower self-motivation and stronger addiction to tobacco.

For my part, I believe that for humans with a low SES the feeling of belonging to a team is much more important than for humans with a high SES. In former times belonging to a group was necessary to

survive (Douglas, 1995). Adler et al.

(1994) add that smoking behaviour is a clear criterion for the categorisation in SES. Moreover they show the connection between education and smoking behaviour. Additionally the auditors have analyzed the current smoking behaviour within the employment grades and discovered that the proportion of smokers decreases with the increase of the employment grade. Similar findings were also reported by Matthews, Kelsey, Meilahn, Juller & Wing (1989). You may turn it over and over in your mind, but there is only one conclusion possible: It is easier for humans with high SES to change their smoking behaviour and complete successfully a smoking cessation than humans with low SES. However, the authors fail to take the quantitative indicators into account. There is not any reference to the exact classification of „low SES“ and „high SES“.

Where do the attributes (SES and success in smoking cessation) cross? To answer this question, a detailed study is required. I have now explained at great length how difficult it is for humans in different SES to change their smoking behaviour.

Now I want to illustrate which behavioural methods are available for selection.

The first method that I want to mention is the method of aversive smoking. This method associates the behaviour of smoking with a galling stimulus or pain (e.i. electronic surge, elastic band on wrist or symptoms of overdosage due to rapid smoking). Hajek (2004) as well as Hill (1988) come partly to contradictory conclusions within their study of „rapid smoking“. Very little has been written about the science-based success of this method this is the reason why doctors advise against this method (Lichtenschopf, 2011). The success speaks for itself: 80% abstinent smokers and smokers that have reduced their number of cigarettes dramatically (Schmahl, Lichtenstein & Harris, 1972).

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Another method is the hypnobehavioural approach. Hypnosis serves as an addition to the widely known cognitve-behavioural therapy (CBT). While CBT is working with techniques like competing behaviours, promotion of motivation or/and cognitive restructuring, hypnosis supports with the visualisation of a life without smoking or/ and a life with e.i. lung cancer (Covino & Bottari, 2001).

Action on Smoking and Health (2013). Illness and Death [Date file]. .

among racially classified social groups.

Addiction, 102 (2), 43-57.

Adler, N., Boyce, T., Chesney, M., Cohen, S., Folkman, S., Kahn, R., Syne, S. (1994).

Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49 (1), 15-24.

Hajek, P. (2004). Aversive smoking for smoking cessation. Cochrane Database Of Systematic Reviews (CDSR), 3.

Due to uncontrolled studies and less evidence, hypnosis canot confirmed as an evaluated method for smoking cessation alone (Hely, Jamieson & Dunstan, 2011; Barnes et al. 2010). Hall, Munoz, Reus & Sees (1993) warn against a reckless use of one of the behavioural methods although some authors recommend them for selftreatment. Starting a cognitivebehavioural therapy or a nicotine replacement therapy with patients that suffer from any mental disorders (e.i. depression) should be thought-out and discussed with a doctor. In case of pre-existing mental disorder, medication should be examined.

Collins, N. (2010, April 03). Smokers have lower IQs. The Telegrapher.

I can only say at the end: Life is what you make it!

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Barnes, J., Dong, C., McRobbie, H., Walker, N., Metha, M., Stead, L. (2010). Hypnotherapy for smoking cessation. Cochrane Database Of Systematic Reviews (CDSR), 2.

Covino, N., Bottari, M. (2001). Hypnosis, Behavioral Theory and Smoking Cessation.

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De Vries, H., Kremers, S., Wetzels, J., Mudde, A., Engels, R. (2003). Parents‘ and friends‘ smoking status as predictors of smoking onset: Findings from six European countries. Health Education Research, 18 (5), 627-636.

Grenhoff, J., Aston-Jones, G., Svensson, T. (1986). Nicotinic effects on the firing pattern of midbrain dopamine neurons. Acto Physiologica Scandinavica, 128 (3), 351358.

Fernander, A., Shavers, V., Hammons, G. (2007). A biopsychosocial approach to examining tobacco-related health disparities

Harte, C.B, Proctor, S., Vasterling, J. (2014).

Prospective Examination of Cigarette Smoking Among Iraq-Deployed and Nondeployed Soldiers: Prevalence and Predictive Characteristics.

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Hiscock, R., Bauld, L., Amos, A., Fidler, J., Munafo, M. (2012). Socioeconomic status and smoking: A Review. Addiction Reviews, 1246, 107-123.

Levin, E., Wilson, W., Rose, J., McEvoy, J. (1996). Nicotine-Haloperidol Interactions and Cognitive Performance in Schirzophrenics. Neuropsychopharmacology, 15 (5), 429-436. Lichtenschopf, A. (2011). Standards der Tabakentwöhnung: Konsensus der ÖsterreichischenGesellschaft für Pneumologie.

Berlin (DE): Springer Verlag.

Schmahl, D., Lichtenstein, E., Harris, D. (1972). Sucessful Treatment of Habitual Smokers with Warm, Smoky Air and Rapid Smoking. Journal of Consulting and Clinical Psychology, 38.

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