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

11. 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.

15. 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.

18. 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.

23. 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.

25. 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.

26. 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 isn’t 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).

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

35. 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.

36. 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