HealthPsyc Seminar#11-12 Session Smoking 2022print

11/3/2022
Health Psychology
01.11.2022
Smoking and medication (ab)use
- Prof. Dr. Sonia Lippke
11/3/2022 Health Psychology (Sonia Lippke) 1
Agenda today
• Mock‐Exam
• General input and facts on smoking (behavior)
• Group work on paper
• More input and discussion on smoking
• Exercise on intervention
• Administrative points re next week
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Advance organizer
• Tobacco and smoking After this session, you should be
– The extent of smoking able to answer:
– Its major health impacts • How many people smoke and did
– Explanations of smoking this change during the last 50
years?
– Interventions to help smokers
to quit • What are the major health
impacts of smoking?
• Which interventions can help
smokers to quit?
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Health effects of smoking: Effects
on active smokers
• Cigarette smoking accounts for more than 480,000 deaths each year in the
U.S. and 120,000 deaths in the UK, nearly one of every five deaths
• More deaths are caused each year by tobacco than all deaths from HIV,
illegal drug use, alcohol use, motor vehicle injuries, suicides and murders
combined
• The risk of dying from lung cancer is at least 22 times higher among men
who smoke, and about 12 times higher among women who smoke,
compared with those who have never smoked
• The 2004 U.S. Surgeon General’s report on smoking and health revealed
that smoking causes diseases in nearly every organ of the body (U.S.
Department of Health and Human Services, 2004)
• The report concluded that quitting smoking has immediate and long‐term
benefits, reducing risks for diseases caused by smoking and improving
health in general. Quitting smoking at age 65 or older reduces by nearly
50% a person’s risk of dying of a smoking‐related disease
Marks, Murray & Estacio (2018). Chapter 12
Health effects of smoking: Effects
on passive smokers
• Those consistently breathing second‐hand smoke (SHS) have a higher risk of
cancer, heart disease, and respiratory disease, as well as sensory irritation
• The Surgeon General estimated that exposure to SHS killed:
– More than 3,000 adult non‐smokers from lung cancer each year
– Approximately 46,000 from coronary heart disease
– An estimated 430 newborns from sudden infant death syndrome. The
Scientific Committee on Tobacco and Health (1998) commissioned review
of the impact of secondary smoking on lung cancer. The report concluded
that sudden infant death syndrome, the main cause of post‐neonatal
death in the first year of life, is associated with exposure to environmental
tobacco smoke. The association was judged to be one of cause and effect
• In addition, SHS causes other respiratory problems in non‐smokers such as
coughing, phlegm and reduced lung function. Passive smoking causes the
premature death of thousands of non‐smokers worldwide
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Big tobacco campaign of
disinformation
• Big Tobacco carried out a disinformation campaign over several decades
• The campaign deliberately sought to create doubt in the minds of
legislators and the public about the effects of smoking
• However, through litigation and the action of whistleblowers and with the
release of thousands of tobacco industry documents, the details of the
disinformation campaign were revealed
Analysis of tobacco industry documents on
smoking and health
(Action on Smoking and Health, 2010)
• Nicotine and addiction: The industry routinely denied that tobacco is
addictive, yet it has known this since the 1960s
• Marketing to children: The companies deny that they target the young. Yet
company documents revealed the companies’ pre‐occupation with
teenagers and younger children and methods to influence smoking
behaviour in these age groups
• Cigarette design: The industry promoted ‘low‐tar’ cigarettes knowing that
they were lacking any health benefits, or even made cigarettes more
dangerous
• Passive smoking: The industry refused to accept the evidence of the harm
caused by SHS
• ‘Emerging markets’: With reducing smoking levels in the West, the
companies moved aggressively into developing countries and Eastern
Europe
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Tobacco industry campaign of
disinformation
• Balbach et al. (2006) argue that the health belief model helps the tobacco
industry through its theoretical stance regarding individual choice, and
‘information’
• They analysed trial and
deposition testimony of
14 high‐level tobacco
industry executives from
six companies plus the
Tobacco Institute to
determine how they
used the concepts of
‘information’ and
‘choice’ in relation to
theoretical models of
health behaviour
change
Tobacco industry campaign of
disinformation
• They concluded that tobacco industry
executives deployed the concept of
‘information’ to shift full moral responsibility
for the harms caused by tobacco products to
consumers
• Discourses about smoking have a powerful
influence on attributions of responsibility,
whether the consumer or the provider is
ultimately to blame. Our ‘blame culture’ can
easily swing in either direction
Sources:
https://www.google.de/url?sa=i&url=https%3A%2F%2Fpixabay.com%2Fde%2Fillustrations%2Finformation‐info‐nachricht‐
1015297%2F&psig=AOvVaw1aIlK9mPEG8yAg_eOjPf3m&ust=1667380716385000&source=images&cd=vfe&ved=2ahUKEwjtqNur04z7AhUu_rsIHQSIDbgQr4k
DegUIARDkAQ
https://www.google.de/url?sa=i&url=https%3A%2F%2Fwww.linkedin.com%2Fpulse%2Ffive‐negative‐impacts‐blame‐culture‐gordon‐
tredgold&psig=AOvVaw0bKwKEu7FQ‐hngcRpPwjCT&ust=1667380648037000&source=images&cd=vfe&ved=2ahUKEwjv0I‐
L04z7AhUPh_0HHYUBBMcQr4kDegUIARDBAQ
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Tobacco promotion to children
and ‘Third World’
• Big Tobacco spends billions worldwide on advertising and promoting
tobacco products
• The U.S. Federal Trade Commission (2016) reported that the major
tobacco companies now spend $9.1 billion per year – nearly $25 million
every day – to promote tobacco products, and much of this activity is
directed towards children
• Hastings and MacFadyen (2000) analysed internal tobacco company
documents and found that the companies worked with advertising
agencies to target young people
• Econometric studies find that increased advertising expenditure increases
demand for cigarettes, while banning advertising leads to a reduction in
tobacco consumption
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Smoking prevalence worldwide
2020, by country | Statista
Smoking prevalence worldwide
2020, by country | Statista
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Smoking Rates by Country 2022
(worldpopulationreview.com)
WHO global report on trends in prevalence
of tobacco use 2000‐2025, fourth edition
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Overview on smoking
• Smoking prevalence is increasing throughout the developing world and
many people continue to smoke in the industrialized world
• Measures to reduce smoking prevalence have met with substantial
success, in spite of deceitful practices and disinformation from the
tobacco industry
• The primary methods to assist smokers to stop are reviewed, together
with research on electronic‐cigarettes
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Future research re smoking
• There is a need for increased understanding of the social, ethnic and
gender variations in smoking among young people and the impact of
tobacco advertising on different groups
• Much of the research to date on smoking cessation has been biased by
industrial interests. Research is necessary by independent investigators on
effective methods of smoking prevention and cessation
• More real‐world research is needed on e‐cigarettes as a potential gateway
to smoking, on dual use of e‐cigarettes with conventional cigarettes, and
on the long‐term effects of vaping on nicotine addiction to clarify the
impact of vaping on human health
• More evaluation of non‐pharmaceutical methods of smoking cessation
that aim at nicotine abstinence rather than substitution by vaping or NRT
What do psychologists interested in alcohol do?
•universal prevention
Schools (Children/
•selective prevention adolescents)
•indicated prevention
Primary Adults (Workplaces)
Prevention
Counseling Centers
Research &
Teaching Acute
psychologist Treatment
Clinics
Relapse Psychotherapy
Prevention Rehabilitation
Supervised Living
Arrangements/ Soteria
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What do psychologists interested in tobacco and smoking?
•universal prevention
Schools (Children/
•selective prevention adolescents)
•indicated prevention
Primary Adults (Workplaces)
Prevention
Counseling Centers
Research &
Teaching Acute
psychologist Treatment
Clinics, hospitals
Relapse Psychotherapy
Prevention Rehabilitation
Institutions like prisons
Effects (r+) of health promotion programs
(Meta Analysis by Noar, Benac & Harris, 2007)
0,1
r+
0,05
0
preventive detective vaccination/ immunisation
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Smoking
kills
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Study to read for today

Hammond & Parkinson, 2009
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Questions to you:
Summarize you section
1. What purpose/ research aim did the study have?

2. What theoretical background did the study have / may have had?
3. What was done in the study? Methodology, analytical procedure?
4. What was found? What can we learn from the study?
Report phase
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The ecological model/framework
policy
social
physical
environmental
individual
Bronfenbrenner, 1979
Higher price = lower consumption in Brazil
Relationship between price and consumption of

cigarettes in Brazil, 1986-2003
1.5 70
1.3 60
pack/capita consumption
1.1
50
US$/pack
0.9
40
0.7
30
0.5
0.3 20
0.1 10
1986 1988 1990 1992 1994 1996 1998 2000 2002
11/3/2022 Ave Pri/pack US$ Consumption/capita

Health Psychology (Sonia Lippke) 38
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100% Smoke‐Free Environments
Protect nonsmokers
• Reduce death and disease
caused by secondhand smoke
exposure
Help smokers quit
• Reduce tobacco consumption
among smokers by 29%
Prevent smoking initiation
• Create a nonsmoking norm
Per capita consumption in countries
with and without advertising bans
(study of 102 countries)
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Smoking ban in public areas is associated with a reduced incidence
of hospital admissions due to ST‐elevation myocardial infarctions
in non‐smokers. Results from the BREMEN STEMI REGISTRY
myocardial infarctions admission per month
Schmucker et al., 2013_EJPC
TTM
Maintenance
Action
Preparation
Contemplation
Precontemplation
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Computer‐based Interventions and Their Effects
Effect sizes Meta‐Analysis by Meta‐Analysis Meta‐Analysis

regarding… Rooke et al. (2010) by Webb, by Portnoy et
Joseph, Yardley al. (2008)
& Michie
(2010)
Smoking cessation d = 0.23, d = 0.07, d=0.33,
p < .01 p > .05 CI 0.08‐0.59
Alcohol cessation1/ d = 0.29, d = 0.14, d=0.24,
reduction of substance p < .001 p < .05 CI 0.04, 0.43
misuse2
Nutrition Not researched d = 0.20, d=0.15,
p < .001 CI 0.07‐0.22
Physical activity Not researched d = 0.24, Not researched
p < .05
Improvement of Not researched Not d=0.18,
general health resereached CI 0.05‐0.30
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Motivational Interviewing
F Personalized Feedback to the client

R Client has Responsibility for change
A Clear Advice on behavior to change
M Menu of options to choose from
E Express Empathy to mobilize change
S Evoke Self‐efficacy to enhance confidence
Miller & Sanchez
11/3/2022 Health Psychology (Sonia Lippke)
Task
• Scratch a smartphone app aiming at decreasing tobacco use and smoking,
and the prevention of both – on basis of the results of the study by
Hammond & Parkinson (2009) and at least 1 psychological theory…
• …for primary prevention purposes:
• Scenario:
undergrad student 1) Achim and 2) Giselle,
or doctoral student 3) Georgia and 4) Achmed
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Summary
• Effective tobacco control requires a multi‐level approach including
economic, political, social and psychological interventions
• Most smokers report difficulty in quitting the habit. However, significant
progress has been made in understanding of smoking cessation from a
psychological perspective
• Efficacy and cost‐effectiveness are higher when treatment strategies
address the causes, not the symptoms
• Smokers wishing to quit are helped using the ‘five As’: ask about tobacco
use; advise to quit; assess willingness to make a quit attempt; assist in quit
attempt; arrange follow‐up
Summary
• Smokers unwilling to quit are helped using the ‘five Rs’: explain the
relevance; risks; rewards; run over the roadblocks; and repeat at every
available opportunity
• Health care systems in Western countries have been compromised by
experts working with the pharmaceutical industry to promote treatments
such as NRT that are less effective than other available interventions
• Evaluation studies using real world observation have produced outcomes
that are significantly less favourable to products such as NRT than RCTs
• The vast majority of smokers who stop smoking have done so without
outside help. Self‐quitting to become nicotine free is safer than vaping and
using nicotine replacement. The self‐help route needs to be promoted as a
viable alternative to pharmaceutical interventions
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Literature
• Hammond, D., Fong, G. T., McDonald, P. W., Cameron, R. & Brown, K. S.
(2003). Impact of the graphic Canadian warning labels on adult smoking
behaviour. Tobacco Control, 12, 391‐395.
25

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11/3/2022

Study to read for today

1. What purpose/ research aim did the study have?

Relationship between price and consumption of

11/3/2022 Ave Pri/pack US$ Consumption/capita

Effect sizes Meta‐Analysis by Meta‐Analysis Meta‐Analysis

F Personalized Feedback to the client

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