Why people smoke

1
Why people smoke
2

• Clinicians are more likely to succeed in helping
  people to quit smoking if they have some
  understanding and empathy for why people start
  smoking and continue to smoke.

3

• This presentation looks at some of the commonly
  perceived benefits of smoking, along with some
  of the more significant barriers to quitting.

4
Why do people start smoking?

• Most smokers begin as children ( 30 by 11 years
  olds)
• There is no single reason why young people begin
  to smoke.
• Predisposing factors include
• low socioeconomic status
• adverse childhood experiences
• mental illness are generally not easily changed.
• Influencing factors
• Friends and the presence of people around them
  who smoke
• Nicotine addiction can occur rapidly. (10
  within 2 days, 25 within a month)

5
Why do people keep smoking?

• Nicotine addiction
• Behavioral rewards
• Stress relief
• Avoid weight gain

6
Nicotine addiction

• Nicotine reaches the brain in 10 to 16 seconds
  (faster than if it was delivered intravenously),
  and lasts about two hours.
• Nicotine induces the release of dopamine, in a
  similar way to amphetamines and cocaine.
• Has a biphasic effect, it can both invigorate and
  relax
• Nicotine improves reaction time in new users, but
  not in chronic users.
• Nicotine withdrawal starts within hours and
  peaking within the first week.

7
Symptoms of nicotine withdrawal

• Lightheadedness
• Sleep disturbance
• Poor concentration
• Craving for nicotine
• Irritability or aggression
• Depression
• Restlessness
• Increased appetite

8
Behavioural rewards of smoking

• The sight, smell and sensations of smoking have a
  behavioural conditioning effect which NRT does
  not address.
• Smoking can elicit Pavlovian response eg.
  having a cup of coffee, concluding a meal, seeing
  or smelling smoke. Considered a reason why light
  smokers, continue to smoke.
• Social norms play a role whether smoker is
  discouraged (smoke free messages) or encouraged
  (high prevalence/social norm)

9
Smoking to deal with stress

• Many smokers report they feel calmer and have
  improved concentration after a cigarette
  although more likely the cigarette has alleviated
  the symptoms of withdrawal.
• Smoking is similar to some relaxation techniques
  
• going outside to smoke leaving the stressful
  situation behind
• smoke is inhaled and exhaled in a slow and often
  deliberate manner similar to relaxation
  breathing techniques.
• These are useful methods in their own right for
  dealing with stress, so remind people they
  probably already have the skills to manage
  stress, even if they dont realise it.

10
Smoking to avoid weight gain

• Weight gain occurs in approximately 75 of people
  following smoking cessation
• Probably due to ? in metabolic rate
• Health risks of smoking considered worse than
  health risks of extra weight

11
Barriers to quitting smoking

• Enjoy smoking
• Craving
• Stress relief
• Withdrawal symptoms
• Weight gain
• Fear of failure
• Cost of meds
• Discouragement
• Cost of classes
• Timing of classes
• Disrupt social relations 

12
The lifetime benefits of quitting

• Many of the major risks associated with smoking
  decrease within two to five years of quitting
  smoking. For some conditions a residual risk
  remains and may never return to the level of a
  non-smoker

13
The social responsibility of smokers

• It is important smokers minimise the risk of
  their smoking for those around them especially
  babies and children

14
The social responsibility of smokers

• Non-smokers can be exposed to smoke by two
  recognised ways
• Second hand smoke, which is exposure to
  cigarette smoke from someone smoking nearby,
  often described as the exposure that occurs as
  an unavoidable consequence of breathing in a
  smoke-filled environment.
• Third hand smoke which is residual tobacco
  smoke and particles remaining after the cigarette
  is extinguished.

15
Second hand smoke

• Also known as environmental tobacco smoke
• 85 sidestream smoke smoke emitted from the
  burning end of the cigarette, and 15
  mainstream smoke smoke exhaled by smokers.
• Sidestream smoke poses the greatest risk because
  it has not been filtered.

16
Second hand smoke at home and work

• Approximately 10 of NZers are exposed to second
  hand smoke in their homes
• Maori most likely to be exposed

17
The effects of second hand smoke

• There is no safe level of second hand smoke
  exposure.
• Contributes to 350 deaths per year.
• People have an increased risk of lung cancer,
  coronary heart disease, stroke and sudden infant
  death syndrome.
• It has been estimated that in New Zealand, second
  hand smoke exposure in the home will contribute
  to approximately
• 15,000 episodes of childhood asthma annually,
• gt 27,000 child respiratory problems
• 1500 operations for glue ear

18
Third hand smoke

• The particles and gases that linger in a room,
  remain in the clothing, hair or possessions after
  someone has smoked.
• It is difficult to quantify the extent of the
  risk.
• Children are generally considered more
  susceptible to the effects of third hand smoke
  because they may touch, mouth, play and crawl on
  contaminated surfaces.

19
Keeping others safe

• While people continue to smoke, it is important
  they consider the risks to those around them.
• Smokefree Homes campaign (2004) adopted the
  message taking the smoke outside.
• Smoke Free Cars campaign (2006) encouraged to not
  smoke in the car, even when alone. the poisons
  linger long after the smoke has disappeared...