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Smoking She Male Fixed

Bonnie Spring, PhD, began smoking as a way to concentrate while writing papers in college. The nicotine and the ritual of lighting up later helped her think through her dissertation on schizophrenia's tangled underpinnings and write grant proposals for her research, she says. But Spring knew that along with this increased concentration came a greatly increased risk of lung cancer and heart disease, so she attempted to quit while completing her clinical internship.

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"I got through the entire internship year not smoking because I was just writing [patient] chart notes," says Spring, now a health psychology professor at the University of Illinois at Chicago. "Then when I went back to writing schizophrenia research grants, I went right back to smoking."

The experience sparked Spring's interest in addictions and led her to switch from abnormal to health psychology after becoming a full professor. Spring observed that her own smoking habit had a specific purpose: She was self-medicating to concentrate. This led her to theorize that smokers use cigarettes to regulate their mood, concentration and weight, to name a few uses. Those attempting to quit smoking might have an easier time if they could replace cigarettes with something else to fill those needs, she thought--such as controlling weight with exercise and an improved diet.

After jumping fields to health psychology, Spring developed an empirically supported smoking-cessation technique that she and other psychologists are using to help people replace smoking with healthy behaviors. Moreover, they can apply the 16-week program to multiple health behaviors simultaneously, such as smoking and overeating, suggests new research by Spring and her colleagues.

Most clinical practice guidelines and some past research suggest that when people take on more than one problem behavior at a time they often fail, says Spring. But a study by Spring, published in the October Journal of Clinical and Consulting Psychology (Vol. 72, No. 5), finds that tackling smoking and diet simultaneously does not harm clients' chances for smoking-cessation success. Moreover, the former smokers in the study learned to use physical activity rather than cigarettes to speed their metabolism--a reason many cite for smoking, says Spring.

Spring and her colleagues recruited 315 female smokers--women are the most likely to be concerned about weight gain while quitting--and assigned them at random to three different 16-week treatment programs. With an average age of 42, these women each smoked about 20 cigarettes a day at the beginning of the intervention.

One group participated in weekly psychologist-led group counseling for cigarette addiction. They discovered their smoking patterns by recording the time of day of each smoked cigarette and the events that immediately preceded the craving.

Then the participants worked with their group leader to avoid situations that led them to smoking--such as drinking in a bar--and tried alternative activities, like taking in a movie. When smoking cues couldn't be avoided, the clients tried to do things incompatible with smoking. Those who smoked after meals, for example, immediately washed dishes after eating. By the time the dishes are done, the urge to smoke has often passed, Spring notes.

"This is traditional cognitive-behavioral problem solving--partnering with smokers on a detective mission to find the hooks that bind them to smoking, and devising experiments that let them get unhooked," says Spring.

Participants in the other two conditions went through this detective mission as well, but their group leaders also taught basics of health and nutrition. They explained the importance of low-fat foods and taught the participants to avoid high-fat, high-calorie treats. Many people gain weight after they quit smoking--in part because smoking increases a person's metabolism about 100 calories a day, but primarily because they increase their consumption by about 300 calories a day, Spring says. Eating high-calorie treats, such as candy and cookies, increases brain serotonin levels, which take a dive as people quit smoking, she notes.

However, healthier foods such as pasta and whole-grain breads also increase serotonin in the brain, Spring says. So the researchers aided the dieting groups in their healthy-eating goals by providing these participants with low-fat meals for the entire 16 weeks of treatment. Each meal plan matched the level of calories the participants consumed before smoking, minus 150 calories to offset quitting-related metabolic changes. And, perhaps most importantly, says Spring, the meals included plenty of mood-boosting carbohydrate-rich foods, like pasta.

The two smoking cessation and weight control groups differed only in the timing of the weight control aspect of the program. One group started the quit-smoking and dieting programs at week one, while the second group also began to quit smoking at week one, but waited until week nine to start dieting. Both of these groups quit smoking at about the same 20 to 40 percent rate as the group that concentrated on smoking cessation only.

In addition to finding that taking on both smoking and weight gain can work, this study suggests that other unhealthy behaviors, such as overeating and overspending, might also be taken on simultaneously, says Spring.

Spring's findings have spurred other researchers to tackle both weight gain and smoking within the same program, using slightly staggered schedules. One such researcher, Robert Klesges, PhD, a psychologist at the Mayo Clinic, recently began an experiment where he will try to replicate Spring's success with hypertensive male and female smokers.

The objectives of this qualitative study were to: a) identify common marketing themes and tactics used by the tobacco industry to entice African Americans (AA's) and youth to initiate and maintain smoking behavior, especially smoking mentholated brands of cigarettes, and b) determine AA youths' knowledge, attitudes, intentions, and beliefs about smoking and the tobacco industry. Together, these activities could aid in the development of effective tobacco counter-marketing campaigns for AA youth. Using publicly available tobacco industry documents, computerized searches using standardized keywords were run and results were cataloged and analyzed thematically. Subsequently, 5 focus groups were conducted with n = 28 AA middle school-aged youth. Results suggest that the tobacco industry consistently recruited new AA smokers through a variety of means, including social and behavioral marketing studies and targeted media and promotional campaigns in predominantly AA, urban, and low income areas. AA youth interviewed in this study were largely unaware of these tactics, and reacted negatively against the industry upon learning of them. Youth tended to externalize control over tobacco, especially within the AA community. In designing a counter-marketing campaign for this population, partnering knowledge of tobacco industry practices with youth needs and community resources will likely increase their effectiveness.

In the United States and in many other parts of the world, tobacco use is the leading preventable cause of lung cancer and other chronic diseases of adulthood, and cigarettes are the most commonly used form of tobacco [1]. Approximately 22% of adults in the United States are current cigarette smokers, with prevalence rates of 24% among males, 19% among females, 23% among Caucasians, and 22% among African Americans (AAs) [2]. AA males suffer disproportionately from the morbidity and mortality of smoking as they have the highest rates of lung cancer and lung cancer-related deaths than any other racial or ethnic group [3]. In addition to sex and race, socioeconomic status is a leading smoking risk factor as well. Estimates are highest for adults with General Education Development diplomas (44%), those who did not complete high school (34%), and individuals who live below the poverty level (31%) [2].

For these and other reasons, the District of Columbia (DC) is among the areas of the United States hardest hit by smoking and cancer. Approximately 60% of residents are AA [4], 22% have not graduated from high school, and 20% live below the poverty level [4]. Further, 1:4 AA adults in DC currently smoke [2], and the lung cancer incidence rate among AA men and women in DC is 84:100,000 [5].

The American Legacy Foundation's "truth" national media campaign is one example of this approach. Truth seeks to counter pro-tobacco messages delivered via the tobacco industry by alerting youth to the industry's marketing practices that glamorize smoking but without mentioning addiction or health consequences. Youth exposed to the campaign through broadcast media advertising hold more negative beliefs about tobacco industry practices and more negative attitudes about the industry itself [15]. Additionally, these negative beliefs about the tobacco industry are, in turn, linked to lower receptivity to pro-tobacco advertising and less progression in smoking intentions and behaviors [15]. However, observed effects are not completely even with respect to age and race. Younger children (i.e., middle school students) and AA's were differentially impact by the campaign, with younger children less affected than older children and AA's more affected than other groups. This suggests that the highly promising counter-marketing approach advocated by the CDC for state-wide tobacco control initiatives [14] may effectively reach a target audience of AA's, though the developmental level of these youth will be important [16].

Shervington (1994) conducted a qualitative investigation of cigarette smoking among AA women and reported that cultural-competence should be a core component of smoking cessation work with this population [23]. Another qualitative report by Gittelsohn and colleagues (2001) focusing on cigarette smoking among AA youth was highly informative with respect to social context risk (e.g., presence of parental smoking, absence of strong anti-smoking policies at school) and protective (e.g., desire not to disrespect parents) mechanisms that affect AA smoking uptake, with notable implications for intervention [24]. Finally, in reporting on the results of a smoking cessation trial conducted with AA adults, Woods and colleagues (2002) used qualitative methods to better understand why AAs may be prone to low enrollment into clinical trials of smoking cessation (e.g., poor transportation, difficulty obtaining time off from work) [25]. These studies provide key examples of where qualitative research has been used to inform tobacco prevention and control among AAs. The current paper applies these methods to AA middle school students, with the hope of gaining important insights into promising counter-marketing strategies for this group [26]. 041b061a72


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