Tobacco smoking alone isn’t enough: More than smoking important in lung cancer death

Christopher Russell and Adi Jaffe

The tobacco epidemic already kills 5.4 million people a year from lung cancer, heart disease and other illnesses. By 2030, the death toll will exceed eight million a year. Unless urgent action is taken tobacco could kill one billion people during this century. (The World Health Organization Report on the Global Tobacco Epidemic, 2008)

These are some scary numbers, right? Cigarette smoking, according to the WHO, is the single most preventable cause of death in the world today, and in conveying these deadly statistics to the general public, cigarettes have come to be alternatively referred to by smokers and non-smokers as “cancer sticks”, “nicotine bullets”, and “coffin nails”.

But does smoking really ‘kill’ anybody in the literal sense with which we use this word?  To an epidemiologist, tobacco smoking (nor many other drugs of abuse for that matter) does not “kill” a person or “cause” illness or death in the way the words “kill” and “cause” are typically understood by the media and general public. For example, if I shoot someone in the head, stab another in the heart, and strangle a third till he stops breathing, it is reasonable to say that my actions were the direct, sole, and sufficient causes of death – I would have killed them. Smoking, however, is often neither a sole nor sufficient ‘cause’ of lung cancer, coronary heart disease, or myocardial infarction because non-smokers die from these diseases, and for example, because only 1 in 10 heavy smokers die from lung cancer when one looks at the overall numbers. Continue reading “Tobacco smoking alone isn’t enough: More than smoking important in lung cancer death”

About Addiction: Addiction Recovery, Alcohol, and Drug Legalization

Yes, you’ve got it, it’s your 30 seconds of news about addiction from around the world (wide web). Enjoy the reading – you can claim you learned your “new thing of the day.”

Addiction recovery- Inpatient and Outpatient treatment plans

Addiction Recovery-Recovering from addiction is hard, no matter what type of addiction it is. In order to complete a successful recovery from addiction, a positive attitude helps. Holding a positive attitude increases the chances that the recovery attempt will be a successful one. We’ve written often about addiction treatment and tips to increase sucess.

Recovery Now– What are the stages to inpatient addiction treatment? According to Recovery Now, the stages of inpatient treatment include:  intake, detox, stabilization, and long term recovery. Though I don’t necessarily agree with every aspect of this article, it contains some good information about addiction treatment that every reader should know. This additional piece from Recovery Now discusses the appropriateness of inpatient versus outpatient addiction treatment for specific patients.

Alcohol use

Science Daily– We’ve talked about the link that has been found between family history of alcoholism and an individual’s obesity risk.  In this study a family history of alcoholism produced an increased risk for obesity, though the environment also played a large role in this link. Environmental factors include the types of foods that are eaten- foods that are typically high in calories from sugars, salt and fat.

Desert News– Everyone knows at least one person whose life has been affected by alcohol abuse in some form or another. Here is a story of how alcohol negatively affected a woman’s life and how it overtook her life ultimately leading to her death.

The Sydney Morning Herald– Drunk Driving is not just a problem in the United States, driving under the influence of alcohol appears to be a problem in other countries as well.  In Australia almost 1,400 people were arrested for alcohol-related offenses.

AOL Health-There is a multitude of information found on billboards and in TV commercials which explains the risks of drunk and drugged driving. Despite this information 30 million Americans are driving drunk each year and 10 million are driving while they are under the influence of drugs. This problem is very serious and is most problematic among drivers who are aged 16-25. Although there has been a drop in the overall number of individuals who are driving while they are under the influence, one in three car accidents still occur from drunk driving.

Drugs- The dangers of legal drugs, Marijuana, Adderall, and Methadone

Belfast TelegraphAlcohol and legal drugs are okay in small doses and can even be helpful in medical settings and for overall health. However it is important to note that there have been many more alcohol related deaths than deaths from illegal substances such as heroin and crystal meth. By far alcohol is the greatest perpetrator followed by prescription drugs including amphetamines, benzodiazepines and antidepressants. In Ireland in 2009 alone there were 283 alcohol-related deaths were registered in the north and 276 the previous year.

NIH News- There has been a recent increase in marijuana use among 8th graders according to NIDA’s monitoring the future survey. It was reported that the rate of eighth-graders who are using illicit drugs is 16 percent, a 2.5 increase from the previous year’s use of 14.5 percent. Among high school seniors cigarette use has declined but marijuana, ecstasy and prescription drug use has increased. Marijuana use among adolescents is so problematic because it affects the brains development as well as a person’s learning, judgment, and motor skills. Additionally 1 in 6 people who start using it as adolescents become addicted. The spike in the drug use may be attributed to the debate on legalization which may give a false impression that the drug has no negative effects or consequences.

‘WisconsinWatch.org– Use of Adderall, a medication for ADHD, is on the rise and in demand on many college campuses. Adderall is increasing in popularity and is easily accessible on college campuses because it helps individuals study.  The drug is particularly popular in the University of Wisconsin and many students are taking it despite the negative side effects it may bring. School officials are not educating the university population of the ill effects of Adderall so it continues to be used as a study aid. At least part of the worry has to do with the potential for such students to move on to even stronger versions of amphetamines such as crystal meth, so maybe the efforts should focus on teaching students about addiction to amphetamines and the associated risks.

Scotsman NewsMethadone a drug which is used to prevent withdrawal symptoms in individuals who were addicted to opiate drugs (and as a replacement medication in heroin addiction treatment) is going to be in high demand after nearly £2 million worth of the heroin was discovered on a raid in Scotland.  Police hope that by working with healthcare professionals they can help these drug users seek addiction treatment. Anyone who was effected by the drug raid are offered the support and care they need

Victimization and Drug Legalization

Physorg.com– A potential link has been found between victimization (and hence trauma) and the prevalence of substance use disorders. This was most evident for homosexual and bisexual men and women than it was for heterosexual men and women. Both gay men and women reported high prevalence rates of victimization some point in their lifetime with lesbian women twice as likely to report victimization experiences. Men and women who reported two or more victimization experiences were found to have higher odds of alcohol and other drug dependence.

London Evening Standard– Should drugs be legalized? That is the question that is popping up in many states across the United States.  Is marijuana safer if it is regulated by the state?  The argument for legalizing drugs goes a little something like this: Despite drugs being illegal there will always be a demand for them so if drugs are legalized then governments will be able to control drug quality before they are sold on the streets. Tax income from drug sales can then to educate individuals about drugs and to aid individuals who need addiction treatment

North West Evening Mail– Paul Brown, the director of Cumbria Alcohol and Drug Advisory Service spoke out after former drugs policy minister Bob Ainsworth and he called for the decriminalization of all banned substances. Brown informed attendees that only Portugal has decriminalized drugs and since that occurred crime rates have fallen and more individuals are willing to seek treatment for drug problems. Many substances that are legal such as alcohol and tobacco are bigger killers than drugs that are criminalized. Alcohol and tobacco kill an average 40,000 people a year this is 10 times more than any illegal drug.

Quitting smoking ‘on the spot’ is more likely to succeed than a quit attempt planned in advance

Christopher Russell

Readers who are smokers will likely have heard that if you approach stopping smoking like any other major life change, with careful preparation and planning, you can succeed, and that quitting depends first on putting together a plan that will work for you. These beliefs stem from the prevailing model of how people stop smoking which states that smokers moves through a succession of motivational stages involving contemplating stopping, preparing to stop, and then subsequently trying to stop (Prochasksa & Velicer, 1997). Consequently, physicians, GPs and smoking cessation therapists have been charged with using the model’s ‘four As’ – ask, advise, assist, and arrange – to guide smokers through these stages of change (Royal College of Physicians, 2000). This typically involves assisting smokers to anticipate potential difficulties in the early stages of quitting (e.g. identify the people, places, and things which stimulate craving), make plans to avoid/resolve these difficulties, set a date on which they plan to have stopped smoking completely, and plan rewards for maintaining abstinence between now and the quit date.

Based on this philosophy of “fail to prepare, prepare to fail”, the overarching goals of current cessation guidelines are to identify the smoker’s current stage, make recommendations appropriate for this stage, and guide the smoker sequentially through to the final stage of putting the quit attempt into action. However this model has been criticised on many grounds, the most notable being the lack of evidence that most smokers actually plan their quit attempts in advance and that doing so increases their chance of success. Indeed, this model conflicts with the accounts of many ex-smokers who say they just decided to stop smoking one day and have not looked back since.  In response to this gap in the literature, two relatively recent studies – one each in Canada and England – investigated the extent to which smokers plan their quit attempts and the extent to which planning increased the  success of quit attempts.

 The benefit of deciding to stop smoking immediately

Larabie (2005) found that while the majority of smokers (63%) planned their quit attempts in advance, the interesting finding was that the 67% of ex-smokers (i.e. successful quitters, defined as those who had not smoked in the past six months) had not planned their successful quit attempt in advance compared to 33% of ex-smokers who planned their successful quit attempt in advance. The three most commonly reported types of planning were (1) planning to quit on a significant date (e.g. birthday, New Year’s Day); (2) planning to obtain nicotine replacement medication in the near future); and (3) planning to quit once they had smoked all the cigarettes in their current carton.

Some examples of the unplanned quit attempts reported are given below, and more are available at the link in the references:

“I found out I was pregnant and I just quit” (LV, age 36).

 “I just felt like I had had enough and it was not going to kill me” (CB, age 36).

“I got ‘the scare’. I went out from work to have a cigarette and got a severe dizzy spell and had difficulty walking for 20 minutes. I quit on the spot. I still had cigarettes left in my pack” (LF, age 40).

Just as interesting was Larabie’s finding that 79% of successful quit attempts were made unassisted (defined as no use of Bupropion, nicotine patches, nicotine gums, tapering, or hypnosis). Larabie’s findings therefore argue against the prevailing model that successful smoking cessation depends on receiving assistance to quit (from medications, counselling etc) and planning quit attempts in advance. Rather, the most effective quit attempts were found to be those done without prior planning and without assistance! The paradox in this, noted by Larabie, is that health care providers may actually be hindering smokers’ chances of quitting by dissuading unassisted quitting (and promoting the uptake of formal treatment programmes) and by discouraging sudden, unplanned quit attempts. These assumptions deserve testing in their own right.

 A similar story in England

West and Sohal (2006) observed a similar success of unplanned quitting in their survey sample of 918 smokers and 996 ex-smokers in England. Almost half of all quit attempts (48.6%) were made without prior planning. Of the 611 quit attempts made between six months and five years previously, 65.4% of unplanned attempts lasted at least six months without smoking compared with 42.3% of planned attempts. This means that smokers who made unplanned quit attempts were 2.6 times more likely to still be not smoking six months later than those who made planned quit attempts. Likewise, smokers who made an attempt to stop smoking between six and twelve months previously were 2.5 times more likely to still be not smoking six months later than smokers who planned their quit attempts.

 Conclusion

A sudden decision to not smoke any more cigarettes was both common and more likely to be successful than were quit attempts made after a period of planning. While this does not necessarily suggest that planning and forethought and promoting treatment options are counterproductive, it does provide a strong case for health care providers going against current guidelines to encourage smokers, particularly those on the cusp of wanting to quit, to recognise and act upon opportunities to quit on the spot. In challenge to the prevailing ‘stages of change’ model, findings from these two studies should encourage smokers to consider the benefits of not thinking ahead, not waiting until Monday or the New Year, not waiting till the carton is empty, but instead, quitting now, without warning, or a running start, or a few days to prepare. West and Sohal state that even small changes in a smoker’s motivation to quit can trigger big changes in his/her behaviour and so smokers should be encouraged to capitalise on any desire to stop smoking. For those readers who are thinking about stopping smoking, planning may help, but consider the larger benefit of quitting today, right now.

Please write your comments in the box below.

 Just for fun

The questions asked of smokers and ex-smokers in West and Sohal’s study are provided below. If you have tried to stop smoking or are an ex-smoker and feel comfortable answering, how would you answer?

Q1. Which of these statements best describes how your most recent quit attempt started?

(a)    I did not plan the quit attempt in advance; I just did it.

(b)   I planned the quit attempt for later the same day

(c)    I planned the quit attempt the day beforehand

(d)   I planned the quit attempt a few days beforehand

(e)    I planned the quit attempt a few weeks beforehand

(f)    I planned the quit attempt a few months beforehand

(g)   Other

(h)   Cannot remember.

Q2. How long did your most recent quit attempt last?

References:

Larabie, L. (2005). To what extent do smokers plan quit attempts? Tobacco Control, 14, 425 – 428.

Larabie, L. (2005). To what extent do smokers plan quit attempts? Appendix A: Examples of responses. Accessible at:

http://tobaccocontrol.bmj.com/content/suppl/2005/11/23/14.6.425.DC1/146425_datasupplement_appendix.pdf

Prochaska, J. O. & Velicer, W. F. (1997). The transtheoretical model of health behaviour change. American Journal of Health Promotion, 12, 38 – 48.

Royal College of Physicians (2000). Nicotine addiction in Britain. London: RCP.

West, R. & Sohal, T. (2006). “Catastrophic” pathways to smoking cessation: findings from national survey. BMJ, 332, 458 – 460.

About Addiction: Marijuana use, cigarette smoking, and crystal meth

Hey ! After a brief period of inactivity we are back and better as always ready to provide you with your 30 minute tidbit of information about addiction. If you want to learn more about marijuana use, (cigarette) smoking, and addiction stigma then read on!

Marijuana use: Harmless?

Fox News– While many think that Marijuana a harmless drug (read our marijuana driving input), a guy high on weed drove his car into a group of cyclists in Italy. Eight cyclists were killed and an additional four people were injured. This accident can serve as a lesson that marijuana is not as “harmless” as a lot of people make it out to be. Educating the public about the dangers of driving under the influence of marijuana may help in preventing future incidents.

The Dome-Nobody is a stranger to the fact that voters in a number of states have been trying to legalize marijuana. But Illinois legislators just went the other way and struck down a bill which would allow medical marijuana to be legal. The legislators stuck this down with the fear that if this practice were legalized then there would be widespread use of marijuana. Right now fifteen states (and Washington DC) allow the use of medical marijuana but apparently Illinois decided they are not going to be the sixteenth.

Psychology Today– Can recreational pot smokers become addicted to marijuana? A large number of individuals only smoke marijuana recreationally and do not ever become addicted (see here), but about 10% to 30% of regular users will develop marijuana dependence (my vote is actually probably more for the 10%-20% range). About 9% will have a serious addition. Marijuana use in the U.S. has gone through quite an evolution from its early introduction in the 1970’s as an anti war statement to today when it is mostly used by teenagers and those who have been smoking for a long time. Most individuals quit when they are parents or homeowners (which is true of most drugs by the way), and this contributes to the thinking by some that marijuana is not very addictive.

Quitting smokingthrough personal stories

Bloomsburg Buisnessweek– Anti-smoking advertisements have been relying on fear appeals to persuade individuals to avoid or quit smoking smoking. But the commercials that show patients with a hole in their throat or the magazine ads showing a black and diseased lung have not really been very effective. However new research shows that advertisements that target emotions more broadly seem to work best when trying to prevent smoking. Personal testimonies seem to be the most effective because  they allow the individuals who are viewing them to emotionally identify with the person in the ad helping them find reasons why they themselves should quit smoking.

Guardian- Passive tobacco smoking kills more than 600,000 people in the world every year including about 165,000 children.  The most problematic regions in terms of these smoking deaths are third world countries due to the combination of the dangerous effects of second hand smoke and infectious diseases. Second hand smoke is most problematic in the home and although women smoke less they are more likely to be exposed to second hand smoke in the house.

Addiction Inbox– The electronic cigarette is finally here although in the past the FDA wanted to prevent these cigarettes from being marketed in the US. The decision to allow the marketing of these cigarettes was established as long as they are not targeted to minors. In addition marketing individuals cannot make any claims that the products are safe alternatives to tobacco. These products are a battery powered device that allow its users to “smoke” and inhale nicotine vapor without any fire, smoke, ash or carbon monoxide.

Alcoholism stigma and seeking treatment for drug addiction

Med– Individuals who are diagnosed with alcoholism are 60% less likely to seek treatment because they fear the stigma that is attached to alcoholism. To be an alcoholic means belonging to a stigmatized group, and no one likes that. The goal then should be to educate individuals in order to try to alleviate the stigma that is associated with alcoholism in order to allow more people to seek treatment from it. Reducing the stigma of addiction is a goal we at A3 take very seriously.

Recovery Now-If there is one thing that teenagers hate it is snooping parents by far. What is the parent is snooping for a good reason however? Is snooping around with concern that your child is using drugs or alcohol okay? Although a controversial topic this article looks at the implication of snooping and when it is okay to snoop in teenagers stuff. It is a great read, enjoy!

Crystal meth and Suicide-Veterans and Substance abuse

Honolulu advertiser– Hawaii has the worst crystal meth problem in the country and a school in Hawaii held a national crystal meth awareness day assembly. Forty percent of people arrested by police in Honolulu test positive for meth, and about 30,000 Honolulu residents are hard-core users of meth (with as many as three times more being recreational users). Government officials in Hawaii want to increase spending to make more drug treatment programs available to prison inmates. In addition the general public needs to be educated about the dangers of crystal meth.

Breaking the cycles-“Veterans at Higher Risk for Suicide,” is a radio broadcast which talks about the impacts of war on the mental health of all veterans in California. The issues that the radio broadcasts focuses on are anxiety, depression, and PTSD. The radio broadcast reported that veterans are at higher risk of committing suicide than other individuals who are not in the military. This article continues to address the topics of mental illness and how mental illness is a key risk factor to developing a substance abuse problem.

Monitoring the Future by NIDA: Teen alcohol and drug use data from a national survey

Teen drug useOne of the perks of being an alcohol, drug use, and addiction researcher, as well as of writing for a website like this and Psychology Today, is that sometimes we get to talk to people that most can’t reach or to receive information that others might not have access to. NIDA‘s Monitoring the Future, a national survey of about 50,000 teens between 8th and 12th grades is a huge annual undertaking the results of which will be released tomorrow for general consumption.

But we got a little sneak peek before everyone else.

If you follow this sort of stuff, you know that teen alcohol and drug use is always shifting as new drugs become more popular and others lose favor with that group of Americans that can’t make up their minds. This year seems to give us more of the same.

Monitoring the future: Early alcohol and drug use results

  1. Daily marijuana use, after being on the decline for a short while is apparently rising once again among teens, following last year’s continuing trend of a reduction in teens’ perceptions of marijuana harmfulness – We’ve written on A3 about some of the specific issues relevant to marijuana use including writing about Marijuana’s addictive potential and its medical benefit. There’s no doubt that the national marijuana debate will continue but the idea of 8th graders smoking weed doesn’t seem to be part of anyone’s plan.
  2. Among some groups of teens drug use is proving more popular than smoking cigarettes – I guess this could be taken as evidence of the effectiveness of anti-smoking campaigns, though until we see the full numbers I’m not going to comment any further on that.
  3. While Vicodin use among high-school seniors (12th graders) is apparently down, non-medical use of prescription medications is still generally high among teens, continuing a recent upward trend – Abuse of prescription stimulants has been on the rise for a number of years as the number of prescriptions for ADHD goes up, increasing access. It is interesting to see Vicodin use go down though the data I’ve received says nothing about abuse of other prescription opiate medications such as oxycontin, so I’m not sure if the trend has to do with a general decrease in prescription opiate abuse among teens.
  4. Heroin injection rates up among high-school seniors (12th graders) – I think everyone will agree that this is a troubling trend no matter what your stance on drug use policy. The associated harms that go along with injecting drugs should be enough for us to worry about this, but again, I’ll reserve full judgment until I actually see the relevant numbers. I’m also wondering if this is a regional phenomenon or a more general trend throughout the United States.
  5. Binge drinking of alcohol is down – As we’ve written before, the vast majority of problems associated with the over consumption of alcohol (binge drinking) among high-school students has to do with the trouble they get themselves in while drunk (pregnancies, DUI accidents, and the likes), so this is an encouraging trend though hopefully it isn’t simply accounting for the above mentioned increases in marijuana and heroin use.

Some general thoughts on NIDA’s annual Monitoring the Future results

I am generally a fan of broad survey information because it gets at trends that we simply can’t predict any other way and gives us a look at the overall population rather than having to make an educated guess from a very small sample in a lab. NIDA‘s annual MTF survey is no different although until I get to see all of the final numbers (at which point there will probably be a follow-up to this article) it’s hard to make any solid conclusions. Nevertheless, I am happy to see binge drinking rates among teens going down and if it wasn’t for that pesky increase in heroin injection rates I would say that overall the survey makes it look like things are on the right tracks.

I’ve written about it before and will certainly repeat it again – I personally think that alcohol and drug use isn’t the problem we should be focusing on exclusively since it’s chronic alcohol and drug abuse and addiction that produce the most serious health and criminal problems. Unfortunately, drug use is what we get to ask about because people don’t admit to addiction and harmful abuse because of the inherent stigma. Therefore, I think that it’s important for us to continue to monitor alcohol and drug use while observing for changes in reported abuse and addiction patterns. Hopefully by combining these efforts we can get a better idea of what drugs are causing increased harm and which are falling by the wayside or producing improved outcomes in terms of resisting the development of abuse problems.

Miley Cyrus and Salvia – Hallucinations in the limelight

Miley CyrusHello there Miley Cyrus, welcome to young adulthood live on TMZ. Our readers probably remember our coverage of Salvia (Salvinorin A) a few months ago but who would have thought that one of the additions to those YouTube videos of kids getting high on this legal hallucinogen would be joined by the American sweetheart Miley Cyrus? I know I wouldn’t have thought it.

Still, let’s all keep in mind that the Salvia Miley was smoking was fully legal (as long as you believe her publicists who would obviously never lie), something a few steps removed from her smoking a cigarette now that she’s 18 (even though Salvia is even less restricted).

I’m wondering what the fallout will be – Lord knows that in the media crazy America it’s hard to predict how fans will react to this kind of stuff. If my Huffington Post article on the topic is any indication, people are still pretty excited/upset about this one.

Does current smoking among health care providers limit their ability to dissuade smoking to the general public?

By Christopher Russell

In 2003, the US Department of Health and Human Services (USDHHS) set a goal of reducing cigarette smoking among US adults (18 years +) to 12% by 2010, which if achieved would halve the adult smoking prevalence rate reported in 1998 (24%). Achieving this current smoking reduction may depend on the extent to which health care providers (doctors, nurses, and such), who are charged with promoting smoking cessation and dissuading the uptake of smoking among to the general public, are themselves current smokers. For example, health care providers’ anti-smoking and pro-quit messages will likely be more persuasive and credible to the smoking public when the messengers practice what they preach about smoking. Such messages may also better motivate quit efforts if the health care providers have had personal success in quitting smoking using the methods and information they are now endorsing. Conversely, smokers may intuit that when health care providers advise quitting but continue to smoke themselves despite enjoying ready access to all the resources, information, and tools which should facilitate quitting, then smokers, without this luxury of access to education and resources, will be even less likely to successfully stop smoking.

Therefore, significant strides in increasing the number of quit smokers and never smokers in the general population may somewhat depend on reducing current smoking among the health care providers who act as both educators and trusted role models to the general public. It is therefore important to know how the prevalence of smoking among health care providers compares to the prevalence of smoking in the general population, which health care providers are charged to reduce.

Current smoking among health care providers

Using US population survey data, a recent study published in Nicotine and Tobacco Research reports estimated changes in the prevalence of current smokers, former smokers, and never smokers among eight groups of health care provider  – physician, physicians assistant, registered nurse (RN), licensed practical nurse (LPN), pharmacist, respiratory therapist, dentist, and dental hygienist – between 2003 and 2006/07. While the majority of these health care providers have never smoked a single cigarette, the authors report that, in 2006/07, approximately one in every five licensed practical nurse (20.55%) and respiratory therapist (19.28%) was a current smoker. Current smoking rates among LPNs and respiratory therapists were marginally higher than the rate of current smoking in the general population (18.01%) and near double the Healthy People 2010 goal of 12% current smoking in the general population. Four groups of health care provider – physicians (2.31%), dentists (3.01%), pharmacists (3.25%), and registered nurses (RNs) (10.73%) were all on course to be below the 12% prevalence goal. Furthermore, seven of these eight health care groups in 2006/07 showed higher quit rates than was found in the general population (52%) – only LPNs had a lower quit rate (46%). However, the concern from a public health perspective, is that while current smoking rates among these health care groups and in the general population have dropped considerably when compared to data reported in a similar cohort study in 1990/91, these decreases in current smoking appear to have leveled off in recent years; current smoking did not significantly decrease in any health care profession or in the general population between 2003 and 2006/07.

An important methodological note about this study is that results reflect weighted population estimates (WPE), not actual data. WPEs allow researchers to make inferences about an entire population group given only some data for that group simply by scaling up the actual data, (i.e. data reported by around 4000 health care providers in each collection year were used to estimate smoking statuses for over 2 million actual individuals). Of course, this technique likely overgeneralizes behavior in the sampling group, but is nonetheless a standard, valuable tool of health epidemiologists when they want to make inferences about how entire populations are behaving. Indeed, many of our health policies have derived from WPEs.

Current smoking among licensed practical nurses

Among the most important findings of this study is that one in five licensed practical nurses in the US is currently smoking. Of the estimated 754,000 LPNs in the US, this equates to roughly 155,000 current smokers in this profession, illustrating that health campaigns designed to depict smoking as socially unacceptable, readily available access to education and empirical research on the health consequences of smoking, working in smoke-free health care campuses, and being charged with task of persuading clients to stop smoking, all appear insufficient to reduce current smoking among LPNs and respiratory therapists to below the rate of current smoking in the general population.

In contrast, 10.73% of registered nurses are current smokers. The discrepancy between LPNs and RNs begs two questions: why are LPNs nearly twice as likely as RNs to be current smokers, and should we expect RNs will be better able than LPNs to persuade current smokers to quit and dissuade smoking to would-be smokers? Certainly, researchers should now ask whether a health care provider’s smoking status is related to his ability to produce cessation in health care recipients. If we assume that health care workers have a central role to play in producing mass behaviour change of whatever kind, then it is plausible to reason that reducing smoking prevalence at the national level will significantly depend on first reducing smoking prevalence among health care providers, our first responders to public health concerns. Testing this hypothesis seems the logical extension to capitalise on these smoking prevalence data.

Why are licensed practical nurses twice as likely as registered nurses to be currently smoking?

If one’s smoking status is important for persuading change in others, we need to know why smoking is more prevalent among LPNs than RNs, why LPNs have a lower quit ratio than the general population, and so, which factors should be addressed to reduce current smoking among LPNs to below the 12% level. The authors of this study suggested that LPNs’ fewer years in education and lower annual income may be associated with their current smoking status since they mirror socioeconomic factors known to associate with higher smoking rates. Comparably large proportions of LPNs and RNs are female, thus ruling out an important effect of gender. In my opinion, given that nicotine produces positively reinforcing psychoactive effects and that smokers commonly report smoking to alleviate affective distress, another consideration may be that LPNs and RNs differ in their exposure to stressful work events and environments, and/or differ in their emotional reactivity and sensitivity to these events, and/or differ in their bias to perceive work events as stressful. Furthermore, as smoking staus is known to be associated with socioeconomic status and socioeconomic status is known to be associated with many health and wellbeing factors including stress, then stress may be important both as a direct influence on smoking behavior and indirectly as a mediator of the effects of socioeconomic variables on smoking behavior. A good start to exploring these hypotheses would be to simply ask LPNs and RNs of their main reasons for smoking in short open-ended interviews; if reliable differences in smoking attributions emerge then we may begin the harder task of counseling LPNs to think of smoking in ways which alter their reasons to smoke, the reasons which may currently be maintaining smoking in one in five LPNs.

Questions for the reader; please give your comments below

1)      Why do you think current smoking is more prevalent among licensed practical nurses than in the general population?

2)      Does a health care provider’s status as a current smoker make him/her more or less able to persuade smoking cessation in others?

3)      Will reducing current smoking nationally depend on reducing current smoking among health care providers?

References:

U.S. Department of Health and Human Services. (2003). Healthy People 2010, Retrieved from http://www.healthypeople.gov/

This report is free to download at: http://www.healthypeople.gov/document/pdf/uih/2010uih.pdf

Sarna, L., Bialous, S. A., Sinha, K., Yang, Q., & Wewers, M. E. (in press). Are health care providers still smoking? Data from the 2003 and 2006/2007 Tobacco Use Supplement-Current Population Surveys. Nicotine and Tobacco Research.