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CHAPTER 12
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Lecture Outline
I. Smoking and the Respiratory System
The respiratory system functions to take in oxygen and to remove carbon dioxide into the
body.
A. Functioning of the Respiratory System
Contractions of the diaphragm move air into the body through the mouth or nose, from
where it travels past the larynx, down the trachea and bronchial tubes, and into the lungs
(see Figure 12.1). The millions of alveoli at the ends of the bronchial tubes are the sites of
oxygen and carbon dioxide exchange. Airborne particles such as smoke and other
pollutants easily enter the body through the respiratory system. The respiratory disorders
of most interest to health psychologists are the chronic lower respiratory diseases of
bronchitis (inflammation of the bronchi) and emphysema (a chronic lung disease in
which scar tissue and mucus obstruct the respiratory passages). (See Figure 12.2.)
B. What Components in Smoke Are Dangerous?
II. A Brief History of Tobacco Use
Native Americans smoked tobacco before the voyages of Columbus and before the
practice was known in Europe. Early explorers of the Americas quickly spread the smoking
habit back to Europe. Despite some efforts to curtail the practice, smoking tobacco became a
popular habit. However, cigarettes did not gain popularity until the early years of the 20th
century. By 1963, well over half the men in the United States were regular cigarette smokers.
From that time until the present, the percentage of adult smokers has declined steadily.
III. Choosing to Smoke
The percent of people in the U.S. who choose to smoke has decreased since the 1964
Surgeon General’s report that concluded that smoking is dangerous to health.
A. Who Smokes and Who Does Not?
1. How Do Smokers Differ from Nonsmokers?
2. Smoking Rates among Young People
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Since the mid-1990s, smoking has declined in all age groups, including
adolescents. Many students begin to use cigarettes during middle and high school and
become established smokers during young adulthood. Young adults in the United
States have the highest smoking rate of any age group at about 28%.
B. Why Do People Smoke?
teenagers begin smoking each year and millions of other people continue to smoke.
1. Why Do People Start Smoking?
2. Why Do People Continue to Smoke?
Some of the same reasons why young people begin smoking also explain why
experienced smokers continue. In addition, the factors of addiction and reinforcement
help explain why many smokers continue.
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IV. Health Consequence of Tobacco Use
Tobacco use is responsible for about 443,000 deaths per year in the United States and
more than 6 million per year worldwide.
A. Cigarette Smoking
Cigarette smoking is the single deadliest behavior in the history of the United
States and the most preventable cause of death.
1. Smoking and Cancer
Smoking plays a role in the development of several cancers, especially lung
cancer. Cigarette smokers have a relative risk of about 23 for lung cancer, but it is also
related to cancers of the lip, oral cavity, pharynx, esophagus, pancreas, larynx, trachea,
urinary bladder, and kidney. From 1950 to 1989, lung cancer deaths rose significantly
for smokers. At the same time, rates among nonsmokers remained about the same. In
the U.S., lung cancer rates among men have begun to fall.
2. Smoking and Cardiovascular Disease
Those who smoke double their risk for cardiovascular disease. Cardiovascular
disease is the second leading cause of cigarette-related deaths.
3. Smoking and Chronic Lower Respiratory Disease
Chronic lower respiratory disease, including chronic bronchitis and emphysema, is
the third leading cause of death in the United States, and cigarette smoking accounts
for most of these deaths.
4. Other Effects of Smoking
Smokers are at increased risk of a variety of other problems, including deaths from
B. Cigar and Pipe Smoking
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Cigar and pipe smoking are neither as common nor as dangerous as cigarette
smoking, provided that these smokers do not inhale. Cigar and pipe smokers, however,
experience elevated risk of lung and several other cancers (especially of the mouth,
pharynx, esophagus, and larynx) as well as cardiovascular diseases.
C. Passive Smoking
Much has been written lately about passive smoking or environmental tobacco
smoke (ETS) as a risk for lung cancer, breast cancer, heart disease, and a threat to the
health of children.
1. Passive Smoking and Cancer
People exposed to environmental tobacco smoke have only a slightly elevated
2. Passive Smoking and Cardiovascular Disease
3. Passive Smoking and the Health of Children
Infants are possibly the people at greatest risk from environmental tobacco smoke.
Children under age 2 who are exposed to tobacco smoke are at increased risk for
sudden infant death (SIDS), asthma, lower respiratory tract infection, bronchitis, and
pneumonia. In general, the negative effects of environmental tobacco smoke diminish
as children pass the age of 2 years, but school-aged children exposed to passive
smoking have more than their share of wheezing, missed school days, and weak lung
function.
D. Smokeless Tobacco
Smokeless tobacco was more popular a century ago, but currently, European
American and Hispanic American adolescent boys are more likely than others to use this
form of tobacco. Smokeless tobacco has been associated with increased rates of oral
cancer and periodontal disease as well as pancreatic and oral cancers.
V. Interventions for Reducing Smoking Rates
Interventions for reducing smoking may either attempt to deter smoking or help people
quit.
A. Deterring Smoking
Although adolescents who smoke usually recognize that smoking is dangerous, they
community-wide anti-smoking campaigns.
B. Quitting Smoking
Although quitting is not easy, millions of U.S. adults have quit. Moving from
contemplation to quitting may be a lengthy process, and many barriers make quitting
difficult.
1. Quitting without Therapy
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Most people who have quit smoking have done so on their own, without
2. Using Pharmacological Approaches
Nicotine chewing gum, patches, inhalers, lozenges, and spray work by providing
3. Receiving a Psychological Intervention
Psychological approaches to quitting smoking typically combine several
4. Participating in a Community Campaign
Many people stop smoking as a result of their participation in a community-wide
health campaign such as antismoking media campaigns or restricting the locations in
which smoking is permitted. The percentage of people who quit as a result of a health
campaign is usually quite small, but if the message reaches millions of people, then
thousands of lives may be saved.
C. Who Quits and Who Does Not?
D. Relapse Prevention
Most people who quit resume smoking. Many people who quit smoking (or other
unhealthy behaviors) equate a single slip with total relapse, an attitude that makes quitting
more difficult. Nevertheless, relapse need not be permanent: Many smokers continue in
cycles of quitting and relapse until they quit permanently. Programs to prevent relapse
have not been very successful.
VI. Effects of Quitting
Quitting smoking will likely bring about two health-related effects—weight gain and
better health.
A. Quitting and Weight Gain
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Many smokers fear weight gain, and their concerns are partly justified. Most
ex-smokers gain a modest amount of weight—about 11 pounds (for men) and 6 pounds
(for women), and the average ex-smoker loses some of that weight over a 5-year period.
Physical activity can curtail weight gain, and cognitive behavioral therapy can help ex-
smokers change both physical activity and eating habits.
B. Health Benefits of Quitting
By quitting smoking, both men and women can improve their life expectancy (see
Figures 12.7 and 12.8). Decreased likelihood of cardiovascular disease occurs rapidly, but
the risk for lung cancer persists for as many as 30 years. Never starting to smoke is
healthier than quitting, but quitting helps.
Exploring Health on the Web
The Internet is a source of statistics about smoking and information about interventions to assist
in quitting. Some U.S. government agencies include information on smoking as well as alcohol
and other drugs, so sites mentioned in Chapter 13 may also be useful.
The Center for Tobacco Cessation website, which is funded by the California Department
of Public Health Tobacco Control Program (CTCP).The Center provides training for
organizations and health care providers and the website features of information sheets, resources,
and links.
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This website explains how and why nicotine is addictive. It contains several
graphics and videos to help explain the addictive properties of nicotine.
Suggested Activities
Personal Health Profile — Impact of Smoking
Less than 15% of college students smoke cigarettes, so most of your students will
probably be nonsmokers. Yet all students should include a smoking section in their Personal
Health Profile. The issue of smoking presents an excellent opportunity for students to examine
the research for “hard” evidence that smoking is or is not harmful. By this time, your students
will be familiar with the various reports from the U.S. Surgeon General and with an abundance
of secondary sources (including the textbook) claiming that smoking contributes to both disease
and death. Students should look at original studies (including ones published after the textbook)
to see the extent to which these claims are justified.
What are the current risks of cigarette smoking for lung cancer, heart disease, and so
forth? What are the actual risks for passive smoking? What does the most recent evidence say
about how the fetus is affected by the mother’s smoking? How dangerous are pipes and cigars?
What about smokeless tobacco? The Personal Health Profile should contain reasons why
smokers should quit (or may continue), and reasons why the nonsmokers should remain abstinent
(or may begin).
Debate: Do the Media Promote or Prevent Smoking?
Trying to Quit
Although college students have one of the lowest rates of smoking, some of your students
smoke and others have quit smoking. Involve these students in a discussion of their attempts to
quit, both successful and unsuccessful. This discussion might include the following questions:
1. What percentage of your students has tried smoking?
2. What factors do they believe contributed to their starting to smoke, and what factors
influenced their attempts to quit?
3. How many have smoked more than 20 cigarettes? Of those, how many are still smoking?
4. Of those who have quit, how many attempts did they make before they were successful?
How confident are they that they will remain abstinent?
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5. How many smokers sought professional assistance in quitting versus how many
quit on their own? Did these two groups differ in their success rate?
6. What were their experiences during withdrawal? How long did these symptoms last?
How many gained weight, how much, and how long did they need to lose the weight?
Online Quizzes
Analysis of Tobacco Advertisements
Have your students collect advertising for cigarettes and smokeless tobacco to analyze
the methods of persuasion and the target audience for the various ads. Instruct the students to
keep a record of the source of each advertisement so that they can use this information in
understanding the target audience. To whom is each ad designed to appeal? Does the product
promote a masculine or feminine image? Are various ethnic groups targeted? With what image
does each product try to associate itself? Are people part of the ad, and if so, what age group is
portrayed? How do advertisements for cigarettes differ from those for smokeless tobacco in their
images, place of appearance, and sources of persuasion?
Vintage Cigarette Ads
The chapter provides some historical context to how cigarette use in the United States
increased and then subsequently decreased. Students may be interested to see vintage cigarette
ads, which may increase their understanding of just how pervasive cigarette smoking was in the
past. Point out to students that these ads do have any warnings on them at all!
Tobacco Companies vs. FDA
Recently, the United States Food and Drug Administration (FDA) wanted tobacco
companies to place more graphic warning labels on their cigarette packaging. Other countries
such as Canada already require these graphic warning labels. However, in 2012, the cigarette
companies sued the FDA and won, so currently these graphic warning labels are not mandated in
the United States. Have students view some of the proposed graphic warning labels and discuss
how effective they believe they would be. Would they be effective in stopping people who are
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already smoking? Would they be effective in preventing people from starting to smoke?
What does the scientific literature suggest concerning graphic warning labels?
Smoking Restrictions on Campus
Within the past decade, more colleges and universities, like other institutions, have
adopted policies that prohibit smoking in various campus facilities. What is your school’s policy
on smoking on campus? What was the impetus for the formation of this policy, and who
formulated the policy? How old is this policy, and how vigorously is it enforced? Is smoking
allowed on campus anywhere?
Answers to these questions will allow your students to decide whether smoking is
tolerated on your campus or whether smoking is actively discouraged. How do your students feel
about these policies? Are they pleased at the official restrictions or do they feel that smokers are
unfairly penalized?
Video Recommendations
From Films for the Humanities & Sciences:
Nicotine and the Brain (2005) shows how nicotine affects the brain and brain chemistry and
presents advice concerning quitting strategies.
Smoking Out the Truth: Teens and Tobacco (2006) targets teens and attempts to puncture myths
and misconceptions about smoking such as “I can quit any time I want.”
We Love Cigarettes: Resisting the Romance of Smoking (2006) explores the worldwide allure of
cigarettes, featuring people who have fought against cigarettes and some who continue to
advocate for them.
Scene Smoking: Cigarettes, Cinema, and the Myth of Cool (2001) is a program that examines the
role of smoking in the movies and how these depictions have the power to influence attitudes and
behavior.
Tobacco (2001) presents four teens and their attraction to tobacco, which counselors examine
and refute. Other authorities comment on the attractions of tobacco use and the difficulties of
quitting.
Women and Cigarettes: A Fatal Attraction (2001) explores the history of women’s smoking and
the increasing number of smoking-related diseases that women are experiencing.
Smokeless Tobacco: A Wad of Trouble (1998) examines the problems associated with smokeless
tobacco use.
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Everyday Addictions (2000) explores the very common addictions of nicotine, alcohol, and
gambling by considering the harm they do and how to change these behaviors.
From Filmakers Library:
The Big Lie: Holding the Tobacco Industry Accountable (2006) focuses on the legal battle over
tobacco advertising. Beginning with Australian Rolah McCabe, who was terminally ill with lung
cancer and sued British American Tobacco, the story of the legal liability for aggressive tobacco
advertising continued for years and extended to many parts of the world.
Videos from the Web:
Multiple Choice Questions
1. The annual number of excess deaths in the United States attributable to smoking has been
estimated to be about
a. 25,000.
b. 57,000.
c. 175,000.
d. 443,000.
2. The principle function of the respiratory system is to take in ____ and to eliminate ____.
a. leukocytes . . . oxygen
b. oxygen . . . carbon dioxide
c. oxygen . . . methane
d. nitrogen . . . carbon dioxide and methane
3. The site of oxygen and carbon dioxide exchange is the
a. alveoli.
b. diaphragm.
c. bronchi.
d. trachea.
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4. People cough in response to smoke because
a. coughing expels irritants from the respiratory tract.
b. coughing is a substitute for sneezing.
c. coughing draws oxygen more deeply into the lungs.
d. of the action of the alveoli.
5. A disorder characterized by the obstruction of respiratory passages and loss of bronchial
elasticity is
a. bronchitis.
b. allergy.
c. emphysema.
d. bulimia.
6. The addictive ingredient of cigarette smoking is
a. nicotine.
b. its good taste.
c. the approval of peers.
d. the aroma of the smoke.
7. Nicotine is
a. a stimulant.
b. a tranquilizer.
c. both of these.
d. neither of these.
8. The most common chronic lower respiratory disease which occurs when bronchi lose
their elasticity is ______________.
a. emphysema
b. acute bronchitis
c. chronic bronchitis
d. lung cancer
9. There are at least 60 types of _______ in cigarettes.
a. carcinogens
b. nicotine
c. tars
d. aldehydes
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10. _______ is/are responsible for cigarette smoking’s addictive nature.
a. Carcinogens
b. Nicotine
c. Tars
d. Aldehydes
11. Nicotine affects the __________ nervous system.
a. central
b. peripheral
c. anterior
d. both a and b
12. The half-life of nicotine is ________.
a. 7 seconds
b. 5 minutes
c. 10 minutes
d. 30 minutes
13. _______ is/are water-soluble resides of tobacco smoke.
a. Carcinogens
b. Nicotine
c. Tars
d. Aldehydes
14. Nicotine
a. is a depressant to those people who smoke, but a stimulant to those who do not.
b. is the main reason why people start to smoke.
c. is a more important factor in starting to smoke than is social pressure.
d. has addictive properties.
15. The presence of nicotine can be detected in the brain
a. as rapidly as 7 seconds after smoking.
b. as rapidly as 2 minutes after smoking and 1 minute after intravenous injection.
c. not until 30 to 40 minutes after smoking.
d. of nonsmokers and smokers alike.
16. Cigarette smoking in the United States reached its peak per capita consumption
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a. prior to the Revolutionary War.
b. during the Civil War.
c. during the early part of the 20th century.
d. during the 1960s.
17. Which of these factors help popularize smoking in the United States?
a. ready-made cigarettes
b. the development of a “blended” cigarette
c. the low cost of cigarettes
d. both a and b
18. When considering sales in Eastern Europe and China, some evidence suggests that
tobacco companies will
a. continue to report large profits.
b. soon become bankrupt.
c. begin to target advertisements toward high school students.
d. voluntarily go out of business as they realize their product contributes to
thousands of deaths each year.
19. Tobacco sales of American tobacco companies are likely to remain strong because
a. smoking rates of Canadians are rising sharply.
b. smokers are living longer and thus will smoke more cigarettes over a lifetime.
c. tobacco markets in Africa, Eastern Europe, and Asia are expanding.
d. more North Americans have begun to smoke pipes.
20. The decline in the rate of cigarette smoking in the United States can be traced to
a. a report from the U.S. Surgeon General that linked smoking with adverse health
effects.
b. adverse weather conditions in southeastern states that significantly reduced the
supply of tobacco.
c. the successful use of hypnosis by health psychologists to get people to stop
smoking.
d. an agreement among movie producers and directors to stop portraying cigarette
smoking.
21. Currently, about ____% of adults in the United States smoke cigarettes.
a. 16
b. 21
c. 47
d. 68
22. The highest rate of per capita cigarette consumption in the US was in _____ .
a. 1934
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b. 1962
c. 1966
d. 2012
23. Of the following, which group is more likely to be current smokers?
a. females compared to males
b. American Indians compared to Asian Americans
c. older adults compared to younger adults
d. highly educated compared to high-school educated
24. Of the following, which group is more likely to be current smokers?
a. females compared to males
b. older adults compared to younger adults
c. poorer adults compared to wealthier adults
d. highly educated compared to high-school educated
25. By the time students reach the 12th grade, ______ of boys and girls are frequent smokers.
a. 1-3%
b. 6-8%
c. 10-12%
d. 17-20%
26. Research on smoking, peer pressure, and adolescents suggest that
a. anti-smoking messages work in decreasing smoking rates in groups of friends.
b. overt pressure from friends is needed to increase the chances that a teen will
smoke.
c. adolescents will begin to smoke to fit in with their social group, regardless of
whether pressure is overt.
d. media exposure does not increase smoking in peer groups.
27. A review of media influence on smoking found ________ association between media
exposure and smoking.
a. a weak
b. a moderate
c. a strong
d. no
28. _____ may be the influence in adolescents’ decision to begin smoking.
a. Curiosity
b. Self-esteem
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c. Depression
d. Anxiety
29. Which ethnic group does not appear to use smoking as a weight control strategy?
a. African Americans
b. European Americans
c. Asian Americans
d. Hispanic Americans
30. In understanding who is addicted to cigarette smoking, smoking more than ______ in
one’s lifetime increases the difficulty of quitting.
a. 1 cigarette
b. 50 cigarettes
c. 100 cigarettes
d. 1000 cigarettes
31. Smokers __________ when smoking lower-nicotine cigarettes.
a. smoke more cigarettes
b. smoke fewer cigarettes
c. smoke the same amount of cigarettes
d. refuse to smoke
32. One way that smokers show an optimistic bias is
a. believing that their friends are less likely to die.
b. believing that their brand of cigarettes are less likely to cause disease.
c. believing that smoking does not cause cardiovascular disease.
d. both a and b.
33. Chris is a smoker. What would be your predictions about Chris?
a. Chris is a man with a college degree.
b. Chris is a woman with a college degree.
c. Chris began smoking as a teenager.
d. Chris has parents who do not smoke.
34. Many of the adolescents who begin smoking
a. do not believe that the hazards apply to them.
b. are unaware of the dangers of smoking.
c. do so because their parents and teachers tell them not to smoke.
d. have an unconscious death wish.