Smoking: Onset And Maintenance Discuss the role of psychological factors in explaining the onset and maintenance of smoking. A health behaviour is defined as a 'behaviour aimed at preventing disease', such as eating a healthy diet (Karl & Cobb, 1996). Health impairing habits are those that include the use of behaviour pathogens, such as smoking (Matarazzo, 1984). Studies have been done which look at the extent to which our own behaviour is responsible for our health. In 1979, McKeown stated that 'contemporary illness is influenced by the individual's own behaviour and it is on modification of personal habits that health primarily depends'.

He also found that the main cause of death in affluent societies is people's own behaviours and in 1981, Doll & Peto found that of all cancer deaths, around thirty percent can be directly attributed to the behavioural factor, tobacco smoking. It is now widely recognised that regular cigarette smoking is harmful to health and smoking cessation would have major and immediate health benefits for men and women of all ages (Novello, 1990). These include the risk of diseases such as lung cancer, first reported in 1954 (Doll & Hill), heart disease and emphysema (Peto et al. 1994). However, in spite of all the evidence about the detrimental effects of smoking, the world consumption of cigarettes is estimated at around six hundred billion cigarettes per year (Bawazeer et al. 1999).

In Britain, the amount of cigarettes smoked per person, the prevalence of smoking, is decreasing, much more in men than women, but in comparison, women are starting to smoke more, therefore stopping more, whereas men may start less than women, but they are quitting less too (Ogden, 2000). A General Household Survey conducted in 1994 found that two-thirds of people want to give up smoking and the majority of people stated it is difficult to not smoke for the whole day. Research investigating the reasons that people smoke has evaluated social, pharmacological and psychological factors. Recently there has been more focus on children and adolescents who smoke, since most try a puff of a cigarette (Ogden, 2000). It is difficult to distinguish between actual initiation and maintenance of smoking behaviour and in 1962, no common agreement on the reasons why people start to smoke had been reached. For the most part, the various explanations fell into the psychological realm (Seltzer, 1962).

Now, it is widely accepted that the factors that influence smoking initiation, or the onset of smoking, differ from those that influence maintenance of smoking behaviour. In 1996, the American Thoracic Society stated that psychological, social and familial factors seem to be particularly important in smoking initiation. Smoking by family members and friends is strongly associated with smoking initiation in adolescence, whereas nicotine dependence, genetic and psychosocial factors are relevant in the maintenance of smoking behaviour. Psychological, or cognitive, reasons for smoking still play a significant role in the initiation of smoking, as a health risk behaviour, and models of health behaviour, such as the Health Belief Model and the Theory of Planned Behaviour can be used to highlight the psychological predictors of smoking initiation (Sherman et al. 1982; Godin et al. 1992).

Smoking mostly starts in childhood, fewer starting after the age of nineteen or twenty (Charlton, 1992). Many children try their first cigarette in primary school (Murray et al. 1984; Swan et al. 1991) and motivating factors range from the desire to appear more grown-up, or the wish for adult status, adolescent rebelliousness and striving for proper group status (Seltzer, 1962). Older groups of smokers studied gave different reasons for smoking, such as the reduction of tension, novel experience, curiosity, peer orientation and personality inferiority. There is even the less examined suggestion of Freud, of the 'phallic significance of the cigarette, cigar and pipe'.

In 1995, Abernathy et al. found there is a strong relationship between people's self-esteem and their future smoking behaviour. They interviewed over three thousand people from age ten to fifteen years. They found that girls with low self-esteem in any given school year, especially between the ages ten and thirteen years, were around three times more likely to start smoking than girls at the same age with high self-esteem. This study did not find a link between level of self-esteem in boys and their probability of starting to smoke, so instead it highlights the current trend whereby girls are more likely to start smoking than boys, since self-worth or self-esteem is an interpersonal value, or a psychological state, which predicts the behaviour of adolescents going through significant changes, such as puberty (Abernathy et al. 1995).

A study done by Bawazeer et al. in 1999, focused on cigarette smoking among secondary-school students in Yemen, and found that the main reason for starting smoking was to see what it was like, or curiosity, but a significantly higher proportion of girls than boys gave this as a reason. Among those aged fourteen years or under, the second reason expressed was to imitate the behaviour of others, while among the fifteen to nineteen year age group, it was due to the encouragement of others. Another study by Stanton, in 1993, found that boys generally have a worse attitude about smoking than girls and this initiates their use of cigarettes.

This means that, in terms of the Health Belief Model, they usually do not believe warnings from other people about the negative effects of smoking. These specific beliefs of reduced susceptibility, e. g. " I will not get cancer from smoking since it does not run in my family" are irrational and weak justifications for the onset of this health risk behaviour. This is highlighted in the same study, by non-smokers, who had priorities that were more well reasoned, they appeared more mature and the reasons they gave for not smoking included social context, e. g.

"Smokers do not look good", and they also understood the short-term and long-term detrimental effects of smoking, such as bad breath, and future poor health prospects. Additional reasons or ideas that predict smoking behaviour are associations made by smokers, to fun and pleasure, calming nerves and building confidence (Ogden, 2000). Pleasurable relaxation is the most significant positive use of cigarettes (Green, 1977). This includes smoking of a cigarette when you are not feeling down, in order to enhance enjoyment, and anecdotally, I have noticed in my own behaviour and that of others in university who began to smoke, that they started when going out to a bar or a club, in order to enjoy themselves more. Here, I would justify my use of cigarettes in order to enhance an already-existing feeling of well-being. Some people also use cigarettes in order to stimulate them (Thompkins, 1966).

Since the start of writing this essay, instead of smoking in my break, I made the conscious effort to eat something instead and realised that I subconsciously would usually have a cigarette, when working, to help me concentrate. Thompkins (1966) also noted that some people use smoking for the pleasure of handling the cigarette. This is much more typical in pipe-smokers, who spend a long time filling their pipe and less than ten minutes smoking it. This is a behaviour that positively reinforces smoking. In this sense, my smoking was pleasurable in the onset stage, as buying lighters, little boxes to hold cigarettes and ash-trays filled my boredom and appealed to my behaviour of collecting and hoarding small items. At the same time, there are many smokers who use the cigarette to reduce negative feelings.

The cigarette becomes a catch, where the person will light a cigarette when feeling angry, upset or nervous (Thompkins, 1966). Psychologically, nicotine acts to reinforce smoking behaviours each time a cigarette is smoked. The smoker learns that each time he or she smokes, they will be rewarded with a "high", or a sense of relaxation. When nicotine wears off, withdrawal symptoms are experienced, causing the smoker to return to cigarettes in order to be reinforced with another "high." As a result, aversive symptoms are avoided, and a cycle begins of smoking to avoid withdrawal and obtain pleasure (Kraft et al.

1998). By this point, smoking has become a habit and the smoker feels the need for the next cigarette build up form the time he puts out the cigarette he has been smoking. This can be very distressing for the smoker and when my smoking was at its' highest prevalence last year, at fifteen cigarettes a day, I would go out in the middle of the night to get cigarettes because I feared the next day where one would not be available when I 'needed' it. At this time, like many others who continue to smoke after the initial few months of trying cigarettes, I did not use cigarettes to manage affect, but instead was smoking out of habit. It was only when my compulsive behaviour was noted by my friends, that I myself realised I had become addicted to cigarettes. Indeed, in 1977, Green stated that 'man is simply not rational enough to appreciate the danger smoking poses to health, which would have to be the major motive for quitting'.

It is only after I have decided to stop smoking that I notice the discomforts I was suffering due to my habit, such as a soar throat, bad cough and coated tongue. Psychological factors are obviously important in the initiation of smoking, especially since it is only actively decided whether one will smoke or not. However, once started, the many negative effects of smoking are visible, so why do people continue or maintain this bad habit? Here, psychology is important in that it explains why an addictive behaviour is maintained, but the social factors must be considered, since these social predictors influence beliefs and behaviour, as an individual psychologically processes them. This is the basis of Bandura's Social Cognitive Theory (1986), which emphasises the effects of environment and cognitions on behaviour, as well as the effects of behaviour on environment and cognitions. Studies have shown that modelling of tobacco use, especially by parents, is a major determinant of smoking in adolescents (Godard, 1990; Patton et al. 1998) who are twice as likely to smoke if their parents smoke (Lader & Matheson, 1991).

The smoking habits of a teen's mother in particular, are very influential and act as one of the greatest long-term predictors of daily smoking (Oy gard et al. 1995). Murray et al. (1984) found that even parental attitudes toward smoking is important as a social predictor influencing an individual's thoughts about cigarette use, since adolescents were seven times less likely to smoke if they perceived their parents to be against smoking. The Cancer Research Campaign in 1992, found that the attitude of the school is also important, where the prevalence of smoking was lower in schools that have a no-smoking policy, particularly if this included staff as well as children (Ogden, 2000). Recent studies have also examined the impact of genetics on smoking maintenance (Hughes, 1986).

Twin studies suggest that genetic factors do contribute to tobacco use and estimates of heritability of the habit of smoking range from thirty-five to sixty-eight percent (American Thoracic Society, 1995). The hypothesis presented is that the mechanism for a genetic influence may be differences in sensitivity to the toxic effects of nicotine. However, smoking behaviour is multi-faceted, and there are still people who begin and then continue to smoke, who show little or no evidence for this genetic link. In conclusion, Pro chaska & Di clemente (1984) proposed the Trans theoretical Model of Behaviour Change. Each stage in the model, when applied to smoking behaviour, is influenced by different factors.

In the Pre contemplation stage, the individual is not thinking about smoking, but receives messages about it. At this stage, parental smoking, advertising and films all exert a heavy influence on the cognitions about smoking. In the Contemplation stage, the individual receives images and peer influence, which build up to the point that curiosity takes over and the person considers trying a cigarette. The behaviour of friends and social predictors come into play here. The Initiation occurs as most young people try smoking, but the majority do not become regular smokers, At this stage it is important to note peers are usually the strongest influence. Young people may become addicted to nicotine after smoking a small number of cigarettes (McNeill et al.

1986) and regular smoking may involve a new set of influences, As well as addiction and habituation, personal factors such as the beliefs about the benefits of smoking, self-efficacy, self-perception and coping join the early influences. In maintenance of smoking, the continuation of regular smoking, all the psychological and social factors are important, but addiction to nicotine, a biological, or pharmacological factor, plays the greatest role. The onset and maintenance of smoking behaviour is clearly complex (Conrad, Flay & Hill, 1992) and this is perhaps why numerous attempts in initiating cessation of smoking in individuals will continue to fail, on the majority of people, until the individual is taken into account, since psychological factors differ from one person to the next.