Smoking and eating behaviour
Research into the interrelationship between smoking and eating has examined: (1) gender dif-ferences in smoking; (2) smoking cessation and changes in food intake; and (3) substitution between substances.
Gender differences in smoking
Research has highlighted gender differences in tobacco use (Grunberg et al. 1991) with the sug-gestion being that, while male smoking has remained stable, or even declined over the past 20 years in the USA and UK, female smoking has increased. This increase is reflected by reports of gender differences in cancer, with lung cancer now being the leading cause of death in Ameri-can women. To explain increases in female smoking, research has focused on the perceived benefits of smoking, suggesting that smokers of both genders continue to smoke for fear of weight gain. Consequently, the present cultural obsession with thinness in women may account for increased female smoking. Smokers generally weigh about 7 lb less than comparably aged non-smokers, and abstinent smokers tend to show weight gains of about 6 lb (US Department of Health and Human Services 1990). As a result, research suggests that female dieters may use cigarette smoking as a weight loss/maintenance strategy (Klesges and Klesges 1988; Ogden and Fox 1994). For example, in a recent study dieters showed greater agreement with statements relating to smoking initiation and smoking maintenance for weight control, the role of weight gain in previous experiences of smoking relapse, intentions to quit following weight loss and intentions to quit in five years (Ogden and Fox 1994).
Smoking and changes in food intake
How cigarette smoking influences weight is unclear, with different possible mechanisms pre-dicting either a change or no change in food intake. For example, it has been proposed that weight gain could be a result of decreased energy use due to withdrawal or fatigue, or that nico-tine may increase metabolic rate; both mechanisms suggest no post-cessation changes in eating behaviour. However, Grunberg (1986) suggests that nicotine may increase blood sugar levels and that post-cessation weight gain could be explained by an increase in sweet food consump-tion, which has been supported by both animal and human research. Further research suggests that smoking cessation may result in increases in consumption of calories, increases in sucrose, fats and carbohydrate intake (see Ogden 1994 for an overview). Theories to explain the changes in food intake following smoking cessation have focused on physiological factors such as a release of brain serotonin following nicotine withdrawal (Benwell et al. 1988), which may be compensated for by carbohydrates. However, an alternative explanation of the relationship focuses on the subjective experience of craving for a substance.
The subjective experience of craving
The desire to eat and the response to food deprivation are characterized by the experience of
‘emptiness’, ‘tension’, ‘agitation’, ‘light-headedness’ as well as more specific feelings such as a
A CROSS-ADDICTIVE BEHAVIOUR PERSPECTIVE 123
‘rumbling stomach’. Smoking abstainers also describe their desire for a cigarette in similar ways, again using language such as ‘emptiness’, ‘agitation’ and ‘light-headedness’. A possible explana-tion of the interacexplana-tion between smoking and eating is that sensaexplana-tions of deprivaexplana-tion may be interchangeable. Alcohol research suggests that craving for alcohol may be a form of misattribu-tion of internal states, with the alcoholic labelling internal states as a desire for alcohol (Ludwig and Stark 1974; Marlatt 1978). With reference to eating and smoking, the desire to smoke may be labelled as hunger and therefore satiated by food intake. In an experimental study, smokers were asked either to abstain for 24 hours or to continue smoking as usual, and their craving for food and cigarettes and food intake was compared with each other and with a group of non-smokers (Ogden 1994). The results showed that smoking abstinence resulted in an increased craving for food and increased food intake. In addition, the results showed that an increased craving for cigarettes resulted in increased food intake. Furthermore, the results showed that this association between craving for cigarettes and food was greater in women than men, and particularly apparent in dieting women.
These studies support a cross-behavioural perspective of addictions and suggest an interrela-tionship between different behaviours. It is possible that because women dieters may use smoking as a means to reduce their eating they develop an association between these behav-iours. It is also possible that the substitution between addictive behaviours may also exist between other behaviours such as alcohol and smoking (stopping smoking increases drinking), or gambling and eating (stopping gambling increases eating). One study in 2001 used an experi-mental design to explore the relationship between smoking and exercise (Ussher et al. 2001).
Seventy-eight smokers abstained from smoking for about 12 hours and then either exercised for 10 minutes on an exercise bicycle or took part in a control condition which involved waiting or watching a video. The results showed that 10 minutes of exercise significantly reduced desire to smoke and withdrawal symptoms.
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To conclude
Smoking and alcohol consumption both have negative effects on health and yet are common behaviours. There are many different theories to explain why people smoke or drink and how they can be encouraged to adopt healthy behaviours. This chapter examined the different models of addiction, including the moral model, the disease models and the social learning per-spective. It then examined the stages of substance use from initiation and maintenance (involv-ing psychological factors, such as beliefs and expectancies, and social factors, such as parental and peer group behaviour), to cessation (involving clinical perspectives, self-help methods and public health interventions) or relapse. Finally, this chapter examined the interrelationship between different behaviours, in particular smoking and eating, to examine the validity of a cross-behavioural perspective.
Questions
1 Could we become addicted to anything?
2 Discuss the role of learning in the initiation and maintenance of an addictive behaviour.
3 Smoking is an addiction to nicotine. Discuss.
4 Discuss the role of health beliefs in the initiation of smoking behaviour.
5 It is the government’s responsibility to stop smoking. Discuss.
6 Lung cancer from smoking is a self-inflicted disease. Discuss.
7 To what extent are addictions governed by similar processes?
8 We have known for a half a century that smoking causes lung cancer. Why do people still continue to smoke?
9 Smoking varies by gender. Outline a research project designed to evaluate why men and women smoke in different ways.
For discussion
Have you ever tried a puff of a cigarette? If so, consider the reasons that you did or did not become a smoker. If you have never even tried a cigarette, discuss the possible reasons for this.
Assumptions in health psychology
The research on smoking and alcohol highlights some of the assumptions in health psychology:
1 Mind–body dualism. Theories of addictions and addictive behaviour emphasize either the psychological or physiological processes. This separation is reflected in the differences between the disease models and the social learning perspectives. There-fore, although some of the treatment perspectives emphasize both mind (e.g. cue exposure) and body (e.g. nicotine replacement), they are still seen as distinct com-ponents of the individual.
2 Changes in theory represent improvement. It is often assumed that the most recent theoretical perspective is an improvement on previous theories. In terms of addictive behaviours, the moral model is seen as more naïve than the disease model, which is more naïve than a social learning theory perspective. However, perhaps these differ-ent models also illustrate differdiffer-ent (and not necessarily better) ways of explaining behaviour and of describing the individual. Therefore, to see an individual who drinks a great deal as to blame and as being responsible for his or her behaviour (the moral model) reflects a different model of the individual than an explanation that describes a physiological predisposition (the second disease model) or learning the behaviour via reinforcement.
Further reading
Heather, N. and Robertson, D. (1989) Problem Drinking. Oxford: Oxford University Press.
This book examines the different theories of addictive behaviours and in particular outlines the contribution of social learning theory.
Marlatt, G.A. and Gordon, J.R. (1985) Relapse Prevention. New York: Guilford Press.
This book provides a detailed analysis and background to relapse prevention and applies this approach to a variety of addictive behaviours. Chapter 1 is a particularly useful overview.
Orford, J. (2002) Excessive Appetites: A Psychological View of Addictions (2nd edn). Chichester: John Wiley.
This book illustrates the extent to which different addictive behaviours share common variables in both their initiation and maintenance and discusses the interrelationship between physiologi-cal and psychologiphysiologi-cal factors.
West, R. (2005) Time for a change: putting the transtheoretical (stages of change) model to rest, Addiction, 100, 1036–9.
This paper presents a critique of the SOC model and suggests that there are better ways of under-standing addictive behaviours. It is accompanied by a series of papers which join in the debate including a response by the authors of the SOC.
West, R. (2006) Theory of Addiction. Oxford: Blackwell.
This is an interesting and comprehensive book which describes existing theories of addiction and offers a new synthetic model of addiction which combines a range of psychological processes.
West, R. and Shiffman, S. (2003) Smoking Cessation. Oxford: Health Press.
This is a very clearly written, accessible book which describes physiological and psychosocial reasons for smoking and provides an excellent account of smoking-cessation strategies.
Chapter overview
This chapter first examines what constitutes a healthy diet, the links between diet and health and who does and does not eat healthily. Three main psychological perspectives which have been used to study food intake are then described. First, the chapter describes developmental models of eating behaviour with their focus on exposure, social learning and associative learn-ing. Second, it examines cognitive theories with their emphasis on motivation and social cogni-tion models. Third, it explores the emphasis on weight concern and the role of body dissatisfaction and restrained eating.
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This chapter covers
● What is a healthy diet?
● How does diet influence health?
● Who eats a healthy diet?
● Developmental models of eating behaviour
● Cognitive models of eating behaviour
● Weight concern and the role of body dissatisfaction and dieting