Under st anding individual
sm oker s’ behaviour and CDTS
Rober t West
Sm oking t r ends in t he UK
0 20 40 60 80 100 120 140
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020
Men total ('000 deaths) W omen total ('000 deaths) Male smokers ('00,000) Female smokers ('00,000)
Smokers
2 Hughes et al, Tob Con 2003, 12, 21-27 3. Shiffman et al, 2002, Addiction, 97, 505-512 4. Addiction supplement March 2005
5. Hughes et al, 2004, Addiction, 99, 29-38
Why do sm oker s not t r y t o st op
m or e oft en?
PRI ME Theor y
A new , com pr ehensive t heor y of m ot ivat ion t hat int egr at es choice, im pulse, ident it y, habit , self-cont r ol, and dr ive int o a single descr ipt ion of t he
Desir es have no effect unless t hey gener at e im pulses
The basis of all behaviour change is: t ension and
t r igger s
What is ‘t ension’?
‘Mot ivat ional t ension’ involves a feeling of
dissat isfact ion w it h t he st at us quo
I t has t he follow ing feat ur es:
1.
I t is only pr esent w hen it is
‘br ought t o m ind’
I t can oft en put ‘out of m ind’ I t is m or e r esponsive t o changes in cir cum st ances t han st eady st at es
2.
I t involves a com par ison w it h
som et hing ‘bet t er ’
w hich is achievable
Ther e is a st r ong t endency t o m ake ‘upw ar d com par isons’
What ar e t r igger s?
Tr igger s ar e event s in t he int er nal or ext er nal
envir onm ent t hat gener at e im pulses t o act t hat ar e st r ong enough t o over com e iner t ia and com pet ing im pulses
I nt er nal t r igger s
Per sist ence of or incr eases in dr ive st at es
Recollect ion of int ent ions or plans
Ext er nal t r igger s
Rem inder s
Cues
‘Pr ovocat ions’
‘Models’
Mot iv at ion t o st op
Mot ivat ional ‘t ension’
Tim e
Act ion t hr eshold
Cut t ing dow n
Tension can be r educed by ‘cut t ing dow n’ or ot her har m m inim isat ion act ivit ies
Appr oxim at ely 50% of sm oker s ar e at t em pt ing t o r est r ict t heir sm oking at any one t im e
New dat a fr om Sm oker s Toolkit Pilot ( N= 84) indicat e t hat sm oker s w ho say t hey ar e ‘t r ying t o cut dow n on how m uch t hey sm oke’ have only slight ly low er
nicot ine int ake ( saliva cot inine of 331ng/ m l ver sus 370ng/ m l)
But pr evious r esear ch show s t hat sm oker s w ho r epor t t hat t hey ar e ‘cut t ing dow n in pr epar at ion for quit t ing’ ar e m or e likely t o have quit one year lat er t han t hose w ho do not ( West et al, 2001)
Tension, t r igger s and sm oking
Tension
Wor r ies about healt h, feeling of disgust ,
em bar r assm ent , sham e, dissat isfact ion w it h t he
cost ,
feeling t hat st opping is possible
Tr igger s
Healt h scar es
Ot her people st opping
I nst r uct ion fr om an aut hor it y
‘New hope’ m essages
Cut Dow n Then St op ( CDTS)
Successful ‘cut t ing dow n’ m ay
incr ease t ension by incr easing t he
feeling t hat st opping is possible
The phar m acological com ponent of
t he dr ive t o sm oke m ay be r educed
Evidence used by Pfizer t o suppor t
CDTS
2.02 4.5% (54)
8.6% (105) Percent (N) of smokers
who were abstinent at 12
I m plicat ions of CDTS
Uncer t ain w het her it w ill incr ease quit at t em pt s or det r act fr om abr upt cessat ion
Possibilit y t hat w ill w eaken t he ‘not a puff’ m essage for sm oker s in clinics
Clinics should not be expect ed t o help sm oker s r educe – no evidence t hat t his is effect ive
GPs should pr obably pr escribe NRT for CDTS in cases w her e st opping is m or e ur gent e.g. COPD but it is
clear t hat t he sm oker w ill not st op abr upt ly
Conclusions
CDTS m ay incr ease t he r at e at w hich quit at t em pt s ar e m ade and t he use of NRT in t hose quit at t em pt s
The effect on pr evalence depends on how far it subst it ut es for abr upt quit s
I t is unlikely in it self t o achieve t he t ar get of doubling quit r at es. For t hat w e need m or e t ension and m or e t r igger s:
1. 20p levy on a pack of cigar et t es funding a t obacco cont r ol pr ogr am m e r un by an independent Tobacco Cont r ol Task For ce
2. Com plet e ban on sm oking in indoor public places
3. Mass m edia cam paigns and advocacy t hat focus m or e on t ension and t r igger s: addr essing t he sm oker ’s
