Smoking
Smoking
Tobacco was introduced to Europe by Columbus upon his return from the New World. As the habit of smoking spread throughout Europe, Russia, Africa, and the Orient, it met with formidable opposition from rulers, who instigated periodic attacks upon it. In 1604, King James i of England issued a proclamation called “A Counterblast to Tobacco.” He and others, however, were unsuccessful in eradicating the use of tobacco, which soon became an export of considerable economic importance to the new American colonies. In the United States tobacco remains economically important; it contributes to national income, and its yield of tax revenue plays a significant role in the budget of the federal government.
Although social and religious controversies occasionally have flared between those segments of society which found smoking pleasurable and those which believed it to be a foul-smelling, unnatural, and loathsome habit, scientists showed little interest in the effects of smoking for some five centuries after its introduction to Europe.
In 1900 vital statisticians reported an increase in the incidence of cancer of the lung. Beginning in 1930, scientists from various parts of the world have reported vital statistics suggesting a relationship between certain populations’ increasing consumption of cigarettes and an increased incidence of lung cancer, heart disease, and other illnesses in the same populations. Since the mid–1950s these results have become sufficiently convincing to cause the following health agencies to declare that smoking is a significant health hazard: the British Medical Research Council; the cancer societies of Denmark, Norway, Sweden, Finland, and the Netherlands; the American Cancer Society; the American Heart Association; the Joint Tuberculosis Council of Great Britain; and the Canadian National Department of Health and Welfare. However, cigarette manufacturers have steadfastly maintained that the evidence linking cigarettes and disease is not conclusive.
In any study of smoking, an initial problem arises with regard to the definition of who is a cigarette smoker and, even more problematic, who is an ex-smoker, light smoker, medium smoker, or heavy smoker. There is no precise definition as to what are the actual behavioral (motions), physiological, or psychological referents of smoking. For example, do all individuals who “smoke heavily” inhale to the same extent? One individual might light 40 cigarettes a day but puff only one-eighth of each, whereas another individual, claiming to smoke only 12 cigarettes a day, could inhale each of these down to the last quarter inch. We also do not know the relationship between reported smoking (through verbal self-report or responses to a questionnaire) and actual smoking. Data relevant to these preliminary questions would contribute greatly to the precision of subsequent research on smoking.
Within the past decade social scientists have become interested in the smoker, as evidenced by the appearance of numerous surveys and other research reports on the psychosocial characteristics of smokers. The vast majority of these have focused only on cigarette smokers, and the findings reported below will relate primarily to them.
The reader interested in a detailed review of this subject may consult five reviews that include comprehensive bibliographies of the original literature. Two of the reviews appeared in 1960—one in the United States (Matarazzo & Saslow 1960), and one in Scotland (Kissen 1960). A third review was published by Lawton (1962) and a fourth by Horn (1963). The most recent review (Hochbaum 1964) was prepared as part of the highly publicized report of the advisory committee to the surgeon general of the United States Public Health Service.
Several individual studies are of especial significance because of their scope, sampling, or over-all design. Haenszel, Shimkin, and Miller (1956) surveyed the smoking habits of a cross section (40,000) of the total population of American men and women 18 years of age and older. Sackrin and Conover (1957) followed this by further study of 18,000 of the same 40,000 individuals. Kallner (1958) studied the entire population of Israel. Lilienfeld (1959) studied 4,400 adults in Buffalo, New York. Horn and his associates (1959) polled the total population of high school students (22,000) in Portland, Oregon, while Salber and her associates (see Salber & MacMahon 1961; Salber et al. 1962; Salber, Welsh, & Taylor 1963; Salber & Worcester 1964; Salber et al. 1961; 1963) have published a series of related studies of 6,810 high school students in Newton, Massachusetts. In England, Both well (1959) conducted a study of the smoking habits of 8,314 Oxfordshire schoolchildren, while Chave and Schilling and their associates (1959) studied another group of 3,500 London youngsters. Also, Eysenck and his co-workers (1960) attempted to measure some personality characteristics of a stratified sample of 2,360 smoking and nonsmoking adult British males and followed this with a more detailed study of 3,194 additional males (Eysenck 1963).
Demographic variables. Although social scientists have only recently begun to study the cigarette smoker, there already seem to be a number of variables whch are consistently found to be associated with smoking. These variables are reviewed below, although, because of space limitations, no attempt has been made to review the findings of every study on each variable. Rather, the more significant or better-established findings of a particular study have been presented, and the original articles can be referred to for more detail. The reader interested in the attempts of health educators and social scientists to understand why people smoke and in some of the methods currently being explored in the United States to help smokers give up their habit should consult the report by Mausner and Platt (1966).
Age, sex, and marital status. With respect to age, data from both sides of the Atlantic are similar and indicate that regular smoking usually begins in mid-adolescence to late adolescence, although a small percentage of youngsters start cigarette smoking earlier. Boys are inclined to smoke somewhat earlier and more heavily than girls (Bothwell 1959; Cartwright et al. 1959; Haenszel et al. 1956; Hochbaum 1964; Horn et al. 1959; Horn 1963; Kissen 1960, p. 368; Matarazzo & Saslow 1960; and Salber et al. 1961). Among women, the incidence of smoking is increasing. In their study in Newton, Massachusetts, Salber and Worcester (1964) report that the number of women, particularly Jewish women, who smoke may soon exceed the number of men who smoke.
Among both sexes and all ages, there is a greater percentage of smoking among divorced and widowed individuals than among those either married or never married. Although this has been established for the United States, comparable data for other countries are not available.
Income, occupation, and education. The five reviews suggest that yearly income is not related in any consistent manner to smoking. However, socioeconomic class, when defined only in terms of occupational and educational level, does appear to bear a consistent relationship to smoking; individuals at the lowest occupational levels start to smoke earlier and in greater numbers than those in all other groups. For example, white-collar groups (professional workers, managers, and so forth) typically contain fewer smokers than are found among craftsmen, foremen, salespersons, and similar groups. Possibly it is because some individuals in the latter groups have higher yearly incomes than do some white-collar workers that the relationship between smoking and socioeconomic class, more broadly defined to include income and place of residence as well, is not clearly established.
Apparently there is no clear linear relationship between the highest educational level attained by maturity and smoking (see especially Lilienfeld 1959). However, among high school students those with highest achievement and those in college preparatory courses are considerably less likely to smoke than those in business and technical courses. An interesting twenty-year longitudinal study of a group of Harvard undergraduates indicates that individuals who major in the arts and letters, education, and social sciences later become smokers in greater numbers than do students whose career choice is in the physical sciences (Heath 1958; McArthur et al. 1958).
Urban—rural differences. In all studies examining urban—rural differences, rural farm populations, including both sexes and all ages, were found to contain a smaller percentage of smokers than either the rural nonfarm or the city populations. Rural nonfarm persons closely resemble urban dwellers in their smoking habits. Women and girls in large cities in the northeastern United States (e.g., New York City and Boston) smoke more than do women and girls in cities in other areas of the United States. It is unknown whether a similar pattern prevails when cosmopolitan centers such as London, Paris, and Rome are used as a basis for comparison.
Race and religion. In the English-speaking countries which have been studied, there appears to be no relationship between race and smoking, the proportion of smokers being approximately equal between the Caucasian and Negro sub-samples.
It is well known that devout followers of some religions do not smoke at all (e.g., Hindus, Muslims, Mormons). Studies of young men and women of high school and college age in the United States (Horn et al. 1959; Salber & Worcester 1964; Straits & Sechrest 1963) have reported that significantly more followers of the Roman Catholic and Jewish faiths were found to smoke than Protestants in these age groups. In the Newton, Massachusetts, study, Salber and Worcester (1964, p. 36) found that Catholic men and boys smoked more than other males, while Jewish women and girls smoked more than other females.
Psychological variables. In addition to sociological and demographic variables, some psychological variables have also been explored.
Intelligence and achievement. Present available evidence suggests that there is no direct relationship between intelligence, as measured by tests of IQ, and smoking (Matarazzo & Saslow I960; Hochbaum 1964).
The same is not true for academic achievement during adolescence, however. The previously mentioned studies in Portland, Oregon; Buffalo, New York; Newton, Massachusetts; and a study in London, England (Davis, as reported in Kissen 1960, p. 369) indicate that those students who are academically inferior to their age mates or classmates have a significantly greater tendency to be smokers. This relationship between achievement and smoking, of course, does not establish that one of the two factors is a cause of the other. It can be stated, however, on the basis of consistent evidence, that groups of young men and women who are academically less successful than theirpeers contain a higher proportion of smokers than is found among their more successful classmates. Also, smokers are found to take the scholastically less demanding academic programs (vocational preparation in contrast to a college preparatory curriculum). Smokers date more but engage in fewer extracurricular activities, including sports of some types, than do nonsmokers. No interpretation of these disparate facts has yet achieved wide acceptance.
Personality. Studies attempting to relate personality variables to smoking suffer from the serious handicap that there exists today no highly valid, universally accepted measure either of global personality or of any specific personality dimension. (This assertion quite probably will find support among serious students of personality.) One result is that seldom do any two studies, even those allegedly measuring the same trait (e.g., neuroti-cism), utilize the same methods of assessment; therefore they cannot be compared meaningfully.
Matarazzo and Saslow (1960), Kissen (1960), Lawton (1962), Horn (1963), and Hochbaum (1964) have presented reviews of the few published studies in this area. The results, meager and poorly supported as they are, suggest the following. In most English-speaking countries roughly half of the population are smokers. Studies using stratified as well as nonstratified samples (some small, some large) reveal the presence of a slightly higher number of “extraverts” and “neurotic,” “anxious,” and “tense” individuals among the smokers as compared to the nonsmokers. However, although the differences in the mean scores of smokers and nonsmokers are statistically significant, they typically reflect a difference in response to only one or two questionnaire items. Two of the most extensive (3,194 individual subjects) and best-designed studies on this subject (Eysenck et al. I960; Eysenck 1963) utilized stratified samples of individuals in the British Isles. In the second one Eysenck (1963, pp. 114–115) concludes : “Degree and type of smoking are ... related to extraversion, in the sense that pipe smokers are introverted, as are non-smokers; light, medium and heavy smokers are extraverted, increasingly so in that order.” The degree of extraversion among ex-smokers is found to be indistinguishable from that among light smokers. Such a strong conclusion may not be justified, however, since the mean extraversion scores, on the 31–item extra-version measure used by Eysenck, were as follows for the groups studied (in the order in which they are mentioned above): 17.07, 17.63, 17.60, 18.70, 18.95, and 17.71. Although several of the groups differed significantly from each other because of the large number of subjects, the mean difference between the highest and lowest groups was only 1.88 items on the 31–item personality measure. Similar small but statistically significant differences between smokers and nonsmokers have been found on the “anxiety” scale used by Matarazzo and Saslow (1960, p. 499) and on the “tension,” “psychosomatic,” and “neuroticism” measures used by other workers.
Referring to the research described above in their 1960 review, Matarazzo and Saslow concluded
. . . while smokers do differ from non-smokers in a variety of characteristics, none of the studies has shown a single variable which is found exclusively in one group and is completely absent in the other . . . [this] is especially true for the variables measuring personality characteristics. . . . Examination of the means, standard deviations, ranges, percentages, etc. . . . makes clear that while group trends suggest the smoker to be more “neurotic,” on the average, there are still many individual smokers with neuroticism, or anxiety . . . scores lower than those of many non-smokers. . . . Thus, a clear-cut smoker’s personality has not emerged from the results so far published in the literature. ... It is hard to believe that they [the half of a country’s population who smoke] would share in common one personality “type.” This is not to imply, however, that the various psychological dimensions along which smokers have been shown, as a group, to differ from non-smokers may not suggest an important single process, or processes, underlying these various demonstrated (but small) differences. Further research may indeed so systematize the disparate findings. (1960, pp. 508–510)
Thus, a number of studies report small differences in mean scores, suggesting that compared to the nonsmoker the average smoker has a slight tendency to be more extraverted, outgoing, adventurous, tense, anxious, inclined to drink more alcohol and coffee, date earlier, watch more television, see more movies, drive an automobile earlier, read fewer books per month, play fewer sports, and belong to fewer clubs and school organizations. However, a large number of individual smokers may show few or none of these characteristics. In addition, no unifying theme, trait, or personality dimension has been abstracted from these separate characteristics. For the present it seems best to conclude that any psychological dynamics that may differentiate the smoker from the nonsmoker have not yet been isolated.
Initiation of smoking. Phanishayi (1951), in India, was one of the first to study variables associated with the initiation of smoking. His researchwas followed by that of McArthur and his associates (1958) with Harvard College undergraduates in Boston; Bothwell (1959) in Oxfordshire, England; Chave, Schilling and their associates (1959) in London; Horn and his associates (1959) in Portland, Oregon; Cartwright et al. (1959) in Edinburgh, Scotland; Morison and Medovy (1961) in Winnipeg, Canada; and Salber and MacMahon (1961) in Newton, Massachusetts.
These studies consistently have identified parental smoking as one of the most important predisposing factors in smoking among school-age children. As mentioned above, most smokers appear to have begun smoking between the ages of 10 and 18. If both parents smoke, the probability that their children will begin to smoke is several times that of children with nonsmoking parents. When only one parent smokes, the incidence of smoking among the offspring falls midway between that of the other two groups. Published data also suggest a higher frequency of smoking among children with older siblings who smoke.
The relationship of some other sociopersonal factors to initiation of the smoking habit is less clear-cut. In general, the studies suggest that youngsters’ beginning to smoke is related to: (a) curiosity about smoking; (b) conformity pressures among adolescents; (c) need for status among peers, including self-perceived failure to achieve peer-group status or satisfaction; (d) the need for self-assurance; and (e) striving for adult status (see the reviews by Hochbaum 1964; Horn 1963). However, it is difficult to measure the strength of such needs, as well as their relative influence, and therefore these relationships should be considered tentative.
There is no convincing evidence that beginning to smoke in childhood or young adulthood is a sign of rebellion against parents or other authority figures, although such a hypothesis has been suggested by several writers.
Most writers have suggested that once the smoking habit has been established the factors associated with its continuation very likely are different from those associated with its initiation. Although the evidence is far from conclusive, it appears that sit-uational tension-reduction is an important motivational factor in perpetuating the smoking habit. Also, a small group of smokers attest that they continue to smoke because it is pleasurable.
Many smokers report considerable dissatisfaction with smoking but, despite repeated attempts, have found themselves unable to break the habit. In fact, Horn (1963, p. 364), who sampled the adult population of the entire United States, reports that only 14 per cent of regular cigarette smokers state that they consider the habit pleasurable, safe, and worth the cost.
Discontinuation of smoking. Why do smokers not give up the habit that so many state they would like to shed? Despite pronouncements from health authorities in all parts of the world, the proportion of smokers reporting successful discontinuation of smoking is from 10 to 20 per cent in males and 3 to 10 per cent in females (Haenszel et al. 1956, p. 24; Hammond & Percy 1958, p. 2,956; Cart-wright et al. 1959, p. 726; and Horn 1963, p. 391).
Immediately following the 1964 report of the surgeon general of the United States, 8.6 per cent of the smoking students at two U.S. colleges reported that they stopped smoking as a result of the health hazard identified in this report (Katahn et al. 1964). Again, a greater percentage of male smokers (10.3 per cent) than female smokers (5.9 per cent) reported quitting. In addition, more natural science majors (18.2 per cent) quit smoking than did liberal arts majors (6.7 per cent). The same students took a story-completion test requiring them to create both an imaginary story and an estimate of the amount of time which in reality would have transpired during the occurrence of the sequence of events in the story. Ex-smokers tended to respond with a longer time perspective than did students who continued to smoke, and the authors suggest that these individuals might be more likely to worry about long-term health hazards.
Immediately before and following the surgeon general’s report, several researchers attempted to find effective means for discouraging initiation and encouraging cessation of– the smoking habit. Horn (1960) used a variety of educational approaches with high school students in Portland, Oregon, but he reported only minimal success in preventing the initiation of smoking. Both Horn (1964, personal communication) and Lawton (1964, personal communication) have attempted to help adult smokers discontinue smoking through the use of weekly educational meetings (Horn in Washington) and weekly “group therapy” sessions (Lawton in Philadelphia). With both techniques, success rates were not much higher than the 10 to 20 per cent “spontaneous” successes reported by other writers. The Horn and Lawton studies raise an important question for all cessation studies: who is an ex-smoker? Is he an individual who quits for a week, a month, a year, or forever? It is both a common observation and an established statistical fact thatmany ex-smokers resume the habit after varyinglengths of time.
Comment. After reviewing the above literature, the present authors have concluded that, in all probability, people begin to smoke for essentially the same reasons that they adopt other habits, such as eating certain foods, using certain brands of soap, wearing lipstick, going to see the Beatles, and so forth. That is, initiation of smoking appears to be a result of the millions of dollars spent yearly by (cigarette) manufacturers to influence people to do so; the standards and fads extant in youthful and adult social circles; the examples provided by parents and families; the depth of commitment to personal religious codes; and, finally, some psychological and personality characteristics (e.g., extra-version, tension, neuroticism, etc.) of the individual himself. In our opinion, the last category (personality characteristics) is the least influential in determining whether a given individual will begin to smoke, whereas the other factors (especially the amount spent on world-wide advertising) have considerable influence. Once started, however, continuation or discontinuation appears to be, in large part, a function of the sociopsychological characteristics of the individual.
Joseph D. Matarazzoand Ruth G. Matarazzo
[Directly related are the entriesDrinking and Alco– Holism; Drugs.]
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