I Smoke, But I’m Not a Smoker
Why some “non-identifying smokers” face risks while denying the behavior
While smoking among California adults has dramatically declined in recent decades, researchers at the University of California, San Diego School of Medicine report there is a surprisingly large number of people who say they use cigarettes, but don’t consider themselves to be “smokers.”
Writing in the February 5 online issue of Tobacco Control, Wael K. Al-Delaimy, MD, PhD, professor and chief of the Division of Global Health in the UC San Diego Department of Family and Preventive Medicine, and colleagues estimate that, in 2011, almost 396,000 Californians (12.3 percent of the state’s population of smokers) smoked on a measurable basis, but rejected the characterization of “smoker.”
Almost 22 percent of these smokers consumed tobacco on a daily basis.
Al-Delaimy said the phenomenon has both individual and social ramifications. For individuals, the behavior puts them at many of the same health risks as identified smokers. “There is no safe level of smoking,” he said.
More broadly, non-identification of “non-identifying smokers” or NIS may be negatively impacting efforts to reduce tobacco consumption by overlooking a significant segment of the affected population, the researchers said. This is especially true at the clinical setting where physicians might ask patients if they smoke and patient fail to identify themselves as smokers.
In their cross-sectional analysis of the 2011 California Longitudinal Smokers Survey, Al-Delaimy and colleagues defined NIS as persons who had smoked at least 100 cigarettes in their lifetime, reported smoking at least one day in the past 30 days or who said they smoked at least “some days.” In all cases, when asked if they considered themselves to be a smoker, the respondents replied “No.”
The researchers believe NIS can generally be divided into two groups with distinct rationalizations for asserting their non-smoker status: According to previous studies, the first group consists of young adults who primarily smoke (and drink) socially and who believe they are not addicted to nicotine. And, for the first time, NIS includes a second group of adults over the age of 45 who were formerly regular smokers and had most likely failed repeated attempts to completely quit. These people, said Al-Delaimy, might seek to avoid the label of “smoker.”
“The younger NIS are typically college students who smoke as a means of social facilitation and who believe they can quit at any time,” he said. “Older NIS are likely the result of stigmatization produced by comprehensive tobacco control programs. They’ve become marginalized parts of society who see little advantage in identifying themselves as smokers or providing accurate reports of their smoking behavior.”
Often, the study authors noted, NIS belong to specific ethnic minority groups, notably black and Asian.
Al-Delaimy said the findings that NIS exist in numbers much greater than previous estimates suggests future surveys should be re-designed to better account for how smokers perceive themselves so that subsequent interventions, media campaigns and public health policies can be refined to more effectively reach smokers who don’t think they’re smokers.
There is a risk for such smokers to continue to smoke and be adversely impacted by the tobacco they smoke, yet they do not seek any assistance nor do they plan to quit because they falsely believe they are not smokers,” Al-Delaimy said. “This more complex issue of identity and self-perception of smokers in today’s social environment will require further studies and understanding.”
Pieces of mind
Edward Bradford Titchener (1867-1927) was a British psychologist best known for creating a version of psychology that classified cognitive function in terms of discrete components.
Dubbed structuralism, it parsed consciousness into three types of mental elements: sensations (elements of perceptions), images (elements of ideas) and affections (elements of emotions). These, Titchener argued, could be studied both qualitatively and quantitatively.
The image above, taken by Titchener to help illustrate a book on tools of psychology, is a three-dimensional rendering of the “phantom course of fibers in the human brain,” built in 1895 by Adam Ferdinand Buechi, a Swiss Feinmechaniker (maker of precision instruments) and optician.
Too Young For This: young survivors of breast cancer
While cancer affects a person’s quality of life at any age, a recent study in The Journal of the National Cancer Institute reports that women under the age of 50 who survive breast cancer are more adversely affected psychologically and physically. The study noted that, “these women suffer from severe psychological distress, infertility, premature menopause, a decrease in physical activity and weight gain.”
Of the estimated 288,130 new cases of breast cancer in 2011, five percent were women under 50 years of age. Because these women are more adversely affected, we asked Wayne Bardwell, PhD, president of the American Psychosocial Oncology Society and director of Patient & Family Support Service at Moores Cancer Center three questions about addressing these patients’ psychological needs.
Question: When does psychological counseling become part of the treatment for breast cancer or does it?
Answer: There are various points in the cancer trajectory where psychological counseling can be helpful. These include the time of diagnosis, the time during active treatment, and during the transition from treatment to “survivorship.” Receiving a cancer diagnosis can be a shocking experience for many patients. The process of treatment, while greatly improved over treatments in the past, can still be an arduous process that may result in fatigue, insomnia, anxiety, pain and other symptoms. Psychotherapy can be helpful in coping with treatment and its side effects. At the completion of treatment, it is not uncommon for a patient’s support system to “breathe a collective sigh of relief” and go back their usual lives. During treatment, many patients use a certain amount of denial to cope (“I’m going to beat this; treatment will not be difficult for me”). Once treatment is over, it is not uncommon for patients to experience a variety of feelings that have been held at bay only to find that their support system is no longer mobilized.
Q: Anxiety and stress are cited as a negative contributing factor in a diagnosis, especially in young women. Why does stress have a more negative effect on younger patients?
A: Cancer strikes younger patients at times in their lives where they may be seeking a partner, raising a family or in the midst of a budding career. Thus, they may have much on their plates and much that they are looking forward to in their lives. For some patients, cancer may present the major adversity that they have faced. Older patients, by virtue of having lived longer, have likely faced more difficulties along the way than a younger patient. Facing and surmounting challenges teaches us coping strategies that are helpful in meeting future challenges.
Q: How can friends and family help improve a patient’s outlook?
A: Friends and family are key in the support system for any patient dealing with cancer. Support can take several forms. The best emotional support involves listening to and accepting the patient as they are in the moment. While an optimistic outlook can be helpful, patients don’t always feel positive, and it is not uncommon for them to feel guilty about this. They may sometimes feel sad, anxious, fearful or angry. Rather than trying to change the patient’s feelings, it is best to convey some sense of understanding why they are experiencing whatever feeling they may express. Tangible support involves helping with logistical issues (e.g., childcare, housecleaning, rides to appointments). I often encourage patients to make a list of things that need to be done. If someone asks “How can I help,” they can be directed to the list and encouraged to sign up for a task. And sometimes, the patient wants to hang out with a good friend and achieve as much normalcy as possible.
The Strange Powers of the Placebo Effect
Also see: “Effects of homeopathic medicine!”
This is one of humanity’s most odd and ill-understood psychological traits. Fascinating, but odd.
Dr. Beatrice Golomb did a paper on the question of placebo: No Standard for the Placebo?