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Intervention for Smoking Reduction

Student Name

Institution Affiliation

Course Name

Instructor Name

Date
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Intervention for Smoking Reduction

Smoking is a widespread behaviour involving the inhalation of tobacco smoke into

the lungs, primarily through cigarettes, pipes, or water pipes. It is a major public health

concern with numerous adverse health consequences. According to the American Lung

Association (2021), smoking behaviour refers to the habitual use of tobacco products,

primarily cigarettes, resulting in the inhalation of harmful chemical compounds. The

prevalence of smoking cigarettes varies by country and demographic factors. According to

the World Health Organization (WHO), in 2019, approximately 1.1 billion people worldwide

smoked tobacco, with most smokers being male. The behaviour of smoking cigarettes is

associated with a range of negative health outcomes, including cardiovascular diseases,

respiratory diseases, and various cancers.

People smoke cigarettes for various reasons, including social, cultural, and

psychological factors. The behaviour of smoking cigarettes is often linked to stress reduction,

relaxation, and pleasure. Some people also use smoking cigarettes as a coping mechanism for

anxiety, depression, or other emotional issues. The behaviour of smoking cigarettes should be

modified because of its negative health outcomes. Smoking cigarettes is a leading cause of

preventable deaths worldwide, and quitting smoking is associated with immediate and long-

term health benefits. Quitting smoking reduces the risk of developing smoking-related

illnesses and can improve overall quality of life.

According to Benowitz (2010)’s nicotine addiction model, the maintenance of smoking

behavior is due to the dependence of nicotine. By this, the nicotine level needs to be

maintained in the addicted person to avoid withdrawal symptoms. Reduction of nicotine will

result in urges motivating the person to smoke. Therefore, receiving nicotine from smoking

acts as a positive punishment to the smoking behaviour by removing the withdrawal

symptoms to the smoker (Benowitz, 2010). Smoking can have both positive and negative
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effects. In the short term, smoking induces pleasurable feelings and can reduce stress.

Nonetheless, smoking is associated with a variety of negative health outcomes, including

chronic diseases and conditions, a lower quality of life, and an increased risk of death.

Quitting smoking has been shown to improve health outcomes and reduce mortality

In Foxx and Brown's study, 14 adults (7 males and 7 females) between the ages of

21 to 57 years were sampled. The study lasted for nine weeks with weekly sessions that

lasted about an hour each. Participants self-monitored their cigarette use by recording the

number of cigarettes smoked per day. Nicotine fading was used as an intervention, which

gradually reduced the nicotine content in cigarettes. Self-monitoring and nicotine fading were

combined as core components of the intervention. Participants monitored their own cigarette

use while receiving cigarettes with gradually decreasing nicotine levels to reduce

physiological dependence on nicotine. They received a fixed schedule for switching to lower-

nicotine cigarettes. The intervention resulted in a significant decrease in daily cigarette

consumption: at the end of the study, there was a mean reduction of 49%. All participants

showed decreased smoking behaviour, and five quit smoking entirely. However, follow-up

data was not collected; therefore, it is unknown if these results are long-lasting. The study's

individual approach to nicotine fading, which allowed participants to move forwards at a pace

that suited their needs, may have increased the likelihood that participants would successfully

quit smoking. However, a limitation is the absence of a control group, which makes it

difficult to assess the intervention's effectiveness in comparison to other treatments or

voluntary quitting attempts.

Sutton and Hallett (1993) conducted a study to identify predictors of success in

smoking cessation. The study had a total of 576 participants, consisting of 245 males and 331

females, with an age range of 16 to 70 years. The participants were recruited through
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advertisements in local newspapers and flyers distributed in community centres. The

monitoring method used in the study involved self-report measures of smoking status, with

participants asked to report their smoking status at 1, 6, and 12 months after their quit date.

The study lasted for 12 months, with participants followed up at regular intervals during this

time. The intervention used in the study consisted of behavioural components such as

nicotine fading, cue elimination, and coping strategies for managing withdrawal symptoms.

Participants received a manual containing information and advice on quitting smoking, as

well as individual counselling sessions with a therapist who provided support and guidance in

implementing the behavioural strategies. The study found that predictors of success in

smoking cessation included higher levels of social support, longer duration of previous quit

attempts, and lower levels of nicotine dependence. The study also found that participants who

received the behavioural intervention had higher rates of smoking cessation than those who

did not receive the intervention. One strength of the study is the large sample size, which

provides statistical power and enhances the generalizability of the findings. However, a

limitation of the study is the reliance on self-report measures, which may be subject to social

desirability bias and may not accurately reflect participants' smoking behaviour.

In the study conducted by Baker et al. (2006), a total of 235 participants aged 18 to 65

were recruited, with a gender ratio of 68% male and 32% female. The participants were

monitored weekly for the duration of the 12-week intervention and again at 3-, 6-, and 12-

months post-intervention. The intervention combined Cognitive-Behavioural Therapy (CBT)

and nicotine replacement therapy (NRT) in the form of nicotine patches. The twelve weekly

group CBT sessions were designed to increase motivation, develop coping skills, and prevent

relapse among those with psychotic disorders. The findings indicated that the individualised

smoking cessation intervention was feasible and effective for this population. At the
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conclusion of the 12-week intervention, 20.3% of intervention group participants had quit

smoking, compared to 4.3% of control group participants. At the 12-month follow-up, 10.2%

of intervention group participants remained abstinent, compared to 2.1% of control group

participants. The generalizability of this intervention may be limited to individuals with

psychotic disorders, despite its success; this is a limitation of the study. Nonetheless, this

study highlights the potential advantages of utilising individualised smoking cessation

interventions in populations with specific mental health conditions.

The aim of this paper is to create an intervention to eliminate the behaviour of smoking

cigarettes for one individual (N=1)

Method:

Participant:

YN, a 20-year-old male psychology student at the University of Queensland. He has

excessive smoking behaviour. Due to the harmful effects of smoking, including cancer, poor

breath, and diminished fitness, YN wants to completely cease his smoking behaviour.

Operational definition:

Smoking is defined as the act of inhaling smoke created from burning tobacco leaves, usually

from a commercially produced cigarette, cigar, or pipe. A participant's smoking behaviour is

scored when he or she (a) lights up a cigarette and smokes it for at least one inhalation, or (b)

smokes a cigarette lit by another person for at least one inhalation. For instance, if a

participant opens a pack of cigarettes, selects one, lights it, and smokes it, this will be counted

as one instance. Then, if participants continue to take out another cigarette and smoke until

they are finished, this will be considered a second instance, and so on. A questionable
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instance that would be scored is if the participant lights a cigarette but only takes a few puffs

before putting it out. A questionable instance that will not be scored is when the participant

holds an unlit cigarette between their lips without lighting it or inhaling any smoke.

Monitoring method:

The behaviour will be recorded in event frequencies for 10 consecutive days. This is because

operational definition requires the behaviour to be recorded every time a participant smoke.

Moreover, using event frequencies would enable researchers to gain an insight to how many

times participants smoked throughout 10 days. However, recording in even frequencies is

repetitive, especially when participants constantly engage in the behaviour. Thus, participants

may not have a motivation or simply forget to record the behaviour.

Results:

Over the 10-day monitoring period, participant P smoked 41 cigarettes, averaging 4.1

per day and ranging from five. Figure 1 demonstrates above-average behavior frequencies on

the first, third, and sixth days. Alcohol intake enhances participants' smoking cravings (King,

McNamara, Conrad & Cao, 2009). Aversive smoking study (Erickson et al., 1983) pairs

negative outcomes with gustatory signals the day after participants quickly smoke, explaining

the low spots in the data on the fourth and seventh days. On the second day, after drinking,

smoking did not considerably decrease. This shows that other things may affect the

participant's smoking. The participant may have been anxious because they were auditioning

for a band where everyone smoked cigarettes. Except on day six, targeted behavior remained

consistent throughout the trial. The outlier may have occurred because individuals drank and

encountered a stressful event—their automobile wheel-cramped. These two things may have

boosted the participant's smoking cravings.

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S O R C K

Stimulus Organismic Target Consequences Contingencies

Behaviour

Historical Genetics may After Immediate

determine how waking up, Gratification Positive
 Exposed to smoking as a quickly and intensely spending reinforcement
child, as regular smokers in one needs nicotine and time with Camaraderie Positive
their family normalised the cigarettes. Smoking as friends, reinforcement
behaviour a coping mechanism having a Relaxation Positive
may be influenced by few drinks, reinforcement
 To fit in with their peers, the genetics and and taking temporary relief Positive
participant began smoking environment. a break reinforcement
during adolescence because from
of peer pressure. Depending on their stressful
mood, someone may activities,
 Predisposed depression and light up. Serenity and the long term
separation anxiety from satisfaction minimize participants Negative
unsuccessful romantic smoking, but stress report lung cancer punishment
relationship contributed to and anxiety increase feeling a Negative
the participant's use of it. momentary heart disease punishment
smoking as a coping relief from Negative
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Quitting may depend their Health punishment

mechanism. on effort. They may feelings of difficulties.
be able to stop melancholy
Contextual smoking despite and anxiety
 Being in the space of emotional or social associated
smokers. obstacles. But if the with being
 Being in places as bars and willpower is weak, the apart.
parties, where smoking person is more Following
friends and acquaintances inclined to give in. dinner, the
are present. individual
 Band auditions Social and will
 having breakfast and dinner environmental factors usually
may influence engage in
Immediate. smoking. Smokers the ritual of
increase the risk of lighting up
 feeling satisfied upon smoking, while non- a cigarette.
waking smokers diminish it.
 Feeling socialized while
chatting with friends Hunger and fatigue
may influence
 Feeling relaxed when
smoking. Smoking
drinking alcohol
may decrease after
 Experiencing temporary
eating but increase if
relief after engaging in a
one is tired and needs
stressful activity
a quick boost.
 Sense of routine, smoking
after dinner

Table 1. The qualitative analysis of excessive smoking cigarettes behaviour.

Behavioural formulation:
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YN, a male psychology student at the University of Queensland who is 20 years old,

believes that smoking behaviours can be influenced by both historical and contemporary

factors. Some of these factors include being exposed to second-hand smoke as a child, feeling

pressured to start smoking as a teenager, and turning to smoking as a coping method for

negative feelings such as melancholy and anxiety. Two environmental factors that can

increase the possibility that YN will start smoking include participating in activities that are

stressful and being in the presence of other individuals who smoke. Both of these

environmental factors are related to the surrounding environment.

Cigarettes have the potential to improve YN's mood first thing in the morning,

increase the amount of social engagement that they engage in, and reduce the amount of

anxiety and concern that they experience. Since smoking after dinner is such a common

practice, the social norm condones the behaviour and encourages its continuation. It has been

hypothesized that the observed behaviour is the result of a synergistic interaction between a

genetic predisposition to nicotine addiction and the effects of the surrounding environment.

YN smoke less cigarettes after meals, but when they are exhausted and looking for a quick

pick-me-up, they are more likely to fire up a cigarette.

Despite the fact that smoking is linked to an increased risk of developing lung cancer

and heart disease, many young people continue to engage in the practice because of the short-

term pleasures that can be derived from it. These can include quick enjoyment, social

connection, relaxation, and momentary relief. It's possible that an individual's ability to kick a

habit can be influenced by factors outside of their control, such as the social and

environmental setting in which they live. This is something that can happen to young people.

One strategy for helping YN kick his smoking habit is to offer him with less harmful

substitutes for nicotine. YN has been trying to kick the habit for a while now.
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Discussion

It is possible for YN to begin smoking immediately after being exposed to smoking

cues such as cigarette advertisements, group pressure, and stress. People have the

misconception that the unpleasant symptoms of nicotine withdrawal, such as coughing and

poor breath, will prevent individuals from starting to smoke again. A desire to enhance one's

health through physical activity, the possibility of financial savings, and the support of one's

loved ones are all potential motivations to give up smoking. It's possible that the social

stigma, the negative effects on one's health, and the financial burden of smoking will be

enough to dissuade someone from engaging in the behaviour.

Initial research suggests that a combination of pharmacological, cognitive, and

behavioural treatments can be effective in assisting smokers in kicking the habit. It has been

demonstrated that using nicotine replacement medication, cognitive behavioural therapy, and

systems of incentives and punishments all work together to assist smokers in effectively

quitting the habit.

The proposed intervention for YN is broken up into three stages, with each stage

having its own individual set of intermediate goals and schedule of reinforcement. YN will

need to discover an activity that she can perform in place of smoking that does not produce

the same feelings in order for her to be able to resume her previous habit of smoking two

cigarettes per day. YN will be included into a program that will award her with financial

incentives after she reaches the halfway mark of her goal to quit smoking two packs of

cigarettes per day.

During the second stage, YN will make the transition from smoking two packs of

cigarettes per day to never smoking again. The length of time that YN has gone without

smoking will now determine the frequency with which he is awarded a prize. It is OK to
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motivate people to carry out your requests by showering them with praise, exerting positive

group pressure, or even offering them a few dollars in cash awards.

The objective of the third stage is to successfully wean YN off of the habit once and

for all. At this point, YN will have access to all of the support that she requires in order to

continue her life free of smoking. The urge to give up a bad habit can be motivated by a

variety of factors, including the approval of loved ones, the chance of making money, the

want to try something new, or the desire to try something different.

Because it incorporates both behavioural and cognitive strategies, the proposed

intervention approach is consistent with research of programs that assist individuals in

quitting smoking. Two types of reinforcement that have been demonstrated to assist smokers

in kicking the habit are risk management and positive social reinforcement.

The proposed intervention approach for YN involves the use of new and different

reinforcers to assist him in cutting back on his smoking or quitting smoking altogether.

Research on what works in smoking cessation programs is combined with YN's individual

features, such as the amount he smokes and his level of familiarity with Pavlovian and

Operant conditioning, to create a customized plan for him to quit smoking.

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References

Lindson, N., Klemperer, E., Hong, B., Ordóñez‐Mena, J. M., & Aveyard, P. (2019). Smoking

reduction interventions for smoking cessation. Cochrane Database of Systematic

Reviews, (9).

Ramseier, C. A., Woelber, J. P., Kitzmann, J., Detzen, L., Carra, M. C., & Bouchard, P.

(2020). Impact of risk factor control interventions for smoking cessation and

promotion of healthy lifestyles in patients with periodontitis: A systematic

review. Journal of clinical periodontology, 47, 90-106.

Daumit, G. L., Dalcin, A. T., Dickerson, F. B., Miller, E. R., Evins, A. E., Cather, C., ... &

Wang, N. Y. (2020). Effect of a comprehensive cardiovascular risk reduction

intervention in persons with serious mental illness: a randomized clinical trial. JAMA

Network Open, 3(6), e207247-e207247.

Goldenhersch, E., Thrul, J., Ungaretti, J., Rosencovich, N., Waitman, C., & Ceberio, M. R.

(2020). Virtual reality smartphone-based intervention for smoking cessation: pilot

randomized controlled trial on initial clinical efficacy and adherence. Journal of

medical Internet research, 22(7), e17571.

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Appendix:

Date/Time Where Who Before After

25 March/ 9:34 pm Home Alone Woke up Felt satisfied

25 March/ 11:45 pm Park Friend Chatting Felt socialised

25 March/ 5 pm Bar Friends Drinking Felt relaxed

25 March/ 6 pm Bar Friends Drinking Felt relaxed

25 March/ 7 pm Bar Friends Drinking Temporary relief

25 March /10:34 pm Home Alone Dinner Sense of routine

26 March / 4 pm Audition Bandmates Bandmates smoking Social bonding

26 March / 5 pm Audition Bandmates Bandmates smoking Felt less nervous

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26 March / 6 pm Audition Bandmates Bandmates smoking Stress relief

26 March / 7pm Audition Alone Bored Felt relaxed

27 March /9:30 am Home Alone Woke up Felt satisfied

27 March /11:22am Home Alone Studying Felt focused

27 March/ 8:12 pm Friend’s house Friends Partying, drinking Felt more relaxed

alcohol

27 March /9 pm Friend’s house Friends Drinking alcohol Felt relaxed

28 March/ 10 am Home Alone Breakfast Sense of routine

28 March/ 8 pm Home Alone Dinner Sense of routine

29 March 10 am Home Brother Breakfast Sense of routine

29 March 12.30 Home Alone Studying Felt focused

29 March 2 pm Home Alone Lunch Sense of routine

29 March 6:30 pm Home Alone Studying Regained focus

30 March 10 pm Home alone Breakfast Sense of routine

30 March 12 pm Home alone Studying Felt focused

30 March 3 pm Road Alone car got wheel- Felt less stressed

cramped

30 March 3:20 pm Road Alone car got wheel- Felt less stressed
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cramped

30 March 5 pm Road Alone car got fixed Felt less nervous

30 March 8 pm Home Friend Chatting Felt more social

30 March 4 pm Home Friend Chatting Felt a sense of

closure,