sample="rhetorical" bates="1003291942" isource="pm" decade="1970" class="ue" date="19720701" Master before 7-/- 72 draft MOTIVES AND INCENTIVES IN CIGARETTE SMOKING William L. Dunn, Jr. Philip Morris Research Center Richmond, Virginia TO BE PRESENTED AT THE CORESTA/TCRC JOINT CONFERENCE OCTOBER 22-28, 1972 WILLIAMSBURG, VIRGINIA There is a lovely little island lying in the Caribbean lying at the northern end of the Antilles called Saint Martin Island. Legend has it that in the 16th century both the Dutch and the French claimed possession, but rather than fight, they agreed to a rational solution to the problem. A Frenchman and a Dutchman were placed back to back on the beach and told to walk until they met again on the opposite side of the island. A straight line was then drawn from where they started to where they met, dividing the island into what have remained the French and the Dutch sides. The French got the bigger half. Some say this was because the Frenchman was drinking French champagne while the Dutchman was drinking Dutch whiskey, so the Frenchman was able to walk straighter and faster. However true all this may be, the French and the Dutch have coexisted peacefully for 200 years under these terms, providing the wisdom of a rational approach to problem solving. Inspired by this rare 16th century display of human reason, the Council for Tobacco Research, U.S.A., chose St. Martin as the place for tweny-five scientists to meet in January, 1972. (The tropical loveliness and the warm January sunshine had absolutely nothing to do with the choice of a meeting place.) The purpose of the conference was to attempt to answer the questoin "Why do people smoke cigarettes?". Those who attended were pharmacologists, psychologists, sociologists and anthropologists. Much of what I will now present is drawn from the papers presented at the St. Martin Conference. To begin I would like to state three propositions that got expressed at the St. Martin Conference. The first proposition reflects the view of the majority of the conferees: The smoker primarily seeks the subtle transient physiological response to inhaled smoke. There are many other reasons why a person smokes, but the primary reason is to obtain the physiological response. All other reasons for smoking are secondary. They come into play only because smoking becomes so much a part of daily living. To emphasize the distinction between the primary and secondary reasons for smoking, I will use the analogy of eating as given by Prof. Seymour Kety of Harvard University in his summary of the conference. He pointed out that elaborate behavioral rituals, taste preferences, and social institutions have been built around the simple act of eating, so much so that even when not hungry we take many pleasures in eating. These many pleasures are second-order incentives to eating, superimposed upon the primary incentive of obtaining physical nourishment. It would be difficult indeed to imagine the fate of our highly evolved eating habits were there not ever any nutritional gain from food intake. As with eating, so it is with smoking. The physiological effect is primary while the taste and smell pleasures, the social symbolism and the satisfactions of lighting up, puffing and handling the cigarette are all of secondary importance. The St. Martin pharmacologist conferees proposed this second proposition: Nicotine is the primary active consitutent of cigarette smoke. They would contend that without nicotine, there would be not sought-after physiological response. The third proposition reflects the expressed views of several of the conferees: The physiological responses to inhaled nicotine are sought after because these physiological responses have a positive effect upon the smoker's physiological efficiency. The term physiological efficiency needs some explaination. It refers to how well a person makes use of his psychological resources in performing tasks and solving problems. Perhaps its best to think of it as a percentage determined from the equation: Resources utilized Resources available X 100 = Psychological efficiency A person's efficiency varies widely over time. Because there are so many factors having an adverse effect, 100% efficiency is rarely achieved. Fatigue can have an adverse effect. So can poor motivation. Emotional state can also have a profound influence, sometimes working for, sometimes against, efficiency. Much of what we do in the normal course of living is aimed at raising or maintaining efficiency. The third proposition of this paper states that smoking cigarettes is one of the things many of us do to improve psychological efficiency. Let me restate the three propositions: 1) One smokes primarily for the physiological response to inhaled smoke. 2) The primary constituent in cigarette smoke which produces the sought-after physiological response is nicotine. 3) The sought-after physiological responses result in increased psychological efficiency. TABLE 3 Personality Traits Smokers are more: extroverted active, energetic anti-social impulsive reliant upon external rather than internal controls risk-taking emotional anxious Life-Style Characteristics Smokers: are more business oriented have poorer academic records use more alcohol use more tea & coffee attend religious services less often remarry more often change jobs more often are hospitalized more often are more active in sports have more auto accidents are of lower socio-economic status These are the diferences that appear when large groups of smokers and non-smokers are compared. Knowing all these facts about a given person, it is still difficult to predict whether or not that person is a smoker. In fact, were you given all this information about each person in a group of people, half of whom smoked and half didn't smoke, your hit rate in identifying the smokers would only improve from the 50% accuracy expected by chance to about 60%. Nevertheless, there is a theme that emerges from among the traits in Table 3. Many of these traits are the traits displayed by people more prone to emotional arousal, either by virtue of their personality makeup or by virtue of their life situation. This brings us to the third source of information; the situational factors which influence rate of smoking. People smoke more when excited or emotionally aroused. This is a commonplace observation, and one which is supported by the fact that people report in surveys that their reason for smoking is to relax. They also report that they smoke when bored, or to overcome monotony or when fatigued, but the great majority of the time a person will say he smokes to relax. This fits well with the personality characteristics of smokers; they are more frequently emotionally aroused than non-smokers. But smoking to relax doesn't fit at all with the physiological responses to inhaled smoke. Smoking tends to induce a physiological state which is the opposite of relaxation. Prof. Stanley Schachter of Columbia University made this paradox the thesis of his paper at the St. Martin Conference -- calling it the Nesbitt paradox, after a graduate student who collaborated with him in studying the phenomenon. Let me state the Nesbitt paradox as clearly and succinctly as I can: The known physiological effects of smoking are those that we consider as indicating body activation or arousal. But smokers smoke more often when under stress and they report that smoking is relaxing. How can an agent that is physiologically arousing be perceived as calming? And why should an already aroused person seek further physiological arousal? Schachter's formulation of the problem in terms of the Nesbitt paradox is fresh and provocative. Its resolution is a challenge to anyone seeking to explain smoking. In fact, I can't think of a more effective test of a theory than its ability to explain this paradox. There are tow theories which in my judgment represent the most promising attacks upon the Nesbitt paradox to date. Schachter begins with the idea introduced earlier in this paper that the bodily arousal accompanying emotion is the same for all the emotions. Arousal takes on emotional meaning as the person interprets the circumstances under which the arousal is occurring. Sometimes the interpretation is faulty, leading to unusual consequences. I can give here a personal anecdote that well illustrates the point. Many years ago, the visit to the dentist was a far greater ordeal for me than it is now. After the injection of the local anesthesia for the filling of a major cavity I would suffer rapid heart beat, rapid breathing and all the other symptoms of being afraid. I assumed I was afraid, and continued to be afraid on every visit until quite casually the dentist informed me on one visit that there was adrenaline in the injection to localize the anesthesia and that it caused the body to respond in much the same way as when one is afraid. This was a great revelation to me. I discovered that the body arousal which I had interpreted to be due to fear was not due to fear. All this time I had not been afraid, or at least not as afraid as I had thought. I had been making a faulty interpretation of my bodily arousal, and feeling quite ashamed of myself for having been so lacking in courage. Today the visit to the dentist is not one of my greater pleasures, but I can go with the dignity and the sense of maliness which that injected adrenaline had stripped me of before I knew what it was all about. A person's emotional arousal level while awake varies within a fixed range, from a low of drowsy calm to a high of pitched excitement. People differ in range. Some have wide ranges, some have narrow ranges. Those with wide ranges are subject to great swings in level of arousal. The magnitude of the swing can be so great as to be disruptive and interfere with one's psychological efficiency, hence those persons with wide ranges are more prone to seek out ways of controlling excessive or unwanted arousal changes. Cigarette smoking is one of those ways, far as we have already seen, smoke inhalation raises the level of body arousal. By smoking, a higher baseline of arousal is achieved, thus in effect narrowing the range within which arousal can vary. Body response to external events is therefore of reduced amplitude, i.e., the response is damped or muted. Through smoking, then, the smoker prepares himself for anxiety, or anger or any other emotion, such that the impact of these emotions upon his psychological efficiency is less intense. The Emory-Ryan hypothesis would not lead us to expect improved psychological efficiency but rather a reduction in the decrement in efficiency that might otherwise occur when the person is confronted with emotionally charged situations. Consider, for example, the person who is subject to excessive anxiety at social gatherings. He is painfully aware of his tendency to stammer, to move about awkwardly and, in general, to display poor psychological efficiency. He smokes a cigarette just before entering the room which raises his body arousal level. Upon entering, the body response to the presence of others occurs as anticipated, but the amplitude of the arousal is not as great as it would have been had he not smokd beforehand, hence the threat is not so great, hence the resulting anxiety is reduced. The vicious neurotic circle is interrupted, the anxiety does not feed upon itself, his body muscles are less tense so that he stammers less and moves about with more smoothly coordinated movements. In sum, he is functioning in a highly arousing situation with less loss of psychological efficiency. Both the Schachter hypothesis and the Emory-Ryan hypothesis introduce a new dimension into research on the psychology of smoking. We are no longer justified in searching for simple order psychological gains from smoking in our efforts to explain smoking behavior. These hypotheses now force us into the study of the counter-effects of smoking. Rather than ask what does the smoker gain, we must ask what does the smoker retain through smoking that he might lose by not smoking. If either of these hypotheses are correct, we should be able to demonstrate that people with high amplitude arousal shifts will display less loss in psychological efficiency under emotionally charged conditions when allowed to inhale smok than when not allowed to inhale smoke. These ideas have had a major impact upon the psychologoy program at the Philip Morris Research Center. Our primary objective is to test out the Schachter and the Emory-Ryan hypotheses. There are many problems, not least of which is the empirical definition of our variables. How do we identify the wide-amplitude person? How can we measure changes in psychological efficiency? How can we achieve emotionally charged situations? As a first step we are attempting to determine whether habitual smoking does raise the arousal baseline. Using radio telemetry, we are sampling heart rate of regular cigarette smokers over an eight-hour period under smoking and non-smoking conditions. The Emory-Ryan hypothesis requires that there be a significant difference in mean heart rate under the two conditions. The conference on the Dutch side of the St. Martin's Island was a significant scientific event. Not only has it influenced our research program at the Philip Morris Research Center, but other programs as well. I know of three other laboratories where studies are underway as a direct consequence of the ideas generated at that conference. The conference proceedings are being published uner the title "Smoking Behavior; Incentives and Motives", by V. H. Winston & Sons, Washington, D.C. As editor of that volume, I can warmly recommend it to you.