sample="rhetorical" bates="2021549648" isource="pm" decade="1970" class="ue" date="19720000" CONFIDENTIAL MOTIVES AND INCENTIVES IN CIGARETTE SMOKING William L. Dunn, Jr. Philip Morris Research Center Richmond, Virginia There is a lovely little island lying about 150 miles east of the Virgin Islands. It is at the northern end of the Antilles, that string of islands flung out crescent-like across the blue Caribbean waters. Legend has it that in the 16th century, both the Dutch and the French lay claim to possession of this tiny body of land. Rather than fight it out as was their wont in those days they showed a surprising and exemplary willingness to apply human reason. A Frenchman and a Dutchman were placed back to back on the beach and told to walk along the beach until they met again on the opposite side. They did so, and a line was drawn between the points of start and finish, dividing the island into the French half called St. Martin, and the Dutch half called San Marteen. It seems that the Frenchman walked faster than the Dutchman, because the French got the bigger half. Some say this was because the Frenchman was drinking French champagne and the Dutchman was drinking Dutch whiskey. However true all this may be, the two colonies continue to live peacefully under these 16th century terms. PLAINTIFF'S EXHIBIT 1971 In January, 1972, the Dutch side of St. Martin was invaded by an unlikely party of twenty-five scientists. There were pharmacologists, sociologists, anthropologists and a preponderance of psychologists. They came from England, Canada and the United States. Each brought with him a carefully prepared scientific paper which represented his best efforts at attacking the question "Why do people smoke cigarettes?" Inspired by the rare 16th century display of human reason shown by the French and Dutch colonies, and while not sunning on the beach, they listened to and reflected upon each other's ideas. You've heard many explanations for cigarette smoking. These were reviewed at the St. Martin conference. I think it's appropriate that we list the more commonly proposed explanations here: 1) For social acceptance or ego-enhancement 2) For pleasure of the senses (taste, smell) 3) For oral gratification in the psychoanalytic sense 4) A psychmotor habit for the release of body tension 5) For the pharmacological effect of smoke constituents. I might mention one other explanation, not because anybody believes it but as an example of how distorted one's reasoning can become under the influence of psychoanalytic theory. Smoking according to this argument, is the consequence of pulmonary eroticism. Translated, this means the lungs have become sexualized and smoking is but another form of the sexual act. If one asks the smoker himself why he smokes, he is most likely to say "Its a habit." If he is intelligent enough, he might be more to the point and say either one of two things: "It stimulates me", or "It relaxes me". And now we are already deep into our topic. The polarity of these two observations has plagued investigators for fifty years. The challenge to any theory as to why people smoke lies in the theory's ability to resolve this paradoxical duality of effect. The St. Martin conference was called by the Council for Tobacco Research, U.S.A., in an effort to goad the scientific community into having another go at the problem. And go at it they did. Much of what follows in this presentation comes from that St. Martin conference. Most of the conferees would agree with this proposition: The primary incentive to cigarette smoking is the immediate salutory effect of inhaled smoke upon body function. This is not to suggest that this effect is the only incentive. Cigarette smoking is so pervasive of life style that it is inevitable that other secondary incentives should become operative. The conference summarizer, Prof. Seymour Kety of Harvard, used eating as analogy. Elaborate behavioral rituals, taste preferences, and social institutions have been built around the elemental act of eating, to such an extent that we find pleasure in eating even when not hungry. It would be difficult for any of us to imagine the fate of eating, were there not every any nutritive gain involved. It would be even more provocative to speculate about the fate of sex without orgasm. I'd rather not think about it. As with eating and copulating, so it is with smoking. The physiological effect serves as the primary incentive; all other incentives are secondary. TABLE 1 INDIVIDUAL TRAITS AND GROUP CHARACTERISTICS BY WHICH A GROUP OF SMOKERS CAN BE DISTINGUISHED FROM A GROUP OF NONSMOKERS PERSONALITY TRAITS More independent (Pflaum, 1965) Greater anti-social tendencies (Smith, 1970) More active, energetic (Schubert, 1959; Straits, 1965) Higher mean extroversion rating (Smith, 1970) "Happy-go-lucky" (Smith, 1969) Higher mean measure of "orality" (Smith, 1970) Poorer mental health (Smith, 1970) Less regid, less orderly, more impulsive (Smith, 1970) Greater reliance on "external" than "internal" controls (Smith, More chance-oriented (Straits, 1963) More emotional (Smith, 1967) Less agreeable (Smith, 1969) "Type A" personality (More time-conscious, competitive, etc.) (Roseman, 1966) Less "strength of character" (Smith, 1969) Higher anxiety level (Walker, 1969; Srole, 1968; Thomas, 1968) LIFE STYLE CHARACTERISTICS More business-oriented in occupation (Seltzer, 1964) Poorer academic performance (Veldman and Brown, 1969; Pumroy, 1967; Salber, 1962) More users of alcohol (Higgins, Kjelsberg, & Metzner, 1967; Lilienfield, 1962) More users of coffee and tea (Lilienfeld, 1959) Religious service attendance less frequent (Cattell, 1967; Straits and Schrest, 1963) Proportionally higher frequency of marriages and job changes (Lilienfield, 1959) Higher incidence of prior hospitalizations (Lilenfeld, 1959) Higher incidence of smoking among parents (Salber and Abelin, 1967) More active participation in sports (Lilenfeld, 1959) More auto accidents (Lanni and Boek, 1958) MORPHOLOGICAL TRAITS Greater body weight (Seltzer, 1963) Greater height (Seltzer, 1963; Baer, 1966) Thinner (Higgins and Kjelsberg, 1967) Higher height/(cube root of weight) ratio (Damon, 1961) Thinner skin folds (triceps and subscapular) (Higgins and Kjelsberg, 1967) DEMOGRAPHIC CHARACTERISTICS More men (Public Health Service Publication No. 1000, 1970) Proportionally more 25-45 year-olds (Public Health Service Publication No. 1000, 1970) Lower mean socio-economic class (Salber and MacMahon, 1961) Proportionally fewer college men (Higgins, Kjelsberg, & Metzner, 1967; Lilanfeld, 1959) More urban residents (Higgins, Kjelsberg, & Metzner, 1967) Many of these characteristics have little meaning without considerably greater explanation than is appropriate for this presentation. Suffice it to say that the list does summarize our state of knowledge on the smoker-nonsmoker differences. As for the relevance of this knowledge to the question of motivation in smoking, I would say that is it is a rich source of hypotheses and hunches, but unfortunately, that is about as far as it can take us. And I regret to say that the major effort of psychologists has been to search for these differences. Hull warned us fifty years ago that the difference approach was a primrose path, but only recently have psychologists begun to appreciate Hull's warning. The pharmacologists and physiologists have done much better, which leads us to the second body of fact; the human physiological response to smoke. The list in Table 2 again is a summary of our knowledge. To be sure there are other responses, some of which have been noted in the literature, some likely yet to be discovered, but those listed have been reportedly by at least two non-related laboratories. TABLE 2 TRANSIENT PHYSIOLOGICAL RESPONSES TO SMOKE INHALATION 1. Elevated heart rate 2. Elevated coronary flow 3. Elevated blood sugar level 4. Lowered cutaneous temperature in the extremities 5. Increase blood flow in skeletal musculature 6. A reactive release of adrenaline 7. Alterations in electrical potential patterns of the brain involving alpha wave suppression 8. Inhibition of patellar reflex Where these responses have been plotted over time, they have been observed to have their onset within several minutes of smoke inhalation, and they are short-lived, having a decay function with a half-life of about thirty minutes. Onset and decay roughly parallel the coincident plotting of nicotine in the bloodstream. (Isaacs & Rand, 1972) These facts are considerably more relevant to the motivation question than are the facts about smoker-nonsmoker differences. In psychology, when we talk about motivation we refer to a force which impels one to act, and the action is goal-oriented. Hunger, for example, is a motive which impels one to the action of ingesting food. The goal is a state of satiety. Reaching the goal is the reward, and the behavior which is instrumental in reaching the goal is reinforced. With this in mind, we can now ask several questions Are any of the listed physiological reactions sought after by the smoker?", "Are these physiological reactions symptomatic of a body state which is the goal of smoking behavior? Two serious flaws in Eysenck's reasoning must be pointed out: 1) The neuropharmacological evidence for the biphasic action of nicotine is based upon observations of neural tissue response to the local application of nicotine in animal studies. Stimulation occured at low concentrations of nicotine, depression at high concentration levels. It is absolutely impossible for the concentration level required to induce neural depression to be attained by means of smoke inhalation. 2) To postulate both activating and sedating effects is to defy the documented universality of the activating physiological effect of smoke inhalation. Eysenck, then, has not dealt effectively with the Nesbitt paradox. And I would remark in passing that the theory of Sylvan Tomkins, widely acclaimed in some circles, suffers from the same criticism. Tomkins has proposed that there are different types of smokers each type seeking different effects from smoking. Tomkins, too, has chosen to overlook the universality of smoke-induced physiological arousal, agreeing with Eysenck that smoking can be either arousing or sedating, depending upon the person and the situation. The second theoretical explanation from the St. Martin conference is that proposed by Professor Schachter, whom I have already mentioned for coining the phrase "the Nesbitt paradox'. Schachter offers an ingenious resolution of the paradox, and an explanation of smoking which you will most certainly find novel and possibly noncredible. Again you must first be briefed on Schachter's theory covering all kinds of affective or emotional experience. The bodily arousal accompanying emotion is the same for all emotions: fear, anger, joy, etc. The person interprets the bodily emotional state in terms of the circumstance under which the emotion is experienced. Sometimes there are faulty interpretations. These can be dramatically demonstrated in a laboratory setting. An example: A male college student is given adrenaline without his knowledge and under pretext that makes him unsuspecting. All this takes place in the presence of a very attractive female lab assistant. At about the time that the adrenaline begins to take effect the young woman crosses her legs provocatively and lets her hand linger a bit too long on his arm. The subject invariably interprets the adrenaline-induced arousal as an erotic arousal and behaves accordingly. The lab assistant threatened to quit if the experiment were to continue. Now how does Schachter apply this theory to resolving the Nesbitt paradox? There is no paradox, of course, in the smoker seeking arousal when at the low end of the arousal continuum, but why seek arousal through smoking when excited, as is so often the case? I quote him: "As we all know, disturbing and frightening events are presumed to throw the autonomic nervous system into action, epinephrine is released, heart rate goes up, blood pressure goes up, blood sugar increases, and so on. Now notice that many of these physiological changes are precisely those changes that we're told are produced by smoking a cigarette. What happens, then, to the smoker in a frightening situation? He feels the way he usually does when he's frightened but he also feels the way he usually does when he's smoking a cigarette. Does he label his feelings as fright or as smoking a cigarette? I would suggest, of course, that to the extent that he attributes these physiological changes to smoking, he will not be frightened. And this, I propose, is a possible explanation for the strikingly calm effect that smoking a cigarette had on the chronic smokers in Nesbitt's experiments." There is a variant on the Schachter hypothesis that should properly be ascribed to Frank Ryan, one of my psychologist colleagues at the Philip Morris Research Center. Ryan suggests that arousal by smoking is perhaps a means of muting or damping an arousal response to exciting or disturbing circumstances. There are limits within which a person will operate on the arousal continuum. If pushed up toward the upper limit by smoke inhalation, there is little room left for further arousal by external events. Thus the smoker can prop himself against the disturbing effect of anxiety or fear, or anger or whatever. This is the end of my presentation. If you have been intrigued by any of these ideas, I recommend the recently published volume entitled "Smoking Behavior: Motives and Incentives", a compendum of papers presented at the St. Martin Conference, published by V. H. Winston & Sons of Washington, D.C.