sample="quota" bates="TINY0003025" isource="ti" decade="1990" class="ui" date="19980409" 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 5171 In January, 1972, the Dutch side of St. Martin was invaded by an unlikely party of 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 colonists, 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 thin it 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 psychmeter 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 when 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 form that St. Martin conference. Most of the conferences would agree with this proposition: The primary incentive to cigarette smoking is the immediate salutary 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 lifestyle that it is inevitable that other secondary incentives should become operative. The conference summarizer Prof. Seymour Kety of Harvard, used eating as an 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 ever 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. Systematic research on the question dates back some fifty years to the time when American Tobacco Co. funded the work of a psychologist later to become the most prominent psychologist of his time. His name was Clark L. Hull. His question then was "Wherein lies the charm of tobacco for those accustomed to its use?" In order to review the data that has been collected over these intervening fifty years, I have organized it under three headings: 1) Differences between smokers and nonsmokers. 2) Human physiological responses to inhaled smoke. 3) Situational variables related to smoking behavior. First, then, let us quickly review what is known about the differences between smokers and nonsmokers. 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 rigid, less orderly, more impulsive (smith, 1970) Greater reliance on "external" than "internal" controls (Smith, 1 More chance-oriented (Stratis, 1963) More emotional (Smith, 1967) Less agreeable (Smith, 1969( "Type A" personality (More time-conscious, competitive, etc.) (Rosenman 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 Bown, 1969; Pumroy, 1967; Salber, 1962) More users of alcohol (Higgins, Kielsberg, & Hetzner, 1967; Lilienfeld, 1969) More users of coffee and tea (Lilienfeld, 1969) Religious service attendance less frequent (Cattell, 1967: Straits and Schrest, 1963) Proportionately higher frequency of marriages and job changes (Lilienfeld, 1959) Higher incidences of prior hospitalizations (Lilienfeld, 1959) Higher incidence of smoking among parents (Salber and Abelin, 1967) More active participation in sports (Lilienfeld, 1959) More auto accidents (Ianni and Beck, 1958) MORPHOLOGICAL TRAITS Greater body weight (Seltzer, 1963) Greater height (Seltzer, 1963; Baer, 1966) Thinner "(Higgins and Kielsberg, 1967) Higher height/(cube root of weight) ration (Damon, 1961) Thinner skin folds (triceps and subscapular) (Niggins and Kjelsberg, 1967) DEMOGRAPHIC CHARACTERISTICS More men (Public Health Service Publication No. 1000, 1970) Proportionately more 25-45 year-olds (Public Health Service Publication No. 1000, 1970) Lower mean socio-economic class (Salber and MacMahon, 1961) Proportionately fewer college men (Higgins, Kjelsberg, & Metzner, 1967; Lillianfeld, 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 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 reported 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. Increased blood flow in skeletal musculature 6. A reactive release of adrenalin 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) 1) The neuropharmacological evidence for the biphasic action of nicotine is based upon observations of neural tissues response to the local application of nicotine in animal studies. Stimulation occurred at low concentrations of nicotine, depression at high concentration levels. It is absolutely impossible for the concentration level required to induce naural 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 Schacther, 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 circumstances 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 smoking smoker in a frightening situation? He 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 calming effect that smoking a cigarette had on the chronic smokers in Nesbitt's experiments." There is a variant on the Schachter hypothesis that should be properly ascribed to Frank Ryan, one of my psychologist colleagues at the Philip Morris Research Center. 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 prep 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 compendium or papers presented at the St. Martin's Conference, published by V. N. Winston & Sons of Washington, D.C.