Smoking Cessation Intervention
Background
My name is ___. I am a 28-year-old graduate student of Russian-Jewish descent. I am the only participant in the single subject design project. I am a full-time student and also a full time administrative assistant. As such, I am often under pressure both at work and at school due to the need for balance. The combination of work and academic pressures impacts stressfully on my life and I suffer from anxiety at times. Because of this, I learned, through my peers that smoking cigarettes could help me to deal with anxiety. I began smoking at 12 due to peer influence and also with an objective of reducing anxiety and stress. Through the years, my smoking escalated to a level where I would smoke 10 to 20 cigarettes each day. In spite of the warnings that I read on the cigarette packages and the effects I knew were associated with smoking, I could not stop myself from the negative habit.
Smoking has been linked to various negative outcomes among frequent smokers. For instance, I learned that research shows that those who smoke are more likely to develop respiratory health problems such as chronic bronchitis. Furthermore, other serious health outcomes such as compulsive obstructive respiratory diseases (COPD) are also highly correlated to smoking. Various forms of lung cancer are attributed to smoking too (Saha et al., 2007). With this information, I realized that I was not doing any good to my health. I, therefore, realized the need to cease smoking and made a decision that I would do as much as I can to eliminate the habit. Through the years, I was able to reduce my smoking from the 10- 20 cigarettes per day to 3- 5 cigarettes per day. I also realized that the calmness I derived from smoking was only ephemeral as I would soon be anxious again once the nicotine effects wore off. This was the reason why I eventually decided that I needed to quit smoking and to do it effectively.
Methods
Smoking is one of the negative habits that are associated with youths in spite of its harmful health outcomes. According to a study by Roberts et al (2013), smoking is one of the leading causes of preventable mortality among adults who begin smoking as youths across the world. This is due to the multiple health impacts such as lung diseases as well as heart diseases. Having heard and read about the health impacts of smoking, I decided that I would not continue to smoke cigarettes anymore. However, this would be a challenge since most of my social groupings, which comprised of mainly young Russian Jews like me, consisted of people who smoked. I could not eliminate all the people from my social networks since I would virtually remain without any friends. Moreover, having been born in the collectivist Russian culture, life was more about social groupings than individuals (Hofstede, 2017). At the same time, I knew that having them with me would cause me to relapse in my efforts to end my smoking habits. This is because many Russian Jews, especially the youths smoke and it would be difficult to convince my friends to go with me through the cessation journey.
Therefore, I decided to go ahead with my intervention idea, believing that I only had to make a conscious decision to go through with the intervention and then inform them of the same. I then told my friends what my plans were and requested them to help by not giving me any of their cigarettes when I asked for them at any time. I then laid down a strategy to accomplish my intervention.
In order to effectively plan my smoking cessation intervention, I decided to use two indicators for the smoking variable. The first was the number of cigarettes smoked per day. I evaluated my baseline through 7 days and realized that I smoked approximately 3- 5 cigarettes per day. I then decided that I would use this as one of the measures of intervention evaluation since the number of cigarettes is measurable. The second indicator used was the urge to smoke. I realized that I always smoked when I felt the urges. Consequently, I decided that by monitoring how frequently I felt the urges, I would be able to quantify my progress and also to reduce my smoking frequency by noticing the urge and noting it down as soon as it appears. I planned for an intervention that would take these two indicators into consideration when helping me address my challenge.
Having noted my baseline smoking habits, I decided that I would use behavioral therapy approach as an intervention to my smoking problems. According to a study by Gabble et al (2015), smoking cessation programs have to take into consideration factors such as accessibility, affordability and cost-effectiveness. Armed with this knowledge, I decided that the intervention of choice would be to have only two cigarettes in my bag every day for one week. I would not buy any cigarettes from the store neither would I ask for cigarettes from people on the streets or from my friends. Although this would be difficult, I was determined to go through with the intervention. My main intention was to reduce and eventually stop smoking through gradual intervention strategy as described by Hajek et al (2009). Hajek et al used an intervention process in which the number of cigarettes available to participants was reduced gradually each day, with the first day being accorded the highest number of cigarettes. The number of cigarettes given to the participants on their first day of participation was slightly less than the average they smoked per day. I believed that by reducing the number of cigarettes I smoked per day, the urge to smoke would increase first before eventually fading away if the intervention lasted long enough. I began by monitoring my habits for seven days and considered the results to be my baseline reports. From day eight and for the next seven days, I engaged in the smoking cessation intervention. I faced several challenges during the intervention. For instance, instead of the urge reducing, it grew stronger and stronger as I smoked fewer cigarettes. Apart from this, I experienced impacts such as withdrawal and unsteadiness throughout the intervention. Withdrawal was signified by feelings of restlessness and irritability especially during times when I could not smoke in spite of feeling the urge to smoke. The fact that I was with my friends who smoked made the effects even worse than I had imagined. I, however, learned self-restraint through the period as I had no alternatives as I could not borrow or buy any cigarettes even though the urge to smoke was strong.
Findings
The findings obtained through the intervention were as shown below.
First Indicator: Number of cigarettes smoked per day; Mean = 4 cigarettes during baseline; SD = 0.7559; Mean – 2SD = 2.4881; Mean + 2SD = 5.5119
Second Indicator: Frequency of urges per day; Mean = 1.8571 per day during baseline; SD = 0.6389; Mean – 2SD = 0.5793; Mean + 2SD = 3.1349
From the findings in the intervention process, it can be said that the expected results were somewhat achieved. As previously stated, the number of cigarettes smoked during the intervention period was controlled in that I only carried two cigarettes in my bag per day. This means that there was a limitation in the number of cigarettes smoked hence the stability of the graph as shown in the chart above. The results for the number of cigarettes can be said to be somewhat reliable based on the information source. Reliability of the information is taken to imply trustworthiness since the information was received from reports made personally. The results are also valid due to their representation of the intended information. The objective of the intervention was to help in smoking cessation, as measured by the number of cigarettes smoked per day as one of the indicators. Validity in this regard means suitability and the records made are applicable in measuring the indicator as outlined.
Based on these results, it was probable that I would go back to my routine smoking at the end of the intervention period. The statistical results indicate significant variations between the baseline period and the intervention period due to the observed limits of standard deviation. The wide range of SD values from 2.4481 and 5.5119 is an indication of statistical balance and hence show that there is a significant difference between the period prior to intervention and the intervention period.
In the second indicator, the frequency of urges was determined. The results obtained in the second indicator were in line with the expectations. The urges to smoke increased as expected. This means that my efforts at smoking cessation were successful to a certain extent. The increase in the frequency of smoking urges was more likely to drive me towards incremental smoking. Based on the outcomes from both indicators, I can thus say that my goals in beginning this journey were realized. I believe then, that smoking cessation intervention can only achieve its objective if practices without enforced abstinence. Like in the number of cigarettes smoked, the statistical report indicates that there was a significant difference between the urges to smoke before the intervention and after. It was therefore expected that I would cease smoking after sometimes, an expectation that was not realized as I went back to my initial smoking habits of about 3- 5 cigarettes per day. The statistical values for the SD in this second indicator are also significant. The differences between the lower SD value of 0.5793 and the higher value of 3.1349 indicate that there is significant variation between the baseline time urges and the urges experienced during intervention. Low SD variations are an indication of insignificant differences unlike the case of the second indicator.
Discussion
While designing this intervention, I believed that the behavioral therapy approach would be effective in helping me achieve my smoking cessation objectives. However, I did not understand the dynamics of planning such an intervention and what it would result in. The intervention design was strong and effective based on various factors. In line with the studies conducted by Roberts et al (2013), a gradual reduction in the rate of smoking produce results comparable to those obtained through an abrupt cessation. In the present intervention, the objective was based on using a one- time reduction technique that was neither gradual nor abrupt as previously explained. The method was however proven to be potentially effective based on various conditions. According to a study by Gabble et al (2015), a smoking cessation program should be evaluated for effectiveness based on various factors such as costs and ease of access. A consideration of these factors places the selected design at a favorable place with regards to potential effectiveness.
The first fact to be considered in the selection of a smoking cessation program is the accessibility of the intervention resources and the places of intervention. From my baseline condition, I was capable of identifying my main triggers for the urge to smoke to be anxiety and stress. Consequently, dealing with the problem of smoking required that I select a program that would enable me to reduce my exposure to anxiety and stress. Additionally, the program selected had to be accessible since am a student as well as an administrative assistant and I could not be in a position to access resources for therapy if I had to go through a more serious regime. I, therefore, needed a program that would enable me to cease smoking while at the same time living my life fully as a student and an administrative assistant. I believe that the program selected, despite not being effective in the long run, fulfilled the requirements for accessibility.
Moreover, Gabble et al (2015) also posited that affordable solutions should be selected over any other solutions that would be presented. In terms of affordability, various factors would be considered. For instance, there are many smoking cessation interventions that rely on social workers, group interventions, as well as pharmacological procedures. The selected intervention strategy was cost effective as it resulted in the overall reduction of costs incurred in cigarette purchase. I managed to save the equivalent of the cost of one to three cigarettes per day as I was limited to only 2 cigarettes per day. Apart from the direct costs of purchase, the other procedures also come with additional costs in terms of time expenditure. When engaging a social worker or pharmacological strategies, time has to be spent in visiting the people or places where such help can be obtained. As a student and administrative assistant, I could not get this additional time to visit therapists although therapy would have been successful as opposed to the intervention I used.
On the other hand, the design of the study was limited in two main areas. As previously stated, the interventions could have been gradually conducted or abruptly conducted with similar outcomes. However, the limitation of the design is such that the intervention is neither gradual nor abrupt. I am of the opinion that a gradual intervention involves a bitwise reduction in the number of cigarettes smoked per day say beginning with four, on day one of intervention, and eventually to zero on the final day of intervention. It is only in this way that actual impact could have been measured. This could also have produced better outcomes since it would no longer be a result of enforcement. In a research conducted by Hajek et al (2009), it was reported that impacts of behavioral therapy for smokers under intervention are minimal when enforced abstinence is practiced. I, therefore, believe that failure to accomplish the objectives of the intervention was a result of the enforced abstinence rather than a willingness to abstain. The study was also limited in that despite my decision to address two indicators, I did not find strategies for managing the urges effectively. I could have practiced physical activity based behavioral therapy as recommended by Gabble et al (2015). This would be through the use of practices that involve the activity such as taking walks, engaging in exercise and playing games such as football to divert attention from the negative behaviors.
Despite my efforts to abstain from smoking cigarettes, I also faced a significant challenge in terms of social influence. As said before, the Russian culture is collectivist, with a score of only 39% on the individualism dimension (Hofstede, 2017). Moreover, many Russian Jews smoke. This implies two things. The first is that most of my time is spent among friends in this collective society. The second is that while among friends, I am likely to be influenced to relapse in my smoking cessation efforts since many of them smoke. I, therefore, strived really hard to go through the seven days of intervention without relapsing. However, the kind of influence that I faced made relapse easy after the end of the intervention period.
Another challenge faced was in dealing with my anxiety. Previously, I was used to smoking as a way of calming myself. This could not continue since I intended to stop smoking. I had to find ways of dealing with stress and anxiety. Adopting a mindfulness-based therapy approach could have helped in dealing with anxiety as well as the smoking urges that I experienced. This is described by Hofmann et al (2010) as more common among Buddhist and Hindu religions. The approach is based on focusing on the present and maintaining a positive and free attitude towards life. I believe that this approach may have been better at dealing with anxiety as well as reduction in the urges to smoke since it has increased in popularity through the years.
Conclusion
The process of smoking cessation is a very demanding procedure that requires self-sacrifice and willingness to forego the outcomes that one gains from smoking. I am a full-time student and administrative assistant and I am bound to face anxiety at different times in my life. However, dealing with such stresses and anxieties can be difficult especially when one is under peer influence. I found smoking to be my way of dealing with such circumstances. However, I realized that smoking has harmful health impacts and therefore I decided to stop and find other alternative ways of handling stress and anxiety. My main intervention design involved carrying only two cigarettes in my bag as opposed to the three to five I normally smoked on a daily basis.
Through an intervention period of seven days, I was unable to realize my smoking cessation goals. I believe this was due to the non-gradual intervention design and the limitation of culture in my society. I, however, believe that better outcomes could have been achieved since the intervention design already satisfied various conditions that are associated with behavioral therapy. Conditions such as affordability (in terms of resources), cost-effectiveness (time and finances) and optimum reach (accessibility) were all satisfied in spite of the limited intervention scope and design. Needless to say, I eventually relapsed even after going through the seven days of intervention. Based on this study and intervention, I have learned that smoking cessation goes beyond the say that one is willing to stop. It requires intensive emotional and mental input into the process. It is also necessary that one applies an intervention strategy that goes beyond the enforced abstinence strategy since once the pressure is eliminated; one easily goes back to old habits. As such, a combination of behavioral therapy and mindfulness could have been a better intervention strategy.
References
Gabble, R., Babayan, A., Disante, E. and Schwartz, R. (2015). Smoking cessation interventions for the youth: A review of literature. The Ontario Tobacco Research Unit.
Hajek, P., Stead, L. F., West, R., Jarvis, M., & Lancaster, T. (January 01, 2009). Relapse prevention interventions for smoking cessation. The Cochrane Database of Systematic Reviews, 2009, 1.)
Hofmann, S., Sawyer, A., Witt, A. and Oh, D. (2010). The Effects of Mindfulness- Based Therapy on Anxiety and Depression: A Meta- Analytic Review. Journal of Consultation in Clinical Psychology, 78(2): 169- 183.
Hofstede, G. (2017). Russia Cultural Dimensions. Retrieved from https://geert-hofstede.com/russia.html
Roberts, N., Kerr, S. and Smith, S. (2013). Behavioral interventions associated with smoking cessation in the treatment of tobacco use. Health Services Insights, 6: 79-85.
Saha, S. Bhalla, D., Whayne, T. and Gairolla, C.G. (2007). Cigarette Smoke and Adverse Health Effects: An Overview of Research Trends and Future Needs. International Journal of Angiology, 16(3): 77- 83.
Appendices
Appendix A: Number of cigarettes smoked per day
| Smoking Cessation | |
| Day 1 | 5 |
| Day 2 | 4 |
| Day 3 | 3 |
| Day 4 | 5 |
| Day 5 | 3 |
| Day 6 | 4 |
| Day 7 | 4 |
| Intervention | |
| Day 8 | 2 |
| Day 9 | 2 |
| Day 10 | 2 |
| Day 11 | 2 |
| Day 12 | 2 |
| Day 13 | 2 |
| Day 14 | 2 |
Baseline Mean = 4
Standard Deviation (SD) =0.755929
Mean + 2SD = 5.511858
Mean – 2SD = 2.44881442
Intervention Phase Mean = 2
Appendix B: Frequency of Smoking Urges
| Urge to Smoke | |
| Day 1 | 3 |
| Day 2 | 1 |
| Day 3 | 2 |
| Day 4 | 2 |
| Day 5 | 1 |
| Day 6 | 2 |
| Day 7 | 2 |
| Intervention | |
| Day 8 | 6 |
| Day 9 | 8 |
| Day 10 | 5 |
| Day 11 | 4 |
| Day 12 | 6 |
| Day 13 | 4 |
| Day 14 | 8 |
Baseline Mean = 1.8571443
Standard Deviation (SD) = 0.638877
Mean + 2SD = 3.1344896
Mean – 2SD = 0.57939
Intervention Phase Mean = 5.9