Exploring Why People Smoke Through the Biopsychosocial Model
Tobacco use not only harms users but also families, communities, society and the environment. While there has been a reduction in tobacco use across Canada, millions of Canadians continue to smoke and tobacco use remains the single most preventable cause of death in Canada. It is estimated that 100 Canadians will die every day due to a smoking-related disease (Government of Canada, 2016). Tobacco kills up to 50% of its users (WHO, 2016).
The Biopsychosocial Model of Health is based on the idea that biological, psychological, and social processes are integrally and interactively involved in physical health and illness (Suls & Rothman, 2004). This model is frequently used to explain the complex interaction between the biological, psychological and social aspects of addictions. Within this model, the biological component includes anatomical, structural, genetic and molecular influences, while the psychological component emphasizes how an individual’s development, motivation, and personality may contribute to the health issue, and the social component examines how cultural, familial, environmental and spiritual factors may contribute (Samenow, 2010).
Applying the Biopsychosocial Model to tobacco use disorder offers several advantages as this model allows for a holistic understanding of the individual and the health issue. Having a better understanding of tobacco use disorder allows for a better understanding of effective tobacco controls and health promotion strategies. In this blog post, using the Biopsychosocial Model, the biological, psychological, behavioral and environmental reasons as to why people smoke will be discussed.
Biological Reasons
The initiation and sustainment of smoking are affected by many biological determinants, including genetic and neurobiological factors.
Genetic
 A person’s individual physiology and genetic make-up can contribute to the addictive and dependence potential of tobacco as an individual's genes regulate the production and metabolism of specific neurotransmitter involved in smoking, the amount of available nicotine and neurotransmitter receptors in the brain and the rate of nicotine metabolism (Bierut & Cesarini, 2015).
Neurobiological
Nicotine stimulates various receptors in the nervous system to activate the release of several various types of neurotransmitters including dopamine, opening the dopamine pathway which is thought to contribute to the positive reinforcing effects of nicotine including feelings of stimulation and pleases while reducing stress and anxiety, leading to dependence (Benowitz, 2010). Repeat exposure to nicotine leads to nicotine receptors becoming less responsive, resulting in a shorter less intense effect leading to increased use to obtain the desired effect, producing the addiction cycle (Benowitz, 2010).
Psychosocial Reasons
Various psychosocial factors can affect an individual’s initiation and sustained use of tobacco. Individuals with personality traits that include rebelliousness, risk-taking, attention seeking and impulsivity are more likely to be smokers (Littlefield, Vergés, Wood & Sher & Sher, 2012).
Mental Health & Trauma
A complex co-morbid relationship between mental health and tobacco use, for example, individuals with serious mental health issues such as depression, bipolar disorder, and schizophrenia are much more likely to be smokers and often smoke in an attempt to cope with or self-medicate their mental health illness (Kalman, Morissette & George, 2005).
In a 2011 British Columbia study on smokers, approximately 20% f participants met the criteria for post-traumatic stress disorder, 55-64% reported some form of childhood abuse and 28-71% reported that they were victims of various types of abuse as adults (Krausz & Schuetz, 2011). Individuals who are experiencing trauma or have a history of trauma may feel that smoking helps them to cope.
Socialization and Peer Groups
Most smokers start smoking as a youth or young adults, during a time when socialization, trying to fit in and peer groups have a major influence on their behavior and development (CDC, 2015). The influence of peer groups has been shown to be a strong influence on whether children and youth decide to smoke (USDHHS, 2012).
Parental Influence
Although parents have less influence over children than their peer groups, they still have a big influence on whether their children will smoke for example, when both parents smoke their children are three to four times more likely to smoke themselves (den Exter Blokland, Engels, Hale, Meeus, & Willemsen, 2004). Initiation of smoking rates by youth are also lower when parents have an intact marriage, spend time with their children, use a positive authoritarian approach to parenting, disapprove of smoking, and observed their children more closely (Hill, Hawkins, Catalano, Abbott & Guo, 2005).
Weight
Smoking is sometimes perceived as a way to lose or maintain weight especially among young females, young females who worry about their weight or have dieted are more likely to smoke (USDHHS, 2012).
Social Determinants
Social determinants have a significant impact on smoking initiation and sustainment. Smoking rates have been linked to income, age, education, unemployment and job security, employment type and working conditions, housing, social exclusion, social safety, Indigenous status, gender, and race. Disadvantaged populations experience higher rates of tobacco use, as compared to the general population. Three of the most significant social determinants that are related to tobacco use are income, age, and gender. Death due to tobacco use and tobacco use rates are significantly higher among individuals and populations of lower socioeconomic status (Blas & Kurup, 2010). Â A recent Statistic Canada Report (2017), notes that the largest group that smokes in Canada are males 20 to 34 years old at 25.8. Globally, smoking rates also remain higher for men than for women (Blas & Kurup, 2010), with the largest group of smokers in the world (68%) being males living in middle-income countries (WHO, 2017).
Behavioral Reasons
Patterns of Use
A study from the University of Pittsburgh (2007), notes that positive reinforcers drive people to engage in repeat behaviors leading to addiction. It is explained in the study that powerful reinforcers include nicotine but that nicotine also amplifies the satisfaction smokers get from their environment. Therefore, if smokers perceive a feeling of pleasure and positive associations from smoking, for example, when smoking a cigarette after a meal, celebrating with friends, while having a drink or relaxing, then they may find it more difficult to quit (Els, Kunky & Selby, 2014).
Skills & Knowledge
Blas & Kurup (2010) note that youth who have lower levels of social competence and self-confidence, have inadequate awareness of the harms associated with tobacco use and underestimate the harms, are not receptive to health education message and are pessimistic about their lives as well as smoking prevention and have poor school performance and attendance have a lower ability to resist peer pressure and tobacco advertising tactics.
Environmental Reasons
Smoking may be a behavior that is learned through modeling others. The more exposed individuals are to tobacco and seeing people smoke the more likely they are to imitate the behavior (Jiaying, Xi, Siman, Falk & Albarracin, 2017).
Living Environment
Individuals that are living in high-risk environments, such as group homes, rooming houses, shelters, the street, couch surfing and precariously housed, are at higher risk for smoking. The British Columbia health report of the homeless survey report (2011), found the rate of smoking of the homeless population to be 81%, it was also noted that individuals that were homeless and smoked tended to smoke more cigarettes a day, initiated smoking at a younger age, and had a longer smoking history as compared to non-homeless individuals.
Although all prisons in Canada have instituted smoking bans within their facilities, the prevalence of smoking among individuals who are incarcerated remains extremely high. A 2011 survey of 113 Quebec inmates in three provincial correctional facilities found a smoking rate of 80%, and 93% of those smokers reported using tobacco products indoors despite the ban (Lasnier, Cantinotti, Guyon, Royer, Brochu & Chayer, 2011).
Work and School Environment
Work sites, schools and community settings that allow smoking support the initiation and continuation of tobacco use. Certain occupations such as blue-collar workers and service workers have high tobacco use rates which can create a culture that drives smoking making the initiation of smoking more likely and quitting more difficult for people working together within these industries (Ham, Przybeck, Strickland, Luke, Bierut, & Evanoff, 2011).
Media
The impact of the media continues to be a strong influence as to whether youth will initiate tobacco use. A study by Heatherton and Sargent (2009) that examined the extent that watching smoking in movies promote youth smoking, concluded that when youth with low exposure to smoking in movies where comparer to those with high exposure, youth with high exposure was about three times more likely to experiment with smoking or become smokers. Similar relationships were also found with exposure to television. In a study completed by Gidwani, Sobol, DeJong, Perrin, and Gortmakerwas (2002) it was found that youth who watched five or more hours of television per day were 5.99 times more likely to initiate smoking behaviors, as compared to youth who watched less than two hours. Furthermore, it was found that youth who watched between four to five hours of television per day were 5.24 times more likely to initiate smoking than youth who watched less than two hours.
Prevention Policies
A recent Report from the WHO (2017) notes that approximately 4.7 billion people, which represents 63% of the world’s population are now covered by at least one comprehensive tobacco control measure. This number has quadrupled since 2007 when only 1 billion people and 15% of the world’s population were covered and reports that on average, smoking rates across 126 countries fell from 24.7% in 2005 to 22.2% in 2015, a reduction of 2.5%.
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