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• PROFESSOR J. STEPHEN THOMAS • • • • • • • • 1. My name is Stephen Thomas. I am a professor of Anthropology at the University of South Alabama in Mobile, Alabama. I have both an undergraduate and a masters degree in anthropology from the University of Wisconsin, Milwaukee, and a Ph.D. from the University of Missouri in Columbia. I have taught and conducted research for nearly 20 years. My research for the last ten years has involved the social dimensions and motivations for smoking. 2. Based on my professional expertise, my review of the literature examining the issue of why people smoke, and my analysis of responses given by participants in a recent independent poll conducted by the Gallup Organization,l I have formed the opinion that there are numerous reasons, both significant and varied, which explain people's desire to smoke which are unrelated to the pharmacological properties of nicotine. As the Advisory Committee to the Surgeon General explained in 1964, "there is no single cause or explanation of smoking.... smokers may start, continue and discontinue smoking in response to different inner needs and external influences, social and other" (U.S. Department of Health, 1964, p. 376). Non-pharmacological motivations for smoking are discussed below: 3. Sensory Factors. Many smokers report that they smoke because they enjoy the taste of cigarette smoke. Flavor and taste are frequently mentioned as motivating factors in the decision to smoke. In connection with the pleasant flavor tobacco provides, smokers also report that they smoke because they appreciate and enjoy the aroma of lit tobacco. In a recent Gallup poll asking 1,158 smokers what they enjoyed about smoking,Z a significant number of respondents cited this aspect. 4. Sensorimotor Stimulation. Smokers frequently report that they derive pleasure from the "process" or "act" of smoking. Specifically, the act of packing the cigarette, lighting it, watching the smoke rise and curl and blowing smoke rings is viewed as an amusement and a diversion -- an activity which fills idle time, occupies the hands and relieves boredom. Several Gallup poll respondents identified this smoking motivation with the following statements: o "something to do with the hands" o "the taste, smell and something to do with my hands" o "flavor and something to do with hands" o "keep my hands busy" 1 Sandoval, J.S., & Larsen, M.D., "National Adult Smoking Study," The Gallup Organization, Rockville, Md. (1995). ~ • 2 Question 6 asked smokers and former smokers (n= 1,504) "(Do you/Did you) C3 t enjoy smoking cigarettes?" 77% of whom responded positively. ~ Question 7 asked these positive respondents the open-ended question, "Please ~ describe briefly what it is about smoking that you enjoy(ed)?" ~ Oo ~ 0

0 • i • • o "having something in my hands and having something to do" o "well it was the flavor and something to do" o "it gives me something to do when I need something to do" o "the time it occupies" _ _ o "the act of smoking" o "lighting up and blowing smoke rings" o "the whole process ... oral fixation ... something to do with my hands" o ". .. I liked seeing the smoke and playing around with the cigarette" o "I guess just blowing the smoke" o "the act of inhaling the smoke and blowing it out" In addition, the "act" of smoking is appreciated by some as a comforting routine or ritual act. As one Gallup Poll participant described it, "the habit, the finger movement, the lighting, the fidgeting, the hand movement ... the dumping of the ashes, the routine of it" were all enjoyable aspects of smoking. Another respondent identified smoking as a "routine or ritual." 5. Orality. Many people smoke because it gratifies a need for oral stimulation. Smokers have identified this non-pharmacological motivation in the following manner: - ~ 0 "something in the mouth" o "I guess it was an oral pleasure" o "oral gratification" o "pacifier" o "something to do with your hands and mouth" ! 0 "hand and mouth fixatiori" o "oral pleaser" o "orally fixated" o "satisfaction of putting something in my mouth" • 6. Pacing and Marking. Some smokers utilize cigarettes as a timing device. Because smoking often takes place before or after an event, such as a conference, phone call, or task,, smoking can be used to mark the beginning or end of an activity. In this way, smoking serves to "frame the event and reflects the human propensity to categorize and organize events so that they are both bounded and sensible" 0 (Feinhandler, 1986). Cigarettes are also often used to mark a shift in interpersonal interaction. For example, smoking may signal the introduction of a new topic of discussion or the end of a meeting (Feinhandler, 1986). By marking time, smoking can also add structure to certain tasks and signal and remind an individual that the task i~ presented requires concentration and attention (Feinhandler, 1986). Gallup Poll ~ O C+~7 ~ O

• • • respondents personally recognized that they "measure time" with cigarettes and identify smoking as a "timer." 7. Time-outs and Buying Time. For many smokers, the act of smoking signals that it is time to take a break from work and relax. Cigarettes serve as a portable symbol of "break time" (Feinhandler, 1986). In addition, smoking provides individuals with an opportunity to gain composure, to "sort things out," and to reflect on a given situation prior to having to comment or act or respond. In support of this non- pharmacological motivation, recent Gallup Poll participants recognized that smoking: o ". . . is like taking a little break" o 11... gives me time to relax from doing things around the • house" 0 is associated "with taking a break ..." o "makes me feel like I can relax, like a break" o is like "time off, time for a break" o ". . . gives me a chance to pause for a second while you light especially if you run into some pressure so you do not put 0 your foot in your mouth" o is a "signal for me to sit back and relax" o "give[s] me time to relax" o is a "break from what your [sic] doing to take time to relax" o ". . . was kind of like a time I could relax" 0 0 is "relaxation -- taking a moment to pause. .." o ". .. relaxes me, gives me time out" 8. Peer Acceptance and Conformity. Quite obviously, people begin smoking for reasons which are unrelated to nicotine. One of the primary motivations for ~ the initiation of smoking is the desire to "fit in" and be part of a social group. This motivation may be viewed as a need for conformity or a desire to gain contact or social acceptance in the face of peer pressure. Here again, responses from participants in a recent Gallup Poll inquiring into why they smoke confirm this non-pharmacological motivation for the initiation of smoking: • o o o 0 ". . . most of my friends smoked, it just seemed like the thing to do. . ." "the social aspect -- everybody was doing it -- the thing to do". "the fact that everybody around me smoked and made me part of the group" "everybody did it" 0 "because everyone else around me was" 0 "other people smoked so I did" ND 0 "an element in an environment that made me fit in" ~ 0 "just to fit into the crowd" ~ ~ © ~ -3- ~ • C.fE

• • • • 9. Rebellion/Independence/Control. Among adults as well as adolescents, smoking provides an avenue for the expression of rebellion. Adolescents revel in the opportunity to engage in an activity which is forbidden or otherwise "off limits." Smoking signals an adolescent's independence from his or her parents, while at the same time signaling "belonging" to a smoking peer group (Doherty and Whitehead, 1986). Poll participants support this motivation among adolescents with the following observations: 0 "I was cool, it was against everything my parents wanted" "At that time it was just getting away with something, doing an adult thing. . ." As adults, smoking can serve as an unambiguous signal of independence from, and even rejection of, external authority and pressure, be it from the government through restrictions on-smoking, family members who "hound" smokers to quit, or non- smokers who react negatively to smoking in public (Doherty and Whitehead, 1986). _ Each act of smoking is a symbol of his or her independence. Similarly, where one partner in a relationship smokes and the other does not, smoking may symbolize the struggle for control in the relationship and the assertion of one partner's needs over the other's (Doherty and Whitehead, 1986). The following responses from a recent Gallup Poll exemplify these non-pharmacological motivations in adults: o "the satisfaction of doing what I want to do" o being "naughty" o "the heck of it -- the orneriness" o ". . . I like to irritate nonsmokers" 10. Companionship. Some smokers anthropomorphize smoking. For these individuals, cigarettes provide stability, and even companionship. For example, some poll respondents described this motivation for smoking as follows: o "it is like company when you are alone" o "sort of a companion . . ." o ". .. cigarette[s] became sort of like a companion" o "just the pleasure of having a companion at all times" o "when you want companionship, the urge to smoke seems to come in" o "it's like an old friend ..." 11. Friendship. The exchange of cigarettes is frequently used as a vehicle for the initiation and maintenance of relationships with other individuals. Cigarettes may serve as an "ice-breaker" during the initial social interaction, just as smoking can assist in penetrating the social barrier around a group of people (Feinhandler, 1986). Furthermore, cigarettes provide a means to promote reciprocity and friendship through the act of giving, receiving and sharing (Feinhandler, 1986). -4-

0 • When two individuals discover that they are both smokers, a bond founded on this similarity may develop between them. In this way, smoking cigarettes may be used to communicate the message that "we are alike." When one party quits smoking while the other continues, friendships can become strained (Doherty and Whitehead, 1986). 12. Boundary Establishment and Maintenance. Smoking provides an effective means to establish boundaries between individuals and groups. For example, when one smoker in a partnership is forced to smoke alone because smoke bothers the other partner, smoking can be used to send a message that the smoker needs or wants to be left alone (Doherty and Whitehead, 1986). In this way, smoking facilitates the definition and maintenance of personal space and privacy in relationships. Similarly, smoking and smoking styles may be used to define groups and create distinctions between them. The activity of smoking can reinforce the bond between members and create distinctions and boundaries between members ("we") and non-members ("they") (Feinhandler, 1986). Gallup Poll respondents highlighted this motivation when they attributed their enjoyment of smoking with "camraderie [sic]" and the pleasure derived from "being with friends" or "being with the crowd." 13. Non-verbal Communication. Similar to Boundary Establishment and Maintenance, some people use smoking to signal the way they feel. Smokers, may smoke their cigarette in a particular fashion, for example taking short, noisy puffs, to signal a partner in a nonverbal manner that he or she is upset about something and wants to be asked what is wrong. Conversely, a person may choose to smoke to foreclose discussion, signaling, through smoking, a desire not to communicate (Doherty and Whitehead, 1986). 14. Indulgence. Smoking can be used as a form of indulgence. Comments which reflect this motivation include: o "a space for me to have time to do something for myself' o "like dessert -- [a] finishing touch" o "when I am tired it's an enjoyment for me to sit down and have a cup of coffee and a cigarette and I enjoy a cigarette after my evening meal" 15. Pleasure. One reason for smoking which is cited most frequently is, quite simply, the pleasure smokers derive from this activity. Recent Gallup Poll participants signaled their desire to smoke for the "sheer pleasure of it" with the following statements: o "nothing in particular, just like it" o "the whole thing, nothing in particular" o "just enjoyed smoking period -- nothing in particular" o "just enjoyed it" 0 "I just enjoy smoking" -5-

! s 0 0 • o "he just enjoyed it when he did" o "liked to smoke" o "1 always smoked and I always enjoyed it" o "1 liked it" o "I just like it" o "she just liked it" o "like to smoke them" o "just likes it" o "enjoyable after a meal" o "the pleasure" o "I just liked it" o "I just liked to smoke -- that is all" o "liked it" o "just like it" o "just enjoyed [it]" _ o "1 just enjoy smoking and I smoke" o "it was pleasurable" o "gave me some sort of satisfaction" o "just enjoyed it" o "enjoyed it" o "just love to smoke" • 16. In sum, my professional experience, review of the relevant literature and analysis of actual responses of smokers confirms the observation that there are numerous and varied motivations for smoking which are entirely unrelated to any pharmacological effects of nicotine in cigarette smoke. As demonstrated above, people smoke for the pleasing taste and smell as well as for oral gratification and sensorimotor stimulation. Smoking serves the emotional needs of smokers by providing relaxation, 9 pleasure and even companionship. Smoking plays a~significant role in the organization of smokers' lives by marking time, pacing events and providing "time-out" from work. Further, smoking serves a critical function in non-verbal interpersonal communication between individuals and groups through achieving peer acceptance, signalling rebellion, independence or control over others, establishing and maintaining friendships with others 0 as well as establishing and maintaining personal boundaries between individuals and groups. Just as many smokers are motivated to smoke "because they like it," it is equally apparent that many smokers "like it" for many important socio-behavioral reasons, wholly unrelated -to any pharmacological effects of nicotine. 0 Dated Stephen Thomas cst 6- ~ CG ~

• REFERENCES • Doherty, W.J., Whitehead, D., "The Social Dynamics of Cigarette Smoking: A Family Systems Perspective," Fam. Proc. Vol. 25, 453-459 (September 1986). Feinhandler, S., "The Social Role of Smoking," Smoking and Society_ 167-186 (1986). Sandoval, J.S., & Larsen, M.D., "National Adult Smoking Study," The Gallup Organization, Rockville, Md. (1995). U.S. Department of Health, Education and Welfare, "Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service," Washington, D.C. (1964).