ST use and effect
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Tobacco Cessation and Nicorette Gum:
As Applied to
A Pilot Study
Professor Paul Finn
Thanks for visiting
my website. My thesis was based on what interested me, chewing tobacco and behavior. I
hope ou enjoed it and
feel free to email me with any feedback you may have.-Jake
The purpose of the study is to examine if a new
reinforcer is needed to help chewing tobacco users stop dipping within
their behavior and is situational context important in use. The
study was conducted by use of survey and self-report questionnaire.
Two groups of participants were established, one using Nicorette
gum and the other group just trying to quit. Participants were
14 chewing tobacco users attending a small liberal arts college. Findings
in the study concluded the need for more examination of social context
and behavioral cues. Use of Nicorette gum was seen to be a positive
reinforcer in helping chewing tobacco users quit. Further research
is needed to look into the importance of context and behavior with a larger
Chewing Tobacco Use and Side Effects
Smokeless Tobacco use is at an all time high
and is one of the few drugs on the steady increase of use. (Darmody,
1994; Schaffer 1986; Disco, 2001) Although the risks of tobacco
are known by many, having the knowledge of the effects has not curbed
the incredible increase in use. Most of the efforts to curb tobacco
use are focused on smokers and little has been done for chewing tobacco
users. (Coffey and Lombardo, 1998; Severson 2000).
Some key terms are needed to understand the
study at hand. Chewing Tobacco is defined as smokeless tobacco
that is placed into the mouth for delivery of nicotine. Chewing Tobacco
is frequently over generalized with the term smokeless tobacco. Chewing
tobacco is commonly
confused with snuff, smokeless tobacco that is inhaled as its source
of delivery. When placed into the mouth, chewing tobacco users frequently
refer to the chewing tobacco as taking a pinch, dip, or a lipper.
Many users of chewing tobacco report that they have
tried to quit the habit, but report severe difficulty in abstaining
from dip. Factors that can play a role in quitting include; perceived
reaction of onlookers and friends, seen negative side effects (browning
of the teeth and receded gum line), and the cost of the habit.
While there has been abundant research on smoking cessation with the
use of the nicotine replacement therapy (i.e., transdermal patch or Nicorette
gum), little research however has addressed nicotine replacement therapy
for individuals who use chewing tobacco. Participants in chewing
tobacco cessation studies should be regular users of dip who report the
“want to quit” (E. Kehoe and N. White, 2002), for it has been shown that
those that do not want to quit will not
Cessation programs are needed to help diminish
the use of smokeless tobacco use. Previous attempts have been
made to study cessation programs. For example, Haksukami (2000)
examined the use of the patch on cessation programs, however Haksukami
found minimal results and discusses the need for further research.
Sinusas (1993) focused a cessation program on the use of Nicorette gum
in baseball players. The results found that after 6 months 3 of
14 users had quit, and after one year only one had completely abstained
from use. The players in the study did say, “quitting the habit (chewing
tobacco) is difficult.
Chewing tobacco users have been found to have four times
the risk of oropharyngeal cancer than non-tobacco users and have an increased
rate of developing cancer in the larynx, esophagus, stomach, and bladder.
Those who chew tobacco for even a short time are more susceptible to
periodontal disease, abrasion and staining of teeth, leukoplakia and
even cardiovascular disease (Disco, Marilyn; Moorman, Robin; Noble, Sarah
2001; Stevens 1995).
Smokeless tobacco use: Context and Cues
Smokeless tobacco use is influenced
greatly due to an individual’s social context (Altman and Jackson, 1998).
Many users develop their habit due to their parent’s risk taking behaviors
with nicotine. Socialization occurs when a parent smokes or dips
and then their children have seen and incorporated this behavior into
their own context. Then when tobacco users see their peers engaged
in tobacco use, they develop it as their own and start use.
A recent study devised by Spielberger (2000)
looked at what caused smokeless tobacco users to start use and what
made them continue use of smokeless tobacco. Original use of smokeless
tobacco was initiated from (in order from 1 to 10); see if I would enjoy
it, try something new, friends enjoy it, many people do it, to feel
relaxed socially, did not want to refuse friends, parents enjoy it,
advertisements, wanted to show their independence, older siblings enjoy
it. Continuation of use resulted from (in order from 1 to 10);
enjoyment, relaxation, something to do, stimulating, boredom when not
using it, helps to forget worries, facilitates thinking, feel comfortable
amongst friends, friends use it, advertisements are attractive.
Spielberger (2000) also found that individuals that use smokeless tobacco
are extremely extroverted and more likely to be aggressive and impulsive.
The findings of Spielberger reinforce the
idea that individuals that use chewing tobacco are influenced socially.
The main reason for one to start using was to fit in socially and to
follow suit of their peers. Continuation of use was found to be
caused by relaxation in stressful situations and peer acceptance.
Stress is a cue for chewing tobacco according
to Spielberger, and this reinforces the idea that users of smokeless
tobacco are impulsive and aggressive. Users that fit this scheme,
impulsion and aggression, can be seen as legitimate in using chew as a
stress relief after they experienced high levels of stress from their
aggressive nature and then using the calming nature of nicotine and chew
under this form of stress, forming a conditioned release for their stress.
Coffey and Lombardo (1998) found that under
varying stress tasks, tobacco users look to tobacco as their preferred
form of relief over fifty percent of the time. Further more it was discovered
that sensory cues associated with tobacco use become conditioned hence
causing further use. The combined research of Coffey and Lomardo
with that of Spielberger informs one that stress was calmed by tobacco
and now has become a condition for tobacco use. In conclusion a new
stimuli must be paired with stress to eventually eliminate the need for
tobacco during stress.
It has been ignored in previous studies the
pairing of friends and family with smokeless tobacco use. The
cues involved in eliciting a dip is then not only stress but social interaction.
Not only does one have to address peer activity and the generalization
of activity associated with peer use, but establishment of cues is needed
to address all the associations behind use of chewing tobacco.
Nicotine Examination with Animal Research
Research in humans and drugs is limited by
ethical reasons, especially the fear of potential harm to participants.
It is because of the dilemma of participant harm that some research
with human participants is somewhat limited. Limitations on research
have leaded some researchers to investigate nicotine within the context
Nicotine use develops strongly within the
paradigm of classical conditioning. Unconditioned
stimuli become very important in the use of nicotine, especially
in the context of performance
anxiety. When an individual pairs nicotine with performance
in sports, they then have a new unconditioned stimulus, nicotine, pair
with the condition response, performance. Kehoe and White (2002)
have examined classical conditioning and pairing of new stimuli to
help eliminate the drive for nicotine in rats.
Reductions of nicotine in rats have shown
a greater yielding of extinction than completely eliminating nicotine
in rats. Reduction showed less withdrawal and reacquisition to
nicotine, than those trying to go cold turkey. Subsequent
experimentation showed spontaneous recovery from nicotine was more likely
to occur after reduction in stimuli. When effect on motor ability
and non specific performance was examined, rats being slowly weaned from
the unconditioned stimuli, nicotine, showed little or no performance depravation
compared to those rats completely withdrawn from the US. Sensitivity to
the lack of US was very prominent within the rats that were significantly
or completely withdrawn from nicotine. In order to extinguish the use
of nicotine and withdrawal, research associated with abstaining from
nicotine has shown that a slow removal of stimuli received the greatest
Individuals have a tendency to exhibit greater
use of nicotine within their original context of use. Athletes
show a greater craving for nicotine when placed within their field of
play, (Darmoody, 1994). Clark and Fibiger (1987) used rats to determine
the effect of conditioned place preference in rats. Examination
of nicotine within place preference was examined within a control group
and independent grouping of rats. The rats were determined to have
no place preference, however nicotine did have a behavioral presence
within the place of conditioning.
When combined with the research of Kehoe and White (2002)
it can be assessed that the rats had fiend for nicotine. The nicotine
had produced a shift of preference by reducing neophobia associated the
non-preferred side, Clarke and Fieber 1987. Rather than showing a
positive reinforcement for the place of use, the rats showed a positive
reinforcement to go the place of the drugs specified place of use.
A direct connection was not shown in the rats as to where they used the
drug, it was shown that they preferred the ability to receive the drug
in the prearranged place.
It is concurred that the rats examined showed a preference for
the drug given as a stimuli and needed to be weaned from the nicotine.
Within context it was shown that the drug became a US and reinforced
use within that certain context, Kehoe and White (2002) however it may
not be the place where the drug is given as a factor, but rather the place
it is taken is assumed to become a positive reinforcer directly, and becomes
a deterrent compared to the negative reinforcement of drug withdrawal and
preference away the original site of use.
Addiction is defined as a compulsive need
for and use of a habit forming substance characterized by tolerance
and by well-defined psychological symptoms upon withdrawal, Merriam-Webster
1998. Chewing tobacco is an addictive substance as stated by the
warning label on the containers, also known as tins. Formerly on
tins of various brands of chewing tobacco were forced by the surgeon general
to state, this product maybe addictive and may cause gum disease and
Shaffer (1986) stated that nicotine is seen as a psychoactive
drug that has the capacity to cause a chemical dependency. Nicotine’s
addictive nature is refined within Shaffer’s belief that smokeless tobacco
is best considered as a behavioral pattern of compulsive use characterized
by overwhelming involvement. Chewing tobacco develops into a habit
forming substance in that certain activities lose their appeal or will
be avoided without use. Some users of chewing tobacco have developed
a habit of playing video games with a pinch in their mouth. Without
chewing tobacco some users will not play video games without a pinch in
their mouth. Users have now developed a behavioral pattern of use.
Understanding under what conditions use of chewing tobacco
is defined, is essential in understanding a user’s addiction. Under
what conditions and normal place of use defines a user’s behavior, hence
signifying the addiction. In order to address the problem of addiction
the use and context is needed in order to assess how to best address the
A systematic study has examined signs and symptoms that
occur during depravation from chewing tobacco addicts (Hatsukami, 1986).
Results in Hatsukami’s study have shown that withdrawal symptoms in
chewing tobacco users are most consistently associated with various
measures of users’ intake. Addiction in chewing tobacco users is
also committed to the number of dips a day and duration of such dips.
Hatsukami neglects to note that under certain contexts
users will dip. Drawing from Schaffer and Hatsukami, one must assess
under what circumstances a user will dip under. This displays their
conditions of addiction and will provide under what circumstances a user
dips and how often. If a chewing tobacco user associates dipping
with playing videos that will be their context. How often they play
and use dip is then their specific nature and will define their amount
of use and number of dips.
Fagerstrom (1999) relates the ideal of needing to know
context in his questionnaires that are based upon number of dips a day,
size, and under what contexts with smokers. This ideal needs to
be applied to chewing tobacco users to initially conclude what circumstances
cause chewing tobacco’s use and what sustains their use. A survey
of such magnitude would allow researchers seeking to evaluate addiction
to note within what contexts and how to address the problem later in cessation
A later study of Hatasukmi and Severson (1999) gave
light to notarizing the effectiveness of use and sustaining behaviors.
Users of smokeless tobacco increase their use over time for the positive
effects received from use. Those positive effects are stimulation,
relaxation, mood modulation, and improvement of cognitive functioning.
These positive effects help sustain use of chewing tobacco.
Several studies of college athletes have shown reinforcing factors
from perceived cognitive enhancement and the relaxing effect on nerves
and stimulation of the body, while calming overall attitude. These
reinforcing ideals can be later placed under circumstances of stress,
a video game player unable to beat a level, or stimulate reaction of perception,
as a baseball player watching a dropping ball and being able to assess
where it will drop faster.
Reinforcement and Behavioral Cues
Reinforcement and behavioral cues play
an essential part in maintaining use of chewing tobacco. Reinforcers
are that which establishes continuation of use through positive reaction.
Behavioral cues are situations in which behavior is condoned and appreciated
within. Through reinforcement and behavioral cues chewing tobacco
use is maintained.
One form of reinforcement is a perceived
performance enhancement, Keenan 1998. Through perceived enhancement
an individual will continue use of chewing tobacco in order to reach
their perceived peak performance.
A second form of reinforcement is the physical
reaction from the nicotine. Nicotine causes the user to become
relaxed and feel like they “fit” into a social setting. Chewing
tobacco users also feel more stimulated, through increased heart rate,
and seem to do better in motor skill activities.
A third form of reinforcement is peer review.
Although generally associated as a behavioral cue, positive peer review
is a reinforcer in causing an individual to see himself/herself better.
The pressure of trying to fit in is difficult on an adolescent (Hatasukami,
1999), and being able to fit in suits an individual and makes them feel
more at ease, making it a positive reinforcement.
Behavioral cues are especially expressed
through the media. Through examples of professional athletes
and Outdoorsman, chewing tobacco can make an individual feel “more masculine”
Modeling of peers and family is another key factor that
reinforces a chewing tobacco users use of chewing tobacco. Younger
children are prone to mimicking parents use of tobacco and adolescents
are more prone to peer mimicking. Regardless of age and length
of use, all chewing tobacco users are acceptable to following their friends
in use of chewing tobacco.
Smokeless Tobacco Cessation on Performance
It has been said that using chewing tobacco
can improve performance, especially in the context of athletics.
Is chewing tobacco truly a performance enhancer or is it a perceived
myth, recent research has searched for the answer.
Nicotine has been shown to be a stimulant with relaxing
qualities, to reduce tension, and a key factor in cognitive/behavioral
aspect within the athlete’s perceived ability. Studies by Keenan
(1998) and Gottlieb (1992) examined varying factors and have determined
chewing tobacco to not enhance performance of college athletes, but rather
give a perceived enhancement of ability.
Gottlieb (1992) found that those using chewing tobacco rated
their performance higher than their actual outcome in 388 college athletes,
varsity and intramural football and baseball players, from those rating
their performance without chewing tobacco. Gottlieb concluded two
key factors in causing a higher self rating in chewing tobacco user’s
to be a strong team belief in a “performance edge” from chewing tobacco
and the ritual of chewing tobacco use.
Gottlieb’s study (1992) results in noting significance
in self-report of performance can be placed back to the effects of chewing
tobacco. Nicotine has a calming effect and stimulates the heart.
The internal process of feeling calmer and more on “edge” is the reason
that athletes may seem to have a competitive edge, although it is only
Keenan (1989) had similar findings as Gottlieb, as in chewing
tobacco users have no advantage in reaction time over non users, even
though users believed they had an advantage when dipping then when not
dipping. Keenan concluded one cause of the perceived enhancement
to be the media’s promotion with use of star athletes in advertising.
Keenan examined withdrawal and state dependent learning as another
factor of chewing tobacco users perceived enhancement in performance.
Many athletes that use chewing tobacco have a perceived performance
enhancement. Research has shown that the performance enhancement
has been clearly aroused through misconceptions of nicotine’s effects
and rituals. Although no enhancement of performance is seen, mentally
athletes still believe in some enhancement through use. What may
attribute further contribution to this ideal maybe the use through behavior
and cognitive effect.
Smokeless Tobacco Cessation Programs
Many cessation programs have been implemented
in order to help chewing tobacco users quit their use. Programs
have been varied from explaining the problematic nature of chewing tobacco
at dentists’ offices to a complete cessation program at an athletic
team level. All programs have had aspects that have enabled them to help
some users quit but have had aspects make them fail. It is important
to examine these programs and note their successes and failures.
Stevens (1995) examined the effectiveness
of chewing tobacco cessation at a dental office. Two groups were
established, one being a regular dental examination and self quitting,
while the second group was paid special attention to areas of the mouth
that dip is used and explained damages and possible complications of
chewing tobacco by a dental hygienist. The second group was followed
up with a self-help video and manual.
Results from Stevens found that a six percent
increase in tobacco cessation after one year in group two over group
one. Strongpoints in-group two was a thorough explanation of chewing
tobacco from a doctor, self help manual, and follow up phone calls after
week one, month 3, and 1 year. Weak points to the study were no inclusion
of family and friends in the intervention and no alternatives to oral
fixation were offered.
Overall dental assistance is helpful in chewing
tobacco cessation, but chewing tobacco has an addictive factor and the
patient will not always see the oral complications of use (Glass, 1994).
A patient must feel the drive to quit and an established chewing tobacco
cessation program that is better suited to deal with addiction.
Severson (2000) examined chewing tobacco
cessation through self-help methodology. Three groups were randomly
assigned to one of three groups. One group received a 1-800 phone
number to call in times of need, one group received a self-help manual,
and the last group received a self-help manual accompanied by a video
and two phone calls.
According to Severson some key points were
that the study was cheap and easily conducted.
Success ranged from the 1-800 number 16 percent cessation to 28
percent cessation of the self-help manual and phone calls. Severson
noted a key factor in phone councilors being able to address behavioral
issues. Assessment of no dips compared to minimization and serious
attempts to quit were also analyzed.
Problems with the study were varied.
In the 1-800 number participants were to call and left open to be swayed
by friends, family, and peers. The self-help manual did not give
follow up and was left for the individual interpretation and did not
have to actually read the manual.
The problems faced in the manual and calls
study were at a minimum. They addressed behavioral issues and
mentioned avoiding risky behaviors. Unlike groups one and two,
the phone calls were more personal to the individuals and had contact
with someone addressing them, the other groups seemed to be addressed
less personally and may have effected calling times in the 1-800 study.
The manual explained complications and ways
to quit chewing tobacco. This is a good idea if the participants
read the whole manual, of which less that seventy percent did. Public
health issues of chewing tobacco were addressed more adamantly than those
issues particularly dealing with the individual.
In looking at creating a cessation
program one should look at relevant sources into the very group they
are examining. Two specific published studies have looked at chewing
tobacco cessation at the collegiate athlete level, (Darmody, 1984 and
Walsh, 1999). Darmody (1984) examined use through team intervention
via NCAA regulated enforcement. Walsh, 1999, looked at various
schools and did either a team intervention or control groups.
Darmody (1984) did an assessment of forty
three users of chewing tobacco. A two part intervention was implemented;
part one consisted of education of negative effects of chewing tobacco
and an oral screening, part two consisted of enforcement of NCAA policy
on non-use of chewing tobacco at practice or games. Finally counseling
was available to participants.
Darmody (1984) focused on the context in
which many users used chewing tobacco. Coaches and assistants
were required to enforce a strict no use policy of chewing tobacco in
their presence on the field. Stopping use at practice is a direct
attack at behavior and peer review. The problem is that use outside
of practice and drive to quit was not addressed. Consequences
were made for those using chewing tobacco as regarded by NCAA rules to
substance abuse on the field.
Darmody’s study in 1984 was well rounded
and attacked the key points of behavior and peer review through consequences.
A problem is the fact that users were forced to quit. Drive to quit
was not addressed and other factors of use, addiction and friends, was
not addressed within the study.
Walsh (1999) examined chewing tobacco in
several hundred college athletes. Two groups were established
for the study, one being a team intervention and group two being a control
group. A complete and thorough study was done in examining varying
aspects within the team nature.
The first aspect examined was group conformity.
The team was taken together and explained the complications from chewing
tobacco by a dentist and then talked to individually. Cognitive
social learning was another issue addressed. Addressing the team
and those chewing tobacco was and is associated with, was instrumental.
Individuals were then asked to establish
what triggers them to chew and how to prevent these situations.
Participants were also asked to set a quit date and stick to it by
slowly reducing use and going cold turkey as the date comes. Those afraid
of withdrawal and craving were given the option of 2mg Nicorette gum
to ease these problems. Two calls were made to each participant
by a doctor to address concerns and verify adjustment away from risky behaviors.
Walsh’s study in 1999 seemed to be fairly
complete. Only issues unforeseen were family and friends that
chew outside of the program. Peer pressure from roommates and neighbors
were other potential factors that could decrease success rate. The
phone calls from the doctor and use of self-report seemed to keep the
study in effect and help prevent use. The control group had a success
rate less than five percent, the success rate doubled with use of the team
Many studies have looked at helping chewers
quit their habit. Key factors in successful programs have been;
self-report, team intervention, doctor assessment of problems and risks,
follow up calls by trained professionals, and assessment of risks and
possible ways of avoidant behaviors.
No cessation program has had a succession
rate of over thirty percent and the mass majority stands around ten percent
when a large enough population is available to assess. The inability
of many to quit use for over a year is astounding, and gives light to
the need of more cessation programs and a look at programs with potential
success rates to help reduce use.
Nicorette Gum and Chewing Tobacco
Nicorette Gum is traditionally associated
with helping smokers quit use of cigarettes. Nicorette Gum is used
to reduce withdrawal symptoms and craving of nicotine. (Physicians Desk
Reference). Few studies have been done to examine the use of Nicorette
on chewing tobacco cessation programs.
Walsh’s study in 1999 offered users Nicorette
in order to help participants deal with withdrawal. Sinusas (1993)
examined gum as an over cessation program in its own. The study
examined the ability of 88 users of chewing tobacco to quit with the
assistance of the gum. It was a preliminary study and its results
were inconclusive. Sinusas (1993) did note his studies lack of
behavioral control. The key point made within the study focused
upon users of the gum suggesting it had a positive value to quitting
and they would recommend Nicorette gum to others, despite their own complaints
of negative side effects.
Chewing tobacco use is on the rise in America.
There are many negative side effects of chewing tobacco including higher
rates of cancer and oral problems. It is pertinent that researchers
examine ways of assisting chewing tobacco users to quit.
One focus needed in order to help chewing
tobacco users quit is examining social context and what conditions make
them dip and sustain their behavior. Some cues have tended to
lead to family, friends, and peers and activities related to other users.
Media, social context, such as playing on a team, and masculinization
of chewing tobacco in the media help maintain the use of chewing tobacco.
A strong factor in not allowing many users
to quit is addiction to the nicotine its self. One must exam how
to prevent addiction and ways to maintain abstinence from such by avoiding
risky behavior and that that got them started.
Key factors in successful cessation programs
have been; self-report, team intervention, doctor assessment of problems
and risks, follow up calls by a trained professional, and assessment
of risks and possible ways of avoidant behaviors.
It is now the purpose of this study to examine
several factors. One is to examine the point to which an individual
is addicted through amount and frequency of use. Secondly, to
examine under what contexts does an individual chew under. Third,
to look at what situations hold a fascination with dipping and to why
a user chooses to dip rather than a secondary option.
The second purpose of this study is to examine whether or not
Nicorette gum provides a alternative to chewing tobacco and helps with
withdrawal and craving. The overall studies purpose will be based
upon: Is a new reinforcer needed to help chewers stop dipping
within their context of use and Is situational context important in
use and condition of dipping (size and frequency).
Begining of Intro
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The study consists of 16 males between the ages
of 18 and 22. They all attend the small private catholic college
of Saint Anselm in New Hampshire. All have used chewing tobacco for
several years and have self reported that they are addicted to chewing
tobacco. All participants want to quit to some degree, some wanting
to quit for good and others realizing the disgusting habit and “believe”
that they want to quit but are not that they can.
Participants were asked to take a survey
once a week for three weeks, and those that would use Nicorette gum would
be asked to do so in weeks 2 and 3. The participants were also asked
if they could be contacted in 6 months for a follow up to their success
in quitting use of chewing tobacco. The questionnaire was a revised
Fagerstrom Questionnaire previously given to smokers. Attached to the
questionnaire was a self report sheet devised for looking at; under what conditions
participants dip and how bad they crave chew and how the participant would
react to the craving. This was given during week one to establish a
baseline as to the amount of dip used and how often it was taken.
In week one each participant was met individually
in their dorm room to be explained how to fill out the questionnaire and
whether or not they were willing to participate for three weeks.
In week 2 the same questionnaire was given to the participants on
an individual basis. Individual exchange of the survey allowed
for the researcher to answer any possible questions and extract more
information from the self report section if it was too vague. Some
self-report information was then also guided in asking for specific reasons
such as stress for increased tobacco use or why the participant did not
feel like using the gum.
Those that did not want to partake in using Nicorette were
asked to quit on their own and continually record cravings and what they
did to combat craving. Users of Nicorette Gum were met individually
and asked to use the gum twice a day. They consented to use of the
gum and to quit all other tobacco use. Nicorette users were then asked
to note when they used the gum, allocated two pieces a day with a weeks supply,
and how it helped or did not help curve their craving for chewing tobacco.
In week 3 the same procedure was used as in week
2. After the debriefing participants were asked if they could be
contacted in 5 months and 1 week as to the success of their quitting chewing
tobacco. Users of the Nicorette were then informed if they wished
to continue that they could contact their physicians to receive a prescription,
however Nicorette gum is available over the counter if physician contact
With the purpose of the study focusing
on a fixed questionnaire and self-report, data was collect in three specific
areas. Situational cues were assessed with size and frequency of
dips in a week in the questionnaire. The first self-report section
data was collected through rating craving and the reason for taking a dip.
The second self-report section examined craving into specific situations
and personal reactions to those cravings.
The questionnaire was based on a rating system
with a scale of 1 to 7. Situational cues were collected and compared
to frequency in the day and week for dip and size of pinch when taken.
Significance was found in several areas with positive and negative correlations
through a Pearson’s Correlation Test.
Alcohol intake and frequency of dips in a week is positively correlated,
Pearson .812, sig. .001, n=14 as well as how often a participant chewed
in a day is correlated with drinking .697, .012, 13. Playing video games
and size and frequency in the day are positively correlated .707, .007,
14. Playing sports was positively correlated with dips taken in a
day, .637 .026 14.
Social settings saw a correlation between social situations
and dipping, while class time showed no occurrence of correlation.
Some correlation was found between after class and dips a day after week
one, .699, and week two, .747, however week three was inconclusive and sporadic
Instinctively one would assess that dips a week and
dips a day would be positively correlated, which it was .755, .005, 14.
Frequency of dips a day and week were both correlated to size of dips by
.812, .005, 14.
Brand was negatively correlated to several aspects in
users lives. How often a week someone dipped was correlated by -.603,
.021, 13 and dips a day -.634, .027, 13. Situational cues seemed
to correlate between brand and shower, -.742, .006, 14 as well as watching
sports, -.755, .005, 13.
Some other significance was found but varied from week
to week in aspects; of wanting to dip in class and frequency, size of dip
and several situations, and situations among themselves. The data
varied from week to week and seemed to be inconclusive. It is note
worthy is saying that there was some correlation, but due to variance from
week to week is disregarded in aspect to significance in overall data.
A good indicator of drive to quit can be seen in how
long it took an individual to take their first three dips compared to their
last dip taken as reported in their daily self-report.
The graph indicates the variance in number of
days between dips to their last day of dipping in the study. If
day three and last day dipped were equivalent, that expresses their final
of day of use.
It may not be clear as to whether an individual
has cut back or necessarily reduced use from the graph when dip was taken.
It was however assessed from week 1 or base line week as compared to amount
of use after week two and three. Participants were also compared as to
their ability to cut back on use or abstain as to whether or not they
used Nicorette gum, as shown in the table Reduction of Chewing Tobacco
The graph clearly delineates the percentage of
users that have reduce use and those that have not, and contrasted the
two groups, gum users and non gum users. The subject pool was small
and may not be able to show significant reduction or abstinence to a larger
pool, as for this study it opens the door or looking at various approaches
to help cessation.
The self-report section gave an inner look into
the participants causes of chewing tobacco at their specific time of
use compared to craving. Incite was also given into whether Nicorette
is an effect means to help chewing tobacco users quit, as well as participants
reasons for sticking with use of the gum. Certain causes were also
found to cause users to increase use in random situations throughout the
Craving and dipping was assessed to be highest when
chewing tobacco users were in the following situations; when they were
stressed, when watching television, playing video games, and at a party.
These strong factors give reaffirmation to the belief of chewing tobacco
to be a relaxant in stressful situations. Using chewing tobacco at
parties shows the need for an individual to fit in with others dipping and
relieve anxiety of social settings.
It was also noted that in certain social
contexts around peers, watching television and playing video games, that
chewing tobacco was at its most used point.
Several users of Nicorette gum stopped after week
two, three of five participants, due to the following factors; it tasted
awful and they did not receive the same sensation as chewing tobacco.
Two participants that did not take the Nicorette in week 2 established
that they had used the gum before and could not stand the taste.
Those that stayed with the Nicorette said that
the taste did not bother them. Users of the gum also stated a strong
drive to quit and want to have something to relieve their craving for tobacco.
Several users seemed to be on task with their
want to quit until certain situations came up. Stress overall would
cause some users to dip, whether from problems with a teacher, talking
to others in a social setting such as a party, or family issues.
Studying for a test or writing a paper showed heightened amounts of use
of chewing tobacco.
Although the data collected was subjective and
limited to the amount of truth through self-report, significant factors
were found in varying areas. A correlation to social and behavioral
contexts was found with the amount and frequency of tobacco use. Self-report
data showed how frequently one took dips randomly and when an individual
was actually ready to quit. Incite was provided by self-report as
to when users would defer back to use to help relieve stress and anxiety
in varying situations.
The results have shown significance in several
areas within the study relating to the hypothesis; Is a new reinforcer
needed to help chewers stop dipping within their context of use and is situational
context important in use and condition of dipping (size and frequency).
Looking at Nicorette users versus Self-Report users
answered whether or not a new reinforcer is needed by exhibiting a higher
succession rate in reduction and cessation of chewing tobacco than self-report
users. Nicorette gum did help some users quit which is shown with
more success of users of the gum over non-users in cessation and reduction.
Those using gum took less random dips and showed an overall reduction in
craving when using the gum over those trying to just quit.
Social Context and dipping showed several key
points in noting a significant correlation in situations where stress
and alcohol were present. When playing sports, chewing tobacco use
rose significantly. The positive correlation to social context
shows a further need to examine the use of social context and behavior
to address the problem of chewing tobacco.
Some participants that reduced use of chewing
tobacco seemed to fall into a relapse under stressful situations, social
settings and peers. Under the stress of school work many felt the
need to use chewing tobacco to help calm them and establish a focus on
doing work. In social settings where others were dipping, peers
and friends, relapse seemed significant. A person’s willingness
to quit was obverted when their roommate or close friends were still dipping.
It is clear that two factors need to be addressed
in a successful cessation program. Factor one is the addressing
of alternatives to dipping when stressed and a way to find focus when
doing work. Factor two is that an individual needs to avoid risky
behavior of being around peers and friends that are still chewing.
A new setting must be established or their peers would have to quit with
Nicorette gum help those that continued its use
to reduce or even quit use of chewing tobacco. Two participants
using the gum, forty percent of gum users, and two users that previously
tried Nicorette stopped use of the gum due to taste and lack of sensation.
To address the issue of taste it is recommended that future studies examine
flavored Nicorette gum to help curve resistance. Lack of feeling
can be accounted by participants either not following directions for using
the gum or desensitization to the lower amounts of nicotine in the gum.
4mg doses of Nicorette is available and maybe a more suitable solution,
even though the nicotine in the 4mg gum is more likely to have a higher
content of nicotine than dippers are receiving through chewing tobacco.
Peer intervention is needed to help users quit.
If peers and friends are still using gum then those users trying to quit
are extremely likely to have a relapse in use. The social context
issue is revisited and needs to be addressed in order for a user to be
able to successfully quit.
Not only is peer intervention needed but behavior
plays an important role. If an individual allows himself to placed
into situations with chewing tobacco, they are likely to fall back into
use. Avoidance at practices and a need for NCAA rules of drug use
on the field needs to be addressed. When playing video games or in
situations with alcohol users must find a new group to associate with or
walk away when chewing tobacco is presented into the situation.
Future Practices Needed
Assistance from medical personal is suggested
in further studies. Health Services should be informed and have
an availability noted on the questionnaire so that users have a place
to turn when advice or consultation is needed.
More situations should be examined in the questionnaire.
Three blank spaces were provided and more situations users noted were;
taking a shower, during excrement of bodily waste, driving, and getting
ready to “go out” to party. Other questions that were left out of the
study that could provide incite are; age started, where you started dipping,
have you tried quitting before, and what is your drive to quit use.
The study in its own right was successful
in assessing situations in which use of chewing tobacco was prevalent,
however the population size was not large enough to generalize findings
to all users of chewing tobacco. A larger population size would allow
for a stronger correlation of data and a more complete study.
Timing was limited in the study due to problems
with the IRB. Getting the study approved and covering possible dilemmas
was difficult and needed to have been done last semester. The hypothesis
was refined over the summer and Nicorette gum was added in order to address
the issue of craving and reinforcers.
The length of the baseline was not long enough.
A baseline should have been established over two weeks to a month.
Dipping can vary due to situations and stress. One week was not
a realistic time frame to truly examine traditional use of chewing tobacco
Data collection was also minimized due to time constraints.
Data was collected and key points were noted, however reduction in use
may take more than 2 weeks to notice. A study should last at least
three months with follow-ups after six months and one year. A six
month follow-up is possible, if time and effort allows the data will be
Conflicting opinions of teachers was another fault of the study.
Dealing with a professor in the field of study and a supervising teacher
caused some conflict and stress on the study. Overall teacher help
was greatly appreciated and needed at times, however having two varying
opinions can be too much to handle, especially when one is grading the
paper and the other is trying to motivate you to do more.
I would loke to offer a thank you to all
those that have helped me in doing my thesis. I would to thank Professor
Troisi for his help in establishing my project and guiding me through the
stress of the IRB. I would like to thank Dr. Connie Richards for her
help with the IRB and guidance on the administration of Nicorette. I
would like to thank Professor Finn for his help in writing and analysising
this thesis. I would like to thank all the participants for their time
and effort in participating in my study. Thank You all for your help
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Relevant Links (examples)
Saint Anselm College