MARCH 2014 • MONITOR ON PSYCHOLOGY 43
to health-care settings, and later, to telephone quit lines, an
area of longstanding expertise for Lichtenstein, Orleans and
University of California, San Diego psychologist Shu-Hong
Zhu, PhD, who developed the award-winning California
Smokers’ Helpline. Quit lines, paid for through tax funds and
administered by state contractors, are now available in every
state and in Washington, D.C., and in many other countries.
Meanwhile, other recent broad-scale evidence-based
smoking-cessation programs — Legacy’s Become An EX
website ( www.becomeanex.org), for instance, and text
messaging on cellphones — have further improved the cost-effectiveness and reach of cessation interventions.
Ellen R. Gritz, PhD, professor and chair of the department
of behavioral science at the University of Texas MD Anderson
Cancer Center in Houston, likewise saw the potential
benefits of the public health view, thanks to her experience
writing a section of the 1980 surgeon general’s report on the
behavioral aspects of smoking in women. Seeing the issue
from a population perspective, she was motivated to apply
psychological smoking-cessation treatments to other specific
groups, including people with cancer and HIV-AIDS.
Ray Niaura, PhD, of Legacy, Johns Hopkins and
Georgetown, was also conducting smoking-cessation work
on people with HIV/AIDS, and he and Gritz joined forces to
further develop programs of research on tobacco and AIDS,
which they are hoping to apply in developing countries.
Tailoring these interventions to specific populations is
important because each group has different issues and needs,
Gritz explains. Research by her and others has shown that
compared with nonsmokers, for example, different kinds
of cancer patients who smoke have differential, and worse,
outcomes in terms of cancer treatment, further disease
development, survival and quality of life.
“You want to be able to point out to the patient exactly
what the relationships are [between smoking and different
outcomes], why it’s critically important that he or she stop
smoking, and how you’re going to help them to stop,” Gritz says.
Other psychologists — among them Abrams, Orleans,
Present and future
Niaura, Carlo DiClemente, PhD, of the University of Maryland
Baltimore County, and James O. Prochaska, PhD, and Wayne
Velicer, PhD, both of the University of Rhode Island — are
creating worksite-wellness and community interventions based
on the “transtheoretical stages of change” model developed
by DiClemente, Prochaska and Velicer, which assesses people’s
readiness to act on healthier behaviors and provides strategies
to get there. That work has evolved into addressing chronic
lifestyle-related diseases, such as obesity and Type II diabetes in
large-scale public health formats, Abrams notes.
Despite these and other forms of progress, the smoking
problem remains pernicious. About 44 million Americans
still smoke, despite the new surgeon general’s report showing
that smoking is linked to an increasing number of diseases,
including diabetes, rheumatoid arthritis and colorectal cancer.
The tobacco industry remains a well-heeled foe, spending
billions of dollars each year to develop and market new products
designed to capture new cohorts of nicotine addicts. And there
remain important areas for research exploration. These include
the new field of neuromarketing, which explores consumers’
sensorimotor, cognitive, and affective responses to marketing
stimuli; pharmacotherapies that are genetically engineered to
suit individual needs; safer forms of nicotine delivery, such the
e-cigarette (see page 48); and effective ways of combating the
socioeconomic and cultural disparities that lead some groups to
smoke more than others (see sidebar on page 52).
That said, it’s a good time to celebrate the successes of the
past 50 years, psychologists in the field say. Last year’s end-of-year National Institute on Drug Abuse report, “Monitoring the
Future,” found the lowest-ever rates of youth smoking. Between
1990 and 2009, the number of states with Medicaid coverage for
smoking cessation grew from one to 45. Tobacco dependence
treatment is covered under the Affordable Care Act. And the
number of physicians providing cessation counseling rose from
16 percent in 1991 to 87 percent in 2011, to name a few of the
And, thanks to its rigorous research in the realm of tobacco
use and cessation, psychology incontrovertibly established itself
as a hard science, says Abrams.
“The laws of human behavior are fairly well understood,” he
says. “If you apply them and align them properly with political
will, you can change a whole population in about a generation,
and get 40 million people to quit smoking. To me, that’s a
spectacular success for behavioral science.” n
Tori DeAngelis is a writer in Syracuse, N. Y.
“It’s been a collective effort — no one has worked alone. Together
we’ve had an extraordinary effect on the health of the American
population, and the health of the world.”
C. TRACY ORLEANS, PHD
Robert Wood Johnson Foundation