PAC 230 Module 6 Substance Use as a Health Behavior Example

Forty Years of Cigarettes, Six Months of Vaping: Substance Use as a Health Behavior Across Three Generations

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 230: Families and Health Psychology

Instructor Name

Month Day, Year

Forty Years of Cigarettes, Six Months of Vaping: Substance Use as a Health Behavior Across Three Generations

Walt Dawson started smoking at fifteen and smoked a pack a day until he was fifty-five, when his doctor warned him about his lungs. He quit, started again after his wife's illness, and quit for good after his heart attack last year. His great-granddaughter Brianna, sixteen, started vaping nicotine pods with friends six months ago and says it is nothing like cigarettes. The family's Sunday dinners and holidays always include beer, and Walt's father drank heavily. Walt's grandson Mike, in recovery from opioid use, does not drink. This paper treats tobacco, vaping and alcohol as health behaviors in the Dawson family and proposes a family response. The Dawsons are composites, the clinic that serves them is invented and the research is real.

The Actual Causes of Death

Mokdad et al. (2004) estimated the number of deaths in the United States in 2000 attributable to behaviors and exposures rather than to diseases. Tobacco was the leading actual cause, responsible for an estimated 435,000 deaths, or about eighteen percent of all deaths. Poor diet and physical inactivity together followed closely, at about 400,000 deaths, and the authors warned that they might soon overtake tobacco. Alcohol consumption was the third leading actual cause, at about 85,000 deaths. The analysis shifted attention from the diseases on death certificates to the behaviors behind them.

The Decade Lost to Smoking and the Years Regained

Doll et al. (2004) reported on a study that followed more than thirty thousand male British doctors for fifty years, from 1951 to 2001, recording their smoking and their deaths. Men who smoked cigarettes throughout their adult lives died on average about ten years earlier than lifelong nonsmokers. About half of persistent smokers were killed by their habit. But the study also showed the benefit of quitting. Men who stopped at about age sixty gained about three years of life expectancy compared with those who continued; stopping at fifty gained about six years, at forty about nine years and at thirty almost the full decade.

Adolescents and Vaping

Most smokers begin in adolescence, and Walt began at fifteen. Brianna's vaping raises the question of whether e-cigarettes lead young people to cigarettes. Soneji et al. (2017) conducted a systematic review and meta-analysis of longitudinal studies of adolescents and young adults who had never smoked cigarettes. Those who had used e-cigarettes were substantially more likely to start smoking cigarettes later than those who had not, and recent e-cigarette use was associated with later recent cigarette smoking. The authors acknowledged that the studies were observational, so the association could partly reflect shared risk factors, but they concluded that e-cigarette use was a strong and consistent predictor of later smoking. Nicotine itself is also addictive, and adolescents may become dependent on vaping alone.

Alcohol's Global Burden

A global analysis of alcohol use and its health effects in 195 countries and territories (GBD 2016 Alcohol Collaborators, 2018) reached a blunt conclusion. Alcohol was a leading risk factor for death and disability worldwide and the leading risk factor among people aged fifteen to forty-nine. The analysis found that any protective effects of moderate drinking on some conditions, such as ischemic heart disease in some groups, were outweighed by increased risks of cancers, injuries and other conditions, and it concluded that the level of drinking that minimized overall health loss was zero. The finding challenged the common belief that a drink or two a day is good for the heart.

The Burden in One Table

How the Behaviors Connect

The three behaviors are not separate stories. Walt's father drank heavily, Walt smoked to manage stress, and Mike's opioid use began with pain but grew in a family where substances had long been the way to cope. Brianna has watched all of this. The research on risky families from the first module of this course suggests that such patterns pass through generations by way of stress, emotion and modeling as much as through genes. The same pathway can carry change. Walt's quitting and Mike's recovery are new models in the family, and Brianna has now seen two relatives stop using a substance that had a hold on them.

A Family Response

For Brianna, research and experience suggest that lectures will not help. Instead, Walt has offered to tell her about starting at fifteen, about the cough that began in his forties and about how hard it was to quit, not as a warning but as his story. The clinic can offer Brianna a confidential visit with the adolescent health team, where she can talk about vaping, stress and school on her own terms and learn about quitting resources designed for teens. Her family can ask what she likes about vaping and what she might want instead, and keep vaping out of the house.

For alcohol, the family can make gatherings easier for Mike and healthier for everyone by offering good nonalcoholic drinks, reducing the amount of beer and not urging anyone to drink. Carla, whose prediabetes plan already includes fewer sugary drinks, may lead this change.

For Walt, the family can celebrate his quitting, which Doll and colleagues' findings suggest has already added years to his life.

Conclusion

Tobacco, vaping and alcohol run through three generations of the Dawson family. Mokdad and colleagues place tobacco and alcohol among the leading actual causes of death, Doll and colleagues show both the decade smoking takes and the years quitting returns, Soneji and colleagues link teen vaping to later smoking and the GBD 2016 Alcohol Collaborators show that the healthiest level of drinking is none. A family response built on stories, support and shared changes can interrupt patterns that began generations ago.

References

Doll, R., Peto, R., Boreham, J., & Sutherland, I. (2004). Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ, 328(7455), 1519. https://doi.org/10.1136/bmj.38142.554479.AE

GBD 2016 Alcohol Collaborators. (2018). Alcohol use and burden for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392(10152), 1015-1035. https://doi.org/10.1016/S0140-6736(18)31310-2

Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. JAMA, 291(10), 1238-1245. https://doi.org/10.1001/jama.291.10.1238

Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., Yang, J., Primack, B. A., Andrews, J. A., Miech, R. A., Spindle, T. R., Dick, D. M., Eissenberg, T., Hornik, R. C., Dang, R., & Sargent, J. D. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics, 171(8), 788-797. https://doi.org/10.1001/jamapediatrics.2017.1488