AN INVESTIGATION OF HOW SPIRITUALITY SUPPORTS SMOKING CESSATION by LENORA D. FOLLETT B.S., Loma Linda University, 1966 M.S., Andrews University, 1996 A thesis submitted to Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirements for the degree of Doctor of Philosophy School of Nursing 2006 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ©2006 Lenora D. Follett ALL RIGHTS RESERVED Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. This thesis for the Doctor of Philosophy degree by Lenora D. Follett has been approved for the School of Nursing by Gene W. Marsh, Chair Marlaine Smith, Advisor Joan K. Magilvy Joan M. Nelson Larry Kent Graham Date j~> | R | Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iii Follett, Lenora D. (Ph.D., Nursing) An Investigation of how Spirituality Supports Smoking Cessation Thesis directed by Professor Marlaine Smith Smoking is a worldwide problem with major economic impact. Smoking cessation is difficult to attain, with the majority of smokers desiring to quit smoking. Religiosity has consistently shown some association with decreased smoking levels and increased smoking cessation, but little was known about how spiritual practice or religiosity could be incorporated into smoking cessation interventions. The purpose of this study was to describe the aspects of spirituality that were reported to be helpful by those who said that God or their spirituality supported them in smoking cessation, and to describe other factors that combine with spirituality to accomplish success in smoking cessation. This study followed an exploratory design, using a qualitative descriptive methodology. Data were generated through taped interviews using open ended questions, focusing on how spirituality and factors other than spirituality contributed to success in smoking cessation. The sample consisted of 19 participants (11 women and 8 men) who had stopped smoking for at least a year. Thirteen of the participants were Seventh-day Adventists at the time of the study. Data were coded using Ethnograph 5.0. The codes were organized into categories and examined for patterns. Spirituality as “connection” was supported by this study, including the domains of Connection with Self, Connection with God, Connection with Others, and Connection with a Church. Connection with God was the most salient domain. All participants Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iv expressed a decision or commitment to stop smoking. Half of the participants had little or no struggle in smoking cessation. God was believed to have provided power above human power. Personal prayer was prominent in connection with God. Connection with others in smoking cessation and medication were most helpful to the three in live-in smoking cessation programs. Connection with a church was increased after smoking cessation. The other factors (besides spirituality) that contributed to success were considered less important and were not unique to this study, including exercise, drinking increased amounts of water, dietary changes and dealing with triggers. The form and content of this abstract are approved. I recommend its publication. Approved: Marlaine Smith Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. V TABLE OF CONTENTS CHAPTER I. INTRODUCTION OF THE PROBLEM.................................................................... 1 Background ................................................................................................................... 2 Significance of the Study............................................................................................. 4 Costs to Society................................................................................................ 4 Theoretical Linkages between Addiction and Unmet Human Needs ..........7 Nursing’s Relationship to Smoking Addiction..................:.......................... 7 Purpose of the Study.....................................................................................................8 Research Questions.......................................................................................................9 Researcher’s Perspective.......................................................................................... ...9 Conceptual Foundations..............................................................................................11 Overview of the Method............................................................................................ 12 Overview of the Structure of the Dissertation..........................................................13 Summary......................................................................................................................13 II. REVIEW OF THE LITERATURE...........................................................................14 Introduction..................................................................................................................14 Theoretical...................................................................................................................15 Transtheoretical Model..................................................................................15 Revelation Readiness Model..........................................................................19 Theoretical Constituents of Motivation........................................................19 Reversal Theory............................................................................................. 20 ■ Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. vi Neurobiology of Addiction........................................................................................21 Addiction Models........................................................................................................23 Empirical..................................................................................................................... 25 Smoking Cessation .........................................................................................25 Spirituality.......................................................................................................30 Addiction and Spirituality............................................................................. 32 Spirituality and Smoking Cessation..............................................................34 Summary......................................................................................................................53 III. APPROACH TO INQUIRY......................................................................................55 Design..........................................................................................................................56 Philosophical Foundations......................................................................................... 57 Sample..........................................................................................................................58 Recruitment Methods.....................................................................................59 Sample Description........................................................................................61 Data Collection...........................................................................................................64 Interview..................................................................... 64 Analysis...........................................................................................................66 Rigor............................................................................................................... 67 Summary..................................................................................................................... 68 IV. FINDINGS.................................................................................................................. 69 Story 1..........................................................................................................................70 Story 2..........................................................................................................................72 Story 3..........................................................................................................................75 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. vii How did Spirituality Contribute to Efforts in Smoking Cessation?.......................77 Connection with Self......................................................................................77 Connection with God.....................................................................................84 Connection with Other People.................................................................... 100 Connection with a Church...........................................................................107 How is the Need for Belonging and Connection Related to Smoking and Smoking Cessation ...............................................................110 What Other Factors (In Addition to Spirituality) Contributed to Success in Smoking Cessation? ............................................................................................