Army Study to Prevent and Treat Tobacco Use

M. D. Anderson Cancer Center

Cancer Newsline Audio Podcast Series

Date: May 18, 2009

Duration: 0 / 17:52

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Lisa Garvin:

Welcome to Cancer Newsline, a weekly podcast series from the University of Texas M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. Today we are talking with Alexander Prokhorov, M.D., Ph.D. He is a professor of Behavioral Science at M.D. Anderson and also is Head of the Tobacco Outreach Education Program, and internationally known smoking cessation expert. Welcome Dr. Prokhorov.

Alexander Prokhorov:

Thank you.

Garvin:

Dr. Prokhorov is here today to talk about a $3.7 million grant from the Department of Defense that will produce a video game that will promote health and stress management for the men and women serving in the U.S. Military. Dr. Prokhorov, tell us about the facts and figures for smoking in the army.

Prokhorov:

Well, unfortunately, the army is you know one of those special group or population in this country that features a very high prevalence of smoking. Particularly, the study showed that about 38% of army service members smoke and about 15% of them use smokeless tobacco and that's much higher than in general population when as we know typically every fifth American, in other words 20% of American population smokes, but in the army we have these numbers. And if you look at by gender, we have about 46% of males who smoke and about 25% of females who use cigarettes. Now, this is of course an alarming situation because you know these -- when the service members get discharged then go back to the, sort of become civilians, then unfortunately breaking the habit is very, very difficult because they are addicted to nicotine. So, what we try to do is to intervene as early as possible to make sure that they are non-smokers.

Garvin:

Do you find that people that are non-smokers become smokers once they get in the military?

Prokhorov:

Well unfortunately, that's what some studies show that people take up smoking sometimes to cope with the hardships of military service.

Garvin:

Because usually, especially in the movies that were made in the 40's and 50's, I mean, that was cigarettes were basically a form of currency and may still be today.

Prokhorov:

That's exactly right and that's unfortunately the tobacco culture, so to speak is quite prevalent in the military. It has been and it's known. If you look at the history of tobacco use and the wars were major events in the history that kind of boost it, the use of tobacco in the entire society. The World War I, of course the World War II was the major, major event that you know increased the rate of smoking in this country tremendously.

Garvin:

Tell me about "Escape With Your Life." This is a prototype video game that you were using as a model for this new program.

Prokhorov:

"Escape With Your Life" is a video game that has been produced with the Department of Defense funding for high risk youth. Not military necessarily, just for general youth who are at high risk for smoking initiation, for school dropouts, for kids who are, you know particularly at risk. And we tested this video game into alternative schools and we found that this video game produced a very significant smoking cessation rates among this high risk youth. At first we were quite skeptical about this. We thought that it would be a good way to combine the entertainment and education because you need to somehow get these kids interested in learning about tobacco, but we were somewhat skeptical because this is a very high risk youth, okay. They would not be easy to work with in anyway, but using the video game seem to have that magic that kept their attention. They went through the game, they went through the whole entire experience and they learned a lot and after six months in the study that we've done on the preliminary basis, we've got over 50% of these kids who quits smoking, which made us very, very optimistic. We still have to double check that this is true by running randomized control trial, but in this preliminary study, we found that over 50% reported quitting smoking and they also displayed very encouraging changing in terms in their beliefs about tobacco, their knowledge about tobacco and their attitudes toward tobacco. So, those who quit were very different from those who continued smoking.

Garvin:

And so the military, the focus for your new video game is of similar high risk population.

Prokhorov:

That's exactly right. We are trying to achieve with this game is to, number one, educate about dangers of tobacco. Unfortunately, lots of young people perceive tobacco as a way to relieve stress, as a way to cope with depression, or dysphoric mood, you know if they feel, sad, down, low, they try to smoke. Some of them smoke for that reason. Some of them think that tobacco is a fantastic way to keep the company, to socialize and so, there is lots of different sort of what we call temptations to smoke. And we are addressing these temptations in the video game, the educational video game and we also teach the skills on how to socialize without cigarettes, how to cope with difficulties with mood problems, with stress without tobacco.

Garvin:

How many modifications will you have to make to "Escape With Your Life" to fit it to the military. I mean, is it going to be the same video game, it will have the same features?

Alexander Prokhorov:

Well, the theoretical underpinnings of this video game will be similar. Please keep in mind this is not just a video game to educate. We are behavioral scientists. We've learned over the years that people change their behavior in certain ways. So, there are certain mechanisms, certain processes that underlying the behavioral change. So, to become a non-smoker, every smoker has to go through certain stages, through certain phases and we've learned a lot about these stages in our projects. So, we are going to be sort of guiding them through this process. Not just educating them on the danger and leaving them to make the intelligent choice not to smoke, but also helping. You know, you might know that quitting smoking per session is not that difficult. It's sometimes -- the most difficult part is preventing relapse, going back to smoking. That's what happens to many, many people who tried to quit and go back and that's what we teach. One of the most important parts of this game is how to prevent that relapse, how to prevent that going back to smoking.

Lisa Garvin:

You know we think especially in combat situations our soldiers in Iraq, Afghanistan they may not have any other stress releaser or feel that they don't have any other release than smoking.

Prokhorov:

Well, that's true, but you know if you want to be a good soldier, if you want to be a better soldier, better prepared, you should be a non-smoker. What we've learned also about the health effects, it's widely known that tobacco leads to a variety of diseases, not just lung cancer like many people think. It's a lot of issues related to cardiovascular health, to you know respiratory health. In order to be fit, in order to be more efficient, in order to enhance your chances to survive in difficult situations, you have to be a non-smoker because what happens is that tobacco unfortunately compromises your physical abilities and your mental abilities. So, your concentration, your physical fitness, your ability to endure all the hardships associated with, you know military service would be much better if you are a non-smoker.

Garvin:

Does this project or will this project give them other coping mechanisms and stress reduction mechanisms.

Prokhorov:

That's one of our absolutely essential part of the game is that the video game teaches a variety of skills on how to cope with different issues, such as stress, such as depressive mood, such as you know things like, you know some people think that smoking helps them concentrate. Well, that's actually not true because what happens is that once you start smoking, you inhale a lot of carbon monoxide. That's a poisonous gas that binds a significant part of hemoglobin in the blood and unfortunately, you know this hemoglobin is no longer able to carry oxygen to tissues, so including brain, including your muscles. So, that means that part of your blood is simply excluded from the process of oxygen delivery. So, meaning that your body gets less oxygen and oxygen is life. So, in the difficult situation, such as combat, such as in military service in general, you know, smoking is no good. So, that's what we would like to offer this opportunity for our military service members, to learn about it, to learn skills how to become a non-smokers and how to adopt non-smoking lifestyle for life.

Garvin:

How will this pilot program roll out, will it be done at Fort Hood, will it be done overseas and how many participants do you expect?

Prokhorov:

Well, we are going to conduct this in the Fort Hood Military Base, a very large military base in Texas. Two thousand service members will participate in this study and we will randomize these participants into two groups. One of them would receive this video game and the other group would get a standard pamphlet on how to quit smoking. So, there will be no service member who wouldn't get anything because that's how we do it in our study. Everybody gets something, but if we establish clearly that our video game outperforms that standard pamphlet in terms of increasing the knowledge, changing attitudes, increasing beliefs in non-smoking as the right, you know lifestyle, and ultimately adopting non-smoking as a lifestyle, then we will be able to submit this video game as an evidenced-based tool for dissemination across the military bases in the United States and possibly even internationally.

Garvin:

Did the army come to you or how did this relationship come together?

Prokhorov:

Well, we've designed the prototype as part of a large scale lung cancer initiative out of M.D. Anderson Cancer Center and we had a preliminary study, a small, relatively small grant within the framework of this larger initiative and as part of that "Escape With Your Life" was developed. During the site visit when the Department of Defense representatives visited M.D. Anderson, we showed them the prototype and they liked it and they said that it would be nice for us to apply for a grant to develop a video game for the army. They didn't say it's going to be you know given to us that we need to apply just like everybody else. They said it's going to be very vigorously reviewed by scientists and by army people and it was. Clearly we came out with something convincing and our reviewers really liked the proposal and they thought it would be beneficial for the army and it would be beneficial for young people in general.

Garvin:

With this perhaps be a springboard to focusing on other groups because I know like firefighters tend to be smokers as a rule. So, is it the future that you know you would be able to use this for other high risk groups.

Prokhorov:

Absolutely! I think, the fact that we are designing it for the military does not preclude us from offering this video game to other people at risk, young people at risk who are only starting their smoking career or maybe smoking just for a few years already addicted. So, we are teaching them how to deal with addictions, how to cope with cravings, how to cope with different situations that make them smoke over and over and over again. To eventually become non-smokers and be healthier people and just overall you know as you probably well aware that our society is becoming less welcoming to smoking behavior. So therefore, I think living in the United States as a non-smoker is much more socially acceptable these days because well, fortunately, we see more and more communities, entire states going smoke-free. So, the tobacco is now prohibited from public places, which is a very healthy development. The majority of Americans are known smokers and we certainly hope that with this video game we will be able to show the disadvantages of using tobacco both short term and long term health consequences. The environmental impact of tobacco use, the financial impact of tobacco use on family budgets, we are living in a difficult you know financial times. People need to realize that by excluding cigarettes from their family budget would, free up a lot of money if you think about maybe a year, ten years, fifteen years and twenty years ahead, how much money can you save by not buying tobacco products. It's a lot of money and that's what, that's one of those components that we are showing in the video game.

Garvin:

Great! Thank you Dr. Prokhorov for talking about your grant and good luck to you in developing that game.

Prokhorov:

It's my pleasure. Thank you so much for having me.

Garvin:

If you have questions about anything you've heard today on Cancer Newsline, contact ask MDAnderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.

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