The smoking problem: A review of the research and theory in behavioral risk modification.

This article reviews findings and examines theoretical implications of studies concerned with initiation, maintenance, and therapy of cigarette smoking in children and adults. The following conclusions are offered: (a) Recent increases in success rates may be due to changes in the social environment that multiply the action of previously unsuccessful procedures, (b) current interventions are based on communication and behavioral models that ignore features unique to smoking, (c) methodological refinements of current interventions are unlikely to significantly increase success rates, (d) prevention studies should be directed toward critical steps in the developmental history of smoking (e.g., preventing initial attempts, facilitating negative interpretations of initial attempts, and retarding regular usage), and (e) studies of cessation and withdrawal must consider findings and theories of nicotine dependence. A hypothesis is presented to account for the development of craving conditioned to internal and external cues, and suggestions about how to eliminate the craving state are made.