A) Acknowledgements

I would like to express my sincere gratitude to the following for their contributions to this

research. This input has enabled what is regarded as an important topic to be researched,

and assisted with completion of the Field Study paper for the Bachelor of Health Science

(Therapeutic Recreation) degree:

Participants

Southland District Health Board:

- Smokefree Support Service

- Practice Development Unit

- Administration

Public Health South

Sherry Elton

Drs Baillie and Corkill

Nga Kete Matauranga Charitable Trust

Waihopai Runaka

Radio New Zealand

Sound Feelings Publishing

SIT School of Health, Exercise and Recreation

Lower South Regional Ethics Committee

Rhythm finds its way into our dancing feet, our poetry, our music, and all beautiful things. Biologically, human life has its own rhythmic periods as expressed by the periods of infancy, adolescence, adulthood, and old age. Life can only be lived to its fullest if we recognize, accept, and adjust to these rhythms and the demands for change which accompany them. Unless we bring ourselves into harmony with the rhythms of life, we cannot appreciate the beauty of life, let alone live it. C.K. Brightbill (1960, p. 57).

1

ContentsA) Acknowledgements 1

B) Abstract 3

C) Introduction 5Background information / Related literature 5Variables included 10

D) Delimitations / Scope of the study 11

E) Assumptions made by the researcher 12

F) Limitations 13

G) Key terms 14

H) Research methods 19

Who are subjectsHow were they selectedHow many were included

Instruments: 20Questionnaire usedProcess described

Procedures: 21How data was collected

Data analysis 22

I) Results (Findings) 23Summary of information collected

J) Discussion 30

Conclusion 34Recommendations 34

For professional practice to people in the fieldTo future researchers studying the same or similar topics

K) Reference List 37

L) Appendices 40

2

B) Abstract

The research focused on what role music can play in assisting heavily dependent smokers

to quit, or move through the stages of readiness to quit. There are considerable

similarities between the effects of music and those of smoking for the person concerned.

Therefore, music is regarded as having the potential ability help people to:

a) move through the stages of readiness to quit;

b) make the quit attempt;

c) maintain compliance with quit attempt.

In the context of Recreation Therapy, the research hypothesis can be summed up as

follows: If music caused no internal response perceived as beneficial, people wouldn’t

listen to it. As for tobacco, without a perceived benefit, there would be no consumption.

If the perceived benefits of music transcend tobacco, then over time, people may come to

depend on what is healthy rather than what is harmful (Reflection, 8/3/07).

The research participants were sought via the Smokefree Support service at the Southland

District Health Board at an amount of 7-10 people. Approval had to be gained from the

Lower South Regional Ethics Committee for this access. The SDHB cessation provider

recommended contacting two other providers in the Nga Kete Matauranga Trust and

Baillie and Corkill’s cessation service. The initial inclusion criteria was either smoking

in excess of 31 cigarettes per day, and/or lighting up within 5 minutes of waking. This

criteria is from the Fagerstrom assessment (see appendices) to ascertain nicotine

dependence, which indicates suitability for nicotine replacement therapy (NRT).

Exceptions to this criteria who still exhibited heavy dependence, were in accordance with

the researcher’s discretion. After an extended period following ethical approval without

sourcing participants, the decision was made to relax the inclusion criteria to allow for

regular smokers. Participants were also sought among SIT nursing students, and through

Sherry Elton, stop-smoking counselor, to increase participant numbers.

3

Participant kits were made up, including a recording of The British Invasion (courtesy of

Radio NZ) to ‘set the scene’ for the research. A consent form, instruction sheet, fourteen

item questionnaire, and music listening tips (www.soundfeelings.com) were also included.

The methods used for investigation entail research participants self-selecting music they

considered had the best potential to replace the perceived benefits of smoking, for one

half hour at a time over the course of three days within a week, recording the names of

the artists and tunes as they went.

Findings

Participants indicated a broad range of preferences for music that had a combination of

stimulating and relaxing effects. Music tended not to be a factor in their decision to

commence smoking (one participant acknowledged it was), nor was a lack of music

considered to contribute to ongoing smoking. Participants tended to smoke to relieve

either boredom, anxiety or both, out of habit, and to think, concentrate and remain calm.

Participants tended to place greater emphasis on personal responsibility for smoking

related illness (five out of six), and even though the same number considered nicotine

more addictive than either heroin or cocaine, four out of six indicated that to quit

smoking it was simply a matter of personal choice.

Conclusions

The hypothesis going into the study (above) is maintained. Namely that due to the

involvement of different brain regions, and subsequent physiological responses to both

music listening and cigarette smoking, the efficacy of music as an aid to smoking

cessation will vary, depending on factors such as the frequency, intensity, time and type

of music listened to, interacting with a given person’s level of engagement with cigarette

smoking. It is not simply a matter of playing any tune for any person over any length of

time, but rather sequencing various types of music in such a way that their effects

combine to supersede the perceived benefits of smoking.

The requirement to seek approval from the Regional Ethics Committee is regarded as

legitimizing this research topic, and the researcher values the experience for learning the

process involved. This entailed coordination of various activities to produce this report.

4

There is scope to develop this topic for further research in this area, to yield greater

insights into the relationships between the comparative effects of smoking and music.

C) Introduction

The research question is defined as ‘the central focus of the research effort that serves as

the basis for the research problem and provides direction for the entire process’

(Baumgartner and Hensley, 2006, p. 29).

The original research proposal detailed three themes as follows:

Dependence-Independence/Intrinsic-Extrinsic (Csikszentmihalyi & Seligman)

Internal-External interaction/exchange (Vygotsky & Bronfenbrenner; McLuhan)

Evolutionary role of music, the internal response (Levitin; Durrant and Thakker; Selye)

Associated with these themes are names of people who have contributed to a variety of

disciplines that the researcher considers relevant to the research question. If music is to

have any efficacy as an aid to smoking cessation, then these areas must be accounted for.

To establish the foundation for this study they are mentioned here to provide the

parameters and will be covered later in the report.

C.1) Background information/Related literature

A search was made of the EBSCO host database CINAHL available through the Southern

Institute of Technology library with the key words ‘Music therapy’. This search yielded

over eleven hundred articles that expressed various applications of music therapy.

Although smoking was not mentioned directly in the titles, these articles suggested that

music can potentially serve as a cessation aid.

For example, a study reported that within five minutes, music can lower blood pressure to

normal levels for patients undergoing surgery (Health, Oct 2001). Advocates of music

therapy believe the main benefit is that it helps people relax, which in turn triggers the

release of endorphins, the body’s natural painkillers (Mazo, 2002). Drumming circles

have applications as complementary addiction therapy for repeated relapse and when

other counseling modalities have failed (Winkleman, 2003). Organising healthful patterns

in music can promote more organized, healthful patterns in the body (Abrams and

5

Decker, 2001). By distracting patients and reducing stress, music may actually block

painful nerve signals in the brain…Listening to music for longer periods might lessen the

need for painkillers (M. Good, Health, 1999).

The ability of music to induce intense pleasure and its putative stimulation of endogenous

reward systems suggest that, although music may not be imperative for survival of the

human species, it may indeed be of significant benefit to our mental and physical well-

being (Blood and Zatore, 2001). To be therapeutic, interventions must be used in an

overall therapeutic context in concert with other therapies. Music therapy should be tied

to specific issues of the therapeutic sessions and the songs should be selected to target

specific therapeutic issues (Gallant, Holosko, and Siegel, 1997). The therapeutic effects

of music are being recognized increasingly in the field of rehabilitation medicine, where

the goal is to assist in physical recovery and health maintenance of clients (Paul and

Ramsey, 2000) Given the inexpensive nature of this intervention, and the lack of adverse

events, it is recommended as an adjunct to normal care practices (Evans, 2002).

As a non-invasive therapeutic tool, music has been shown to relieve anxiety and pain;

increase feelings of relaxation; heighten the immune system and decrease blood pressure,

pulse rate and breathing (McCaffrey, 2002). The fact that a variety of different

[biological, psychological and social] treatments with divergent methods and theoretical

underpinnings can be – at least modestly – efficacious points to the role of non-specific

factors in recovery from drug problems (Durrant and Thakker, 2003, p. 228).

The research focused on what role music can play in assisting heavily dependent smokers

to quit, or move through the stages of readiness to quit. The word efficacy stems from

the Latin efficax, means ‘producing or able to produce the desired effect’, and is related

to the word ‘efficiency’ (Thompson, 1992, p. 239).

Efficiency is a common theme running through three different examples from

Therapeutic Recreation (the relationship between client programmes and needs);

Statistics (decision on alternate hypotheses and alpha level), and Management thought,

(the relationship between efficiency and effectiveness). These examples are contained in

the appendices. The importance of smoking cessation is expressed by the extent of

smoking-related illness, and the flow-on effects for families, society, and the health

6

system. For music to have benefit as a cessation aid, this common theme would have to

be accounted for when designing interventions for people seeking to quit smoking.

Music is part of the human environment. It is present in so many aspects of life that it is

virtually impossible to avoid its influence:

Music is perhaps the most basic and universal activity of humankind. Beginning as the

simple and natural sound of the human voice, music has existed in some form from the

earliest days. Through the centuries, music has taken many forms and reflected many ways

of life (Russell, 2005, p. 13).

This lasting influence is expressed in the following statement, which covers the

evolutionary role: ‘New research on how our minds process rhythm and melody suggests

that music played a crucial role in the evolutionary development of the brain’. This role is

confirmed by neuroscientist Daniel Levitin, who is quoted in the same article: ‘There

may be a common genetic linkage between sociability and musicality’ (Smith, 2006, p.

24). The word ‘entertain’ stems from the Latin term teneo – hold (Thompson, 1992, p.

289). Music ‘plays’ such a substantial part in leisure lifestyle that it is considered to have

potential use as a therapeutic tool. A working definition from K.E. Bruscia states:

Music therapy is a systematic process of intervention wherein the therapist helps the

client to promote health, using music experiences and the relationships that develop

through them as dynamic forces of change (Hanser, 1999, p. 2).

Smoking is a pervasive influence on health status in New Zealand society and

internationally, affecting large numbers of people. Tobacco use is one of the chief

preventable causes of death globally. The World Health Organisation attributes 4.9

million deaths a year to tobacco use, a figure expected to rise to more than 10 million

deaths a year by 2030 (Peto and Lopez, 2001, cited in HSC, 2005, p.12).

The majority of these deaths are projected to occur in developing nations where under-

resourced health systems are ill-equipped to cope (source unknown). In the course of the

twenty-first century, one billion people across the globe will die of tobacco-related

diseases, a figure representing a ten-fold increase over deaths associated with the

cigarette in the last century (Brandt 2007. p. 14).

7

People cite a variety of reason for smoking. Placing individuals as ‘the self’ surrounded

by cultural-historical, biological and psycho-social variables, Durrant and Thakker state

that substances have a functional context for use, and suggest the categories of medicinal,

recreational, social, pragmatic, ritual-religious, and dietary (2003, p. 21). These authors

address reasons for human drug use and abuse, stating that:

It is unlikely, however, that the brain systems implicated in the rewarding effects of

psychoactive drugs have evolved specifically for the ingestion of such drugs. Rather

these systems are implicated in the generation of positive emotional states that are

linked to stimuli in the world that do have survival and reproductive relevance for the

organism (Durrant and Thakker, 2003, p. 43).

This research postulates that whatever these reasons are (for example, to provide comfort

and security in times of stress) quality music has the capacity to transcend these

perceived benefits, and therefore can potentially be used to aid smoking cessation.

This provides the report title The efficacy of music as an aid to smoking cessation. It is

necessary to explain various concepts that relate to smoking cessation to lead in to the

remainder of this report:

Smoking cessation – a dynamic process that occurs over time rather than a single

event. Smokers cycle through the stages of contemplation, quitting and relapse an

average of three to four times before achieving permanent success.

(National Health Committee, 2002, p, 3)

Stages of change – Prochaska and DiClimente (Transtheoretical model):

…the basic idea is that behaviour change is a process and not an event, and that

individuals have varying levels of motivation, or readiness to change. People at

different points in the process of change can benefit from different interventions,

matched at their stage, at that time. The four distinct stages identified are: Pre-

contemplation; Contemplation; Preparation/Action and Maintenance

(Anderson and Matthews, 2005, p. 72).

8

Fagerstrom assessment

..known as the Fagerstrom Test of Nicotine Dependence, this will assist in evaluating

the level of physiological dependence on nicotine, which helps to establish whether or

not nicotine replacement therapy (NRT) will be of benefit. A score of four or more

indicates that the biochemical dependency on nicotine is sufficient to warrant NRT

(National Heart Foundation, 2006, Quit Cards).

This assessment asks six questions, and allocates different points according to responses. For

allocating a maximum of three points each, the two relevant questions are:

- How soon after you wake do you smoke your first cigarette?

(three points if within five minutes)

- How many cigarettes a day do you smoke?

(three points if in excess of thirty-one).

Nicotine Replacement Therapy (NRT)

The rationale for this is the use of a product containing nicotine previously taken in

by smoking. NRT decreases withdrawal symptoms and improves cessation outcomes

for many people. NRT is not the mainstay of smoking cessation but is an effective

supplement to behavioural interventions and good support

(National Health Committee, 2004, p. 15)

Multi-faceted approach to Tobacco Control

Some of the key tools to call upon when addressing different tobacco control issues include:

- advocacy: campaigning at local, regional and national levels

- legislation: aiming to influence health outcomes through public policy,

maintaining the activity, making it a legal requirement.

- cessation: supporting smokers to quit.

- education: based on increasing individual knowledge regarding the harm that

smoking causes, both to the smoker and non-smoker.

- social marketing: using marketing theories and strategies to help achieve

behavioural change in social and health areas.

- community mobilization/action: participation in setting priorities, making

decisions, and planning and implementing strategies to improve community health.

(Anderson and Matthews, 2005, p. 30).

9

DSM-IV diagnostic criteria for nicotine withdrawal

According to these criteria, the diagnosis of nicotine withdrawal is established if at least four of

the eight symptoms and signs (listed) occur within 24 hours of nicotine cessation

1. Dysphoria or depressed mood

2. Insomnia

3. Irritability

4. Anxiety

5. Difficulty concentrating

6. Breathlessness

7. Decreased heart rate

8. Increased appetite or weight gain

(Hulse, White and Cape, 2002, p. 103)

These six concepts explain the nature of tobacco control, and the role that smoking

cessation has within it. They are mentioned here to indicate the type of forces acting on

therapeutic contexts for treating nicotine addiction, and to provide a foundation for the

rest of this report.

C.2) Variables included in the study

Variable: “A characteristic, trait, or attribute of a person or thing that can take on more

than one value and be classified or measured” (Baumgartner and Hensley, 2006, p. 39)

The variables measured according to this definition are contained in the questionnaire

(appendices). They include perceptions about the ability of music to aid smoking

cessation, or move through the stages of readiness; Number of years spent smoking; Age

commenced smoking; The role music had in commencement; The role music has in

continuation; Three most beneficial tunes for their ability to divert attention, reduce

craving, and substitute for cigarettes; Effect on listener; Main purpose of smoking;

Favourite types of music; Levels of agreement with statements regarding human

responsibility and person/environment interaction. Since they were influential in

determining participant reliance on either cigarettes or music, other variables indirectly

included for measurement were: perceived Quality of life and Health status. Participants

were also given an opportunity to expand on any responses made.

10

D) Delimitations/Scope of the study

1. Type of research participants

- regular smokers on/not on NRT willing to participate.

- preference: a variety of individual difference to be represented (for example: age,

gender, ethnicity), although the research accepted the first respondents.

2. Number of research participants

- Seven to Ten sought, six gained.

3. Measures to be collected

- perceptions regarding the effects of self-selected music on craving

- recording of tunes and artists listened to

4. Instruments used

- fourteen item questionnaire; song/tune recording sheet; personal interviews

5. Time and duration

- One week, consisting of one half hour on three days within that week (data collection).

- Follow-up fortnight/month for collecting data, and writing up results and report.

6. Setting

- Participant’s own homes, since these are a natural setting

- Saturday (more associated with leisure) and Wednesday.

7. Type of intervention or treatment

- Leisure/recreation based: participants are required to self-select and give full attention

to music believed to transcend the perceived benefits of smoking.

11

E) Assumptions made by the researcher

That this is a worthwhile research question to pursue, with potential to benefit people

seeking to quit smoking, or at least move them through the stages of readiness to quit.

That there are several postulated similarities and differences that imply music can serve

as an aid to smoking cessation.

That music originates within the artist (unlike substances), has greater potential to

be health promoting over the long term, and therefore genuinely therapeutic.

That if someone is ‘dependent’ they have a need for resources to flow from external

(outside) to internal (inside), whereas ‘independence’ is expressed by a reverse trend:

internal to external.

The research also regards any interaction (such as between a person and their

environment) as an example of exchange, with the implication that there is a potential

gain or loss of value to quality of life present in that interaction/exchange.

That there are no risks to participation in this type of research that supersede those of

ongoing smoking.

With regard to the evolutionary role of physiological functions impacted by both music

and smoking, it is acknowledged that these may be used to produce a variety of effects

different from their traditional or intended use, allowing adaptations to occur.

That participation may produce emotional responses and/or trigger different memories,

consistent with the research design/intention.

That assistance sought for finding prospective participants would mention the research to

clients, encouraging their participation without coercion.

That terminating the study would not be envisaged due to the worth of the research.

That there is little complexity involved in participation, and the research provides an

opportunity for variety and enjoyment.

That the use of the British Invasion recording (Courtesy Radio NZ) would help to ‘set the

scene’ for this research, enabling participants to understand the rationale. This recording

is about the prevalence of The Beatles influence on the music industry in the 1960’s.

12

F) Limitations

“Aspects of the study that cannot be controlled, that represent weaknesses to the study, and

that may negatively affect the results” (Baumgartner/Hensley, 2006, p. 30).

o If efficacy is being measured, validity could be influenced by the frequency and duration

of research (design consideration).

o Variations in amounts smoked for people on NRT. The recommendation: people on NRT

should completely abstain to avoid nicotine overdose (NHC, 2004, p. 15) The exception

to this is Nicotine Assisted Reduction to Stop (NARS), allowing for use of nicotine

replacement products to cut down on smoking prior to a quit attempt (ASH UK, 2005).

o Time constraints influence decisions on study design.

o Regional Ethics Committee: waiting for response (approval received 20th June).

o Non-standard explanation of research from one participant to the next.

o Novice research: influence on questionnaire design.

o The extent to which participants have followed instructions:

- Whole half hour?

- Complete questionnaire and filled out recording sheets correctly?

- All available for interview?

o Not included in the literature review are examples of tunes (words put to music).

13

G) Key terms defined

Central Nervous System (CNS): consists of brain and spinal cord. The CNS interprets incoming

information and initiates action potentials that are transmitted through the efferent division to

produce a response. The efferent division is divided into the somatic (somatomotor) nervous

system and autonomic nervous system (Seeley, Stevens, Tate, 1992, pp. 354/5).

COPD: Chronic Obstructive Pulmonary Disease. the obstructive lung diseases associated with

smoking (Ford, 1994, p. 90).

Dependence: a state of psychological and/or physical need for a substance, usually characterized

by compulsive use, tolerance, and physical dependence manifested by withdrawal sickness

(Kunstler, 2001, p. 95)

Distress: damaging or unpleasant stress (Selye, 1974. p. 31)

Ecological validity: the extent to which the environment experienced by the subjects in a

scientific investigation has the properties it is supposed or assumed to have by the researcher

(Bronfenbrenner, 1979, p. 29)

‘..what matters for human behaviour and development is the environment as it is perceived,

rather than as it may exist in “objective” reality’ (Bronfenbrenner, 1979, p. 4).

Efficacy: [L. efficax] producing or able to produce the desired effect. Related to the word

‘efficiency’ (Thompson, 1992, p. 239).

Emphysema: what is generally called emphysema is a manifestation of one or more of three

separate conditions, for which health professionals use more specific names:

o Chronic bronchitis (or chronic mucus secretion)

o Emphysema (involving the breakdown of alveolar walls and other structures)

o Small airway obstruction (involving thickening of the walls of the small airways)

(Ford, 1994, p. 89)

Energy: may be described as the capacity to perform work

(Fox, Bowers, and Foss, 1989, p. 63).

Ergogenic aid: erg [Gk. ergon work] genic [Gk. gen- be produced]

(Thompson, 1992, p. 293/p. 364).

14

(ergogenic aid continued)

‘…in its broadest sense, one could call anything that can be related to an improvement in

performance an ergogenic aid’ (Fox, Bowers, and Foss, 1989, p. 632).

Exchange: 1. giving of one thing and receiving of another in its place

(Thompson, 1992, p. 300). A type of interaction (‘gas exchange’; ‘principle of exchange’).

Extrinsic: 1. characterizing that which is outside or external. 2. pertaining to that which is not an

inherent part of something but which is related to it. Contr. Intrinsic (Chaplin, 1985, p. 171).

FITT principle: Frequency, Intensity, Time, Type. This is usually applied to athletic training.

Flow: (autotelic experience): ‘In each case, intrinsic rewards appeared to overshadow extrinsic

ones as the main incentives for pursuing the activity’.

[The experience] is not boring, as life outside the activity often is. At the same time, it does not

produce anxiety, which often intrudes itself on awareness in “normal” life. Poised between boredom

and worry, the autotelic experience is one of complete involvement of the actor with his activity….In

the flow state, action follows upon action according to an internal logic that seems to need no

conscious intervention by the actor. He experiences it as a unified flowing from one moment to the

next, in which he is in control of his actions, and in which there is little distinction between self and the

environment, between stimulus and response, or between past, present, and future

(Csikszentmihalyi, 2000, pp. 35/36).

Heart disease: There are a multitude of heart conditions and diseases. The largest categories of

cardiovascular diseases are heart attacks (myocardial infarction) and strokes. Most heart

diseases are actually vascular diseases that constrict or block normal blood flow either in or

out of the heart.

o Arteriosclerosis (the most common form of heart disease) is a group of diseases

characterized by a thickening and loss of elasticity of the heart walls.

o Artherosclerosis is a type of arteriosclerosis in which fatty deposits (plaque) make the

inner layer of the artery wall thick and irregular.

o Myocardial infarction is the death or damaging of an area of the heart muscle as a

result of an interruption in the blood reaching that area (McGuire, 2000, p. 270)

Homeostasis: (homoios = similar and stasis = position) the body’s tendency to maintain a steady

state despite external changes; physiological “staying power” (Selye, 1974, p. 139).

15

(Homeostasis continued)

The maintenance of a relatively constant internal environment (within the body) in the

presence of a constantly and sometimes dramatically changing external environment (outside

the body) (Seeley, Stevens and Tate, 2002, p. 12).

Internalisation (Vygotsky, 1960) a set of social relationships, transposed inside, and having

become functions of personality and the forms of its structure (Linzey, 1991, p. 242).

Intrinsic: pertaining to a quality or property of something in itself, without regard to value arising

from its relations to other objects, properities etc. Syn. Inherent. Contr. Extrinsic

(Chaplin, 1985, p. 239).

Leisure: the meaning of leisure today can generally be described in three ways. First, leisure is

free time. Next, leisure is non-work activity. Finally, leisure is a state of mind, or special

attitude (Russell, 2005, p. 31)

Locus of control: the degree to which the individual attributes the cause of their behaviour to

environmental factors or to their own decisions (Chaplin, 1985, p. 260).

Lung cancer: numerous different types occur within the lungs, although most are very rare. The

exceptions are four types that can be caused by smoking (Percentages are approximate)

o Squamous cell carcinoma (30-35% of cases) tends to start in the larger airways in the

central part of the lung.

o Small cell (‘oat cell’) carcinoma (25% of cases) is highly malignant and has often spread

by the time of diagnosis. It usually starts in the same part as the squamous cell type.

o Adenocarcinoma (25% of cases, though US studies indicate is increasing) forms a tumour

with a gland like structure. It is more often located around the outer parts of the lung.

o Large cell carcinoma (10-20% of cases) This type behaves similarly to adenocarcinoma,

forming large ‘silent’ tumours, usually away from the centre of the lung, and has often

spread to other organs by the time it is first diagnosed (Ford, 1994, pp. 41-43).

Media: 1. plural of Medium:

1. middle quality, degree, etc, between extremes

2. means of communication

3. substance, eg., air, through which sense-impressions are conveyed

16

4. physical environment etc. of a living organism (L. medius middle)

(Thompson, 1992, p. 552).

Motivation: an intervening variable used to account for factors within the organism that arouse,

maintain, and channel behavior toward a goal (Chaplin, 1985, p. 288).

Peripheral Nervous System (PNS): consists of nerves (bundles of axons and their sheaths) and

ganglia (collections of nerve cell bodies located outside the CNS). The afferent division of

the PNS detects stimuli and conveys action potentials to the CNS

(Seeley, Stevens, Tate, 1992, pp. 354/5).

Pleasure pathway: Part of the reinforcement of smoking comes from relief of nicotine withdrawal

(negative reinforcement). However, nicotine also produces a number of pleasurable effects

that are important in positive reinforcement. It has both stimulant and depressant-like

actions. The smoker feels alert and active, yet there is some muscle relaxation.

Nicotine activates the reward system in the brain that includes the pathways from the ventral

tegmental area to the nucleus accumbens (Hulse, White and Cape, 2002, p. 105).

The critical brain circuit implicated in the rewarding effects of many psychoactive drugs

connects areas of the frontal cortex with the nucleus accumbens and the ventral tegmental

area, in the limbic system of the brain. This brain circuit – the mesolimbic reward pathway –

is served by a variety of neurotransmitters, although the most critical one appears to be

dopamine (Durrant & Thakker, p. 42)

It was Levitin who conducted the first study to prove that listening to music increases the

amount of dopamine in the nucleus accumbens, a brain structure involved in feelings of

pleasure and reward. Levitin says that pleasureable music activates the same brain regions

like heroin and opium (www.levitin.mcgill.ca/pdf/The-Sydney-Morning-Herald).

NB: The researcher first heard ‘Pleasure pathway’ used in a Radio NZ interview (Kim Hill,

circa 2000) with Dr Carl Erikson on the topic of substance abuse and treatment.

Prevalence: 1. general existence or occurrence. 2. Predominance (Thompson, 1992, p.708).

Psychological space: the content of what is perceived, desired, feared, thought about, or acquired

as knowledge, and how the nature of this psychological material changes as a function of a

person’s exposure to and interaction with the environment, rather than emphasis on the

traditional psychological processes of perception, motivation, thinking and learning

(Bronfenbrenner, 1979, p. 9) Relates closely to ecological validity.

17

Recreation: In the twentieth century, the word recreation has three primary meanings

(1) as a form of voluntary activity that is carried on in leisure time, usually for pleasure but

also to satisfy other personal needs or drives;

(2) as a positive emotional state, with feelings of well-being, achievement, self-discovery,

and satisfaction derived from participation; and

(3) as a societal institution composed of varied governmental, commercial, non-profit and

other sponsoring organizations (Kraus and Shank, 1992, p. 20).

Stress: the nonspecific response of the body to any demand made upon it. For general orientation,

it suffices to keep in mind that by stress the physician means the common results of exposure

to any stimulus (Selye, 1974, p. 141).

Tolerance: reduced sensitivity resulting in the need for increased dosage to achieve the desired

drug affect (Kunstler, 2001, p. 95).

Withdrawal: The effect of abrupt cessation of smoking, or reduction in the amount of nicotine

used. Diagnosis of withdrawal is established if at least four of eight symptoms and signs

(DSM-IV diagnostic criteria) occur within twenty-four hours of nicotine cessation

(Hulse, White and Cape, 2002, p. 103)

Work: the application of a force through a distance. Work is expressed in the following formula:

W (Work) = F (Force) x D (Distance) (Fox, Bowers, and Foss, 1989, p. 63).

Work is described as the body’s capacity for exertion, and is therefore related to energy.

18

H) Research methods

H.1) Participants (who are subjects)

The subjects initially sought for this study were people heavily dependent on nicotine, as

indicated by the Fagerstrom assessment (see appendices). Individual differences were

anticipated for variables such as age, gender, education levels, socio-economic

background and musical preferences. After an extended period following ethical approval

without sourcing participants, the decision was made (1st August) to relax these inclusion

criteria to allow for regular smokers who were willing to contribute. Participants were

also sought among SIT nursing students (20th August) to increase participant numbers.

how were they selected

The participants were sought via the Smokefree Support Service, Southland District

Health Board (SDHB). The SDHB cessation provider recommended contacting two other

providers in the Nga Kete Matauranga Trust and Doctors Baillie and Corkill’s service,

who informed their clients/patients about the research, and told them to contact the

researcher directly.

The initial inclusion criteria was heavy nicotine dependence (an excess of thirty-one

cigarettes per day, and/or lighting up within 5 minutes of waking) in accordance with the

Fagerstrom assessment. To account for the influence of NRT, which recommends that

recipients cease smoking completely (to avoid nicotine overdose), this inclusion criteria

should be interpreted to mean people who have smoked up to the amounts mentioned.

Permission had to be sought from the Regional Ethics Advisory Committee to continue

with the research, since these people are part of the SDHB population.

how many were included in the study

The number sought for participation was seven to ten smokers. A reason for relaxing the

inclusion criteria was to ensure at least seven participants were gained. At the time of this

decision (1st August), just two participants (‘MPH’ and ‘Lorraine’) were sourced. On 20 th

August, two nursing students (‘Dolly’ and ‘Doris’) agreed to participate, and two more

participants came via the SDHB provider (‘Yodel’) and Sherry Elton (‘Patsy’).

19

Of these six participants, ‘Dolly’, ‘Doris’ and ‘Patsy’ were not on NRT.

Another person contacted (who may have brought the total to the originally desired

minimum of seven participants) expressed interest, though when contacted about

involvement, was unable to commit due to a heavy work schedule. This person was

posted a copy of the research proposal and course information for the Bachelor of Health

Science degree (Therapeutic Recreation). The final number of participants was six.

H2) Instruments: questionnaires or interview schedules used

A 14 item, student-developed questionnaire (see appendices) that consists of:

- six ‘scale’ questions, where the participants select an answer on a continuum;

- seven ‘choice’ questions where participants select one or more options, and

- one space provided for providing further feedback to expand upon answers.

Process described The process for developing the questionnaire was conducted with an emphasis on key

terms ‘efficacy’, ‘music’, ‘aid’ and ‘smoking cessation’. The questionnaire was designed

to be used with the recording sheets for the self-selected music. The rationale for

recording the tunes was to allow participants to reflect upon what effect the music they

selected had on their motivation to smoke. The question about favorite types of music

(11) is about ‘taste’ (a similarity to smoking), while questions 12 and 13 related to

personal responsibility and the person/environment interaction. A space was provided for

expanding upon the answers given (question 14).

An application was made through the Regional Ethics Advisory Committee (NEAC) for

access to SDHB patients. This entailed filling out a standard application online and on

their recommendations also making alterations to the participant consent form, flyer,

questionnaire and instruction sheet (see appendices).

The SDHB Cessation provider recommended contacting other providers to ensure the

desired number of participants were sourced. These providers were Baillie and Corkill

doctors and Nga Kete Matauranga Charitable Trust. They were each left an example of

the flyer and participant kit to show prospective people. These kits included tips for

music listening (courtesy: www.soundfeelings.com).

20

After an extended period following ethical approval without sourcing participants, the

decision was made (1st August) to relax these inclusion criteria to allow for regular

smokers who were willing to contribute. Participants were also sought among SIT

nursing students (20th August) and through Sherry Elton, stop-smoking counselor, to

increase participant numbers.

The consent form indicated that participants would be de-identified by use of

pseudonyms. Participants were required to listen to a copy of The British Invasion

(courtesy: Radio NZ) to set the scene for appreciation of music’s ability to influence

people. Participants were asked to self-select music for listening for one half hour each

on three days (one Wednesday and two Saturdays) within a week, recording the

tunes/artists on sheets provided.

The emphasis was on selecting music considered to have the best potential to replace the

perceived benefits of smoking. They were then asked to link these sheets with a fourteen

item questionnaire designed to measure the efficacy of the music they selected. Once

participants had completed this questionnaire, their role was largely complete, although

they were free to contact the researcher with any questions.

H3) Procedures (how the data was collected)

The research was based on the exercise training principles of frequency, intensity, time

and type (otherwise known as the ‘FITT’ principle). Included within participant kits (see

appendices) were an Introductory letter; Consent form; Instruction sheet; Cassette copy:

The British Invasion; List sheets for music listened to; Questionnaire (fourteen items);

Tips for music listening; SIT Course information: Bachelor of Health Science

(Therapeutic Recreation).

The recording sheets were to list both the artist and the tune over the course of these days.

These sheets are essential to link in with the questionnaire presented to participants. It

was specified that participants ensure continuity of listening for these three half-hour

periods by self-selecting music prior to these periods. By allowing a gap between the

21

listening periods, participants were able to reflect on what effect the music had on them,

and to prepare their next half hour listening period.

Participants were asked to keep the questionnaire until the following week of the study,

when the recording sheets would be used to help them answer the questionnaire.

Participants were then required to complete a fourteen item questionnaire that used the

recording sheets as a memory aid for identifying what particular tunes had a greater or

lesser effect on their ability to quit smoking, or influence their readiness to quit.

The completed forms were collected by the researcher in the following week after the

music listening period. This was an opportunity to gain verbal feedback from the

participants regarding their involvement, and reflections they had.

H4) Data analysis

Data analysis is included in italics following each question listed . As stated in Section C

(Introduction) the influence of three themes is to be accounted for if music is to have

efficacy as a smoking cessation aid. These are 1) Dependence-Independence/Intrinsic-

Extrinsic; 2) Internal-External interaction/exchange, and 3) The Evolutionary role of

music and the internal response.

These must also be considered in relation the different types of questions included in the

participant questionnaire (Section H2; appendices) including ‘scale’ questions; ‘choice’

questions, and the ‘expansion’ question. Another term of reference is the three examples

of efficiency from Therapeutic Recreation; Statistics, and Management (P. 6; appendices)

as factors to consider in analyzing participant responses.

In summary, the data analysis is seeking to account for the combined effect of all the

factors above on participant involvement, even if these factors are not directly measured,

for the reason that the data analysis may yield useful information to the research question.

22

I) Results (Findings)I.1) A summary of the information (data) collected

1. On a scale of 1 (least) to 10 (most) how would you rate the ability of music for you personally to attempt to quit smoking?

Dividing 23 (response total) into a potential amount of 60 (6 responses x 10/most) yields an average of 0.3833. This figure does not include an amount for Lorraine (no response).

2. On a scale of 1 (least) to 10 (most) how would you rate the ability of music for all smokers to attempt to quit smoking?

Dividing 27 (response total) into a potential amount of 60 (6 responses x 10/most) yields an average of 0.45.

23

1. Ability of music for smoker personally to attempt to

quit smoking

012

3456

789

MPH Lorraine Dolly Patsy Yodel Doris

Rat

ing

: 1

(lea

st)

to 1

0 (m

ost

)

2. Ability of music for all smokers to attempt to quit smoking

0

2

4

6

8

10

12

MPH Lorraine Dolly Patsy Yodel Doris

Rat

ing

: 1

(lea

st)

to 1

0 (m

ost

)

3. How many years have you been smoking?

MPH Lorraine Dolly Patsy Yodel Doris25+ 25+ 5- 25+ 25+ 6-10

67% (4) of the participant group have been smoking for in excess of 25 years. 16% (1) has been smoking for 6-10 years, and the same amount for 5 years or less.

4. At what age did you commence smoking?

Of significance is that 33% (2) commenced in their early teens, while 50% (3) commenced in their mid-teens (Combined total for teens = 83%). 17% (1) commenced aged 7.

5. On a scale of 1 (least) to 10 (most) how would you rate the ability of music to assist smokers to move through the stages of readiness to quit (as opposed to quitting smoking immediately)

24

4. Age commenced smoking

7

15 14 15 16

13

0

5

10

15

20

MPH Lorraine Dolly Patsy Yodel Doris

5. Ability of music to assist smokers through the

stages of readiness to quit

0

2

4

6

8

10

12

MPH Lorraine Dolly Patsy Yodel Doris

Rati

ng

1 (

least)

to

10 (

mo

st)

Dividing 23 (response total) into 60 (6 responses x 10/most) yields an average of 0.3833

6. Was music a factor in your decision to commence smoking?

Yes: DollyNo: MPH; Lorraine; Patsy; Yodel; Doris.

Only 16% (1) stated that music contributed to their decision to commence smoking.

7. Does a lack of music contribute to your ongoing smoking?

Yes: (none)No: MPH; Lorraine; Dolly; Patsy: Yodel; Doris

Of significance is that all participants (100%) stated that their ongoing smoking is not affected by a lack of music.

8. Of all tunes selected, the three most effective for their ability to divert attention, reduce craving, and substitute for cigarettes

MPH: none selected for Qu 8. Examples on recording sheet: Messum Dorma (Pavarotti);

American Pie (Don McLean); Cats, Act 1 (London cast)

Lorraine: Many Reasons; The Beauty of My Home (both Isla Grant);

Stand Beside Me (Daniel O’Donnell).

Dolly: C’est la Vie (Bewitched); R-Kelly (Ignition Remix); Creed (My Sacrifice)

Patsy: Apache; Flingel Bunt (both The Shadows); Crazy (Patsy Cline)

Yodel: none selected for Qu 8. Artist examples on recording sheet: Isla Grant, Shirley

Thoms (tunes not given)

Doris: Bad Dream (Keane); ELO – tune not given; School (Supertramp)

The answers provided indicate two things to support postulated similarities between smoking and music: 1) that preferences relate to sense experience or ‘taste’, and preferences are influenced by exposure at stages of development in the lifespan.

8 b) Of these three, what particular aspect played a greater role in diverting attention, reducing craving, and substituting for cigarettes?

Lyrics: (none)Melody: PatsyBoth: Lorraine; Dolly; Yodel; Doris

MPH: none

25

These answers are inconsistent with the research examples provided, and suggest that alterations to the person’s listening style can occur, with changes to factors such as the length of time, volume, type of music, frequency of listening, combined with personal motivation to quit smoking can make music more effective as a cessation aid. These answers also indicate that the research could be repeated with the same participants and their understanding of what to do would be enhanced.

Participants were asked to record the tunes listened to, with the intention they might become creative in their selection. 50% (3) fulfilled the requirements adequately by listing a variety of tunes for the three half hour periods, while the other 50% either tended to rely solely on single albums, or only list the artists name without the actual tunes listened to.

9. Of all the tunes selected, what effect did the majority have?

Stimulating: DorisRelaxing: MPH; Lorraine; Dolly; Yodel

Patsy: Both

10. When you smoke, is it mainly to relieve:

Boredom: Dolly; Yodel Anxiety: Lorraine

MPH: ‘habit’Patsy: see qu 14.Doris: both

Questions 9 and 10 are related in that if a person is experiencing boredom, they will seek stimulation, and conversely if they are anxious, they will seek relaxation. Of interest is that there was little ‘balance’ in the responses. Although 67% (4) indicated that the tunes they listened to were relaxing, only 17% (1) indicated they smoked to relieve anxiety. Likewise, 17% (1) indicated the tunes they listened to tended to be stimulating, although did not state they smoked to relieve boredom. Of the 2 responses (33%) who stated they smoked mainly to relieve boredom, the majority effect of tunes listened to was relaxing.

Of the ‘Both’ responses, these came from two different participants to Qu 9 (Stimulating/Relaxing) and Qu 10 (Boredom/Anxiety). The responses provided by these participants also indicate that music can fill a gap, since it comes in various forms (stimulatory or relaxing) that can address boredom or anxiety, whereas many of the participants responses express they rely on cigarettes when experiencing both extremes.

11. Please circle your favorite types of music

Options given: Blues MPHClassical MPHCountry/Western Lorraine; YodelGrunge: DorisHeavy Metal MPH; DorisHip Hop -Indigenous -

26

Instrumentals Lorraine; Patsy; DorisJazz -New Age -Opera MPHPop Doris; DollyRap DorisReggae -Religious YodelRock & Roll Lorraine; Patsy; Doris; DollySpirituals Lorraine; PatsyShows/Musicals MPH; DorisSynthetic -Other -

This question more than others expresses the importance of ‘taste’ in music. By offering a variety of options ( including ‘other’) participants were able to reflect on preferences to self-select tunes with an emphasis on music they considered had the best potential to replace the perceived benefits of smoking.

The responses indicate exposure to these various types of music at important stages in their lifespan have been appreciated, since they have continued to listen to them. One observation from the responses is that of all the options provided, likely preferences were not indicated (that is, the participant likely would have enjoyed the type of music, but didn’t list this).

The predominant theme is that participants tend to rely on traditional preferences, and that exposure to unfamiliar types of music may enhance their awareness of music variety as a way of coping with an attempt to quit smoking.

12. Please state your level of agreement with these statements

(Strongly Disagree Disagree Agree Strongly Agree)

Everybody knows how harmful smoking is Nicotine is more addictive than either heroin or cocaine To quit smoking is simply a matter of personal choice Cigarettes should be banned

27

11. Musical preference or 'taste'

Instrumentals

13%

Heavy Metal

9%

Grunge

4%

Classical

4%

C'try/ Western

9%

Blues

4%Shows/ musicals

9%

Spirituals

9%

Rock & Roll

18%

Religious

4%

Rap

4%Pop

9%

Opera

4%

Music is another form of pollution

(Qu. 12 continued)

Strongly Disagree Disagree Agree Strongly Agree

Everybody knows..

Patsy Yodel MPH; Lorraine; Dolly; Doris

Nicotine is..

Doris Lorraine; Patsy; Dolly

MPH; Yodel

Personal choice?

MPH Patsy Lorraine; Yodel; Dolly; Doris

Ban cigarettes?

Patsy; Dolly; Doris

MPH; Lorraine; Yodel

MusicPollution?

MPH; Lorraine; Dolly; Doris

Patsy Yodel

12. Please indicate on the following scale where you believe the answer is

The ultimate responsibility for commencing tobacco addiction lies with:

Individual The tobacco smokers industry

……………………………………………………………………………………..

Doris Lorraine/Yodel MPH Dolly Patsy

The ultimate responsibility for treating tobacco addiction lies with:

Individual Thesmokers government

……………………………………………………………………………………Dolly Lorraine/Yodel Patsy MPH

Doris: (no response)

These questions were about human responsibility, and personal interaction with the environment. As indicated, 100% (6) placed greater responsibility on personal agency for smoking-related illness, albeit in varying degrees below halfway on the continuum.

Similar responses were provided for the second question, although 17% (1) stated more responsibility lies with the government for treating tobacco addiction, and 17% (1) did not respond. The relationship to music listening is that just as an interaction occurs that can lead a person to commence smoking, so can there be an interaction that occurs when people

28

listen to music, that can prevent smoking from occurring, or enhance quit attempts. If the respondents represent the wider population in the store placed on personal responsibility, this is further indication that individual smokers could use music to assist them.

13. Additional feedback to questions:

Only three participants expanded upon their responses. These responses are:

MPH: Smoking is an addiction & a habit. Listening to music does not quell either of these

things. This is born out by the number of people who continued to smoke after smoking was

prohibited in the workplace and bars etc. More time and money should be available to assist

habitual smokers to quit.

Lorraine: I can’t see how this will stop me smoking, but they are relaxing and I don’t smoke

while listening to them.

Patsy: (Personal communication) I am so used to listening to music whilst smoking anyway.

Re: Qu 10: (‘When you smoke, is it mainly to relieve Boredom or Anxiety’):

“For all reasons, never boredom. To think, concentrate, relax, stop anger, etc”.

The researcher sought to have more input from participants for this section, since it allowed

expansion upon previous answers, and provided an opportunity for clarification and

comments. Of the three given, the motivations for smoking (to relieve anxiety and to relax) is

indicated, and endorsement of music as a cessation aid is expressed to varying degrees on a

continuum from least to most..

29

J) Discussion

Tobacco use is the leading cause of preventable death in the world and in New Zealand. It is

responsible for the death of one in ten adults worldwide – about five million deaths each

year, 13,500 deaths per day (WHO, 2005) and in New Zealand kills around 5000 New

Zealanders every year, including around 350 from exposure to second-hand smoke. Tobacco

is the only legally available product which, when used as the manufacturer intends, kills half

its users (WHO, 2005) (Anderson and Matthews, 2005, p. 9).

Re: variety and change

In discussing bodily pleasures that are ‘immediate, come through the senses, and are

momentary’ and includes the ending of the Beatles “Hey Jude”, Seligman (2002, p. 103)

acknowledges that these are difficult to build one’s life around due to their momentary

nature, and it is important to space these encounters out abstemiously to avoid

diminishing these pleasures:

they fade very rapidly once the external stimulus disappears, and we become

accustomed to them vary readily (“habituation”), often requiring bigger doses to

deliver the same kick as originally (Seligman, 2002, p. 103).

Various types of music are produced that can meet the need humans have for either

stimulation or relaxation. These terms (stimulation and relaxation) express a potential

relationship to life situations where people may turn to cigarettes due to boredom or

anxiety. These two terms are included in the title of a book Beyond boredom and anxiety

(Csikszentmihalyi, 1990) and were also mentioned by the Frenchman Blaise Pascal

(1623-1662) in a quote lamenting the nature of the human condition: ‘Inconstancy,

boredom, anxiety’ (Krailsheimer, 1966, p. 36).

Csikszentmihalyi is known for Flow: ‘the holistic sensation that people feel when they

act with total involvement’ (1990, p. 36). He believes that substance abuse contributes to

false sensations of Flow (Austin and Crawford, 2001, p. 99). Seligman states that when

people are engaged (absorbed in flow), ‘an investment is occurring’ (2002, p. 116), and

acknowledges Csikszentmihalyi’s theory ‘flow is the state that builds psychological

capital that can be drawn on in years to come’ (2002, p. 117).

30

Flow is expanded upon as:

…action follows upon action according to an internal logic that seems to need no

conscious intervention by the actor. He experiences it as a unified flowing from one

moment to the next, in which he is in control of his actions, and in which there is little

distinction between self and the environment, between stimulus and response, or

between past, present and future (Csikszentmihalyi, 1990, p. 36)

Re: Internal-External / interaction-exchange

The mention of internal and external environments, as well as stimulus and response,

links in with Homeostasis, a central theme developed by Walter Cannon (1871-1945).

This is an example of regulation for the processes occurring within human beings, and

responsible for maintaining a ‘steady state’ to preserve health.

What enables humans to sing along to music and dance to its rhythms is the fact that the

lyrics and the melody are stored in memory ‘banks’ (‘psychological space’), just as

substances are psychoactive, and occupy physical space. The research is based upon the

rationale that if someone is ‘dependent’, they have a need for resources to flow from

external (outside) to internal (inside), whereas ‘independence’ is expressed by a reverse

trend – internal to external. The following quote (Cole and Scribner, 1978) expresses the

directional flow of music as an example of an environmental stimulus:

Like tool systems, sign systems (language, writing, number systems) are created by

societies over the course of human history and change with the form of society and

the level of it’s cultural development…the internalization of culturally produced sign

systems brings about behavioral transformations and forms the bridge between early

and later forms of individual development (McMillan, 1991, p.32).

The developmentalist responsible for this quote (Vygotsky, 1896-1933) believed that

language held the key to understanding how society influences each person, and also how

individuals influence society (McMillan, 1991, p 38). Music therefore, cannot be neutral

in its effects. This is the key aspect of the rationale for this research, because it indicates

the influence that music potentially can have on individuals.

31

Music often contains lyrics (another name for words) and these are culturally produced

influences that ‘ride’ on the melody, ‘taken in’ to human consciousness from the external

environment. This happens with a concomitant effect on the developing person,

especially over time.

The concepts of internalization (Vygotsky) and psychological space (Bronfenbrenner) are

detailed in the ‘key terms’. These influence the internal response to quality music which

has the potential to produce genuine ‘Flow’, and enhance personal health and well-being

(a goal of Recreation Therapy). Stress was defined by Canadian physiologist Hans Selye

as ‘the non specific response of the body to any load placed on it’ (1974, p. 27). If this is

a contributing factor to the prevalence and continuation of smoking, then it can be

observed that the effect of cigarettes is non-specific also (the same internal physiological

response each time), whereas there is much greater variety in music (an external

influence), and therefore greater potential to benefit the person (that is, ‘efficacy’).

Re: Media.

Related to the themes developed around internal-external interaction and exchange is the

concept of media, from Latin medius for middle (Thompson, 1992, p. 552). Media was

defined as ‘technological extensions of the body’ by communications theorist Marshall

McLuhan (1911-1980), who reflected that a principal aim of his media analyses faculty

could be summarized as the training of perception, a phrase that aptly summarises his

own aim throughout his career. McLuhan had written Understanding Media (1964)

focusing on the media effects that permeate society and culture, but with an individual

starting point (Gordon, 2002).

Working with a hint from a political economist who had discovered that certain media of

communication are time-based and certain media - more portable and ephemeral – are

space based, and discovering simultaneously a critique of radio and TV, McLuhan

articulated these ‘extensions of the human body’ perceptions of media and of electronic

media, in particular, as extensions of the nervous system, imposing, like poetry, their own

assumptions on the psyche of the user (Marchand, 2002).

32

Contained within these biographical segments are the themes already mentioned, related

to the developmental theorists Vygotsky and Bronfenbrenner. The role of the nervous

system is mentioned, and media is situated between (medius) an individual’s internal and

external environment. If certain media are space based and others are time based, this

expresses the socio-historical nature of these media influences, consistent with these

theorists. In each case, there is something common to both music and smoking:

“Nothing has its meaning alone. Every figure [consciously noted element of a

structure or situation] must have its ground or environment [the rest of the structure

or situation which is not noticed]. A single word, divorced from its linguistic ground

would be useless. A note in isolation is not music. Consciousness is corporate action

involving all the senses (Latin sensus communis or ‘common sense’ is the translation

of all the senses into each other). The ‘meaning of meaning’ is relationship”.

Marshall McLuhan (Gordon, W.T. 1997, p.20)

33

J. Conclusions and Recommendations

J1) Conclusions (based on results)

For music to have efficacy as a smoking cessation aid, it will have to do more for the

person than the function served by cigarettes. A decisive factor in people’s reliance on

cigarettes is that they produce a near immediate physiological effect within the person,

and it this effect that smokers seek to reproduce each time they light up. Cigarettes are an

example of immediate gratification (nicotine reaches the brain in 7-10 seconds). A

conclusion is that music would have to have the same immediate effect, or produce the

desired feelings consistently over a period of time to reduce the nicotine dependence.

If the reason many people smoke is to cope with stress, then the ‘non-specific’ nature of

it is an indication that music is potentially efficacious for smoking cessation. Music too,

is non-specific, meaning that it is variable, and different tunes could be used to produce

various responses within people seeking to quit smoking, as the physiological response to

smoking is relatively constant.

In other words, the variability of music has greater potential for people to cope with

stress, because the right use of it potentially makes it specific to a person’s internal needs.

This is the reason for including in the appendices the common theme of efficiency

expressed through three different examples from Recreation therapy, Statistics, and

Management. The implication is that music potentially could serve as an aid to smoking

cessation, provided that it is perceived by the smoker to have the qualities that enable it to

do more for them than smoking does, and is relied on over a period of time.

J2) Recommendations (based on the conclusions)

J2.1) For professional practice to people in the field

It has been acknowledged that a key function of research is to contribute to a body of

knowledge for the particular profession (Baumgartner and Hensley, 2006). This implies

that the nature of the research focus must be clarified and related research must be

considered early on, since the topic chosen is broad with many aspects to it. Maintaining

a specific focus ensures that energies are used most effectively, and sight of the overall

research question is not lost while the initial details are sorted into respective order.

34

Looking for similarities between concepts used in tobacco control and recreation therapy

is important to establish common ground conducive to effective, collaborative practice. It

is likely that concepts relied on bear similarities but go by different names. An example

is the use of terms to describe the process. For example, Recreation Therapy uses the

‘APIE’ model (Assessment, Planning, Implementation, Evaluation), whilst it has been

observed that the Tobacco control concept of social marketing (Donovan and Henley,

2003) contains these terms also:

the application of commercial marketing technologies to the analysis, planning,

execution, and evaluation of programmes designed to influence the voluntary or

involuntary behaviour of target audiences in order to improve the welfare of

individuals and society (Health Sponsorship Council, 2005, p. 81, emphasis added).

It will be necessary to liaise with a variety of people to accomplish the research objective,

and the implication is that the research has to adapt to different schedules, which can be

time-consuming, and requires a great deal of coordination.

Future research could pursue a similar theme, though experiment with different designs

to find the most effective indicator that music can be an aid to smoking cessation.

An article (Arnott, 2007) covered the theme of human responsibility, stating that

individual smokers should not be held wholly responsible for their situation, due to the

addictive nature of nicotine. Researchers should keep this in mind when dealing with

subjects who smoke.

J2.2) to future researchers studying the same or similar topics

Further research:

Length of time

Could music serve as a cessation aid due to the length of particular tunes lasting longer than the

time it takes to smoke a cigarette?

Sequence

What is the role of sequence (especially of lyrics) for attracting/maintaining attention? That is,

playing songs with a similar theme but vary to some degree gradually.

35

The rationale is that just as arrangement of words and letters make a sentence, arrangement of

lyrics (and notes) contribute to an overall effect (that is, greater or lesser efficacy).

Research design

Could the nature of the research (for example, frequency and duration of listening periods) better

reveal the efficacy of music as a cessation aid?

Impact of different types of music and artists performing

- do different vocal styles, instrumentation impact more/less than others?

- what is the role of cultural/ethnic music (as opposed to contemporary?)

Music as a ‘universal language’

Does the enduring quality of various tunes indicate the common preferences of large proportions

of the population (despite individual differences), and does this relate to the enduring ‘quality’ of

various types of tobacco?

(Example: Hey Jude by the Beatles compared with Marlboro by Phillip Morris/Altria)

Flow

What is the role of music in producing the state of genuine Flow (and therefore enhance personal

health and well-being?)

Role of the Nervous system (Autonomic: sympathetic/parasympathetic)

This needs to be considered in depth, to discover if the same parts of the brain/central nervous

system are affected by music as they are for smoking.

Efficacy of music to treat other substance use and behaviours

Alcohol, Cannabis and ‘harder’ drugs, Gambling.

Music’s role on contributing to smoking uptake and prevalence.

- social learning.

- the association of music with smoking as a tobacco industry strategy.

- does music contribute to increased prevalence and use?

- how do different types of music, played at different frequencies and times influence smoking

behaviour and prevalence?

Sight/Sound = ‘media’

What is the role of music videos, (which combine a visual aspect with lyrics and melodies to

produce an interactive experience) in smoking prevention or prevalence?

Integration of research influences

The references cited are all considered to relate the topic of smoking-related influences, though

these relationships need further exploration for the sake of ‘efficacy’.

36

K) Reference list.

Anderson, M. and Matthews, K. (2005) Beginner’s guide to tobacco control in Aotearoa- New Zealand. Wellington: Health Sponsorship Council

Arnott, D. (2007, January 8) Don’t hate the smoker. Comment is free…www.commentisfree.guardian.co.uk (retrieved 27/4/07)

Baumgartner, T.A., and Hensley, L.D. (2006, 4th Edition) Conducting and reading research in health and human performance. Boston: McGraw-Hill

Blood, A.J., and Zatore, R.J. (2001, September 25th) Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotionPNAS, Vol 98, no 20 (www.psych.mcgill.ca Retrieved 18/5/07)

C.K. Brightbill (1960) The Challenge of LeisureEnglewood Cliffs, NJ: Prentice-Hall

Brandt, A. M. (2007) The cigarette century New York: Perseus books

Bronfenbrenner, U. (1979) The ecology of human development; experiments by nature and design. Cambridge, MA: Harvard University Press

Chaplin, J.P. (1985) Dictionary of psychologyNew York: Laurel books

Csikszentmihalyi, M. (2000) Beyond boredom and anxietySan Francisco: Jossey-Bass

Durrant, R., and Thakker, J. (2003) Substance use and abuseThousand Oaks, CA: Sage

Ford, B.J. (1994) Smokescreen: a guide to the personal risks and global effects of the cigarette habit. Perth, WA: Halcyon Press

Fox, E.L., Bowers, R.W., and Foss, M.L. (1989) The physiological basis of physical education and athletics. Dubuque, IA: Wm. C. Brown

Gordon, W.T. (1997) Take today. McLuhan for beginnersLondon. Writers and Readers Ltd.

(2002, July) Biography 2. www.marshallmcluhan.com (Retrieved 25/7/07)

Hanser, S. B. (1999) The new music therapist’s handbookBoston, MA; Berklee Press

Health Sponsorship Council (July, 2005) Reducing smoking initiation literature review: a background discussion document to support the national framework in Aotearoa-New Zealand. Wellington: Health Sponsorship Council

37

Hulse, G., White, J., and Cape, C. (2002) Management of alcohol and drug problemsMelbourne: Oxford University Press

Jones, G.R., George, J.M., and Hill, C.W.L (2000) Contemporary managementBoston: Irwin McGraw-Hill

Krailsheimer, A.J. (1966) Blaise Pascal: PenseesLondon: Penguin

Kraus, R., and Shank, J. (1992) Therapeutic recreation service: principles and practiceDubuque, IA; Wm. C. Brown Publishers

Kunstler, R. (2001) Substance abuse. (pp 94-112) McGuire, F. (2001) Cardiac rehabilitation (pp 269-279)

In D.R. Austin and M.E. Crawford (Eds) Therapeutic recreation: an introductionNeedham Heights, MA: Allyn and Bacon

Linzey, T. (1991) Metaphors and theoretical innovation in human development (pp. 227-252)McMillan, B. (1991) All in the mind (pp 30-45)

In J.R. Morss and T. Linzey (Eds) Growing up: the politics of human learningAuckland: Longman Paul

Marchand. P. (2002, July) Biography 3. www.marshallmcluhan.com (retrieved 25/7/07)

National Health Committee (2004) Guidelines for smoking cessationWellington: Ministry of Health

National Heart Foundation (2006) Guidelines for smoking cessation: practitioner training programme. Christchurch: National Heart Foundation

Peterson, C.A., and Stumbo, N.J. (2000) Therapeutic recreation: principles and practiceNeedham Heights, MA: Allyn and Bacon

Russell, R.V. (2005) Pastimes: the context of contemporary leisureChampaign, Il: Sagamore

Seeley, R.R., Stevens, T.D. and Tate, P. (1992) Anatomy and PhysiologySt Louis, MI: Mosby Year-Book, Inc

Seligman, M.E.P. (2002) Authentic happinessNew York: The Free Press

Selye, H. (1974) Stress without distressLondon: Hodder and Stoughton

Smith, N. Counting the beat. The Listener (11/11/06, pp. 24-26)

Thompson, D (1992) The pocket oxford dictionaryLondon: Oxford University Press

38

www.ash.org.uk (2005, Oct 14) Nicotine Assisted Reduction to Stop (NARS): Guidance for health professionals on this new indication for nicotine replacement therapy

www.psych.mcgill.ca/pdf (Daniel Levitin) The beat goes on – in your brain. (April 19, 2007) by Susan Dominus, Sydney Morning Herald, p.11 (Retrieved 25/7/07).

This is your brain on music. (Retrieved 18/5/07)

Journal articles cited:

Abrams B., and Decker G.M. Integrated care: Music, cancer and immunity. Clinical Journal of Oncology Nursing, 2001 Sep-Oct; 5 (5): 222-224

Evans, D. The effectiveness of music as an intervention for hospital patients: a systematic review. Journal of Advanced Nursing, 2002 Jan; 37 (1): 8-18

Gallant, W., Holosko, M., and Siegel, S. The use of music in counseling addictive clients.Journal of Alcohol and Drug Education, Winter 97. 42 (2) 42-52

Healthy news. The sounds of healing. Health 2001, Oct; 15 (8) 28

Vital signs: news for healthy living. Killing pain softly with a song. Health, 1999 Sep; 13 (7): 24

Mazo, E. The medicine of music. Health, 2002 Jun; 16 (5) 74-81

McCaffrey, R; Music listening as a nursing intervention: a symphony of practiceHolistic Nursing Practice, 2002 Apr 16 (3): 70-7

Paul, S., and Ramsey, D. Music Therapy in physical medicine and rehabilitationAustralian Occupational Therapy Journal, 2000 Sep; 47 (3) 111-8

Winkleman, M. Drumming out drugs: Complementary therapy for addictionAmerican Journal of Public Health, 2003; 93, 647-651

39

L) Appendices

Efficiency is a common theme running through three different examples from

Therapeutic Recreation (1. the relationship between client programmes and needs);

Statistics (2. decision on alternate hypotheses and alpha level), and Management thought,

(3. the relationship between efficiency and effectiveness).

1. Relationship between client placement into programmes and client needs

Client placed into programme Client not placed into programme

Client needs programmeI. Correct decision II. Incorrect decisionClient receives necessary Client does not receiveServices – likely to be necessary services – no orintervention unnecessary programme

involvement

Client does not need programmeIII. Incorrect decision IV. Correct decisionClient receives unnecessary Client does not receive Services – not likely to be services – programmeintervention involvement not necessary

(Peterson and Stumbo, 2000, p. 205)

2. Decision on alternate hypotheses and alpha level(Figure: four possible outcomes in a research study)

Decision

True Accept Reject

Good decision Type I error

Type II error Good decision

False

40

(No 2. continued)

Explanation: The null hypothesis (Ho) is the hypothesis stating that the independent

variable has “no effect” on the dependent variable. A Type I error is rejection of a true

null hypothesis. A Type II error is acceptance or non-rejection of a false null hypothesis

(Baumgartner and Hensley, 2005, pp. 70; 289-290)

3. The relationship between efficiency and effectiveness

EfficiencyLow High

Low efficiency/High effectiveness

Manager chooses the right goals to pursue, but does a poor job of using resources to achieve

these goals.

Result: A product that customers want, but that is too expensive for them to buy

High efficiency/High effectiveness

Manager chooses the right goals to pursue and makes good use of resources to achieve these

goals.

Result: A product that customers want at a quality and price that they can afford.

Low efficiency/Low effectiveness

Manager chooses wrong goals to pursue and makes poor use of resources.

Result: a low-quality product that customers do not want.

High efficiency/Low effectiveness

Manager chooses inappropriate goals, but makes good use of resources to pursue these

goals.

Result: A high quality product that customers do not want.

Explanation: Organisational performance is a measure of how efficiently and effectively

managers use resources to satisfy customers and achieve organizational goals. Efficiency

is a measure of how well or productively resources are used to achieve a goal.

Effectiveness is a measure of the appropriateness of the goals of an organization is

pursuing and the degree to which the organization achieves those goals

(Jones, George, and Hill, 2000, pp. 5-6).

41