Pathways through adolescent smoking: a 7-year longitudinal grouping analysis.

This study examined longitudinal patterns of smoking among students (N = 852) followed from 6th through 12th grades using longitudinal grouping analysis. Six patterns (clusters) were identified: nonsmokers, quitters, experimenters, early escalators, late escalators, and continuous smokers. Baseline (6th-grade) differences in associated risk factors were examined. Growth curve modeling revealed meaningful intercluster differences in risk factor trends over the study period. In general, nonsmokers had the fewest baseline risk factors and slowest increase in risk factors, whereas continuous smokers had higher baseline and more rapidly increasing trends in risk factors. Results suggest that some clusters may respond to population-based antismoking interventions, whereas others (early escalators and continuous smokers) will probably require more focused interventions.     

Interest in Participating in Smoking Cessation Treatment Among Latino Primary Care Patients

Smoking is the leading preventable cause of disease and death for U.S. Latinos. This study identified correlates of interest in participating in a smoking cessation program among urban Latinos seen in community clinics. Interviews were completed with 141 current smokers. Participants were predominantly Spanish-speaking (93%) males (66%), who were on average 37.6 years old and smoked 8.7 cigarettes per day. Over two-thirds (63%) of participants were “definitely interested” in participating in a smoking cessation program. Participants who smoked more cigarettes per day and reported greater nicotine dependence, depression, and readiness to quit were more likely to be interested, while those employed fulltime were less likely to report high interest. Treatment preferences were consistent with Clinical Practice Guidelines recommending counseling, social support, and pharmacotherapy. Results support recommendations that healthcare providers intervene with all Latino smokers, including light smokers and those who do not report initial interest in smoking cessation.     

Adolescent personality antecedents of adult cigarette smoking: a longitudinal study

Comprehensive personality assessments, made independently for early and late adolescence, were employed to predict smoking onset and maximum number of cigarettes smoked per day as reported by adult smokers. Also, comparisons were made between adult smokers and nonsmokers. The results indicate that men who had been more sexually active as adolescents smoked more but that women who had been more emotionally constricted and under more conflict as adolescents were heavier smokers. Smoking started earlier for men who had showed little self-awareness and a rather macho orientation during their adolescence; early-smoking women tended to have been conventionally feminine. Personality differences between future smokers and nonsmokers were few but showed similar sex differences. The results suggest that manifesting once traditional sex-role characteristics for both adolescent boys and girls presages early onset and heavier adult cigarette smoking. Preventive antismoking educational campaigns aimed at youth might be guided by these findings because they suggest some motivational bases that may find later expression in smoking practices.     

Adolescent Personality Antecedents of Adult Cigarette Smoking: A Longitudinal Study

Comprehensive personality assessments, made independently for early and late adolescence, were employed to predict smoking onset and maximum number of cigarettes smoked per day as reported by adult smokers. Also, comparisons were made between adult smokers and nonsmokers. The results indicate that men who had been more sexually active as adolescents smoked more but that women who had been more emotionally constricted and under more conflict as adolescents were heavier smokers. Smoking started earlier for men who had showed little self-awareness and a rather macho orientation during their adolescence; early-smoking women tended to have been conventionally feminine. Personality differences between future smokers and nonsmokers were few but showed similar sex differences. The results suggest that manifesting once traditional sex-role characteristics for both adolescent boys and girls presages early onset and heavier adult cigarette smoking. Preventive antismoking educational campaigns aimed at youth might be guided by these findings because they suggest some motivational bases that may find later expression in smoking practices.     

A model of situational preference amongst smokers

Seventy-five medium-light smokers rated their performance for smoking in 25 situations covering a range of high- and low-stress situations. Information on personality, age, sex, length of habit, number of cigarettes smoked, amount inhaled and amount of cigarettes smoked was also obtained. Six main factors were extracted by principal-factor analysis which were related respectively to situations involving preparatory activity, attentional stress, neutral relaxation conditions, unpleasant (anxiety) and pleasant (excited) emotional stress and social vs isolated activity. Smokers who scored high on Neuroticism tended to smoke more when experiencing unpleasant emotions; older smokers smoked predominantly in pleasant relaxing conditions; extraverts and low-activity situational smokers, reported inhaling more. A model of smoker motivation is developed which suggests that both pharmacological and psychological factors contribute to habit maintenance. Three basic motivational types of smokers are identified: high-stress smokers for whom smoking is a secondary activity, and who rely on smoking to form a minor distraction for their current task. Low-activity smokers who wish to act, or change their current affective state in some way and who rely on pharmacological factors. Neutral relaxation smokers for whom smoking is a pleasurable activity in its own right.     

Smoking patterns and dependence: contrasting chippers and heavy smokers

The authors used ecological momentary assessment to contrast smoking patterns among chippers (CHs; n = 26)--smokers who smoke despite an apparent absence of tobacco dependence--with those seen in heavy smokers (HSs; n = 28). Smoking and nonsmoking settings (activity, mood, etc.) were assessed by means of electronic diary. CHs were not social smokers; like HSs, they smoked half their cigarettes while alone. When smoking, CHs' urge levels equaled those of HSs; between cigarettes, CHs had few urges, whereas HSs reported moderate urges. CHs' smoking was particularly associated with indulgent activities: relaxation, socializing, eating, and drinking alcohol. Outside of these indulgent settings, CHs' (but not HSs') smoking was associated with negative affect. In idiographic analyses, CHs' smoking was under much stronger stimulus control than was that of HSs. The authors propose that the disappearance of stimulus control over use is a characteristic of dependence.     

Perceived health: a test of incremental validity in relation to smoking outcome expectancies, motivation to smoke and desire to quit smoking

This study examined the role of perceived health in predicting theoretically-relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.     

A national survey of older smokers: treatment needs of a growing population

Examined smoking and quitting patterns among 289 smokers ages 50 to 74 years who took part in a nationwide survey of American Association of Retired Persons members. Respondents were predominantly chronic, heavy smokers. They had smoked for an average of 45 years, more than one third smoked 25 or more cigarettes per day, and more than two thirds showed evidence of high nicotine addiction. Nonetheless, most were interested in quitting smoking and reported plans to quit in the next year. Concerns about missing or craving cigarettes; losing a pleasure; and being nervous, tense, or irritable after quitting were the most common barriers to quitting reported. These problems were rated as more serious by heavier, longer term smokers and by smokers with lower quitting self-efficacy. The variables most strongly associated with "contemplating" quitting were beliefs in quitting health benefits, recent attempts to quit or cut down, prior attempts to quit, and high self-efficacy. Limitations of these findings are discussed along with implications for the design of treatments geared to the special needs of older smokers.     

Implicit alcohol and smoking associations among young adult heavy drinkers: Associations with smoking status and alcohol-cigarette co-use

Implicit memory associations may play a role in motivation to use alcohol and cigarettes, but the relationship between implicit associations and co-use of alcohol and cigarettes is currently unknown. This study provided an initial examination of alcohol and smoking implicit associations among young adult drinkers who were either nonsmokers or relatively light smokers (i.e., 10 or fewer cigarettes per day) as a function of smoking frequency and daily-level alcohol-cigarette co-use. Drinkers (n?=?129) completed alcohol-arousal and smoking-valence variants of the implicit association test as well as a daily-level assessment of past 90-day alcohol and cigarette use. Smokers were grouped according to whether they reported daily or nondaily smoking frequency. Results showed that although implicit alcohol-arousal associations did not differ between smokers and nonsmokers, stronger implicit alcohol-arousal associations were observed for nondaily smokers relative to daily smokers after controlling for drinking frequency. Further, implicit positive-smoking associations were stronger for smokers relative to nonsmokers. Within the subgroup of nondaily smokers, more frequent co-use of alcohol and cigarettes was associated with stronger implicit positive-smoking associations when controlling for total drinking and smoking frequency. The findings suggest that implicit alcohol and smoking associations may be linked with smoking patterns (daily vs. nondaily) and co-use of alcohol and cigarettes among young adult drinkers who are not heavy smokers, highlighting the need for more research on the role of implicit associations in the co-use of cigarettes and alcohol.     

Perceived Health: A Test of Incremental Validity in Relation to Smoking Outcome Expectancies,Motivation to Smoke and Desire to Quit Smoking

This study examined the role of perceived health in predicting theoretically‐relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.     

The acute effects of nicotine on positive and negative affect in adolescent smokers

Although adolescent cigarette smoking remains a critical public health concern, little is known about the reinforcing mechanisms governing smoking in this vulnerable population. To assess predictions derived from both positive and negative reinforcement models of drug use, the authors measured the acute effects of nicotine, as administered via tobacco cigarettes, on both positive and negative affect in a group of 15- to 18-year-old smokers. A matched group of nonsmokers served as a comparison group. Findings revealed that whereas adolescents who smoked a cigarette experienced reductions in both positive and negative affect, the observed reductions in negative affect were moderated by nicotine content of the cigarette (high yield vs. denicotinized), level of nicotine dependence, level of baseline craving, and smoking expectancies pertinent to negative affect regulation. Nonsmokers experienced no change in affect over the 10-min assessment period, and no interaction effects were observed for positive affect. Overall, the findings conform to a negative reinforcement model of nicotine effects and strongly suggest that, even among young light smokers, nicotine dependence and resultant withdrawal symptomatology may serve as motivating factors governing smoking behavior.     

Gender differences in smoking behavior in a university workplace

Behavioral approaches to smoking intervention benefit from an understanding of smoking behavior. We investigated gender differences in smoking behavior by observing 292 men and 648 women smoking in a university workplace. Although men smoked more cigarettes in longer break times than women, there were no gender differences in the time individual cigarettes were lit or time in the mouth. However, men inhaled significnatly more than women. The social environment differed with male smokers talking to equal numbers of men and women, while female subjects talked to more females than males while smoking. In smoking lounges, more women than men held the cigarettes near their face (38 vs. 28%). With increasing age, male smokers took longer breaks, had cigarettes lit for less time, and talked to more men, whereas with increasing age female smokers took fewer puffs and talked to fewer men. Thus men take longer breaks, smoke more cigarettes, and inhale more often than women in a university workplace setting.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

Predictors of Smoking Status After Eight Years: The Interaction of Stages of Change and Addiction Variables

Abstract

With a smoking rate of 30% of the population Switzerland has one of the highest rates of all industrialised countries. Changes in smoking status over eight years are examined by analysing the course of non-smokers, former smokers and current smokers between 1987 and 1995. Stages of change and addiction variables, as well as their interaction, are analysed for 1987 as predictors of smoking status in 1995.A sample of 953 non-smokers and former and current smokers was interviewed in 1987 and followed up in 1995. Between 1987 and 1995 every fifth non-smoker (20.9%) began smoking. The higher one is in the stage hierarchy the higher the probability of forward than of backward movement. Within the stages of change the likelihood of cessation is moderated by addiction variables. Thus, in the case of contemplating smokers in 1987, the more cigarettes they smoked daily at that time the less likely they were to be former smokers by 1995, but for preparating smokers who had already made an attempt to quit the converse holds - the more they smoked in 1987, the more likely they were to be non-smokers eight years later. The same holds for former smokers in 1987: former moderate smokers then were more likely to relapse than former heavy smokers. The implications for prevention and intervention are discussed.     

Conscientiousness, perceived risk, and risk-reduction behaviors: a preliminary study.

Participants (N = 343) from an Oregon community completed surveys at baseline, 3 months, and 12 months to assess personality, the perceived health risk of radon in combination with smoking, and changes in smoking behavior. Conscientiousness predicted instituting a more restrictive household smoking rule (p < .01), and perceived risk predicted reduction in cigarettes smoked per day for men (p < .001). Perceived risk predicted a reduction in the proportion of cigarettes smoked in the home for those who had high (p < .05) but not low or moderate levels of Conscientiousness, a dimension in one personality model. The results demonstrate the importance of Conscientiousness in the prediction of health behavior, particularly behavior that affects others as well as oneself.     

Learned Resourcefulness,Drinking, and Smoking in Young Adults

The purpose of this study was to examine the relationship between learned resourcefulness and two common addictive behaviors, namely, drinking and smoking. Male and female college students (N = 175) completed the Self-Control Schedule (SCS), the Quantity-Frequency-Variability questionnaire, and a smoking history form. Learned resourcefulness was related to self-reported patterns of alcohol consumption; specifically, heavy drinking subjects were lower in learned resourcefulness than were light and moderate drinkers who, in turn, were lower in learned resourcefulness than were infrequent drinkers and abstainers. Learned resourcefulness was only modestly related to smoking, with students who had never smoked evidencing somewhat higher learned resourcefulness than ex-smokers and current smokers. Overall, these data provide correlational support for the notion that learned resourcefulness may protect young adults against substance abuse.     

Effects of Enforcement of Youth Access Laws on Smoking Prevalence

Smoking is the primary preventable cause of death, and yet 3,000 adolescents become smokers each day. Most adult smokers begin this deadly habit when they are under the age of 18, which is the minimum legal age for the purchase of cigarettes. The majority of adolescent smokers are able to purchase cigarettes even though laws prohibit the sale of cigarettes to minors. In the late 1980s, Woodridge, IL, became one of the first towns in the nation to demonstrate a significant reduction in the ability of youth to purchase cigarettes. Almost 2 years after passage of this legislation, the percentage of regular smokers among 7th- and 8th-grade students had been reduced from 16 to 5%. Seven-year follow-up data in a sample of high school youths indicate that youths living in communities with regular enforcement had significantly less smoking than those living in communities without regular enforcement. In particular, rates of regular smoking were 8.1% in communities with regular enforcement versus 15.5% in communities without regular enforcement. It is possible that adolescents who had restricted access to tobacco products were less likely to become regular smokers. These findings have important public health implications, particularly in light of recent federal legislation mandating that all states develop programs to reduce access of youth to tobacco products.     

Learned resourcefulness, drinking, and smoking in young adults

The purpose of this study was to examine the relationship between learned resourcefulness and two common addictive behaviors, namely, drinking and smoking. Male and female college students (N = 175) completed the Self-Control Schedule (SCS), the Quantity-Frequency-Variability questionnaire, and a smoking history form. Learned resourcefulness was related to self-reported patterns of alcohol consumption; specifically, heavy drinking subjects were lower in learned resourcefulness than were light and moderate drinkers who, in turn, were lower in learned resourcefulness than were infrequent drinkers and abstainers. Learned resourcefulness was only modestly related to smoking, with students who had never smoked evidencing somewhat higher learned resourcefulness than ex-smokers and current smokers. Overall, these data provide correlational support for the notion that learned resourcefulness may protect young adults against substance abuse.     

Attitudinal and Social Factors in Adolescent Smoking: In Search of Peer Group Influence1

The smoking attitudes and behavior of two samples of British 15-year-olds (N = 278) were studied by questionnaire. “Smokers” (anyone who had smoked at all within the previous week) held less negative attitudes about smoking, were more likely to have a father who smoked, and anticipated less parental disapproval of their smoking. When asked to name their five best friends among their classmates, smokers were more likely to name other smokers than were nonsmokers. On the basis of these results, we argue that the notion of “peer group influence” should be reconceptualized in terms of intergroup processes and social identity concerns within the peer group.