Warning! The following packet contains shocking images: The impact of mortality salience on the effectiveness of graphic cigarette warning labels

This research looks at a recent initiative to encourage smokers to quit smoking and to discourage nonsmokers from starting to smoke. Evidence has shown that text‐based warning labels are ineffective in drawing attention to the dangers of tobacco consumption; therefore, some governments are looking to draw current smokers and potential smokers away from cigarettes by displaying graphic images of various smoking ailments. This research draws on Terror Management Theory as a means of understanding the effects of graphic visual images in cigarette packaging and offers implications for public health researchers, social marketers, and antismoking campaigners to help smokers to quit and reduce the likelihood of potential smokers becoming smokers. Copyright © 2012 John Wiley & Sons, Ltd.     

Cigarette smokers do more than just smoke cigarettes

In this study, we hypothesized that light and moderate-to-heavy cigarette smokers, when compared with nonsmokers, would exhibit significantly less healthy attitudes and behaviors on several dimensions relevant to the risk of coronary heart disease (CHD). A factor analysis of survey items measuring knowledge, attitudes, and behaviors in five CHD risk areas produced four major factors, which we labeled Attitudes (Factor 1), Health Consciousness (Factor 2), Knowledge (Factor 3), and Unhealthy Behaviors (Factor 4). Factor-based scales generated for each of these four factors were used in a one-way multivariate analysis of variance to examine differences between nonsmokers, light smokers, and moderate-to-heavy smokers. Cigarette smokers versus nonsmokers exhibited less positive attitudes toward CHD risk behaviors, whereas moderate-to-heavy cigarette smokers, as compared with the light smokers and the nonsmokers, exhibited lower levels of health consciousness and enacted unhealthy behaviors at a greater frequency. The moderate-to-heavy cigarette smokers also exhibited a lower commitment to enact healthy behavioral changes in the immediate future, even after corrections were introduced for their lower frequency of healthy behaviors during the past week. Overall, these results support our hypothesis that cigarette smokers, particularly as they become more involved with cigarette smoking, do more than just smoke cigarettes; they exhibit a less healthy lifestyle as shown by cognitive, behavioral, and motivational dimensions related to cardiovascular health.     

The Aura of Tobacco Smoke: Cigars and Cigarettes as Image Makers

Male and female college undergraduates evaluated the character traits of men and women who were seen smoking cigars, smoking cigarettes, or not smoking. The evaluated adults were about 10 years older than the students. Irrespective of the evaluated persons' gender, ratings of appeal were specific to the gender of the evaluator. Men and women agreed in their perception of cigarette smokers as being less appealing than nonsmokers. However, whereas men ascribed markedly less appeal to cigar smokers than to cigarette smokers, women perceived cigar smokers as being as appealing as nonsmokers. This pattern was observed for all positive aspects of appeal; the inverse pattern was apparent for all negative aspects of appeal. In contrast, men and women concurred in judging cigar smokers as being more confident and secure than either nonsmokers or cigarette smokers.     

Electroencephalographic responses to photic stimulation in habitual smokers and nonsmokers.

Two studies are reported in which electroencephalograms (EEGs) of habitual cigarette smokers and of nonsmokers were taken before and after they were required to smoke a cigarette. The EEGs were scored for incidence of EEG "driving" responses to photic stimulation, an index that appears to reflect the balance between central adrenergic and cholinergic nervous systems. The findings suggest that smokers tend to have a central autonomic balance less in favor of adrenergic functioning than do nonsmokers. Cigarette smoking may alleviate a possible central adrenergic insufficiency of smokers. These findings suggest a solution to "Nesbitt's paradox," which has reference to the fact that while nicotine is a central adrenergic stimulant, smokers describe the effect of smoking in sedational terms (i.e., as relaxing or calming).     

Effects of tobacco smoking on electroencephalographic, auditory evoked and event related potentials

After overnight abstinence, tobacco smokers smoked an average nicotine yield cigarette and nonsmokers sham smoked an unlit placebo cigarette. EEG alpha(1), delta, and theta frequency amplitudes decreased, whereas alpha(2) and beta frequency amplitude increased. Short, middle (EP) and long latency ERP were also studied in nonsmokers and smokers just after smoking, and after overnight abstinence from tobacco. Short latency potentials were unaffected by tobacco smoking or abstinence. Middle and long-latency potentials were reduced during abstinence and enhanced immediately after tobacco smoking. These findings indicate that compared to nonsmokers smokers have a higher arousal level after smoking than when partially abstinent. Evidence for both normalization from tobacco abstinence as well as stimulation was obtained.     

Smoking,personality, and imagery preference in Relation to spontaneous bilateral electrodermal activity

Effects of smoking on spontaneous bilateral skin conductance were studied as a consequence of interactions with set and setting. Bilateral skin conductance was recorded in six men and six women who smoked and an equal number of nonsmokers on two different days. On the first day, spontaneous electrodermal activity was recorded before and after a 10-minute rest period during which half the smokers smoked a cigarette. On the second day, one week later, spontaneous activity was again recorded before and after a 10-minute rest period during which the remaining smokers smoked a cigarette. Nonsmokers did not smoke at any time. Following smoking there was a significant negative correlation between a preference for visual over nonvisual imagery and spontaneous skin conductance responsivity in the left as compared to the right hand. Correlations were significantly different in smokers and nonsmokers. Smokers showed significantly greater preferences for either visual or nonvisual imagery than nonsmokers. Nonresponding nonsmokers were higher on the psychoticism (P) scale of the Eysenck Personality Questionnaire (EPQ) than responding nonsmokers. Smokers scored higher on P than nonsmokers. Interactions between personality, cognitive style, and the experimental situation, set, and setting were discussed in relation to the arousing effects of nicotine.     

Prevalence of cigarette smoking in Iran.

The current research assessed the prevalence of cigarette smoking in Shiraz, Iran by randomly selecting 1,335 subjects (782 men and 553 women) from the city for a face-to-face interview and completion of a questionnaire. Of the participants, 205 (26%) of the men and 20 (3.6%) of the women reported being current smokers. The mean ages of smokers and nonsmokers were 41.8 and 37.0 yr., respectively (range between 16 and 90 years for smokers and nonsmokers). The mean age of starting to smoke cigarettes was 21.3 yr. (range of 10 to 60). The most common reasons for current cigarette smoking were Need to avoid withdrawal symptoms, Release of tension, and Pleasurable purposes. Foreign filter-tipped cigarettes were the most common type consumed. The mean number of cigarettes per day was 13.4 (SD = 10.3). Reports for onset of cigarette smoking included Modeling, Release of tension, and Pleasurable purposes. Cigarette smoking was reported by more males than females. The most common reason for onset of cigarette smoking was different from that for current smoking. Frequencies of smokers within age groups were varied.     

A note on responses to ethyl alcohol before and after smoking1

Differential sensitivity was measured before and after smoking a cigarette by 10 smokers, using 10 nonsmokers as controls. Stimuli consisted of reagent grade ethanol in eight concentrations ranging from 4% to 12%. No significant differences were observed between smokers and nonsmokers or before vs after smoking, although slightly higher overall correct responses and correspondingly smaller jnds were obtained for the nonsmokers. No practice affects were noted among the control group between the first and second set of samples. The findings confirm previous results which had been recently questioned.     

Residual effects of cigarette smoking on cognitive performance in normal aging

The present study examined the residual effects of smoking status on cognitive function in 76 nondemented older adults. Current smokers, ex-smokers, and nonsmokers who were screened for health and intellectual impairments were administered a battery of standardized neuropsychological tests to measure problem solving, psychomotor speed, memory, attention span, perception, and language production. Performance decrements were found for smokers on measures of psychomotor speed. No between-group differences were noted on any of the nonspeeded tests. There were no differences between nonsmokers and ex-smokers on any measures. The results suggest that the residual effects of current cigarette smoking negatively influence speeded cognitive capabilities in older adults.     

Associations Among Smoking,Anhedonia, and Reward Learning in Depression

Depression and cigarette smoking co-occur at high rates. However, the etiological mechanisms that contribute to this relationship remain unclear. Anhedonia and associated impairments in reward learning are key features of depression, which also have been linked to the onset and maintenance of cigarette smoking. However, few studies have investigated differences in anhedonia and reward learning among depressed smokers and depressed nonsmokers. The goal of this study was to examine putative differences in anhedonia and reward learning in depressed smokers (n = 36) and depressed nonsmokers (n = 44). To this end, participants completed self-report measures of anhedonia and behavioral activation (BAS reward responsiveness scores) and as well as a probabilistic reward task rooted in signal detection theory, which measures reward learning (Pizzagalli, Jahn, & O'Shea, 2005). When considering self-report measures, depressed smokers reported higher trait anhedonia and reduced BAS reward responsiveness scores compared to depressed nonsmokers. In contrast to self-report measures, nicotine-satiated depressed smokers demonstrated greater acquisition of reward-based learning compared to depressed nonsmokers as indexed by the probabilistic reward task. Findings may point to a potential mechanism underlying the frequent co-occurrence of smoking and depression. These results highlight the importance of continued investigation of the role of anhedonia and reward system functioning in the co-occurrence of depression and nicotine abuse. Results also may support the use of treatments targeting reward learning (e.g., behavioral activation) to enhance smoking cessation among individuals with depression.     

Gustatory responses during periods of controlled and ad lib cigarette smoking

Three psychophysical methods, differential sensitivity, perceived intensity, and degree of liking, were used to measure gustatory responses among nonsmokers and among smokers who were placed on 2-week schedules of increased and decreased cigarette consumption. Varying the smoking levels had little influence on the smokers’ sensitivity to the tastes of sucrose and sodium chloride. Throughout the experiments, nonsmokers were slightly more sensitive than smokers. Lower intensity ratings were ascribed to both compounds by smokers than by nonsmokers. Degree of liking of the test solutions was unrelated to smoking. A subsequent experiment showed that 45 nonsmokers were slightly, but not significantly, more sensitive than were 45 smokers to the tastes of sucrose, sodium chloride, citric acid, and quinine hydrochloride, with no differences in their sensitivity to the odor of 2-butanone and to the viscosity imparted by carrageenan gum. There was a slight inverse relationship between sensitivity and the number of cigarettes smoked per day. Smokers liked coffee significantly better and drank more cups per day than did nonsmokers. Few changes in body weight were observed, despite the smokers’ subjective assessment that their appetites and food intake were inversely related to the number of cigarettes smoked.     

Tobacco Smoking as an Index of Military Personnel Quality

Previous studies indicate that smokers attrite from military service at significantly higher rates than nonsmokers. The purpose of the current effort is twofold: (a) to examine the implications of treating smoking status as a third military accession quality indicator along with educational credential and mental ability, and (b) to explore preservice psychosocial and health differences between smokers and nonsmokers in support of hypothesis development about reasons for elevated attrition rates in smokers. The results indicate that individuals who smoke tobacco prior to entering military service are almost twice as likely to attrite as nonsmokers, even after statistically controlling for education and mental ability. Moreover, smokers report higher rates of psychosocial and health problems prior to military service. These results support using smoking status as a personnel quality indicator for recruiting and assignment purposes and indicate that smokers, as a group, enter the military with identifiable psychosocial and physical vulnerabilities.     

Differences in generosity between smokers and nonsmokers in an upcoming smoking ban

The stigmatization of smokers has become a social norm as new information about its health effects continues to be uncovered. This study investigated smokers in terms of their generosity as a means of stigma management. A field study was undertaken in which the experimenters frequented local establishments in the eight days prior to the 2010 Michigan antismoking legislation taking effect. Experimenters, sometimes while smoking and sometimes while not smoking, approached patrons of the establishments who were either smokers or nonsmokers and asked them for a dollar. Results indicated smokers were more likely to give a dollar than nonsmokers, regardless of whether or not the experimenters were smoking. This was interpreted as a strategy smokers use to combat social stigma.     

REDUCTION OF CIGARETTE SMOKING IN A UNIVERSITY CAFETERIA

Passive smoking has been shown to be hazardous to the health of nonsmokers. Given this documented link between exposure to smoke-filled environments and deleterious health consequences, there is a need to develop effective procedures that establish and maintain no-smoking areas in various public settings. The present study focused on decreasing cigarette smoking in a section of a university cafeteria. Posting of no-smoking signs was found to decrease levels of smoking only minimally. However, when smokers were verbally prompted not to smoke, in the presence of the signs, marked decreases in smoking occurred in the target area.     

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample

The purpose of this investigation was to evaluate carefully smoking-related knowledge and beliefs and their relationships to smoking status in a large, heterogeneous sample of smokers and nonsmokers in two settings: (a) a large, biracial southern city and (b) a small midwestern community. Participants were 611 (198 male, 413 female) adult respondents to a random-dialing telephone survey in Fargo, North Dakota (n = 200), and Memphis, Tennessee (n = 411). Each participant was given the Smoking Attitudes Survey, which assesses generalized health beliefs as well as health-related problems associated with smoking. Participants' knowledge of smoking-associated diseases (e.g., lung cancer) and of diseases not associated with smoking (e.g., kidney stones) was assessed. Stepwise regression analysis of composite knowledge scores revealed four independent predictors of the health consequences of smoking: education, race, smoking status, and income. Smokers, compared to nonsmokers, reported less knowledge related to the health consequences of smoking, were more likely to be male, were less concerned with the health consequences of smoking, and were more concerned about the health consequences of cholesterol. The best predictor of smokers who had never attempted cessation was their greater concern over weight control when compared to smokers with a history of smoking cessation attempts. The results are discussed in terms of smoking prevention and intervention efforts.     

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.     

Five‐Year Prospective Study of Risk Factors for Daily Smoking in Adolescence Among Early Nonsmokers and Experimenters1

Grade 7 nonsmokers and experimenters (N= 4,165) were compared on a wide range of risk factors for future smoking derived from four prominent theories and whether these factors predicted daily smoking at Grade 12. Early experimenters scored consistently higher than did early nonsmokers on risk factors for future smoking. Common predictors of Grade 12 daily smoking for both groups included early exposure to an important adult who smokes, being young for one's cohort, and weak academic bonds. For Grade 7 non‐smokers, unique predictors of daily smoking included exposure to pro‐smoking social influences (cigarette offers, sibling who smokes), early binge drinking, and being female. Unique predictors for early experimenters were less sharply delineated, although certain family factors appeared to be more important for this group. African Americans and His‐panics were also less likely to progress from experimental to daily smoking. Results point to the importance of adapting prevention efforts to the special needs of early nonsmokers and experimenters.     

Adolescent Smoking Behavior and the Recognition of Cigarette Advertisements1

In a study designed to assess the relationship between smoking status and correct identification of cigarette brands, junior high school students from two schools viewed cigarette and automobile advertisements with brand and model identification deleted. Results showed that adolescents with higher ad recognition scores were more likely to smoke cigarettes. In addition, a relationship was found between age and correct identification of cigarette advertisements, with older students identifying more ads correctly than younger students. No significant effects emerged for identification of automobile advertisements except for sex, with boys identifying more advertisements than girls. Additional findings indicated that even “experimental” smokers, who smoked as little as once per year, recognized significantly more cigarette advertisements than nonsmokers. These and other results are discussed in terms of their implications for prevention and policy issues. It is argued that society's allowance of printed cigarette advertising overlooks adolescents' heightened vulnerability to the kinds of appeals used in cigarette advertisements. Present policy also overlooks adolescents' relative unresponsiveness to the health risk information required in cigarette advertisements.     

Smoking and psychological health in relation to country of origin

In English-speaking, Western-Anglo countries, where smoking has become stigmatized in recent decades as a result of widespread anti-smoking campaigns, smokers commonly report poorer psychological health on average than nonsmokers do. This may be indirectly related to the strong pressures to quit in such countries, as poorer psychological health is associated with a reduced likelihood of quitting, thus leading to a selection bias for smokers with relatively poorer psychological health. In the present study, 147 smoker and nonsmoker participants either came from Western-Anglo countries where smoking has become stigmatized (Australia, Canada, USA) or countries in regions where smoking remains relatively more accepted (Asia, Latin America, Europe). Smokers and nonsmokers were assessed on a widely used self-report measure of anxiety, depression, and stress. Multivariate analysis revealed a significant interaction between smoker status (smoker, nonsmoker) and country of origin (Western-Anglo, other) on psychological health ratings, with univariate analysis showing a significant interaction on anxiety scores. Among those from Western-Anglo countries, smokers reported significantly higher levels of anxiety than nonsmokers did, whereas there was no difference in anxiety between smokers and nonsmokers from other countries. There was no difference in the number of cigarettes smoked per day between the samples of smokers, indicating very similar levels of nicotine intake in the two groups. The findings support the notion that a selection bias for smokers with relatively poorer psychological health is occurring in Western-Anglo countries.     

Oral contraceptive use and hemodynamic, lipid, and fibrinogen responses to smoking and stress in women.

The effects of acute smoking and oral contraceptive (OC) use on cardiovascular, lipid, and fibrinogen stress responses were examined in 52 female smokers and nonsmokers, half of whom were using OCs. Women smoked or sham-smoked a cigarette and then performed 2 stressful tasks. Stress elicited increases in total and low-density lipoprotein cholesterol, and in triglycerides among women who smoked, and in fibrinogen among all women. Smokers who used OCs had greater blood pressure increases to smoking and to stress than did smokers who did not use OCs. OC use was also associated with enhanced total peripheral resistance stress responses among women who smoked and cardiac output stress responses among women who sham-smoked. Results suggest that OC use moderates cardiovascular reactivity in smokers but not nonsmokers, enhancing vascular responsivity to smoking combined with stress and myocardial responsivity to stress alone.