The relationship of childhood trauma to nicotine dependence in pregnant smokers

Pregnant women with high levels of nicotine dependence are the least likely to quit smoking spontaneously during pregnancy or to benefit from smoking cessation interventions. In the general population, there is increasing evidence of a relationship between smoking, nicotine dependence, and exposure to childhood trauma. We examined the relationship of childhood trauma to several measures of nicotine dependence and evaluated whether this relationship was mediated by major depressive disorder or depressive symptom severity in pregnant smokers. Moderate to extreme levels of childhood trauma were significantly related to smoking within 5 minutes or less of waking, and to the Behavioral Choice-Melioration, Negative Reinforcement, and Tolerance subscales of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) scale. The relationships between childhood emotional abuse and the WISDM-68 Total and Negative Reinforcement subscale were partially mediated by depressive symptoms. Results suggest that childhood trauma may be a risk factor underlying nicotine dependence in pregnant smokers. Increased understanding of the relationship of affect regulation to smoking in individuals with childhood trauma histories may aid in the development of more effective treatments of nicotine dependence for this population of smokers.     

Smoking motives in the prediction of affective vulnerability among young adult daily smokers

The primary aim of this study was to examine whether smoking to reduce negative affect was uniquely related to a range of affective vulnerability factors (e.g., anxiety sensitivity, anxious arousal, and negative affectivity) among daily smokers. Participants were 276 young adult daily smokers (124 females; M(age)=25.12, SD=10.37). Partially consistent with prediction, the motivation to smoke to reduce negative affect was significantly related to anxiety sensitivity and negative affectivity, but not anxious arousal; the observed significant effects were above and beyond other theoretically relevant factors (e.g., smoking rate, years smoked, age, gender). In contrast to prediction, habitual smoking motives demonstrated significant incremental associations with anxiety sensitivity and anxious arousal symptoms. These results suggest that there are important associations between certain smoking motives and negative affective states and that such relations are not attributable to other smoking factors (e.g., smoking rate).     

Does heightened affect make smoking cues more salient?

Negative affect (NA) states are robustly related to relapse. However, the mechanisms for this relationship are not well understood. Whereas most models have proposed that NA directly promotes lapsing, some models suggest that NA may promote lapses indirectly by increasing reactivity to smoking cues. This hypothesis was tested in secondary analyses of a study in which 248 smokers used ecological momentary assessment to self-monitor affective valence, smoking cues, and lapses during an attempt to quit smoking. The smoking cues the authors examined were others' smoking and consumption of alcohol or coffee. The odds of lapsing when exposed to smoking cues were compared across conditions of positive affect, neutral affect, and NA. Consistent main effects of affective valence were seen but not the hypothesized interaction. Indeed, analyses showed that the effect of cues was typically diminished under conditions of NA. No evidence was found to support the hypothesis that smoking cues and lapsing are more closely linked under NA conditions.     

Subjective and reinforcing effects of smoking during negative mood induction

Two notions strongly held by many smokers are that negative mood increases smoking behavior and that this increase is due to the ability of smoking to alleviate negative affect. This study used a modified mood induction procedure to examine both the impact of smoking on induced mood, as well as the effect of induced mood on actual smoking behavior. Forty-eight smokers were randomly assigned to a smoking or a water-drinking comparison group. Each participant attended 3 sessions during which 1 of 3 mood states (positive, negative, or neutral) was induced. Contrary to expectation, smoking did not attenuate negative affect. However, negative mood induction subsequently quickened latency to smoke and increased number of puffs consumed ad lib.     

Smoking withdrawal dynamics in unaided quitters

Considerable research shows that withdrawal severity is inconsistently related to smoking cessation outcomes. This may result from measurement problems or failure to scrutinize important dimensions of the withdrawal experience. Two recent studies demonstrated that withdrawal elevation and variations in the time course of withdrawal were related to relapse in smokers treated with the nicotine patch (T. M. Piasecki, M. C. Fiore, & T. B. Baker, 1998). This article reports a conceptual replication and extension of those findings in unaided quitters. Evidence for temporal heterogeneity was found across different types of withdrawal symptoms. Patterns or slopes of affect and urge reports over time predicted smoking status at follow-up, as did mean elevation in withdrawal symptoms. These results suggest that affect and urge withdrawal symptoms make independent contributions to relapse and that relapse is related to both symptom severity and trajectory.     

Smoking and social anxiety: the role of false safety behaviors

ABSTRACT

Despite the negative health consequences associated with smoking, most smokers find it difficult to quit. This is especially true for smokers with elevated social anxiety. One factor that may play a role in maintaining smoking with elevated anxiety is false safety behavior (FSB), behaviors geared toward decreasing anxiety short-term but that maintain or increase anxiety long-term. The present study tested whether FSB explained the relation of social anxiety severity with smoking among 71 current smokers. Avoidance-related FSB was the only type of FSB related to cigarettes smoked per day (CPD) and it was robustly related to more CPD. Further, social anxiety was related to CPD indirectly via FSB-Avoidance. Findings suggest that more frequent use of avoidance behaviors to manage anxiety may maintain smoking and may partially explain the high rates of smoking among those with elevated social anxiety. Thus, FSB may be a promising target in smoking cessation interventions, especially among those with elevated social anxiety.     

Examining gender differences in received,provided, and invisible social control: an application of the dual-effects model

The dual-effects model of social control not only assumes that social control leads to better health practices but also arouses psychological distress. However, findings are inconsistent. The present study advances the current literature by examining social control from a dyadic perspective in the context of smoking. In addition, the study examines whether control, continuous smoking abstinence, and affect are differentially related for men and women. Before and three weeks after a self-set quit attempt, we examined 106 smokers (77 men, mean age: 40.67, average number of cigarettes smoked per day: 16.59 [SD = 8.52, range = 1–40] at baseline and 5.27 [SD = 6.97, range = 0–40] at follow-up) and their nonsmoking heterosexual partners, assessing received and provided control, continuous abstinence, and affect. With regard to smoker's affective reactions, partner's provided control was related to an increase in positive and to a decrease in negative affect, but only for female smokers. Moreover, the greater the discrepancy between smoker received and partner's provided control was the more positive affect increased and the more negative affect decreased, but again only for female smokers. These findings demonstrate that female smokers' well-being was raised over time if they were not aware of the control attempts of their nonsmoking partners, indicating positive effects of invisible social control. This study's results emphasize the importance of applying a dyadic perspective and taking gender differences in the dual-effects model of social control into account.     

Prevalence and predictors of transitions in smoking behavior among college students.

The prevalence of smoking among college students is surprisingly high and represents a significant public health issue. However, there are few longitudinal studies of smoking in this population. This study examined the prevalence and predictors of transitions in smoking behavior among a cohort of 548 college students. Over the course of 4 years, 87% of daily smokers and almost 50% of occasional smokers continued to smoke. Among nonsmokers, 11.5% began smoking occasionally and none became daily smokers. In general, predictors of smoking behavior change were significant only among baseline occasional smokers and included gender, smoking outcome expectancies, and affect regulation expectations. Peer and parental smoking, demographics, affect, stress, and alcohol use were generally not predictive of change. Tobacco control interventions targeted at college students are clearly warranted.     

Positive psychotherapy for smoking cessation: Treatment development,feasibility, and preliminary results

Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers making a quit attempt. Positive psychotherapy can both increase positive affect (PA) and decrease NA and, therefore, may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a positive psychotherapy for smoking cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in PA at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of the participants (31.6%) sustained smoking abstinence for six months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.     

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.     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts.     

Attitudes, perceptions, and risk-taking behaviors of smokers, ex-smokers, and nonsmokers.

A sample of American adults completed questionnaires relevant to cigarette smoking. The questions were related to three areas: risk, perceptions of their or others' smoking, and satisfaction with life and health. The results revealed that smokers were greater risk-takers, that they perceived their smoking to be due to both physical and psychological addictions, and that they expressed less satisfaction and control. Results also indicated that smokers who saw their smoking as being addictive tended to be less satisfied with their health and felt less control over their lives. On the other hand, those smokers who were more likely to deny the health risks did not differ from either non- or ex-smokers on any of the satisfaction or control questions.     

Personality predictors of the time course for lung cancer onset

Numerous findings suggest that personality is linked to the incidence and experience of negative health outcomes. More specifically, trait negative affect is negatively related to a number of health outcomes. The current study expands our understanding of the link between personality and disease by examining the time course for lung cancer onset. In a sample of patients who had recently undergone surgical resection for lung cancer, a variety of negative affect related personality variables were assessed to determine their relationship with age at surgery. After controlling for smoking behavior, it was found that trait negative affect was associated with time course for lung cancer onset, such that those with higher (vs. lower) levels of trait negative affect manifested lung cancer earlier in their lives. Thus, trait negative affect represents an independent risk factor among those prone to lung cancer (i.e., smokers).     

Disengagement beliefs in smokers: Do they influence the effects of a tailored persuasive message advocating smoking cessation?

Disengagement beliefs function to reduce cognitive dissonance and a number of predictions with regard to disengagement beliefs have been tested and verified. However, the influence of disengagement beliefs on persuasion has not been studied yet. In a field-experiment, 254 smokers were randomly assigned to a persuasive message condition or a no-information control condition. First, it was assessed to what extent disengagement beliefs influenced persuasion. In smokers with low adherence to disengagement beliefs, quitting activity (attempting to quit) in the control condition was high, but this was not further increased by persuasive information on the negative outcomes of smoking. In contrast, smokers who strongly adhered to disengagement beliefs showed low quitting activity in the control condition, but significantly more quitting activity when they received the persuasive message. Second, it was studied what smokers do when they experience negative affect caused by the persuasive message. The results show that in smokers who strongly adhered to disengagement beliefs, negative affect was associated with less quitting activity. Although these results show that quitting activity as assessed at 2 and 8 months follow-ups was influenced by disengagement beliefs, point prevalence seven-day quitting was not. This study shows that adherence to disengagement beliefs is a relevant individual difference in understanding effects of smoking cessation interventions.     

Antismoking attitudes and general prejudice: an empirical study

A group of 5,977 persons was interviewed concerning attitudes towards smoking and smokers. Prejudice against smoking was significantly related to prejudice against various racial, religious and political groups and was noted in personality types previously found to be characteristically prejudiced. Mortality was much greater in prejudiced nonsmokers than in nonprejudiced smokers.     

Smoking in movies, implicit associations of smoking with the self, and intentions to smoke

We examined whether identifying with a film character who smokes increases implicit associations of the self with smoking. Undergraduate men were randomly assigned to view film clips in which the male protagonist either smoked or did not smoke. We measured subsequent levels of self-smoking associations using a reaction time task, as well as self-reported beliefs about smoking and smokers. Greater identification with the smoking protagonist predicted stronger implicit associations between the self and smoking (for both smokers and nonsmokers) and increased intention to smoke (among the smokers). Stronger implicit self-smoking associations uniquely predicted increases in smokers' intentions to smoke, over and above the effects of explicit beliefs about smoking. The results provide evidence that exposure to smoking in movies is causally related to changes in smoking-related thoughts, that identification with protagonists is an important feature of narrative influence, and that implicit measures may be useful in predicting deliberative behavior.     

Evaluating the role of anxiety sensitivity in barriers to cessation and reasons for quitting among smokers with asthma

The aim of the present study was to examine the unique predictive ability of anxiety sensitivity (AS) in terms of perceived barriers to cessation and smoking cessation motives among daily smokers with asthma (n = 125, 54% male, M_age = 37.7 years, SD = 12.1). As hypothesized, after controlling for the effects of race, asthma control, negative affect, and smoking rate, AS significantly predicted greater barriers to cessation, and reasons for quitting related to health concerns and self-control. Contrary to hypotheses, AS did not significantly predict external reasons for quitting. These findings suggest that smokers with asthma who are fearful of physiological arousal may be a particularly ‘at-risk’ population for smoking cessation difficulties due, in part, to greater perceived barriers to cessation. Interventions focused on enhancing intrinsic motivation for quitting and reducing AS may be most effective for this population.     

Are smokers interested in genetic testing for smoking addiction? A socio-cognitive approach

Genetic advances have made genetically tailored smoking cessation treatments possible. In this study, we examined whether smokers are interested in undergoing a genetic test to identify their genetic susceptibility to nicotine addiction. In addition, we aimed to identify socio-cognitive determinants of smokers’ intention to undergo genetic testing. Following the protection motivation theory (PMT), we assessed the following constructs using an online survey among 587 smokers: threat appraisal (i.e. susceptibility and severity), fear, coping appraisal (i.e. response efficacy and self-efficacy), response costs and intention. In addition, knowledge, social norms and information-seeking behaviour were measured. Mean intention rates were 2.57 on a 5-point scale. Intention was significantly associated with threat appraisal and coping appraisal, as predicted by the PMT. Fear of the outcome was negatively associated with the intention to undergo genetic testing, but response costs, knowledge and social influence were not. Intention to undergo genetic testing in turn was positively related to seeking information about genetic testing and genetically tailored smoking cessation treatments. Smokers seem ambivalent or ‘on the fence’ with regard to undergoing a genetic test for smoking addiction. Socio-cognitive concepts such as susceptibility, severity, response efficacy and self-efficacy may be used to inform or educate smokers about the value of genetically tailored smoking cessation treatments.     

Effects of cigarette smoking on lexical decision-making

10 habitual smokers, aged 19-25 yr., were randomly assigned to smoke either a very low nicotine "Placebo" cigarette (.05-mg nicotine delivery as estimated by the FTC method) or a Nicotine cigarette (.7-mg estimated nicotine delivery). Each participant was asked to abstain from smoking for 4 to 7 hr. prior to testing. After completing a presmoking test of lexical decision-making, participants smoked either a Nicotine or Placebo cigarette and were then retested for reaction times and accuracy on the lexical decision test. When presented the most difficult lexical decisions, participants responded significantly faster after smoking a Nicotine cigarette than they did before smoking; smoking a Placebo cigarette did not affect reaction times. Response accuracy was unaffected by smoking either kind of cigarette. These results suggest that smoking a nicotine cigarette may improve attention or memory retrieval after several hours of smoking abstinence.     

Quality of life after quitting smoking and initiating aerobic exercise

Quitting smoking and aerobic exercise each improve health. Although smokers may be concerned that quitting smoking will reduce their quality of life (QOL), recent research has shown that cessation is associated with QOL benefits. Elements of smoking cessation interventions, such as exercise, may contribute to changes in QOL. However, it is unknown whether initiating exercise in the context of smoking cessation is associated with greater or different effects on QOL than smoking cessation alone. The current study is a secondary analysis of data from a randomized trial (n = 61) of an exercise intervention for smoking cessation. We hypothesized that smoking abstinence and engagement in exercise would have positive, additive effects on QOL at end-of-treatment, 6- and, 12-month follow-ups. Sedentary adult smokers were randomized to the exercise intervention or a health education control (HEC) group. Additionally, all participants received smoking cessation counseling and nicotine patches. Data were analyzed using actual engagement in exercise, rather than group assignment as a proxy for exercise engagement, because some HEC participants also began exercising. Abstinence was positively associated with higher total and physical health QOL at follow-up. Exercise was not associated with total QOL and only marginally associated with physical health QOL, but was positively related to overall sense of well-being. Emphasizing that smoking cessation is associated with higher QOL may help motivate smokers to initiate quit attempts.