Lee M. Cohen

Predictors of Smoking and Smokeless Tobacco Use in College Students: A Preliminary Study Using Web-Based Survey Methodology

Cigarette smoking and smokeless tobacco (SLT) use are associated with numerous health hazards and economic costs, and rates of tobacco use have recently increased among young adults. In this study, the authors compared predictors of smoking and SLT use among college students (N = 21,410) from 13 Texas universities using a Web-based survey. Results revealed that sex, belonging to a fraternity or sorority, participation in intercollegiate sports, peer influences, and ethnicity predicted smoking and SLT use. Although common factors predicted both lifetime and current smoking and SLT use, patterns of prediction differed across dependent variables. The authors discuss implications for developing tobacco prevention programs targeting specific risk factors salient to the young adult population.

The role of impulsivity on smoking maintenance

In order to better understand why those higher in impulsivity experience more difficulties during smoking abstinence, the current study examined the possible mechanisms contributing to cigarette smoking relapse. Fifty dependent cigarette smokers completed measures designed to assess craving, tobacco withdrawal severity, and negative affect during 48 hours of nicotine abstinence. Using a series of multilevel models (SAS Proc Mixed Procedure), significant impulsivity x time analyses revealed differences in craving, F(2, 96) = 3.74, p<.05, and anxiety, F(2, 96) = 3.23, p<.05. Simple slopes analyses indicated that heightened trait-impulsivity predicted greater increases in craving and anxiety during a 48-hour abstinence period. These findings suggest that smokers with higher levels of impulsivity may lack the ability to find an accessible and comparable substitute for cigarette smoking during a cessation attempt. This study also highlights the importance of considering individual differences when treating those who wish to quit smoking.

Negative affect combines with smoking outcome expectancies to predict smoking behavior over time.

The present study examined whether the tendency to experience negative affective states combines with smoking outcome expectancies to predict smoking behavior over time. Participants were 121 young adults and resource people recruited from 3 alcohol and drug treatment programs and through community advertisements. Each participant completed 3 interviews over a 4-year period. Results indicated that dispositional negative affect and positive smoking expectancies were significantly correlated with smoking behavior both within and across time. Expectations of positive and negative reinforcement partially mediated negative affects relation with smoking across time. Positive expectancies did not function as a moderator of negative affects relation with smoking behavior. These results represent an important step in incorporating smoking outcome expectancies into multivariate models of smoking risk.

The influence of personality and affect on nicotine dependence among male college students.

Many clinicians and researchers hypothesize that tobacco use disorders, regardless of the route of administration, are maintained by the ability of nicotine to regulate positive and negative mood states. The present study (N=137) examined whether certain mood states predicted dependence on either cigarettes or smokeless tobacco and whether specific personality characteristics (e.g., extraversion, neuroticism, and psychoticism) mediated these relationships among young male college students. Results indicated that positive and negative moods predicted cigarette dependence (p values=.01) and that neuroticism partially mediated the relationship between positive affect and cigarette dependence. Exploratory analyses revealed that positive affect also interacted with neuroticism to predict smokeless tobacco dependence (p=.04). Simple effects analyses revealed that this relationship was maintained only among individuals high in neuroticism. Results suggested that dependence on cigarettes and smokeless tobacco among male college students may have different affective correlates and that certain personality characteristics may enhance and explain the effects of mood on tobacco dependence.

Depression vulnerability predicts cigarette smoking among college students: Gender and negative reinforcement expectancies as contributing factors.

This study examined the association between vulnerability to depression and smoking behavior in 1214 college students (54% female), and evaluated gender and expectancies of negative affect reduction as moderators or mediators of this relationship. Depression vulnerability predicted smoking in females, but not males. The relationship between depression vulnerability and smoking status was mediated by expectancies of negative affect reduction in females only. Female college students who are vulnerable to depression may smoke because they expect smoking to relieve negative affect. Smoking interventions for college females may increase in effectiveness by targeting depression and emphasizing mood regulation.

Examining the interrelationships between social anxiety, smoking to cope, and cigarette craving

Smokers with symptoms of social anxiety often report smoking as a way to cope with negative affect. These individuals have lower success rates when attempting cessation compared with the general population. However, there is a paucity of research examining the role of social anxiety in nicotine dependence. The present study explored the relationships between symptoms of social anxiety, smoking to cope with these symptoms during social situations (STC), and cigarette craving. Thirty-eight participants completed measures of social anxiety and STC at baseline. Cigarette craving was subsequently assessed pre and post exposure to smoking-related images during periods of nicotine satiation and deprivation. Regression analyses revealed that greater symptoms of social anxiety predicted the frequency of STC behaviors and the number of cigarettes participants thought they would need in order to feel more comfortable in social situations. Symptoms of social anxiety and several behaviors associated with STC (e.g., avoiding social situations in which smoking is not permitted) predicted increases in craving during nicotine deprivation, but not satiation. These findings suggest that symptoms of social anxiety and STC behaviors may play a role in the maintenance of smoking behaviors. Further, targeting symptoms of social anxiety within the context of smoking cessation treatment may be particularly helpful and may improve the rates of smoking cessation among individuals with symptoms of social anxiety.

Assessment of Nicotine Dependence Among Substance Abusing Adolescent Smokers: A Comparison of the DSM-IV Criteria and the Modified Fagerstrom Tolerance Questionnaire

Nicotine dependence has been found to be a significant factor in adolescent smoking persistence. However, measures of this construct are primarily adult-derived, limiting their utility as bases for characterizing nicotine dependence and formulating youth intervention strategies. This issue is of particular importance among substance abusing youth who have substantially higher rates of cigarette smoking than do adolescents in the general population. The objectives of this preliminary study were to examine the construct validity of the DSM-IV nicotine dependence criteria and the modified Fagerström Tolerance Questionnaire (mFTQ) and to compare the DSM-IV diagnostic criteria for nicotine dependence with the mFTQ in a sample of 67 adolescent smokers in treatment for substance abuse. Results revealed that more participants were classified as nicotine dependent using DSM-IV criteria than by mFTQ scores. Little evidence was found for construct validity of these measures and convergence between the two measures was low. Findings also suggested that the present measures do not capture optimally broad dimensions of adolescent nicotine dependence.

Impulsivity and the role of smoking-related outcome expectancies among dependent college-aged cigarette smokers

The relationship between trait-impulsivity and smoking expectancies on smoking progression in undergraduate college students was examined over a 48-hour period of smoking abstinence. Participants were forty-nine college-aged dependent cigarette smokers who completed measures designed to assess impulsivity, nicotine dependence, and smoking expectancies. Using a series of multilevel models, impulsivity by time analyses indicated significant differences in positive reinforcement expectancies, [F (2, 94)=3.19, p<.05], but not in negative reinforcement expectancies, [F (2, 94)=0.49, p=.61]. Simple slopes analyses indicated that heightened trait-impulsivity predicted greater increases in positive reinforcement outcome expectancies at 48 h of abstinence. Level of impulsivity, however, was not related to changes in negative reinforcement expectancies. Results indicate that during an abstinence period, college students higher in trait-impulsivity may be more prone to relapse due to stronger beliefs about the positive effects from smoking a cigarette. These findings highlight the importance of understanding the interaction of personality and cognitive factors when working with young adult smokers wishing to quit this health-compromising behavior.

Physiological and psychological symptoms and predictors in early nicotine withdrawal

The present study assessed the structure and intensity of the nicotine withdrawal syndrome in 30 (22 male, 8 female) heavy smokers across three experimental conditions: smoking, brief abstinence (3.5 h), and extended abstinence (18 h). Physiological variables (heart rate and blood pressure) and psychological variables (anxious and depressed mood) were examined in terms of symptom validity and as predictors of nicotine withdrawal intensity. As length of abstinence increased, heart rate and blood pressure decreased, and anxious and depressed mood increased. Only anxious and depressed mood were significant individual predictors of withdrawal intensity. The symptom structure of withdrawal did not change over time as abstinence levels increased; each symptoms contribution to nicotine withdrawal intensity remained stable throughout the first 18 h of abstinence.

Electronic Cigarette Use Among College Students: Links to Gender, Race/Ethnicity, Smoking, and Heavy Drinking.

Abstract Objective: Electronic cigarette (e-cigarette) use continues to rise, and current data regarding use of e-cigarettes among college students are needed. The purpose of this study was to examine e-cigarette use and the relation of such use with gender, race/ethnicity, traditional tobacco use, and heavy drinking. Participants and Methods: A sample of 599 college students enrolled in General Psychology at a state university completed a self-report questionnaire. Results: Twenty-nine percent of students reported prior use of e-cigarettes, with 14% reporting use in the past 30 days. E-cigarette use was linked to male gender but not to race/ethnicity. Dual use (ie, concurrent use of both traditional and e-cigarettes) was related to heavier use of traditional and e-cigarettes, and nicotine use was linked to pronounced rates of heavy drinking. Conclusions: E-cigarette use among college students is exponentially on the rise, and its co-use with alcohol may contribute to negative outcomes in this population.