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Evaluating the mediating role of coping-based smoking motives among treatment-seeking adult smokers

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Empirical work has demonstrated a linkage between smoking rate and anxious arousal symptoms. However, there is little understanding of the mechanisms underlying this association. The present investigation examined the role of coping-based smoking motives in terms of mediating the relations between smoking rate and anxious arousal symptoms and anxious arousal symptoms and smoking rate among a sample of treatment-seeking adult smokers (N = 123; 84 women; M(age) = 45.93, SD = 10.34). Results indicated that coping motives mediated the relations between smoking rate and anxious arousal symptoms and anxious arousal symptoms and smoking rate. These results suggest that coping motives play a key role in terms of better understanding the association between smoking rate and anxious arousal symptoms.
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Nicotine & Tobacco Research, Volume 11, Number 11 (November 2009) 1296–1303
1296
doi: 10.1093/ntr/ntp134
Advance Access published on August 24, 2009
Received March 23 , 2009 ; accepted June 19 , 2009
© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.
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Wittchen, Stein, Höfl er, & Lieb, 2003 ; Johnson et al., 2000 ; McLeish,
Zvolensky, & Bucossi, 2007 ; Zvolensky, Schmidt, & McCreary,
2003 ). For instance, Johnson et al. (2000) found that smoking rate
was prospectively related to an increased risk of panic attacks.
A related body of scientifi c literature, while limited, has demon-
strated that more severe symptoms of anxiety may be associated
with greater rates of smoking ( Morissette et al., 2007 ; Patton et al.,
1998 ; Rose, Ananda, & Jarvik, 1983 ). For example, prospective work
examining smoking initiation among adolescents has demonstrat-
ed that anxiety-related symptoms may increase the likelihood of
(a) initiating smoking and (b) transitioning to regular (e.g., daily)
smoker status ( Patton et al., 1998 ).
Despite the documented association between smoking rate
and anxiety symptoms and vice versa, there is less understanding
of the mechanisms involved. Motivational models of substance
use predict that distinct motives may theoretically be related to
particular types of substance-related problems or individual
emotional vulnerability characteristics ( Cooper, 1994 ; Cooper,
Frone, Russell, & Mudar, 1995 ; Cox & Klinger, 1988 ; Stewart,
Zeitlin, & Samoluk, 1996 ). Such an approach recognizes that two
individuals may use tobacco for different reasons and one indi-
vidual may use for multiple types of reasons (Cooper; Ikard, Green,
& Horn, 1969 ; Russell, Peto, & Patel, 1974 ). Motivational models
predict that distinct motives may theoretically be related to
particular types of problems (Cooper). Several distinct smoking
motives have been identified (Ikard et al.). Of particular
relevance to the study of anxiety smoking relations are coping-
oriented motives. To provide greater clarity to the overall
presentation of ideas and contextualization of them within the
larger scientifi c literature, we use the term coping motives
throughout the present article (please see Measures section for
additional information regarding the coping motives subscale).
Specifi cally, individuals who frequently use tobacco for negative
affect reduction or regulation reasons may be apt to be at an
increased concurrent and prospective risk for negative emotional
Abstract
Introduction : Empirical work has demonstrated a linkage
between smoking rate and anxious arousal symptoms. However,
there is little understanding of the mechanisms underlying this
association.
Method : The present investigation examined the role of coping-
based smoking motives in terms of mediating the relations
between smoking rate and anxious arousal symptoms and
anxious arousal symptoms and smoking rate among a sample
of treatment-seeking adult smokers ( N = 123; 84 women;
M age = 45.93, SD = 10.34).
Results : Results indicated that coping motives mediated the
relations between smoking rate and anxious arousal symptoms
and anxious arousal symptoms and smoking rate.
Discussion : These results suggest that coping motives play a
key role in terms of better understanding the association
between smoking rate and anxious arousal symptoms.
Introduction
A recent and increasingly robust body of literature has begun to
examine the linkages between smoking and anxiety-related
disorders ( Feldner, Babson, & Zvolensky, 2007 ; Morissette, Tull,
Gulliver, Kamholz, & Zimering, 2007 ; Patton et al., 1998 ; Zvolensky,
Feldner, Leen-Feldner, & McLeish, 2005 ). Several empirical studies
have demonstrated that smoking at higher rates may be concur-
rently and prospectively associated with an increased risk of more
severe anxious arousal symptoms and greater life impairment
related to such symptoms ( Breslau & Klein, 1999 ; Breslau, Novak,
& Kessler, 2004 ; Goodwin, Lewinsohn, & Seeley, 2005 ; Isensee,
Original Investigation
Evaluating the mediating role of
coping-based smoking motives among
treatment-seeking adult smokers
Kirsten A. Johnson , Sherry H. Stewart , Michael J. Zvolensky , & Dan Steeves
Kirsten A. Johnson, B.A., Department of Psychology, The University
of Vermont, Burlington, VT
Sherry H. Stewart, Ph.D., Department of Psychology, Dalhousie
University, Halifax, Nova Scotia, Canada
Michael J. Zvolensky, Ph.D., Department of Psychology, The
University of Vermont, Burlington, VT
Dan Steeves, B.Ed., Capital District Health Authority, Addiction Pre-
vention and Treatment Services, Dartmouth, Nova Scotia, Canada
Corresponding Author:
Michael J. Zvolensky, Ph.D., Department of Psychology, The
University of Vermont, 2 Colchester Avenue, John Dewey Hall,
Burlington, VT 05405-0134, USA. Telephone: 802-656-8994;
Fax: 802-656-8783; E-mail: Michael.Zvolensky@uvm.edu
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Nicotine & Tobacco Research, Volume 11, Number 11 (November 2009)
states such as anxiety ( Zvolensky & Bernstein, 2005 ). Thus,
cigarette smokers who are more motivated to use tobacco as a
coping strategy for negative emotional experiences, such as
anxious arousal, may be most vulnerable to anxiety disturbances.
Alternatively, smokers with higher levels of anxious arousal
symptoms may rely on smoking to cope and therefore be more
apt to smoke at higher rates. Thus, there are possible bidirec-
tional effects between smoking rate and anxious arousal symptoms,
but in both cases, coping motives for smoking may play a key
explanatory role.
It is presently unclear whether coping-based smoking
motives mediate the relation between smoking rate and anxious
arousal symptoms or the alternative model of anxious arousal
symptoms to smoking rate. This information is important theo-
retically for explicating the mechanisms underlying smoking
anxiety linkages and may help guide treatment planning for
high-risk samples (e.g., smokers with anxiety disturbances).
Accordingly, the present investigation tested the hypothesis
that among treatment-seeking adult daily smokers, coping
motives for smoking would concurrently mediate (explain) the
relation between smoking rate and anxious arousal symptoms
(see Figure 1 ). A secondary aim of the present investigation was
to explore a second mediational model wherein coping motives
mediated the relation between anxious arousal symptoms and
smoking rate (see Figure 2 ). Please see the Data Analytic Strategy
section for a detailed description of our statistical rationale.
Method
Participants
Figure 3 shows a CONSORT fl ow diagram detailing recruitment
procedures and the identifi cation of the present sample. Partici-
pants included 123 daily cigarette smokers (84 women; M age =
45.93 years, SD = 10.34) living in the Halifax Regional Munici-
pality, in the Canadian province of Nova Scotia. Daily smokers
were recruited for participation from among those attending
a structured 4-week group Tobacco Intervention Program
offered through Addiction Prevention and Treatment Services,
Capital District Health Authority. All those daily smokers partici-
pating in the program were invited to participate. Participants
reported attaining the following levels of education: 41% com-
pleted high school, 31% completed college (community college
or technical schooling), 13% completed university (tradi-
tional 4-year schooling), 11% completed junior high school,
and 4% completed elementary school. With regard to marital/
relationship status, 48% of the sample reported being married/
cohabiting with a partner, 35% reported being separated/divorced/
widowed, and 17% reported being single.
Participants reported smoking an average of 15.46 ( SD =
7.95) cigarettes per day and endorsed relatively high levels
of nicotine dependence ( M = 6.25, SD = 2.17), as indexed
by the Fagerström Test for Nicotine Dependence (FTND;
Fagerström, 1978 ; Heatherton, Kozlowski, Frecker, & Fagerström,
1991 ) at treatment outset. Participants reported initiating
daily smoking at a mean age of 16.60 years ( SD = 4.77) and
smoking regularly for an average of 28.28 years ( SD = 10.64).
In terms of smoking cessation, participants endorsed an aver-
age of 2.95 ( SD = 2.85) self-defi ned “ serious ” lifetime quit
attempts, and 5.77 ( SD = 12.57) lifetime quit attempts lasting
longer than 12 hr (as indexed by the Smoking History Ques-
tionnaire [SHQ]; Brown, Lejuez, Kahler, & Strong, 2002 ).
The average longest lifetime period of smoking abstinence af-
ter a quit attempt among participants was 1.14 years ( SD =
2.74).
Measures
Smoking History Questionnaire . The SHQ (Brown et al.,
2002) is a self-report questionnaire used to assess smoking his-
tory and pattern. The SHQ includes items pertaining to smok-
ing rate, age at onset of smoking initiation, and years of being
a daily smoker. The SHQ has been successfully used in previous
studies as a measure of smoking history (e.g., Zvolensky, Lejuez,
Kahler, & Brown, 2004 ). Smoking rate (i.e., average number
of cigarettes smoked per day in the past week) was used in the
present analyses.
Fagerström Test for Nicotine Dependence . The
FTND(Fagerström, 1978 ; Heatherton et al., 1991) is a six-
item scale designed to assess gradations in tobacco depen-
dence ( Heatherton et al., 1991 ). The FTND has shown good
internal consistency, positive relations with key smoking
variables (e.g., saliva cotinine; Heatherton et al.), and high
degrees of test retest reliability ( Pomerleau, Carton, Lutzke,
Flessland, 1994 ).
Mood and Anxiety Symptom Questionnaire . The Mood and
Anxiety Symptom Questionnaire (MASQ; Watson et al., 1995)
is a 62-item measure of affective symptoms. Participants indi-
cate how much they have experienced each symptom during
the past week on a 5-point Likert-type scale (1 = not at all to
5 = extremely ). Factor analysis indicates that this scale taps dis-
tinct anxiety and depression symptom domains. The Mood
and Anxiety Symptom Questionnaire Anxious Arousal
(MASQ-AA) subscale measures symptoms of somatic tension
and arousal (e.g., felt dizzy ). The Mood and Anxiety Symp-
tom Questionnaire Anhedonic Depression (MASQ-AD) sub-
scale measures a loss of interest in life (e.g., felt nothing was
enjoyable ), and reverse-keyed items measure positive affect.
The MASQ shows excellent convergence with other measures
of anxiety and good discriminative validity for anxious versus
depressive symptoms via the MASQ-AA and MASQ-AD sub-
scales, respectively ( Watson et al., 1995 ). The MASQ-AA and
MASQ-AD subscales displayed good internal consistency in
------------------------
Coping Motives
Smoking Rate Anxious Arousal
Symptoms
Figure 1. Hypothesized mediational model: coping motives mediating
smoking rate and anxious arousal symptoms.
1298
Coping motives mediation
the current sample (alpha coeffi cients: .83 and .89, respec-
tively) and were used to index anxious arousal and depressive
symptoms in the present investigation.
Wisconsin Inventory of Smoking Dependence Motives .
Smoking dependence motives were assessed with the Wisconsin
Inventory of Smoking Dependence Motives (WISDM-68; Piper
et al., 2004), a 68-item measure in which respondents indicate
on a 7-point Likert-type scale (1 = not true of me at all to 7 =
extremely true of me ) the degree to which they have smoked
cigarettes for a variety of possible reasons (e.g., improves my
mood ). Factor analysis of the scale indicates that it has 13 fi rst-
order factors. In the present study, we were primarily interested
in the coping motives subscale termed Negative Reinforcement
Smoking Dependence Motives (e.g., smoking improves my mood ;
Piper et al., 2004 ). The WISDM has acceptable levels of internal
consistency for each of the 13 factors and has been shown to be
signifi cantly related to several measures of dependence (i.e.,
DSM-IV nicotine-dependence criteria; Piper et al., 2004 ). The
coping motives subscale demonstrated good internal consis-
tency within the present sample (alpha coeffi cient: .89).
Procedure
The current study is a facet of a larger investigation ( Zvolensky,
Stewart, Vujanovic, Gavric, & Steeves, 2009 ). The current analyses
have not been reported previously and therefore are a novel
contribution. The procedure of the study has been described in
detail elsewhere ( Zvolensky et al., 2009 ). The initial phase of the
larger study recruited smokers attending an information session
about the Tobacco Intervention Program offered through Capital
Health. Potential participants were informed about the nature
and purpose of the study and were invited to participate in the
research portion of the program. Two weeks following the initial
information session, eligible participants participated in the
study at their first (precessation) meeting of their Tobacco
Intervention Program group. At this time, participants were in-
structed to complete a demographic questionnaire, the SHQ,
the FTND, the MASQ, and the WISDM. In addition, partici-
pants were offered the chance to receive Nicotine Replacement
Therapy (NRT). The program consisted of one 90-min group
session per week for 4 weeks, including clinical time (1-hr group)
as well as the time for the research component (half an hour).
The manualized treatment included both evidence-based
behavioral and cognitive strategies and NRT. All participants
were provided with a $10 movie pass as compensation. The
present analyses were conducted using baseline (precessation)
data from the larger study.
Data Analytic Strategy
To test the hypothesized mediational model as well as to ex-
plore the second mediational model, we used analytic strate-
gies that are recommended by Baron and Kenny (1986) .
Specifi cally, two separate series of mediational analyses were
used to test whether: (a) coping motives would mediate the
relation between smoking rate (predictor) and anxious arousal
symptoms (criterion) and (b) coping motives would mediate
the relation between anxious arousal symptoms (predictor)
and smoking rate (criterion). Overall, this analytic approach is
consistent with general recommendations for mediational
analysis ( Preacher & Hayes, 2004 ).
Results
Table 1 shows the zero-order (or point-biserial, as applicable)
correlations among predictor and criterion variables. It should
also be noted that a correlational analysis was conducted to
examine the relation between the smoking rate and the FTND
( Fagerström, 1978 ). Smoking rate was signifi cantly related to
the FTND ( r = .64). Moreover, smoking rate was signifi cantly
related to coping motives and anxious arousal symptoms (ob-
served r s: .27 and .23, respectively); however, smoking rate was
not signifi cantly related to anhedonic depression symptoms
( r = .13). In addition, coping motives were signifi cantly related
to anxious arousal ( r = .32) and anhedonic depression symp-
toms ( r = .28). Please note that in order to ensure that the
current fi ndings were unique to anxious arousal symptoms, a
supplementary test of specifi city also was conducted, replacing
anxious arousal symptoms with anhedonic depression symp-
toms. Specifi cally, smoking rate did not signifi cantly predict
anhedonic depression symptoms; likewise, anhedonic depres-
sion symptoms did not signifi cantly predict smoking rate. Be-
cause smoking rate and anhedonic depression symptoms were
unrelated, we could not proceed further to test the possible
-----------------------
Coping Motives
Anxious Arousal
Symptoms Smoking Rate
Figure 2. Hypothesized mediational model: coping motives mediat-
ing anxious arousal symptoms and smoking rate.
Enrolled in Treatment
Study (n=123)
Withdrew from Treatment
(n=17)
Current Analyses
(n=123)
Completed Treatment
(n=106)
Figure 3. CONSORT diagram illustrating the process of participant
selection.
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Nicotine & Tobacco Research, Volume 11, Number 11 (November 2009)
mediating role of coping motives. Please contact the corre-
sponding author (Dr. Zvolensky) for the full results of these
additional analyses.
Initially, a hierarchical linear regression was conducted to
examine the relation between smoking rate (the predictor) and
anxious arousal symptoms (the criterion). Gender was included
as a covariate at Step 1 of the model, and smoking rate was en-
tered at Step 2. Overall, the model predicted 5.1% of variance in
anxious arousal symptoms, F (2, 120) = 3.17, p < .05. Step 1 of
the model did not signifi cantly predict anxious arousal symptoms
(see Analysis 1 in Table 2 ). Step 2 accounted for 5.1% of variance,
and as hypothesized, smoking rate was a signifi cant predictor of
anxious arousal symptoms above and beyond gender (see Analysis
1 in Table 2 ).
A second hierarchical linear regression was conducted to
examine the relation between smoking rate (the predictor) and
coping motives (the mediator). Gender was included as a covariate
at Step 1 of the model, and smoking rate was entered at Step 2.
The model predicted 12.6% of variance in coping motives,
F (1, 118) = 8.35, p < .001. Step 1 of the model predicted 5.0% of
variance, with gender being a signifi cant predictor of coping
motives (see Analysis 2 in Table 2 ); here, women endorsed
greater levels of coping motives than men. Step 2 accounted for
an additional 7.5% of variance, and as hypothesized, smoking
rate was a signifi cant predictor above and beyond gender (see
Analysis 2 in Table 2 ).
A nal hierarchical linear regression was conducted to
examine the relation between coping motives (the mediator)
and anxious arousal symptoms (the criterion). Similar to the
above analyses, gender was included as a covariate at Step 1 of
the model, and coping motives were entered at Step 2. Here,
10.4% of variance in anxious arousal symptoms was explained
in total, F (1, 119) = 6.80, p < .01. Step 1 of the model did not
signifi cantly predict anxious arousal symptoms (see Analysis 3
in Table 2 ). Step 2 accounted for 10.4% of variance, and cop-
ing motives signifi cantly predicted anxious arousal symptoms
above and beyond the variance accounted for by gender (see
Analysis 3 in Table 2 ).
As described in Table 2 , the mediational role of coping motives
in the relation between smoking rate and anxious arousal
symptoms was then examined by using the strategy proposed by
Baron and Kenny (1986) . In this analysis, when controlling for
the effects of smoking rate, coping motives signifi cantly predicted
anxious arousal symptoms (see Analysis 4 in Table 2); however,
smoking rate was no longer a signifi cant predictor of anxious
arousal symptoms after controlling for coping motives. Thus, cop-
ing motives mediated the relation between smoking rate and
anxious arousal symptoms (see Analysis 5 in Table 2 ). More-
over, post-hoc analyses using the Sobel test of mediation re-
vealed that coping motives signifi cantly mediated the relation
between smoking rate and anxious arousal symptoms Z = 2.32
( p < .05).
As mediational analyses are often conducted using
longitudinal data, one powerful method of strengthening the
interpretation of mediational analyses conducted with cross-
sectional data is to conduct an additional analysis reversing
the proposed mediator and criterion variable ( Preacher &
Hayes, 2004 ; Sheets & Braver, 1999 ; Shrout & Bolger, 2002 ).
This analytic approach helps ensure that the observed rela-
tions are not simply apparent for all combinations of tested
variables. That is, reversing their order in the mediational test
permits an examination of mediation via a different ordering
of the variables. Here, we evaluated whether anxious arousal
symptoms mediated the relation between smoking rate and
coping motives. Analyses indicated that smoking rate re-
mained a signifi cant predictor of coping motives after control-
ling for anxious arousal symptoms, F (3, 118) = 9.17, p < .001.
This result initially appears inconsistent with mediation. How-
ever, post-hoc analyses using the Sobel test for mediation re-
vealed that anxious arousal symptoms partially mediated the
relation between smoking rate and coping motives Z = 1.96
( p = .051). Specifi cally, anxious arousal symptoms accounted
for a portion of the unique variance in coping motives; how-
ever, anxious arousal symptoms did not fully explain (medi-
ate) the relation between smoking rate and coping motives.
To examine our second model that coping motives medi-
ate the relation between anxious arousal symptoms and smok-
ing rate, an initial hierarchical linear regression was conducted
to examine the relation between anxious arousal symptoms
(the predictor) and smoking rate (the criterion). Gender was
included as a covariate at Step 1 of the model, and anxious
arousal symptoms were entered at Step 2. Overall, the model
predicted 5.1% of variance in smoking rate, F (2, 120) = 3.18,
p < .05. Step 1 of the model did not signifi cantly predict smok-
ing rate (see Analysis 1 in Table 3 ). Step 2 accounted for 5.1%
of variance, with anxious arousal symptoms being a signifi cant
Table 1. Zero-order correlations among theoretically relevant variables
Va r i a b l e 1 2 3 4 5 M or % ( SD ) Observed range
1. Gender 1 − .01 .23* .00 .10 68.29% female
2. Cigs/Day 1 .27** .23* .13 15.46 (7.95) 1 – 45
3. WISDM-NR 1 .32** .28** 4.78 (1.47) 1 – 7
4. MASQ-AA 1 .42** 28.18 (8.90) 17 – 54
5. MASQ-AD 1 58.06 (13.77) 31 – 91
Note . Gender dummy coded 0 = males, 1 = females; Cigs/Day = average number of cigarettes smoked per day; WISDM-NR = Wisconsin
Inventory of Smoking Dependence Motives Negative Reinforcement subscale; MASQ-AA = Mood and Anxiety Symptom Questionnaire Anxious
Arousal subscale; MASQ-AD = Mood and Anxiety Symptom Questionnaire – Anhedonic Depression subscale.
* p < .01; ** p < .001.
1300
Coping motives mediation
predictor of smoking rate above and beyond gender (see Anal-
ysis 1 in Table 3 ).
A second hierarchical linear regression was conducted to
examine the relation between anxious arousal symptoms (the
predictor) and coping motives (the mediator). Gender was in-
cluded as a covariate at Step 1 of the model, and anxious arousal
symptoms were entered at Step 2. The model predicted 15% of
variance in coping motives, F (2, 119) = 10.29, p < .001. Step 1 of
the model predicted 5.1% of variance, with gender being a sig-
nifi cant predictor of coping motives (see Analysis 2 in Table 3 );
here, women endorsed greater levels of coping motives than
men. Step 2 accounted for an additional 9.9% of variance, and
once again, anxious arousal symptoms were a signifi cant predictor
above and beyond gender (see Analysis 2 in Table 3 ).
A nal hierarchical linear regression was conducted to ex-
amine the relation between coping motives (the mediator) and
smoking rate (the criterion). Similar to the above analyses,
gender was included as a covariate at Step 1 of the model, and
coping motives were entered at Step 2. Here, 8% of variance in
smoking rate was explained in total, F (2, 118) = 5.06, p < .01.
Step 1 of the model did not signifi cantly predict smoking rate
(see Analysis 3 in Table 3 ). Step 2 accounted for 8% of variance,
and coping motives signifi cantly predicted smoking rate above
and beyond the variance accounted for by gender (see Analysis
3 in Table 3 ).
As described in Table 3 , the mediational role of coping mo-
tives in the relation between anxious arousal symptoms and
smoking rate also was examined. In these analyses, when con-
trolling for the effects of anxious arousal symptoms, coping mo-
tives signifi cantly predicted smoking rate (see Analysis 4 in
Table 3); however, anxious arousal symptoms were no longer a
signifi cant predictor of smoking rate after controlling for cop-
ing motives. Thus, coping motives mediated the relation be-
tween anxious arousal symptoms and smoking rate (see Analysis
5 in Table 3 ). Moreover, post-hoc analyses using the Sobel test
of mediation revealed that coping motives significantly medi-
ated the relation between anxious arousal symptoms and smok-
ing rate Z = 2.07 ( p < .05).
As with the previously tested mediational model, we attempted
to strengthen this interpretation by conducting an additional
analysis reversing the proposed mediator and criterion variable
( Preacher & Hayes, 2004 ; Sheets & Braver, 1999 ; Shrout & Bolger,
2002 ). Here, we evaluated whether smoking rate mediated the
relation between anxious arousal symptoms and coping
motives. Results were not consistent with mediation in this di-
rection, as anxious arousal symptoms remained a significant
predictor of coping motives after controlling for smoking rate,
F (3, 118) = 9.17, p < .001. Post-hoc analyses using the Sobel test
of mediation revealed that smoking rate did not mediate the
relation between anxious arousal symptoms and coping motives
Z = 1.59 ( p = ns ).
Discussion
Smoking rate was signifi cantly and uniquely associated with
anxious arousal symptoms; specifi cally, smoking rate account-
ed for approximately 5.1% of the unique variance in anxious
arousal symptoms, and its effect was apparent after controlling
Table 2. Regression analyses testing for
mediation: Coping motives mediating the
relation between smoking rate and anxious
arousal symptoms
Independent variable(s) Dependent variable b F
1. Gender (Step 1) MASQ-AA .01 .00
Cig/Day (Step 2) .23 6.34*
2. Gender (Step 1) WISDM-NR .23 6.20*
Cig/Day (Step 2) .28 10.02**
3. Gender (Step 1) MASQ-AA .07 .00
WISDM-NR (Step 2) .33 6.80**
4. Gender (Step 1) MASQ-AA .05 3.23*
Cig/Day (Step 1) .15
WISDM-NR (Step 2) .29 9.57**
5. Gender (Step 1) MASQ-AA .05 6.79**
WISDM-NR (Step 1) .29
Cig/Day (Step 2) .15 2.74
Note . b = standardized beta weight provided for hierarchical multiple
regression; F = change in F statistic provided for hierarchical multiple
regression (only one F statistic is reported for each step); gender
dummy coded 0 = males , 1 = females ; Cigs/Day = average number
of cigarettes smoked per day; WISDM-NR = Wisconsin Inventory of
Smoking Dependence Motives Negative Reinforcement subscale;
MASQ-AA = Mood and Anxiety Symptom Questionnaire Anxious
Arousal subscale.
* p < .05, ** p < .01.
Table 3. Regression analyses testing for
mediation: Coping motives mediating the
relation between anxious arousal
symptoms and smoking rate
Independent variable(s) Dependent variable β F
1. Gender (Step 1) Cig/Day − .01 .01
MASQ-AA (Step 2) .23 6.34**
2. Gender (Step 1) WISDM-NR .22 6.32*
MASQ-AA (Step 2) .31 13.59**
3. Gender (Step 1) Cig/Day .09 .09
WISDM-NR (Step 2) .29 10.02**
4. Gender (Step 1) Cig/Day .08 3.28*
MASQ-AA (Step 1) .16
WISDM-NR (Step 2) .24 6.16**
5. Gender (Step 1) Cig/Day .08 5.06**
WISDM-NR (Step 1) .24
MASQ-AA (Step 2) .16 2.74
Note . b = standardized beta weight provided for hierarchical multiple
regression; F = Change in F statistic provided for hierarchical multiple
regression (only one F statistic is reported for each step); gender
dummy coded 0 = males , 1 = females ; Cigs/Day = average number of
cigarettes smoked per day; WISDM-NR = Wisconsin Inventory of
Smoking Dependence Motives Negative Reinforcement subscale;
MASQ-AA = Mood and Anxiety Symptom Questionnaire Anxious
Arousal subscale.
*p < .05, ** p < .01.
1301
Nicotine & Tobacco Research, Volume 11, Number 11 (November 2009)
for the variance accounted for by gender (Level 1). Also, cop-
ing motives mediated the relation between smoking rate and
anxious arousal symptoms. Although the cross-sectional na-
ture of the research design does not allow us to defi nitively
disentangle whether coping motives develop following
smoking at higher rates per se ( Baron & Kenny, 1986 ), the
present data are consistent with a coping motives mediational
model of anxiety symptoms among daily smokers. We at-
tempted to strengthen confi dence in this observation by evalu-
ating an alternative model where anxious arousal symptoms
mediated the relation between smoking rate and coping mo-
tives. Analyses indicated that smoking rate remained a signifi -
cant predictor of coping motives after controlling for anxious
arousal symptoms. While this result initially appeared to be
inconsistent with mediation, post-hoc analyses revealed that
anxious arousal symptoms partially mediated the relation be-
tween smoking rate and coping motives. Specifi cally, anxious
arousal symptoms accounted for a portion of the unique vari-
ance in coping motives; however, anxious arousal symptoms
did not fully explain (mediate) the relation between smoking
rate and coping motives (see below for an expanded discussion
of this fi nding).
A secondary aim of the present investigation was to explore
a second mediational model. Namely, we sought to examine
whether coping motives mediated the relation between anxious
arousal symptoms and smoking rate. Here, anxious arousal
symptoms were signifi cantly related to smoking rate. Specifi -
cally, anxious arousal symptoms accounted for 5.1% of the
unique variance in smoking rate, above and beyond the variance
accounted for by gender (Level 1). Moreover, coping motives
mediated the relation between anxious arousal symptoms and
smoking rate. Similar to the method described above, we at-
tempted to strengthen confi dence in this observation by evalu-
ating an alternative model where smoking rate mediated the
relation between anxious arousal symptoms and coping mo-
tives. Consistent with our initial fi ndings, smoking rate did not
mediate this relation.
Taken together, these mediational fi ndings suggest that
there may be a bidirectional effect between the studied variables
where anxious arousal leads to greater smoking rate, which in
turn contributes to elevations in anxious arousal. It is not possible
to determine the causal processes potentially at play due to the
cross-sectional and correlational nature of the research design.
Despite this limitation, the present data suggest that coping
motives are a possibly important mediational element in the
smoking rate anxiety linkage and serve as a potentially clinically
important step in the elucidation of smoking anxiety pathways.
For example, a feed forward cycle may develop, whereby smoking
is used as a coping strategy for managing aversive anxiety states
in the short term yet paradoxically confers longer term risk for
experiencing more frequent and intense anxious arousal symptoms
( Zvolensky & Bernstein, 2005 ). Alternatively, for smokers with
higher levels of anxiety symptoms, coping motives may lead to
greater rates of cigarette use ( Patton et al., 1998 ). From a clinical
perspective, it is possible that coping-based motives for smoking
may need to be addressed as part of cessation-based care
for smokers with anxiety-related vulnerabilities or diffi culties.
For example, among smokers with high levels of anxious arousal
symptoms, it may be necessary to focus educational and thera-
peutic strategies on the role of coping motives in smoking
behavior. This type of targeted strategy may help such smokers
more accurately learn about the nature of their smoking behavior
and perhaps be better equipped to change it during efforts to
stop smoking.
The present study has a number of limitations and related
future directions that warrant further discussion. First, the pres-
ent sample is limited in that it comprised a relatively homoge-
nous group of adult smokers who volunteered to participate in
a treatment-focused study. To rule out potential self-selection
bias among persons with these characteristics and increase the
generalizability of these fi ndings, it will be important for re-
searchers to draw from populations other than those included
in the present study. Second, given that self-report measures
were used as the assessment methodology, method variance due
to the unimethod approach used may have contributed, in part,
to the observed results. To address this concern, future research
could use alternative assessment methodologies that incorpo-
rate multimethod approaches. For instance, future studies may
choose to use an ecological momentary approach to assess
smoking motives in real time ( Shiffman, 2000 ). Finally, the
cross-sectional nature of the current data precludes defi nitive
conclusions regarding directional effects. Building from the
current study, future work is poised to make further exciting
inroads into this domain of study by exploring the empirical
merit of more complex models. Here, it is possible that certain
coping mechanisms may interact with specifi c smoking expec-
tancies (beliefs about the effects of smoking; Brandon, Juliano,
& Copeland, 1999 ; e.g., negative affect reduction) to explain
rates of smoking. Thus, future prospective tests examining the
mediational and moderational role of coping motives for smok-
ing is a useful next research step.
Overall, the present study provides novel empirical infor-
mation concerning putative bidirectional pathways among
smoking rate, coping-based smoking motives, and anxious
arousal symptoms among treatment-seeking adult smokers.
Results indicated that coping motives mediated the relation
between smoking rate to anxious arousal symptoms and anx-
ious arousal symptoms to smoking rate. Although still pre-
liminary, the present data globally highlight the important
role of coping-based smoking motives in terms of better un-
derstanding linkages between smoking rate and anxious
arousal symptoms.
Funding
Dr. S.S. is supported by a Killam Research Professorship from
the Dalhousie University Faculty of Science . This work was sup-
ported by an Idea Research Grant from the Canadian Tobacco
Control Research Initiative (15683) awarded to Dr. S.S.,
Dr. M.J.Z, and D.S.
Declaration of interests
The authors declare that they have no competing interests for this
research project.
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A 4-factor measure of drinking motives based on a conceptual model by M. Cox and E. Klinger (see PA, Vol 75:32975; see also 1990) is presented. Using data from a representative household sample of 1,243 Black and White adolescents, confirmatory factor analyses showed that the hypothesized model provided an excellent fit to the data and that the factor pattern was invariant across gender, race, and age. Each drinking motive was related to a distinct pattern of contextual antecedents and drinking-related outcomes, and these relationships did not generally vary across demographic subgroups. Results support both the conceptual validity of Cox and Klinger's model and the utility of this measure for clinical and research purposes across a diverse range of adolescent populations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Context Studies of selected groups of persons with mental illness, such as those who are institutionalized or seen in mental health clinics, have reported rates of smoking to be higher than in persons without mental illness. However, recent population-based, nationally representative data are lacking.Objective To assess rates of smoking and tobacco cessation in adults, with and without mental illness.Design, Setting, and Participants Analysis of data on 4411 respondents aged 15 to 54 years from the National Comorbidity Survey, a nationally representative multistage probability survey conducted from 1991 to 1992.Main Outcome Measures Rates of smoking and tobacco cessation according to the number and type of psychiatric diagnoses, assessed by a modified version of the Composite International Diagnostic Interview.Results Current smoking rates for respondents with no mental illness, lifetime mental illness, and past-month mental illness were 22.5%, 34.8%, and 41.0%, respectively. Lifetime smoking rates were 39.1%, 55.3%, and 59.0%, respectively (P<.001 for all comparisons). Smokers with any history of mental illness had a self-reported quit rate of 37.1% (P = .04), and smokers with past-month mental illness had a self-reported quit rate of 30.5% (P<.001) compared with smokers without mental illness (42.5%). Odds ratios for current and lifetime smoking in respondents with mental illness in the past month vs respondents without mental illness, adjusted for age, sex, and region of the country, were 2.7 (95% confidence interval [CI], 2.3-3.1) and 2.7 (95% CI, 2.4-3.2), respectively. Persons with a mental disorder in the past month consumed approximately 44.3% of cigarettes smoked by this nationally representative sample.Conclusions Persons with mental illness are about twice as likely to smoke as other persons but have substantial quit rates.
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Background Epidemiologic studies have reported a lifetime association between smoking and panic disorder. In this study, we examine potential explanations for this association. Methods Analysis was conducted on data from 2 epidemiologic studies, the Epidemiologic Study of Young Adults in southeast Michigan (N = 1007) and the National Comorbidity Survey Tobacco Supplement (n = 4411). Cox proportional hazards models with time-dependent covariates were used to estimate the risk for onset of panic attacks associated with prior smoking and vice versa, controlling for history of major depression. The role of lung disease in the smoking–panic attacks association was explored. Results Daily smoking signaled an increased risk for first occurrence of panic attack and disorder; the risk was higher in active than past smokers. No significant risk was detected for onset of daily smoking in persons with prior panic attacks or disorder. Exploratory analyses suggest that lung disease might be one of the mechanisms linking smoking to panic attacks. Conclusions The evidence that the association between smoking and panic disorder might result primarily from an influence in one direction (ie, from prior smoking to first panic attack) and the possibility of a higher risk in active than past smokers suggest a causal hypothesis for the smoking–panic attacks relationship.
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Using a 34-item self-completion questionnaire relating to a wide variety of smoking motive themes gleaned from previously published work, responses of 175 normal smokers were subjected to factor analysis. Six oblique factors were obtained representing the following six types of smoking: psychosocial, indulgent, sensorimotor, stimulation, addictive and automatic. Previous work suggesting a sedative type of smoking was not confirmed. The most striking finding was a major "pharmacological addiction" dimension which completely separated the stimulation, automatic and addictive factors and their items from the rest. It was these three factors which were correlated (.50, .56, .63 respectively) with cigarette consumption and which differentiated the sample of normal smokers from a criterion sample of 103 addicted heavy smokers attending smoking withdrawal clinics. It is suggested that it may prove more useful to classify smokers according to their position on the single dimension of pharmacological addiction to nicotine rather than in terms of their profiles on the six types of smoking. The interpretation and limitations of factor analysis of questionnaire-type data are discussed.
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