Psychology of Addictive Behaviors

The Relationship Between Depression Level and Smoking Motives in College Smokers
Christine Vinci, Megan M. McVay, Amy L. Copeland, and Maureen H. Carrigan Online First Publication, May 9, 2011. doi: 10.1037/a0023772

CITATION Vinci, C., McVay, M. M., Copeland, A. L., & Carrigan, M. H. (2011, May 9). The Relationship Between Depression Level and Smoking Motives in College Smokers. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0023772

Psychology of Addictive Behaviors 2011, Vol. , No. , 000 000

2011 American Psychological Association 0893-164X/11/$12.00 DOI: 10.1037/a0023772

The Relationship Between Depression Level and Smoking Motives in College Smokers
Christine Vinci, Megan M. McVay, and Amy L. Copeland
Louisiana State University
While the link between cigarette smoking and depression symptomatology has been well established, more research is needed to determine how smoking motives are related to depression levels in smokers. Specifically, smoking motives related to the friendship-like attachment to smoking (i.e., affiliative attachment) may play an important role in individuals reporting depressive symptomatology. The present study examined the relationship between three smoking motives and depression levels in a sample of 79 mildly nicotine-dependent, college student cigarette smokers. A hierarchical multiple regression analysis was conducted with depression as the dependent variable and gender and cigarettes per day as the independent variables (Step 1), positive and negative reinforcement motives (Step 2), and affiliative attachment motives (Step 3). Results of regression analyses indicated that affiliative attachment motives explained significant variance in participant depression level above and beyond that explained by positive and negative reinforcement motives. These findings suggest that smokers with elevated depression should be assessed for social functioning and affiliative attachment smoking motives, and future research should be conducted to determine if individuals with high levels of affiliative attachment may benefit from smoking cessation treatment programs with an enhanced social support component. Keywords: cigarette smoking, depression symptoms, motives

Maureen H. Carrigan
University of South Carolina Aiken

The prevalence of comorbid depression and cigarette smoking has been well-established, as one recent study found that about 50% of individuals aged 20 39 who experience depression also smoke cigarettes (Pratt & Brody, 2010). Research has suggested that smokers experiencing high levels of negative affect/depressive symptoms may differ in their motives for smoking from those low in negative affect/depressive symptoms (Copeland, Brandon, & Quinn, 1995; Friedman-Wheeler, Ahrens, Haaga, McIntosh, & Thorndike, 2007; Johnson et al., 2008; McChargue, Spring, Cook, & Neumann, 2004). Understanding these differences may contribute to the development of more effective prevention and treatment programs for those with a history and/or current symptoms of depression, as these individuals tend to have the most difficulty quitting (Glassman et al., 1990; Piper et al., 2010). Previous literature has primarily focused on the relationship between depression and positive and negative reinforcement expectancies or motives.1 Depressive symptoms have been found to correlate with positive reinforcement expectancies for smoking (Copeland, Kulesza, & Hecht, 2009; Friedman-Wheeler et al., 2007), and even more specifically, it has been shown that positive reinforcement expectations about smoking mediate the relation-

Christine Vinci, Megan M. McVay, and Amy L. Copeland, Department of Psychology, Louisiana State University; Maureen H. Carrigan, Department of Psychology, University of South Carolina Aiken. Correspondence concerning this article should be addressed to Maureen H. Carrigan, Department of Psychology, University of South Carolina Aiken, 471 University Parkway, Aiken, SC 29801. E-mail: maureec@ usca.edu 1

ship between history of depression and smoking status (McChargue et al., 2004). Negative reinforcement expectancies are also associated with higher levels of negative affect/emotional vulnerability in smokers (Copeland et al., 1995; Johnson et al., 2008). In preliminary data recently presented, Vinci, Carrigan, and Copeland (2010) found that a number of additional smoking motives differentiate smokers high and low in depressive symptomatology. Specifically, motives related to smoking being a source of companionship or playing a friend-like role, a motive termed affiliative attachment by Piper et al. (2004), were stronger in those higher in depressive symptoms. This is of particular interest, as the link between depression and poor social skills is wellestablished (Segrin, 2002). Previous research has found that individuals with higher levels of depressive symptoms struggle with certain aspects of social interaction (i.e., empathy and forgiveness)a pattern which may maintain or further exacerbate negative mood (Burnette, Davis, Green, Worthington, & Bradfield, 2009). Problems in social interactions among smokers with depressive symptoms may lead these individuals to have a more emotional connection to cigarettes, as they may engage in smoking as an alternative source of reinforcement. It is not uncommon for smokers to report feeling as though cigarettes are a friend, and it may be that depressed individuals experience an even greater sense of friendship-like attachment to the act of smoking than

While differences between expectancies and motives have been noted elsewhere (Copeland et al., 1995; Fidler & West, 2009), the present paper will view them synonymously due to the large degree of overlap in these constructs.

VINCI, MCVAY, COPELAND, AND CARRIGAN

nondepressed smokers (Piper et al., 2004), as was suggested in the preliminary findings of Vinci et al. (2010). The present study examined the relationship between theoretically relevant smoking motives and depression level in a sample of college smokers. As with the general population, it has been found that a link exists between smoking and negative affect in college smokers (Magid, Colder, Stroud, Nichter, & TERN Members, 2009); however, the relationship between depression level and smoking motives in college students has not been fully examined. In the current study, we have made two hypotheses, based in part on the initial findings of Vinci et al. (2010), with a more targeted focus on affiliative attachment motives, which research suggests may be a particularly important motive in depressed patients (e.g., Burnette et al., 2009; Segrin, 2002). First, we hypothesized that endorsement of positive and negative reinforcement motives would predict depression level, as suggested by previous findings (Copeland et al., 1995; Friedman-Wheeler et al., 2007; Johnson et al., 2008; McChargue et al., 2004). Second, we hypothesized that endorsement of a friendship-like attachment to smoking would predict depressive symptoms above and beyond positive and negative reinforcement.

Method Participants
Participants were recruited as part of a larger, smoking cue exposure study consisting of multiple sessions. Undergraduate students were recruited to participate in the study through a participant sign-up system to receive course credit. After signing up, students came into the lab to complete questionnaires as part of a screening for the larger study (which examined individuals smoking, mood, and physiological responses to a mood induction procedure). Participants were required to be current cigarette smokers 18 years old and older. The present study utilized only those participants who reported that they smoked cigarettes daily.

good testretest reliability (.85), concurrent validity (ranging from .30 .80, depending on the compared measure) and has been standardized on the general population (as opposed to a clinical population; Radloff, 1977). Participants also completed the WISDM-68 (Piper et al., 2004), a 68-item measure used to determine individuals motives for smoking that has shown good reliability (.73 .95) and concurrent validity (.15.78, depending on the compared measure and WISDM-68 subscale). The positive and negative reinforcement subscales were examined for reinforcement motives, while the affiliative attachment subscale of the WISDM-68 was utilized to assess friendship-like attachment to smoking. The positive reinforcement subscale assessed the positive effects the individual experienced from smoking, while the negative reinforcement subscale measured participants perceptions that smoking alleviates unpleasant emotional states. The affiliative attachment subscale measured the endorsement of the belief that, cigarettes come to share many of the same affective and motivational properties as attractive social stimuli (Piper et al., 2004, p. 49). The authors of the scale suggest that those who endorse this motive are more attached to cigarettes, as they consider cigarettes similar to a friend (Piper et al., 2004). Following the completion of the questionnaires, participants were provided with information regarding the second part of the study (not described here).

Results
The sample consisted of 79 undergraduate college smokers and was comprised of 57% female and 43% male smokers. Eighty-four percent of participants were Caucasian, 7.6% were African American, and 7.6% self-identified as Other. The average age of the sample was 20.19 (SD 3.75). The sample smoked an average of 8.25 (SD 5.29) cigarettes per day for a mean of about three years. The average FTND score was 2.28 (SD 1.91), which is considered a low average score on this measure (Heatherton et al., 1991). The average CES-D score of the sample was 15.36 (SD 9.85). In the present sample, 60% scored within the minimal range of depressive symptoms (0 15), 26% scored in the mid to moderate range (16 26), and 14% scored in the severe range (Radloff, 1977). Correlations of all variables can be seen in Table 1. Given that the positive and negative reinforcement subscales were highly correlated, and to avoid violating the assumption of multicollinearity in the hierarchical linear regression, positive and negative reinforcement were combined in the regression model by averaging the means of the two scales. This change is supported by recent changes in the WISDM-68 scale, in which the authors combined

Materials and Procedure

After signing the informed consent form, participants completed a variety of questionnaires. Participants were provided with a demographic questionnaire and the Fagerstrm Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Reckler, & Fagerstrm, 1991) to assess nicotine dependence level. Additionally, participants completed The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a 20-item self-report measure that assesses for depressive symptoms that occured within the past week. This measure has demonstrated

Table 1 Correlational Results

Variable Cigarettes/Day Negative/Positive Reinforcement Affiliative Attachment CES-D p .05. p .01. Cigarettes/day 1 .248 .325 .079 Negative/positive reinforcement 1 .612 .245 Affiliative attachment CES-D

1 .443

DEPRESSION LEVEL AND SMOKING MOTIVES

positive and negative reinforcement, partially because they loaded onto the same factor structure (Smith et al., 2010). Hierarchical linear regression was conducted to determine if positive reinforcement, negative reinforcement, and affiliative attachment predicted depression levels. In order to hold cigarettes smoked per day and gender (coded: 1 Female, 2 Male) constant, these variables were entered into the model as Step One (given the low mean FTND score and limited variability, we chose to not control for FTND score and instead decided that cigarettes smoked per day was a more appropriate level of dependence in this sample), with CES-D score as the dependent variable. These variables were entered first because prior research has indicated that dependence and gender may differentially impact smoking motives and/or depression variables (e.g., Lerman et al., 1996; Wetter et al., 1999). This step was significant, F(2, 76) 4.74, p .011. The combination of positive and negative reinforcement motives were entered into the model at Step Two. This second model was also significant, F(3, 75) 4.69, p .005, and significantly explained variance above and beyond cigarettes smoked per day and gender, Fchange (3, 75) 4.19, p .044. In Step Three, affiliative attachment was entered into the model. The total model was significant, F(4, 74) 7.34, p .001. Notably, the addition of affiliative attachment added significantly to the amount of variance explained, Fchange (4, 74) 13.04, p .001. In the final model, affiliative attachment was significantly positively associated with depressive symptoms, while gender was significantly negatively associated with depressive symptoms. The combined variables of positive and negative reinforcement and cigarettes smoked per day were not significantly related to depression symptoms. The adjusted R2 of .245 for the final model indicates that the amount of variance explained doubled when affiliative attachment was added to the equation (see Table 2 for beta weights).

Discussion
The current study examined the relationship between smoking motives and depression levels in a college sample. Our hypothesis that the motives of positive and negative reinforcement would predict depression level was supported. College smokers experiencing higher levels of current depressive symptomatology endorsed higher levels of positive and negative reinforcement motives for smoking.

Our second hypothesis was that a friendship-like attachment to smoking would predict depressive symptoms above and beyond positive and negative reinforcement. This hypothesis was supported. Indeed, the addition of affiliative attachment was not only significant, but it also doubled the amount of variance explained. Depression is associated with poor social functioning (Burnette et al., 2009; Segrin, 2002), suggesting that one potential explanation for the present findings is that smokers with depressive symptoms may be using smoking to substitute for an absence of social reinforcement. If this is the case, some individuals with high levels of depression may benefit from an additional emphasis on improving social functioning during smoking cessation treatment. In addition to treatment focusing on improving social functioning outside of therapy, there is some evidence from past research that depressed individuals may particularly benefit from smoking cessation treatment that has enhanced social support within the therapeutic relationship. Specifically, research has found that smokers high in pretreatment negative affect responded better to supportive counseling than to skills training therapy (Zelman, Brandon, Jorenby, & Baker, 1992). Similarly, Brandon, Copeland, and Saper (1995) concluded that individuals high in negative affect may benefit from a more supportive therapy environment. Thus, given prior findings and the present results, individuals in treatment for smoking cessation who have high levels of depression may benefit from increased emphasis in two areasfocusing on potential social interactions outside of therapy and having a more supportive therapy environment. However, before additional research is conducted to empirically test these two hypotheses, these treatment implications remain speculative. Given the preliminary nature of the present studys findings and the need for additional research, the following suggestions are made to potentially lay groundwork for future research examining depression, smoking, and social interactions. In addition to the possibility that the poor social functioning that oftentimes accompanies depression is contributing to smoking behaviors, it is also possible that smoking behaviors might partially replace social interactions in individuals with high levels of depression, thereby worsening depression levels. Thus, it may be worthwhile to assess the motives for smoking of smokers in treatment for depression, and consider the possible role of smoking in maintaining depressive symptoms via its effects on social functioning. In addition, examination of these motives may not only target those individuals

Table 2 Hierarchical Linear Regression Results

Model 1 Variable Cigarettes/Day Gender Negative/Positive Reinforcement Affiliative Attachment Adjusted R2 F Fchange Note. B p .05. unstandardized coefficient. p .01. B .094 6.423 SE B .202 2.147 .088 4.742 4.742 standardized coefficient. .051 .325 B .204 5.828 .305 Model 2 SE B .205 2.123 .149 .124 4.689 4.186 .109 .295 .226 B .379 4.570 .057 .668 Model 3 SE B .197 2.002 .171 .185 .245 7.342 13.040 .203 .231 .042 .475

VINCI, MCVAY, COPELAND, AND CARRIGAN Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrm, K. (1991). The Fagerstrm Test for Nicotine Dependence: A revision of the Fagerstrm Tolerance Questionnaire. British Journal of Addiction, 86, 1119 1127. Johnson, K. A., Zvolensky, M. J., Marshall, E. C., Gonzalez, A., Abrams, K., & Vujanovic, A. A. (2008). Linkages between cigarette smoking outcome expectancies and negative emotional vulnerability. Addictive Behaviors, 33, 1416 1424. doi:10.1016/j.addbeh2008.05.001 Lerman, C., Audrain, J., Orleans, C. T., Boyd, R., Gold, K., Main, D., & Caporaso, N. (1996). Investigation of mechanisms linking depressed mood to nicotine dependence. Addictive Behaviors, 21, 9 19. Magid, V., Colder, C. R., Stroud, L. R., Nichter, M., & TERN Members. (2009). Negative affect, stress, and smoking in college students: Unique associations independent of alcohol and marijuana use. Addictive Behaviors, 34, 973975. McChargue, D., Spring, B., Cook, J., & Neumann, C. (2004). Reinforcement expectations explain the relationship between depressive history and smoking status in college students. Addictive Behaviors, 29, 991 994. doi:10.1016/j.addbeh.2004.02.048 Piper, M. E., Piasecki, T. M., Federman, E. B., Bolt, D. M., Smith, S. S., Fiore, M. C., & Baker, T., B. (2004). A multiple motives approach to tobacco dependence: The Wisconsin inventory of smoking dependence motives (WISDM-68). Journal of Consulting and Clinical Psychology, 72, 139 154. Piper, M. E., Smith, S. S., Schlam, T. R., Fleming, M. F., Brown, J. L., Zehner, M. E., . . . Baker, T. B. (2010). Psychiatric disorders in smokers seeking treatment for tobacco dependence: Relations with tobacco dependence and cessation. Journal of Consulting and Clinical Psychology, 78, 1323. Pratt, L. A., & Brody D. J. (2010). Depression and smoking in the U.S. household population aged 20 and over (NCHS Data Brief No. 34). Hyattsville, MD: National Center for Health Statistics. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385 401. Rigotti, N. A., Lee, J. E., & Wechsler, H. (2000). US college students use of tobacco products: Results of a national survey. Journal of the American Medical Association, 284, 699 705. Segrin, C. (2002). Social skills deficits associated with depression. Clinical Psychology Review, 20, 379 403. Smith, S. S., Piper, M. E., Bolt, D. M., Fiore, M. C., Wetter, D. W., Cinciripini, P. M., & Baker, T. B. (2010). Development of the brief Wisconsin Inventory of Smoking Motives. Nicotine and Tobacco Research, 12, 489 499. Vinci, C., Carrigan, M., & Copeland, A. L. (2010, November). Impact of depression levels on motives for smoking. Poster presented at the meeting of the Association for Behavioral and Cognitive Therapies, San Francisco, CA. Wetter, D. W., Kenford, S. L., Smith, S. S., Fiore, M. C., Jorenby, D. E., & Baker, T. B. (1999). Gender differences in smoking cessation. Journal of Consulting and Clinical Psychology, 67, 555562. Zelman, D. C., Brandon, T. H., Jorenby, D. E., & Baker, T. B. (1992). Measures of affect and nicotine dependence predict differential response to smoking cessation treatment. Journal of Consulting and Clinical Psychology, 60, 943952.

who may benefit from increased focus on social support but perhaps also those individuals who have adequate support and instead would benefit from interventions targeting other deficits. Future research may examine the interpersonal functioning of individuals who are elevated on a scale such as affiliative attachment in order to better clarify the potential uses of the WISDM-68 in future research. The limitations of the present study include the fact that we were not assessing clinical levels of depression but only depressive symptoms. However, we were interested in the continuum of depressive symptoms and not solely major depression. Also, we were unable to analyze other variables that may impact the findings, such as alcohol consumption. Another limitation may be that the present sample was comprised of undergraduates who smoked an average of 8.25 cigarettes per day. Although this may indicate low dependence levels, research suggests that college students smoke less on average than the typical smoking population (Rigotti, Lee, & Wechsler, 2000); thus, the smokers in our sample appear to be typical of college smokers. However, generalizability to other populations may be limited. Our findings suggest that additional focus and understanding of the relationships between smoking, depression, and social interaction could help prevent relapse, as smokers with current or past depressive symptoms often have worse smoking cessation outcomes than those without such symptoms (Glassman et al., 1990; Piper et al., 2010). Thus, determining current and past depressive symptoms as well as smoking motives could be extremely helpful in smoking treatment and relapse prevention.

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Received December 18, 2010 Revision received March 28, 2011 Accepted March 30, 2011