Pharmacological and non-pharmacological smoking motives: a replication and extension.

Cigarette smokers (n = 387) completed a questionnaire measure of smoking motives, and subgroups of this sample provided external validation information. Seven factors emerged from a principal components' analysis: automatic, sedative, addictive, stimulation, psychosocial, indulgent and sensorimotor manipulation. A higher-order principal components analysis revealed the presence of two second-order factors. Inspection of the pattern of correlations between factor scores and criterion variables clearly indicated that the first four factors above and their underlying second-order factor are more closely related to nicotine pharmacology and mood-altering effects of nicotine than the latter three motives and their underlying second-order factor. Moreover, the positive correlations between these pharmacological motives and age, coupled with a negative relationship between age and the non-pharmacological motives, support the description of the smoking career as a progressive transfer of reward from non-pharmacological to pharmacological factors. These findings suggest that self-reported reasons for smoking represent more than bias in verbal report.

Treatment session frequency and smoking cessation.

In a retrospective program evaluation analysis, we compared abstinence rates in 78 smokers participating in a 2-, 3-, or 6-week clinic-based behavioral-pharmacological smoking cessation program. The three treatment formats consisted of six sessions that varied in session frequency. Retention and end-of-treatment smoking cessation rates were best in the medium-frequency (3-week) and high-frequency (2-week) treatment session formats. One-year follow-up abstinence rates were highest in the medium-frequency format, and lowest in the high-frequency format. A significant patient-treatment interaction effect was found for pretreatment smoking rate. Individuals with lower pretreatment smoking rates benefited most with respect to end-of-treatment cessation rates from the medium- and high-frequency treatment session format. However, this effect was not significant at the 1-year follow-up. The need for prospective research and patient-to-treatment matching implications in smoking cessation programs are discussed.

Gender differences in prospectively versus retrospectively assessed smoking withdrawal symptoms.

Investigations of gender differences in the frequency and/or intensity of smoking withdrawal symptomatology have yielded conflicting findings. Several studies using measures collected both before abstinence and at the peak of symptomatology have failed to find gender differences. Yet, when asked to rate symptomatology experienced during past quit attempts, women have repeatedly been shown to endorse significantly more symptomatology than men. A possible explanation is that, although men and women show no differences when rating symptoms prospectively, women remember their past withdrawal symptoms as being more severe than do men, either because women exaggerate the difficulties they experience or because men downplay them. To test this hypothesis, and to determine whether men or women were more accurate in their recollections, we combined data from two studies in which subjects were asked to assess symptoms prospectively following 2 days of abstinence, and also to rate withdrawal during past quit attempts. As predicted, we found the effects of abstinence to be similar when assessed prospectively but different when assessed retrospectively, with women reporting more symptomatology than men. Men whose retrospective and prospective responses were discordant consistently underestimated the likelihood of experiencing symptomatology; women showed no consistent trends. The total number of symptoms reported retrospectively by women was similar to the total number reported prospectively, whereas men significantly underestimated the number of symptoms that they actually experienced. These findings may suggest ways in which treatment strategies can be tailored to the differences between male and female styles in recalling past experiences with abstinence from smoking.

A proposed revision of the Fagerstrom Tolerance Questionnaire.

This article presents the results of initial testing of a revised version of the Fagerstrom Tolerance Questionnaire (TQ). Revisions were designed to improve the psychometric properties of the TQ. Four diverse samples of cigarette smokers completed the 10-item Revised Tolerance Questionnaire (RTQ), and responses were subjected to psychometric and factor analyses. Substantial improvement in internal consistency was obtained as compared to prior studies of the TQ. In addition, the results of factor analysis indicate that a substantial amount of covariation among the 10 items can be accounted for by a single common factor. Thus, unlike the TQ, the RTQ appears to be measuring a unidimensional construct. Also, preliminary data on temporal stability are positive. With respect to validity, the RTQ correlated moderately with the TQ and outperformed the TQ in predicting expired alveolar carbon monoxide. Finally, suggestions for further establishing the validity of the RTQ are offered.

Measuring the stages of change in cigarette smokers.

This article describes preliminary reliability testing of an instrument for measuring a smoker's progress toward abstinence or relapse. We have developed a set of visual-analog scales intended to measure subtle changes in the smoking cessation process. These are based on the Stages of Change described by DiClemente and Prochaska and the presentation format suggested by Biener and Abrams. In this study, we presented the scales in two different formats (projected on a screen using an overhead projector or printed on sheets of paper) to 23 subjects, all inpatients in a chemical dependency treatment program. The subjects' response on the two modalities were highly correlated, indicating reliability of the scale between modalities and within the time frame studied. We offer this instrument as an inexpensive and efficient means of evaluating smoking cessation strategies and the progress of individuals in smoking cessation programs.

Temporal stability and within-subject consistency of nicotine withdrawal symptoms.

This study tested the temporal stability and within-subject consistency of the Diagnostic and Statistical Manual-III-R (DSM-III-R) nicotine withdrawal symptoms in 39 (21 female, 18 male) regular smokers. Subjects provided withdrawal symptom ratings while smoking ad libitum and during two 48-hour abstinence periods that were separated by 1 week. All but two symptoms, increased eating and hunger, demonstrated adequate temporal stability (i.e., stability coefficients > or = .70). Within-subject consistency was found for impatience, anxiety, difficulty concentrating, and irritability. The total (average) score emerged as the most stable and consistent indicator of withdrawal. Results of a cluster analysis suggest the presence of two groups of smokers based on the withdrawal experience. Possible reasons for variability in nicotine withdrawal symptom reports are discussed.

The female weight-control smoker: a profile.

Hypothesizing the existence of a subgroup of female smokers for whom nicotine masks, and abstinence unmasks, a tendency toward hyperphagia and perhaps even subthreshold disordered eating, we compared female "weight-control smokers" (WC; n = 46) and "non-weight-control smokers" (NWC; n = 52) on smoking- and eating-related variables. We also examined the relationship between weight-control smoking and withdrawal symptomatology during 48-hours of nicotine abstinence (n = 23). Although WC were not more depressed, anxious, or nicotine-dependent than NWC, they were significantly more likely to report weight gain and increased hunger during abstinence; they also scored higher on Cognitive Restraint and Disinhibition (Three-Factor Eating Questionnaire). The expected correlation of cotinine with weight emerged for NWC but not for WC. Weight-control smoking correlated with increased eating during abstinence. Our findings suggest that WC use dietary restraint as well as smoking to manage weight, and that abstinence may precipitate episodes of disinhibited or binge eating. If WC overinclude women vulnerable to excess or unpredictable eating and consequently to substantial weight gain that can be managed by nicotine, highly focused treatment strategies may be helpful.

A critical review of the Reasons for Smoking Scale.

The present article reviews studies bearing on the psychometric characteristics and clinical utility of the Reasons for Smoking Scale (RFS). It is concluded that the instrument possesses adequate psychometric properties such as a stable factor structure, internal consistency, and temporal stability. However, the supportive results of validity studies are weak and inconsistent. Moreover, the instrument appears to possess little clinical utility. Consequently, there exists little empirical evidence to justify its widespread use in clinical practice.

Assessment of the validity of the Reasons for Smoking scale.

To assess the convergent validity of the Reasons for Smoking scale (RFS) 30 male and 24 female smokers completed the RFS and then self-monitored their smoking motives over seven days. Significant validity coefficients, ranging from .39 to .51, were obtained for the stimulation, pleasure, habit, and psychological addiction motive scales. The stimulation, habit, and psychological addiction scales also demonstrated sound discriminant validity. Validity coefficients for the sensorimotor manipulation and negative affect reduction motive scales were nonsignificant. These results contrast sharply with the less positive findings of previous research. Sample and methodological differences between the studies may explain the dissimilarity in results.