Addictive Behaviors, Vol. 10, pp. 197-201, 1985 Printed in the USA. All rights reserved.

0306-4603185 $3.00 + .OO Copyright e 1985 Pergamon Press Ltd

BRIEF REPORT

REASONS FOR SMOKING AMONG EXTREMELY HEAVY SMOKERS

MARGARET W. LINN and SHAYNA STEIN Veterans Administration Medical Center and University of Miami School of Medicine

Abstract-Four factors describing reasons for smoking were identified in 200 heavy smokers. When these four factor scores were correlated with other variables, the Addictive/Habitual Needs factor correlated most often with increased use of tobacco, alcohol, and coffee. The Pleasure factor was associated with obesity and the Stress Reaction factor with more perceived stress. The Stress Reaction factor was consistently correlated with more unfavorable ratings on psychological adjustment. Persons who smoked to alleviate stress or for addictive/habitual needs had tried to stop more often, whereas those who smoked for pleasure had little motiva- tion to stop smoking. Findings suggest that there are individual differences in reasons for smoking among extremely heavy smokers and that these need to be taken into account in trying to help such individuals.

Smoking behavior has often been seen as motivated by affective states. Innate rein- forcing properties combine with learning so that smoking becomes capable of either relieving negative affective states or evoking positive reactions. Tomkins (1968) sug- gested that there were four types of smokers. There were those who smoked for the positive results that smoking could produce, such as relaxation and stimulation. There were those who smoked to relieve negative feelings. There were also those who were habitual smokers for whom the act of smoking was no longer consciously associated with tension reduction or pleasure, and the addictive smoker who has become depen- dent on tobacco to the extent that awareness of not smoking elicits such negative feel- ings that further smoking is constantly required.

The purpose of this study was to determine how major reasons for smoking would relate to smoking behaviors, excessive use of alcohol and coffee, obesity, perceived stress, and psychological characteristics in a group of 200 men who were extremely heavy smokers.

METHOD

From 1981 to 1983,200 men were selected randomly from ambulatory care clinics of the Veterans Administration Medical Center if they met criteria of being between 40 and 60 years of age, free from autoimmune diseases, and had a history of use of at least two packs of cigarettes per day for 20 or more years. Men responded to a questionnaire concerning smoking history and behaviors. They also rated 15 items describing reasons for smoking on scales of l-4 ranging from “not at all” to “very much.” Prior and cur- rent use of alcohol was assessed on a 4-point scale ranging from 1 = none to 4 = extreme for the prior 6 months and over most of their lifetime. Number of cups of coffee con- sumed per day was recorded. Men were classified as to degree of obesity on a 3-point scale ranging from none to severe by the nurse clinician conducting the interview. Per- ceived stress was measured over the prior year by a modified version of the Social

This project was supported by Veterans Administration Grant #5289-005. Requests for reprints should be sent to Margaret W. Linn, Director, Social Science Research, Veterans Ad-

ministration Medical Center, 1201 N.W. 16th Street, Miami, FL 33125.

197

I98 MARGARET W. LYNN and SHAYNA STEIN

Readjustment Rating Scale (Holmes & Rahe, 1967). Subjects responded on scales of O-9 for degree of perceived stress related to occurrence of any of 41 stressful life events.

Psychological adjustment was measured with a battery of scales. The Hopkins Symp- tom Checklist (Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) provided factor scores that describe somatization, obsessive-compulsiveness, depression, interpersonal sensitivity, and anxiety. Rotter’s (1966) 23-item Locus of Control Scale was used to measure the degree to which the person feels that he has control over events in his life (internal locus), or the degree to which he believes that luck or fate controls what hap- pens to him (external locus). How alienated the individual felt from others was mea- sured by Srole’s (1956) 9-item Alienation Scale. Life satisfaction was assessed using Neugarten’s (1961) 15item Life Satisfaction Scale. Lastly, a 20-item scale (Rosenberg, 1965) was used to measure degree of self-esteem. Scales were scored so that higher scores were less favorable responses.

The 15 reasons for smoking were factor analyzed to determine the dimensions of smoking motivations in this group of men. Using the first 100 men who entered into the study, random halves of this sample were analyzed separately to cross-validate the fac- tor structure. All 100 ratings were then entered into the factor analysis to determine the final item loadings for the factors that had been identified. Item ratings on the 15 reasons for smoking then were factor scored for the entire sample. The resulting four factors were correlated with the other variables to see if major reasons for smoking were related to smoking history and behavior, use of alcohol and coffee, obesity, de- gree of perceived stress, or any particular psychological characteristics. Pearson pro- duct moment correlations were used with a two-tailed test of significance.

RESULTS

Sample characteristics The average age of the men was 54.9 (SD = 6.9). They had about 12 years of educa-

tion and were mostly from lower-middle to middle class populations. Most of the sam- ple (95%) had been married at some time during their lives, but only 51% were cur- rently married and living with their wives. A large proportion (32%) were divorced, 6% were separated, and 6% widowed. Of the sample, 28% were living alone when they en- tered the study. The men averaged about $225 a week income; however, there was con- siderable variance in income from 13% who had less than $100 per week, to 20% who received over $300 per week.

In regard to smoking history, results confirm the heavy smoking history in this group of men. They averaged slightly over two packs of cigarettes per day. Over most of their adult lives they smoked about 2.3 packs, with 10 individuals smoking four packs per day. In terms of the most packs ever smoked, the average was three with 15 individuals who had at some time smoked five packs or more per day.

The men started smoking at an average age of 16 and had smoked for about 30 years. They had tried to stop smoking about five times during their lifetime, with the longest time they had not smoked averaging eight months. Over half (60%) said they would like to stop smoking. A large proportion (34%) chain smoked, had two cigarettes lit at one time (52%), smoked as soon as they awakened in the morning (64%) or at night when they awoke (48010), and took about 6 minutes to smoke a cigarette.

Dimensions of reasons for smoking Results of the factor analysis are shown in Table 1. There were four factors describ-

ing the 15 items. The strongest factor was one that appeared to describe a reaction to

Reasons for smoking 199

Table 1. Factor structure of the reasons for smoking scale.

Variables

Social Addictive/Habitual Stress Reaction Pleasure Acceptance Needs (25% variance) (13% variance) (10% variance) (12% variance)

Take away pressure Cope with anxiety When feeling bored To get rid of jitters Help me think To give me a boost To give pleasure Tastes good To relax To be like friends Keep from gaining weight Something to do with hands To give social poise To make me feel confident Constant habit, don’t

.83

.81

.1-l

.I2

.60

.59 .86 .85 .50

.64

.59 .I5 .61 .59

know I’m smoking .51

stress, with items such as “to take away pressure or cope with anxiety.” Six items loaded on this factor. Another factor appeared to describe smoking for pleasure. A third fac- tor described wanting to be like friends and preventing weight gain as reasons for smok- ing and was called a social acceptance factor. A fourth factor was associated with what seemed to be addictive/habitual needs as a reason for smoking in that it dealt with items such as having something to do with one’s hands, making one feel confident, or acknowledging that it was so much of a habit that the smoker was unaware of smoking. The 15 reasons for smoking were scored into the four factors for the 200 individuals and these factor scores were then correlated with smoking history/behaviors, other re- lated behaviors, perceived stress, and with psychological assessments.

Correlates of reasons for smoking with other smoking and related behaviors and perceived stress

None of the demographic variables, such as age, race, education, living alone, or marital status, was significantly associated with the four factors. Smoking behaviors, alcohol use, and amount of coffee consumed were all significantly correlated (p < .05) with the addictive habitual needs reasons for smoking. Alcohol use in this group of men had been high in the past. During most of their lives, only 5% had never used alcohol, 31% reported moderate use, 44% said they had heavy use but did not consider it a problem, and 20% reported heavy use and considered it problem drinking. In considering alcohol use during the past 6 months, only 23% said they were heavy users. Current use was not related to any of the smoking factors. However, prior use of alcohol was correlated with both the Social Acceptance and Addictive/Habitual Needs factors. The men averaged using about 4.5 cups of coffee per day (SD = 3.5). The more coffee they drank, the higher their ratings were on the Addictive/Habitual Needs factor of the scale. The average rating on obesity was 1.5 on a three-point scale (SD = .6). Degree of obesity was correlated significantly with the Pleasure factor as a reason for smoking. The average number of stressful life events that occurred over the preceding year was 4.8, and the amount of perceived stress associated with these events was 26.8 (SD = 21.2). The higher the perceived stress, the more one smoked for the

200 MARGARET W. LYNN and SHAYNA STEIN

stress reaction reason and for social acceptance (p < .Ol). Those who smoked as a reaction to stress or from addictive/habitual needs had tried to stop more often even though their attempts were unsuccessful.

Correlates of reasons for smoking with psychological adjustment All of the psychological adjustment scores correlated significantly and highly with

the Stress factor (p < .Ol, except for locus of control which was p < .05). The more the person smoked to relieve stress, the more symptoms of somatization, obsessive- compulsiveness, depression, anxiety, and problems of interpersonal sensitivity were reported. Furthermore, smoking to relieve stress occurred more in men who had less internal locus of control, were more alienated, had less life satisfaction, and lower self- esteem. Smoking for pleasure related only to more problems in interpersonal sensitivity. Smoking for social acceptance was associated with more depression, less life satis- faction, and poorer self-esteem. Smoking for addictive/habitual needs was correlated with more obsessive-compulsiveness and more problems with interpersonal sensitivity. Again, although these other factors correlated with some of the psychological adjust- ment scores, the Stress Reaction factor was the outstanding correlate for all of the psychological variables.

DISCUSSION

Although all of the men in this study were addicted to cigarettes, as demonstrated by their smoking histories and current use of cigarettes, the fact that the Addic- tive/Habitual Needs factor correlated more often with the amount smoked during dif- ferent times in their lives and with other habits, such as chain smoking and having more than one cigarette lit at a time, confirms that individuals who scored high on this factor were those with strong needs to smoke more. These same kinds of needs were also associated with more use of alcohol and coffee.

Although 60% of the sample indicated a desire to give up smoking, an average of about five previous attempts had proved unsuccessful. Those who smoked as a reaction to stress or from addictive/habitual needs had tried more often to quit. Persons in this study who reported smoking more to alleviate stress were also those with poorer psy- chological functioning. Moreover, these persons perceived more stress from recent life events. Whether they perceived more stress because they were initially less well- equipped to handle the pressure is unknown. What does seem apparent is that it would be more difficult for these persons to withdraw from smoking, especially since with- drawal can create its own anxiety.

Interpersonal influences of family, friends, and acquaintances are seen as very po- tent motivators for smoking behavior. In this study, social acceptance as a reason for smoking related to more packs of cigarettes smoked per day over the lifetime and to amount of perceived stress. Being accepted and liked by friends are probably associated with the personality of the smoker, since the Social Acceptance factor also correlated significantly with low self-esteem, poorer life satisfaction, and depression. Those who smoked for social acceptance, as with those who smoked to alleviate stress or from ad- dictive/habitual needs, were more likely to believe they could not quit.

The more one smoked for pleasure, the more one was obese. These persons may be the least likely to seek change since their smoking is neither brought about by distress nor apparently causing them distress. This group was the only one showing a relation- ship to not wanting to stop smoking.

There are individual differences in reasons for smoking among extremely heavy

Reasons for smoking 201

smokers and these would need to be taken into account in trying to help such in- dividuals. Among heavy smokers, personal characteristics did not distinguish between different motivations for smoking, suggesting that the reasons described cut across all demographic variables. Persons who smoked to alleviate stress or for addictive habit- ual needs had tried to quit more often; whereas those who smoked for pleasure had little motivation to stop smoking. Reasons for smoking are complex and varied, and factors contributing to behavior change are relatively unexplored. Nevertheless, under- standing what contributes to an individual’s continued use of cigarettes may help to develop appropriate treatment modalities.

REFERENCES

Derogatis, L.R., Lipman, R.S., Rickels, D., Uhlenhuth, E.H., & Covi L. (1974). The Hopkins symptom checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19, l-15.

Holmes, T.H., & Rahe, R.M. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213-218.

Neugarten, B., Havighurst, R.J., & Tobin, S.S. (1961). The measurement of life satisfaction. Journal of Gerontology, 16, 134-143.

Rosenberg, M. (1965). Society and the udolescenr self-image. Princeton, NJ: Princeton University Press. Rotter, J.B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psy-

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