Direct and indirect effects of psychological distress on stress-induced smoking

Objective: Numerous studies have modeled the effects of stress in the laboratory, demonstrating that smokers who are exposed to experimental stressors exhibit significant increases in acute psychological distress. Whether these stress reactions are predictive of stress-induced smoking during an actual quit attempt, however, has not been examined. Furthermore, the possibility that such effects are particularly strong among smokers with higher ambient levels of distress has not been addressed. Method: Nicotine-dependent smokers (N = 60; 40 women, 20 men) completed the Brief Symptoms Index (BSI) and then participated in a laboratory stress task 1 week before a quit attempt. Acute psychological distress was measured immediately before and after exposure to stressful and neutral stimuli. After they quit, partici- pants completed a smoking diary for 14 days in which they recorded the degree to which their smoking was precipitated by emotional stress. Results: Consistent with our hypotheses, BSI scores predicted both exaggerated laboratory stress responses (p <.005) and smoking that was attributable to stress during the 14-day postquit period (p <.01). Laboratory stress reactions were predictive of stress-induced smoking (p <.01), and acute psychological stress reactions mediated the effects of BSI on stress-induced smoking. Conclusions: Acute psychological stress reactivity is a potential mechanism underlying the effect of stress-induced smoking during a quit attempt.