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Situational factors in cigarette smoking
Behaviors, Vol. 15, pp. l-12, Printed in the USA. All rights reserved.
Addictive
SITUATIONAL DOROTHY
1990 Copyright
FACTORS
IN CIGARETTE
K. HATSUKAMI, STEVEN F. MORGAN, STEPHEN E. CHAMPAGNE University
0306.4603190 $3.00 + .OO Q 1990 Pergamon Pres\ plc
SMOKING
ROY W. PICKENS.
and
of Minnesota
Abstract - Situational factors related to smoking behavior in the natural environment were studied. Six subjects smoked all cigarettes over 10 days with a portable, electronic recording device which measured a number of frequency and time-based features of smoking. Subjects also coded activities and internal states associated with each cigarette smoked. Across subjects. there were considerable differences in the distribution of cigarettes smoked across the activity and internal states categories. Within subjects, all subjects showed variation in measures of smoking topography (number of puffs/cigarette, mean puff duration, total puff time/cigarette) as a function of situational variables. It did not appear that pharmacological factors could fully account for the substantial situational differences found. The results suggest that different factors may be involved in the control of different aspects of smoking topography.
Psychological-behavioral intervention strategies to facilitate smoking cessation have had only limited success (Hunt & Bespelac, 1974; Pechacek, 1979). Difficulties in this area may be due in part to lack of an understanding of the stimulus variables which control smoking behavior in the natural environment (Epstein & Collins, 1977). Laboratory studies have demonstrated that smoking behavior may vary as a function of the smoking situation, with differences measured for several aspects of smoking topography (Ashton & Watson. 1970; Comer & Creighton, 1978; Fuller & Forrest, 1973; Glad & Adesso, 1976). There is also evidence that smoking topography differs when measured in the laboratory as compared to the unobtrusive observational measurement of subjects smoking in a naturalistic setting (Comer & Creighton, 1978; Ossip-Klein, Martin, Lomax, Prue, & Davis. 1983). Because of obvious practical difficulties in measuring smoking behavior from situation to situation outside the laboratory, there is little information on the variation in aspects of smoking topography in the natural environment. Research in the area has been limited to smokers’ self-reports on various smoking behavior questionnaires (e.g., Frith. 197 I ; lkard & Tomkins, 1973; McKennell, 1970) and to the self-monitoring of situations associated with each cigarette smoked (Epstein & Collins, 1977). While these studies have demonstrated that smokers differ in the situations in which they smoke, measures of smoking behavior have been limited to the frequency with which smoking occurs in situations or classes of situations. While smoking rate or frequency is only one of many dimensions of smoking behavior, there is evidence that other dimensions of smoking (e.g., puff duration, number of puffs/cigarette) may not be strongly related to frequency measures in the natural environment (Hatsukami, Morgan, Pickens, & Hughes, 1987; Morgan, Gust, Pickens, Champagne, & Hughes, 1985). The extent to which various topographies of smoking vary across situations in the natural environment is thus not known. The present study examines a novel methodology for the study of smoking topography in the natural environment, with particular focus on situational factors related to smoking topography. Smokers smoked all cigarettes over a IO-day period using a lightweight, This research was supported by N.I.D.A. Research Grants No. DA 02988 and No. 02413 and N.I.D.A. Training Grant No. DA 07097. Requests for reprints should be sent to Dr. Dorothy Hatsukami, University of Minnesota. Department of Psychiatry, Box 392 Mayo, Minneapolis, MN 55455.
2
DOROTHY
K. HATSUKAMI
et al
portable, electronic recording device which recorded a number of frequency and time-based measures of smoking. Situational factors were broadly defined to encompass activities in which the subject was engaged while smoking and internal states predominant at the time the subject started to smoke. Situational factors were defined as such in this initial investigation because past research has often focused on the arousal/motivational/affective components of situations in which persons smoke (e.g., Ashton & Watson, 1970; Comer & Creighton, 1978; Fuller & Forrest, 1973; Glad & Adesso, 1976; Ikard, Green, & Horn, 1969; McKennell, 1970). Subjects in the present study thus coded Activity and Internal State factors for each cigarette smoked. Smoking behaviors associated with different categories of activities and internal states were contrasted. METHOD
Subjects Subjects were six smokers (one male, five females) between the ages of 18 and 35, five of whom were employed in settings in which smoking was not restricted and one of whom was unemployed. All subjects were naive to research on smoking behavior. Their mean reported smoking rate was 29.5 cigarettes per day (SD = 4.2), and the mean FTC-rated nicotine yield of their chosen cigarette brands was .79 mg (SD = .23). All the subjects had been smoking for greater than one year. Subjects were paid $7 for each day in which they adhered to the experimental procedure, with a $30 bonus for 10 consecutive days of compliance. Measurement Topographical aspects of smoking were measured using a small portable recorder. The recorder consisted of a three-foot length of plastic tubing, which was attached at one end to an opening in the side of a commercial cigarette holder (Tar Gard No. 1274, Venturi Inc.) and at the other end to a pressure switch (Model 505-3, Coventry Corp.) mounted inside an aluminum box (1 in. x 4 in. x 5 in.). In addition to the pressure switch, the box contained electronic circuitry for time measurement (L . 1 sec.) and digital memory storage of up to 2048 temporal events. Events were defined as the opening or closing of the pressure switch, allowing the duration of successive puff durations and interpuff intervals to be stored in successive memory locations. From these data, it was possible to derive a number of topographical measures of smoking behavior - the number of cigarettes smoked per day, the number of puffs per cigarette, puff duration, cigarette duration, the total puffing time per cigarette, and intercigarette and interpuff intervals. This device has been found to be accurate and reliable in measuring smoking behavior and to have minimal interference with normal activities (Pickens, Gust, Catchings, & Svikis, 1983). For each cigarette smoked, subjects recorded the following: (a) the time at which the cigarette was lit, and (b) numbers coded for the activity in which the subject was engaged and the subject’s internal state immediately prior to the time the subject started to smoke the cigarette. The category options are listed in Table 1. The categories which were included in the Activity and Internal State lists were extracted from previous analyses of smoking situations (McKennell, 1970) and from a survey of smoking situations endorsed by early pilot subjects in this project. Recording sheets were 4 in. X 5 in. and designed to be folded into thirds and slipped into the subjects’ cigarette pack. One side of the sheet listed the various coding categories. The other side consisted of columns headed Time, Activity, and Feelings. Under each of these columns were 20 rows for the coding of the above categories for 20 consecutive cigarettes. In addition to the categories offered, subjects were encouraged to write in any other category which they felt was more appropriate in describing the activity
Factors in cigarette smoking
Table 1. Activities and Internal States Categories as listed on the reverse side of the self-monitoring forms Feelings
Activities
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
After a meal Socializing Driving w/beverage Working Taking a break Watching TV or relaxing Waiting Nothing to do On telephone
Il.
Other (write in)
1. Relaxed 2. Anxious, tense 3. Low, depressed 4. Bored 5. Angry,
6. 7. 8. 9. 10.
irritated Tired Hungry Happy Busy Other (write in)
or internal state associated with a cigarette. The subject was required to select at least one of the category options for each cigarette, but more than one could also be endorsed. Since the majority of responses required only the recording of a number, self-monitoring took only a few seconds once the subjects became familiar with the categories. Procedure Subjects used the smoking device and self-monitored with the above recording sheets for all cigarettes smoked over 10 consecutive days. Subjects came in to the lab each morning of the study to exchange recording devices and recording sheets and to take a bogus breath analysis. The necessity of full compliance with the procedure was emphasized and encouraged by the contingencies of payment - subjects were told that they would be paid only for those days in which all cigarettes were smoked with the device and that the daily breath analyses would verify compliance. Also, subjects received a $30 bonus for 10 consecutive days of compliance. Subjects were cued to the experimental procedures by the placement of the recording sheets, which were bright yellow, in the subjects’ cigarette packs. Subjects were instructed to self-monitor after beginning the cigarette, as Epstein & Collins (1977) report that reactive effects of self-monitoring are minimal under such conditions when subjects are not motivated to change their smoking patterns. Dependent measures For each cigarette smoked in the study, the following dependent variables were calculated - number of puffs/cigarette, mean puff duration, total puff time/cigarette (number of puffs/cigarette times mean puff duration), and intercigarette interval prior to the cigarette. RESULTS For each subject ratings.
If more
individually, than
one
cigarettes
activity
were separated
was endorsed
on the basis of Activity
for a cigarette,
then
category
a constellation
of
activities became a separate activity category (e.g., the category for all cigarettes during which the subject was both socializing and drinking). Categories were included in further analyses only if they included a minimum of six cigarettes. Each of the six subjects had at least five Activity categories included in their analyses, with a maximum of 12 categories
(e.g., subjects 6). Because subjects varied from one another on the different Activities and Internal States associated with their cigarette smoking, the data from each subject were analyzed separately.
m
Yz$ s -s 5’ (P 5 e ,_ n
m-as F&._
erv, 8. B
-Vm w g._ .>* If
INTERNAL
STATES
SOCIALIZING DRIVING DRlNKlNG WORKING ON BREAK TV/RELAXING WAIT&G NOTHING TO DO ON TELEPHONE WORKING/DRINKING SOCIALIZINQIDRINKING
MEALS
ACTIVITIES
IO
II
I4
Number
12 I3
Puffs/Cigarette
I5 I6
73
I7 75
80
80
90
90
95
95
Duration
Seconds
85
85
Puff
bb
Mean
Total
3 Puff
12 13 14 I5
120 I30 140 150
Time/Cigarette
Seconds
100 85 90 IO II
100 B590 100 II0
Subject
I
I
I
I
Intercigarette
I
I
Interval
Seconds
1000 1500 2000 2500 3000 3500
IO00 1500 2000 2500 3000 3500
Prior
ti
0
o -D O1 m3eg ;d%=:
Q$
&?“5
-6
FEELINGS
ACTIVITIES
3
4
IL
3456789’
5
Number
6
7
8
of PuffslCig.
9
130 1.35 140
155
145 150 155
140 145 150
Puff Duration
** b
130 135
Mean
160
160
(sec.)
5
5
6
6
Total
7
7
8
8
3
3
10
10
I1
11
Puff TimelCig.(sec.)
12 0
12 0
Prior
2000
2000
Intercig.
4000
4000
Interval
6000
6000
(sec.1
6
DOROTHY
K. HATSUKAMI
SUBJECT
et al.
3
26.5 r .
. . . .
(L
”
. . . .
. . .
=;;r, -.i + . ”
”
.
”
.
. . t . i .
” i ; 8
J
Activities Fig. 3. Scatterplot of the Total Puff Time/Cigarette Subject 3. Each dot represents a cigarette.
measure
across the Activities
categories
for
dependent measures. While it would have been of interest to covary out the effects of the interval prior to cigarettes smoked when examining the three topography dependent measures as a function of activities, the data do not meet the requirements for such an analysis - there was not a linear relationship between the prior intercigarette interval and the other dependent measures. Thus, each of the four measures was analyzed independently. Highly significant differences in smoking topography were found across smoking situations for each subject. For the number of puffs/cigarette, mean puff duration, and total puff time/cigarette measures, all F values for five of the six subjects (Subjects 2, 3, 4, 5, and 6) were highly significant (r, < ,005) across Activity categories. For Subject 1, the F value was significant (p < ,005) for puff duration, approached significance (p = .06) for number of puffs/cigarette, but failed to approach significance on the total puff time/cigarette measure. On the prior intercigarette interval measure, significant main effects (p < ,005) across activities were found for all subjects except Subjects 3 and 5.
7
Factors in cigarette smoking
SUBJECT
3
26.5,
.
24.0 3 z
& c 19.0 aJ z
1 t
f g
16.5 -
;
2
14.0 -
I; .
z
11.5-
T-
.. .
l
.
:
m
. --i--
--s--
9.0 -
15 ”
6.5 -
t
.
.
h
:
.
.
.
Y .
:
__*__
Y __
w
0
:
:
_____ .: . * . . 1 . ”
I-”
8 . .
.
Y
l
_:
-
i
l
z z
.
: .
_.
i=
.
.
21.5 -
” . .
;
.
Fig. 4. Scatterplot of the Total Puff Time/Cigarette Subject 3. Each dot represents a cigarette.
.
*
;
T 8
_t
-_
a
YE
measure across the Internal States categories
for
The above procedures were repeated for the Internal States categories. Each subject had at least four Internal States categories represented in the analyses, with a maximum of eight for Subject 3. Relative to the Activities factor, the Internal States main effects on the topography measures were somewhat less robust. Still, four of the six subjects (Subjects 1, 3, 4, and 6) showed statistically significant (p < .OOOl) effects of Internal States on the number of puffs/cigarette, two of six subjects (Subjects 3 and 6) did so on mean puff duration @ < .Ol), and four of six did so on total puff time/cigarette (p < .Ol), and four of six did so on total puff time/cigarette (p < .Ol for Subject 1; p -C .005 for Subjects 3, 4, and 6). On prior intercigarette interval, the measure varied significantly across Internal States categories for four of the subjects (p < .05 for Subjects 2 and 6; p < .005 for Subjects 1 and 5). In order to more clearly demonstrate the nature of the findings, the data for two representative subjects (Subjects 3 and 4) are presented for more detailed examination. These subjects were both employed females who smoked at a similar rate (20.4 vs. 21.4 cigarettes/day, respectively). The FTC-rated nicotine yield of their chosen cigarette brands were .58 and 1.04 mg, respectively. Figures 1 and 2 display smoking topography data across the different activity and internal state categories for the two selected subjects. Within
DOROTHY
K. HATSUKAMI
et al.
4
199-
2
.
178-
5
.
i 157Y Q, z Q, 136 ;;I ?
”
. -
1,5-
i _-•__ ”
._E” E
.
73-
.
.
. . .
.
-:-;
0..
g4.
f.? ‘iij z l-
.
.
.
v
.. : .
.
2 .y& .
zA
& !
52-
i
31-
”
i
. .
; Y a . -
. .
1 .o -
Activities Fig. 5. Scatterplot of the Total Puff Time/Cigarette Subject 4. Each dot represents a cigarette.
measure
across the Activities
categories
for
subjects, differences in all measures of smoking topography as a function of Activities and Internal States are apparent. Some of the differences are of striking magnitude, especially in light of the standard errors of the mean indicated. For example, the difference in total puff time/cigarette between the “waiting” versus the “working/drinking” categories for Subject 3 was 6.6 seconds, or 68% more mouth-level smoke exposure for cigarettes smoked while waiting. In general, examination of the mean intercigarette intervals associated with the categories suggests that differences in intercigarette intervals are not likely to account for differences in smoking behavior between categories. Increases in intercigarette interval are not necessarily associated with increases in smoke exposure. Figures 1 and 2 also characterize the substantial individual differences measured in the study. Although equal on the number of cigarettes
9
Factors in cigarette smoking
SUBJECT 4 22.0
1
.
19.9
. .
17.8 z
C s 157
s a, 136 z 2 .s 0 2
11.5
. . . .
. .
88
x
_!L 8 .
.
.
l
t
l
”
.
8
-
T --f-
: ; . .
3.1
iL . .
”
8 . .
. . .
.
.
--r-:
;.
. . .-: . . :
t . . . . .
i _;_
T Ic 8 .
.
1 .c )-
Fig. 6. Scatterplot of the Total Puff Time/Cigarette Subject 4. Each dot represents a cigarette.
measure across the Internal States categones
for
smoked per day, these subjects differed considerably in mean values for the other topography measures. For Subject 3 versus Subject 4, respectively, overall mean values were 13.9 versus .9 versus 1.5 seconds on mean puff duration, and 6.2 puffs on number of puffs/cigarette, 12.1 versus 9.1 seconds on total puff time/cigarette. Also characteristic of all subjects in the study, these two subjects differed in the Activities and Internal States associated with their smoking. Figures 3, 4, 5, and 6 are scattergrams of the total puff time/cigarette measure for each cigarette smoked in the different Activities and Internal States categories for Subjects 3 and 4. These figures allow an examination of the overlap in distributions associated with the different categories. While in general there is considerable overlap, the distributions of a number of categories are strikingly disparate.
IO
DOROTHY K. HATSUKAMI et al
DISCUSSION
Situational factors associated with smoking behavior were studied in the natural environment. Activities and internal states associated with over 1300 cigarettes were recorded as six subjects smoked over IO consecutive days. Also, the number of puffs, mean puff time, total puff time, and prior intercigarette interval were obtained for each cigarette smoked. Each of the six subjects demonstrated that cigarette smoking behavior can vary with situational factors. Not only did subjects differ in the distribution of smoking across the various Activity and Internal States categories, but subjects were also found to smoke cigarettes differently as a function of the different situations. These differences were manifested in the number of puffs taken per cigarette, the average puff time per cigarette, and in the total puffing time per cigarette. The scatterplots of the total puff time/cigarette measure across categories of Activities and Internal States for the two representative subjects (Figures 3, 4, 5, and 6) demonstrate some fairly dramatic distributional differences. While it has been suggested that variations in smoking behavior may best be understood as attempts to regulate nicotine intake (e.g., Schachter, 1978), the present data demonstrate consistent and large differences in smoking behavior which seem unlikely to be totally accounted for by pharmacological factors. Visual examination of Figures 1 and 2 show that, in general, differences in smoking topography between categories cannot be simply explained by differences in the prior intercigarette intervals characteristic of the different categories. For example, categories associated with longer intercigarette intervals are not necessarily associated with larger mean values on the topography measures. Furthermore, although Schachter’s work suggests that situational influences are mediated by changes in the metabolism of nicotine, the naturalistic data collected here show little indication of such a pattern. Despite evidence that situational stress may increase the rate of excretion of nicotine (Schachter, Silverstein, & Perlick, 1977). for Subject 4 mouth level smoke exposure was substantially greater when smoking a cigarette while relaxed than when anxious or tense (Figure 5). In addition, across the five subjects who had a sufficient number of cigarettes represented in the “anxious, tense” and “relaxed” categories, there was no significant tendency for measures of smoking topography to differ as a function of those categories. On the other hand, since no biochemical measure of smoke exposure (e.g., expired CO, plasma nicotine, etc.) was obtained during the day, perhaps specific extension of the results to Schachter’s hypothesis may be limited. It is of interest that smokers may smoke with similar frequency in different situations but be quite dissimilar in other aspects of their smoking topography in those same situations. For example, Subject 4 smoked with a high frequency in situations described as “socializing” and “watching tv/relaxing,” but Figure 5 reveals that cigarettes falling into the two categories were smoked quite differently. Similarly, Subject 4 smoked a lower frequency of cigarettes in the categories “after a meal” or “on telephone,” but again those categories differed substantially in smoking topography. These contrasts raise the possibility that factors which are related to the initiation of a cigarette may be different than those controlling other aspects of smoking topography. There is supporting data from experimental studies suggesting that measures of smoking rate (number of cigarettes/time period) may vary independent of how cigarettes are smoked. For example, Epstein, Ossip, Coleman, Hughes, and Wiist (1981) demonstrated that manipulating a subject’s smoking frequency did not affect other parameters of smoking topography. Russell, Sutton, Feyerabend, and Salojee (1980) concluded that when nicotine content of cigarettes is reduced, subjects tend to increase their smoke intake per cigarette but tend not to show any change in number of cigarettes smoked. While it was impossible to insure subjects’ compliance in the study, our interactions with
Factors in cigarette smoking
11
the subjects gave little indications of non-compliance. Record keeping indicated a high commitment to accuracy (e.g., the subject’s recording of the time at which the cigarette was lit rarely deviated by more than a couple minutes from the time recorded by the smoking device). Also, the categories “socializing” and “working” were the two categories endorsed with the highest frequency, suggesting that subjects were not inhibited from using the smoking device while in social or work environments. It should be noted that a failure to use the device for a particular cigarette would only affect the frequency measure - that is, if the subject did not use the device on a cigarette while working, the measure of the total number of cigarettes smoked while working would be in error. The other measures of smoking topography, which are averaged across cigarettes smoked in this category, would be unaffected. There are several limitations involved in the study. First, although the smoking habits of the present sample were similar to those of the national sample (see Hughes & Hatsukami, 1986) there is still the question of the extent to which subjects who are willing to use the device are representative of the general population of smokers. Furthermore, the generalizability of the results may be limited due to the small sample size. Second, although the device has been found to minimally interfere with activities in previous studies, it is possible that the device may have been obtrusive in some situations compared to others (e.g., social situations). Thus, the obtrusiveness of the device associated with these situations may have affected the smoking pattern (i.e., shorter puff duration, shorter total cigarette duration, etc.). However, reports from subjects indicated that they did not find the use of the smoking devices embarrassing or difficult. Third, smoking topography measured in the natural environment has been found to vary as a function of time of day (Morgan et al., 1985). It is possible that particular situations occurred during particular time periods, thus confounding the results. That is, a specific smoking pattern may be as a result of the particular time periods which are associated with the occurrence of specific situations, or a result of the situation in and of itself. Fourth, puff volume, which would be the best estimate of smoke exposure, was not measured. However, the topographical features of smoking which were measured in the present study offer a more accurate measure of smoke exposure than previous investigations which have been limited to cigarette frequency. While further examination of the relationship between situational factors and smoking behavior offers hope of more precise behavioral interventions in the future, more detailed descriptive data regarding a smoker’s behavior may in and of itself be of value in treatment. For example, Subject 4 not only smoked fewer cigarettes when anxious as opposed to when she was relaxed, but she also smoked more intensely when relaxed. Thus, the advisability of using relaxation training as a component of a treatment program (e.g., Danaher & Lichtenstein, 1978) with such a subject is possibly questionable. In summary, the present data indicate that smoking behavior does vary as a function of situational factors in the natural environment. Across subjects, there was considerable variability in the distribution of cigarettes smoked across situational categories. Within subjects, it was demonstrated that a smoker’s smoking topography may differ fairly dramatically from situation to situation. The frequency with which cigarettes were smoked in a situation appeared unrelated to other features of smoking topography in that situation. This accentuates the importance of considering smoking behavior as a complex operant with many topographies. Future research to elucidate controlling factors relative to different features of smoking topography offers hope of improving behavioral intervention strategies for smoking cessation.
12
DOROTHY
K. HATSUKAMI
et al.
REFERENCES Ashton, H., & Watson, D.W. (1970). Puffing frequency and nicotine intake in cigarette smokers. British Medical Journal, 3, 679-681. Comer, A.K., & Cmighton, D.E. (1978). The effect of experimental conditions on smoking behavior. In R.E. Thornton (Ed.), Smoking behavior (76-86). New York: Churchill-Livingston. Danaber, B.G., & Lichtenstein, E. (1978). Become an ex-smoker. Englewood Cliis, NJ: Prentice Hall. Epstein, L.H., & Collins, F.L. (1977). The measurement of situational influences of smoking. Addictive Behaviors, 2, 47-53. Epstein, L.H., Ossip, D.J., Coleman, D., Hughes, J., & Wiist, W. (1981). Measurement of smoking topography during withdrawal or deprivation. Behavior Therapy, 12, 507-519. Frith, CD. (1971). Smoking behaviour and ita relation to the smoker’s immediate experience. British Journal of Social and Clinical Psychology, 10, 73-78. Fuller, R.G.C., & Forrest, D.W. (1973). Behavioral aspects of cigarette smoking in relation to arousal level. Psychological Reports, 33, 115 12 1. Glad, W., & Adesso, V.J. (1976). The relative importance of socially induced tension and behavioral contagion for smoking behavior. Journal of Abnormal Psychology, 85, 119-121. Hatsukami, D., Morgan, S.F., Pickens, R.W., & Hughes, J.R. (1987). Smoking topography in a non-laboratory environment. The International Journal of Addictions, 22, 719-725. Hughes, J.R., & Hatsukami, D. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43, 289-294. Hunt, W.A., & Bespelac. D.A. (1974). An evaluation of current methods of modifying smoking behavior. Journal of Clinical Psychology, 30, 431438. Ikard, F.F., Green, D.E., & Horn, D. (1969). A scale to differentiate between types of smoking as related to the management of affect. The International Journal of the Addictions, 4, 649-659. Ikard, F.F., & Ton&ins, S. (1973). The experience of affect as a determinant of smoking behavior: A series of vaiidity studies. Journal of Abnormal Psychology, 81, 172-181. McKennell, A.C. (1970). Smoking motivational factors. Brifish Journal of Social and Clinical Psychology, 9, 8-22. Morgan, S.F., Gust, SW., Pickens, R.W., Champagne, S.E., & Hughes, J.R. (1985). Temporal patterns of smoking topography in the natural environment. The International Journal of Addictions, 20, 613621. Ossip-Klein, D.J., Martin, J.E., Lomax, B.D., Pme, D.M., & Davis, C.J. (1983). Assessment of smoking topography generalization across laboratory, clinical, and naturalistic settings. Addictive Behaviors, 8, 1 l-17. Pechacek, T.F. (1979). Modification of smoking behavior. In N.A. Krasnegor (Ed.), The behavioral aspects of smoking. National Institute of Drug Abuse Research Monograph 26. Pickens, R.W., Gust, S.W., Catchings, P.M., & Svikis, D.S. (1983). Measurement of some topographical aspects of smoking in the natural environment. In J. Grabawski (Ed.), Measurement in the analysis and treatment of smoking behavior. National Institute on Drug Abuse Research Monograph 48. Russell, M.A.H., Sutton, S.R., Feyerabend, C., & Salojee, Y. (1980). Smokers’ response to shortened cigarettes: Dose reduction without dilution of tobacco smoke. Clinical Pharmacology and Therapeutics, 27, 210-218. Schachter, S. (1978). Pharmacological and psychological determinants of smoking. Annals of Inrernul Medicine, 88, 104-114. Schachter, S., Silverstein, B., & Perlick. D. (1977). Psychological and pharmacological explanations of smoking under stress. Journal of Experimental Psychology, 106, 314.
Addictive
SITUATIONAL DOROTHY
1990 Copyright
FACTORS
IN CIGARETTE
K. HATSUKAMI, STEVEN F. MORGAN, STEPHEN E. CHAMPAGNE University
0306.4603190 $3.00 + .OO Q 1990 Pergamon Pres\ plc
SMOKING
ROY W. PICKENS.
and
of Minnesota
Abstract - Situational factors related to smoking behavior in the natural environment were studied. Six subjects smoked all cigarettes over 10 days with a portable, electronic recording device which measured a number of frequency and time-based features of smoking. Subjects also coded activities and internal states associated with each cigarette smoked. Across subjects. there were considerable differences in the distribution of cigarettes smoked across the activity and internal states categories. Within subjects, all subjects showed variation in measures of smoking topography (number of puffs/cigarette, mean puff duration, total puff time/cigarette) as a function of situational variables. It did not appear that pharmacological factors could fully account for the substantial situational differences found. The results suggest that different factors may be involved in the control of different aspects of smoking topography.
Psychological-behavioral intervention strategies to facilitate smoking cessation have had only limited success (Hunt & Bespelac, 1974; Pechacek, 1979). Difficulties in this area may be due in part to lack of an understanding of the stimulus variables which control smoking behavior in the natural environment (Epstein & Collins, 1977). Laboratory studies have demonstrated that smoking behavior may vary as a function of the smoking situation, with differences measured for several aspects of smoking topography (Ashton & Watson. 1970; Comer & Creighton, 1978; Fuller & Forrest, 1973; Glad & Adesso, 1976). There is also evidence that smoking topography differs when measured in the laboratory as compared to the unobtrusive observational measurement of subjects smoking in a naturalistic setting (Comer & Creighton, 1978; Ossip-Klein, Martin, Lomax, Prue, & Davis. 1983). Because of obvious practical difficulties in measuring smoking behavior from situation to situation outside the laboratory, there is little information on the variation in aspects of smoking topography in the natural environment. Research in the area has been limited to smokers’ self-reports on various smoking behavior questionnaires (e.g., Frith. 197 I ; lkard & Tomkins, 1973; McKennell, 1970) and to the self-monitoring of situations associated with each cigarette smoked (Epstein & Collins, 1977). While these studies have demonstrated that smokers differ in the situations in which they smoke, measures of smoking behavior have been limited to the frequency with which smoking occurs in situations or classes of situations. While smoking rate or frequency is only one of many dimensions of smoking behavior, there is evidence that other dimensions of smoking (e.g., puff duration, number of puffs/cigarette) may not be strongly related to frequency measures in the natural environment (Hatsukami, Morgan, Pickens, & Hughes, 1987; Morgan, Gust, Pickens, Champagne, & Hughes, 1985). The extent to which various topographies of smoking vary across situations in the natural environment is thus not known. The present study examines a novel methodology for the study of smoking topography in the natural environment, with particular focus on situational factors related to smoking topography. Smokers smoked all cigarettes over a IO-day period using a lightweight, This research was supported by N.I.D.A. Research Grants No. DA 02988 and No. 02413 and N.I.D.A. Training Grant No. DA 07097. Requests for reprints should be sent to Dr. Dorothy Hatsukami, University of Minnesota. Department of Psychiatry, Box 392 Mayo, Minneapolis, MN 55455.
2
DOROTHY
K. HATSUKAMI
et al
portable, electronic recording device which recorded a number of frequency and time-based measures of smoking. Situational factors were broadly defined to encompass activities in which the subject was engaged while smoking and internal states predominant at the time the subject started to smoke. Situational factors were defined as such in this initial investigation because past research has often focused on the arousal/motivational/affective components of situations in which persons smoke (e.g., Ashton & Watson, 1970; Comer & Creighton, 1978; Fuller & Forrest, 1973; Glad & Adesso, 1976; Ikard, Green, & Horn, 1969; McKennell, 1970). Subjects in the present study thus coded Activity and Internal State factors for each cigarette smoked. Smoking behaviors associated with different categories of activities and internal states were contrasted. METHOD
Subjects Subjects were six smokers (one male, five females) between the ages of 18 and 35, five of whom were employed in settings in which smoking was not restricted and one of whom was unemployed. All subjects were naive to research on smoking behavior. Their mean reported smoking rate was 29.5 cigarettes per day (SD = 4.2), and the mean FTC-rated nicotine yield of their chosen cigarette brands was .79 mg (SD = .23). All the subjects had been smoking for greater than one year. Subjects were paid $7 for each day in which they adhered to the experimental procedure, with a $30 bonus for 10 consecutive days of compliance. Measurement Topographical aspects of smoking were measured using a small portable recorder. The recorder consisted of a three-foot length of plastic tubing, which was attached at one end to an opening in the side of a commercial cigarette holder (Tar Gard No. 1274, Venturi Inc.) and at the other end to a pressure switch (Model 505-3, Coventry Corp.) mounted inside an aluminum box (1 in. x 4 in. x 5 in.). In addition to the pressure switch, the box contained electronic circuitry for time measurement (L . 1 sec.) and digital memory storage of up to 2048 temporal events. Events were defined as the opening or closing of the pressure switch, allowing the duration of successive puff durations and interpuff intervals to be stored in successive memory locations. From these data, it was possible to derive a number of topographical measures of smoking behavior - the number of cigarettes smoked per day, the number of puffs per cigarette, puff duration, cigarette duration, the total puffing time per cigarette, and intercigarette and interpuff intervals. This device has been found to be accurate and reliable in measuring smoking behavior and to have minimal interference with normal activities (Pickens, Gust, Catchings, & Svikis, 1983). For each cigarette smoked, subjects recorded the following: (a) the time at which the cigarette was lit, and (b) numbers coded for the activity in which the subject was engaged and the subject’s internal state immediately prior to the time the subject started to smoke the cigarette. The category options are listed in Table 1. The categories which were included in the Activity and Internal State lists were extracted from previous analyses of smoking situations (McKennell, 1970) and from a survey of smoking situations endorsed by early pilot subjects in this project. Recording sheets were 4 in. X 5 in. and designed to be folded into thirds and slipped into the subjects’ cigarette pack. One side of the sheet listed the various coding categories. The other side consisted of columns headed Time, Activity, and Feelings. Under each of these columns were 20 rows for the coding of the above categories for 20 consecutive cigarettes. In addition to the categories offered, subjects were encouraged to write in any other category which they felt was more appropriate in describing the activity
Factors in cigarette smoking
Table 1. Activities and Internal States Categories as listed on the reverse side of the self-monitoring forms Feelings
Activities
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
After a meal Socializing Driving w/beverage Working Taking a break Watching TV or relaxing Waiting Nothing to do On telephone
Il.
Other (write in)
1. Relaxed 2. Anxious, tense 3. Low, depressed 4. Bored 5. Angry,
6. 7. 8. 9. 10.
irritated Tired Hungry Happy Busy Other (write in)
or internal state associated with a cigarette. The subject was required to select at least one of the category options for each cigarette, but more than one could also be endorsed. Since the majority of responses required only the recording of a number, self-monitoring took only a few seconds once the subjects became familiar with the categories. Procedure Subjects used the smoking device and self-monitored with the above recording sheets for all cigarettes smoked over 10 consecutive days. Subjects came in to the lab each morning of the study to exchange recording devices and recording sheets and to take a bogus breath analysis. The necessity of full compliance with the procedure was emphasized and encouraged by the contingencies of payment - subjects were told that they would be paid only for those days in which all cigarettes were smoked with the device and that the daily breath analyses would verify compliance. Also, subjects received a $30 bonus for 10 consecutive days of compliance. Subjects were cued to the experimental procedures by the placement of the recording sheets, which were bright yellow, in the subjects’ cigarette packs. Subjects were instructed to self-monitor after beginning the cigarette, as Epstein & Collins (1977) report that reactive effects of self-monitoring are minimal under such conditions when subjects are not motivated to change their smoking patterns. Dependent measures For each cigarette smoked in the study, the following dependent variables were calculated - number of puffs/cigarette, mean puff duration, total puff time/cigarette (number of puffs/cigarette times mean puff duration), and intercigarette interval prior to the cigarette. RESULTS For each subject ratings.
If more
individually, than
one
cigarettes
activity
were separated
was endorsed
on the basis of Activity
for a cigarette,
then
category
a constellation
of
activities became a separate activity category (e.g., the category for all cigarettes during which the subject was both socializing and drinking). Categories were included in further analyses only if they included a minimum of six cigarettes. Each of the six subjects had at least five Activity categories included in their analyses, with a maximum of 12 categories
(e.g., subjects 6). Because subjects varied from one another on the different Activities and Internal States associated with their cigarette smoking, the data from each subject were analyzed separately.
m
Yz$ s -s 5’ (P 5 e ,_ n
m-as F&._
erv, 8. B
-Vm w g._ .>* If
INTERNAL
STATES
SOCIALIZING DRIVING DRlNKlNG WORKING ON BREAK TV/RELAXING WAIT&G NOTHING TO DO ON TELEPHONE WORKING/DRINKING SOCIALIZINQIDRINKING
MEALS
ACTIVITIES
IO
II
I4
Number
12 I3
Puffs/Cigarette
I5 I6
73
I7 75
80
80
90
90
95
95
Duration
Seconds
85
85
Puff
bb
Mean
Total
3 Puff
12 13 14 I5
120 I30 140 150
Time/Cigarette
Seconds
100 85 90 IO II
100 B590 100 II0
Subject
I
I
I
I
Intercigarette
I
I
Interval
Seconds
1000 1500 2000 2500 3000 3500
IO00 1500 2000 2500 3000 3500
Prior
ti
0
o -D O1 m3eg ;d%=:
Q$
&?“5
-6
FEELINGS
ACTIVITIES
3
4
IL
3456789’
5
Number
6
7
8
of PuffslCig.
9
130 1.35 140
155
145 150 155
140 145 150
Puff Duration
** b
130 135
Mean
160
160
(sec.)
5
5
6
6
Total
7
7
8
8
3
3
10
10
I1
11
Puff TimelCig.(sec.)
12 0
12 0
Prior
2000
2000
Intercig.
4000
4000
Interval
6000
6000
(sec.1
6
DOROTHY
K. HATSUKAMI
SUBJECT
et al.
3
26.5 r .
. . . .
(L
”
. . . .
. . .
=;;r, -.i + . ”
”
.
”
.
. . t . i .
” i ; 8
J
Activities Fig. 3. Scatterplot of the Total Puff Time/Cigarette Subject 3. Each dot represents a cigarette.
measure
across the Activities
categories
for
dependent measures. While it would have been of interest to covary out the effects of the interval prior to cigarettes smoked when examining the three topography dependent measures as a function of activities, the data do not meet the requirements for such an analysis - there was not a linear relationship between the prior intercigarette interval and the other dependent measures. Thus, each of the four measures was analyzed independently. Highly significant differences in smoking topography were found across smoking situations for each subject. For the number of puffs/cigarette, mean puff duration, and total puff time/cigarette measures, all F values for five of the six subjects (Subjects 2, 3, 4, 5, and 6) were highly significant (r, < ,005) across Activity categories. For Subject 1, the F value was significant (p < ,005) for puff duration, approached significance (p = .06) for number of puffs/cigarette, but failed to approach significance on the total puff time/cigarette measure. On the prior intercigarette interval measure, significant main effects (p < ,005) across activities were found for all subjects except Subjects 3 and 5.
7
Factors in cigarette smoking
SUBJECT
3
26.5,
.
24.0 3 z
& c 19.0 aJ z
1 t
f g
16.5 -
;
2
14.0 -
I; .
z
11.5-
T-
.. .
l
.
:
m
. --i--
--s--
9.0 -
15 ”
6.5 -
t
.
.
h
:
.
.
.
Y .
:
__*__
Y __
w
0
:
:
_____ .: . * . . 1 . ”
I-”
8 . .
.
Y
l
_:
-
i
l
z z
.
: .
_.
i=
.
.
21.5 -
” . .
;
.
Fig. 4. Scatterplot of the Total Puff Time/Cigarette Subject 3. Each dot represents a cigarette.
.
*
;
T 8
_t
-_
a
YE
measure across the Internal States categories
for
The above procedures were repeated for the Internal States categories. Each subject had at least four Internal States categories represented in the analyses, with a maximum of eight for Subject 3. Relative to the Activities factor, the Internal States main effects on the topography measures were somewhat less robust. Still, four of the six subjects (Subjects 1, 3, 4, and 6) showed statistically significant (p < .OOOl) effects of Internal States on the number of puffs/cigarette, two of six subjects (Subjects 3 and 6) did so on mean puff duration @ < .Ol), and four of six did so on total puff time/cigarette (p < .Ol), and four of six did so on total puff time/cigarette (p < .Ol for Subject 1; p -C .005 for Subjects 3, 4, and 6). On prior intercigarette interval, the measure varied significantly across Internal States categories for four of the subjects (p < .05 for Subjects 2 and 6; p < .005 for Subjects 1 and 5). In order to more clearly demonstrate the nature of the findings, the data for two representative subjects (Subjects 3 and 4) are presented for more detailed examination. These subjects were both employed females who smoked at a similar rate (20.4 vs. 21.4 cigarettes/day, respectively). The FTC-rated nicotine yield of their chosen cigarette brands were .58 and 1.04 mg, respectively. Figures 1 and 2 display smoking topography data across the different activity and internal state categories for the two selected subjects. Within
DOROTHY
K. HATSUKAMI
et al.
4
199-
2
.
178-
5
.
i 157Y Q, z Q, 136 ;;I ?
”
. -
1,5-
i _-•__ ”
._E” E
.
73-
.
.
. . .
.
-:-;
0..
g4.
f.? ‘iij z l-
.
.
.
v
.. : .
.
2 .y& .
zA
& !
52-
i
31-
”
i
. .
; Y a . -
. .
1 .o -
Activities Fig. 5. Scatterplot of the Total Puff Time/Cigarette Subject 4. Each dot represents a cigarette.
measure
across the Activities
categories
for
subjects, differences in all measures of smoking topography as a function of Activities and Internal States are apparent. Some of the differences are of striking magnitude, especially in light of the standard errors of the mean indicated. For example, the difference in total puff time/cigarette between the “waiting” versus the “working/drinking” categories for Subject 3 was 6.6 seconds, or 68% more mouth-level smoke exposure for cigarettes smoked while waiting. In general, examination of the mean intercigarette intervals associated with the categories suggests that differences in intercigarette intervals are not likely to account for differences in smoking behavior between categories. Increases in intercigarette interval are not necessarily associated with increases in smoke exposure. Figures 1 and 2 also characterize the substantial individual differences measured in the study. Although equal on the number of cigarettes
9
Factors in cigarette smoking
SUBJECT 4 22.0
1
.
19.9
. .
17.8 z
C s 157
s a, 136 z 2 .s 0 2
11.5
. . . .
. .
88
x
_!L 8 .
.
.
l
t
l
”
.
8
-
T --f-
: ; . .
3.1
iL . .
”
8 . .
. . .
.
.
--r-:
;.
. . .-: . . :
t . . . . .
i _;_
T Ic 8 .
.
1 .c )-
Fig. 6. Scatterplot of the Total Puff Time/Cigarette Subject 4. Each dot represents a cigarette.
measure across the Internal States categones
for
smoked per day, these subjects differed considerably in mean values for the other topography measures. For Subject 3 versus Subject 4, respectively, overall mean values were 13.9 versus .9 versus 1.5 seconds on mean puff duration, and 6.2 puffs on number of puffs/cigarette, 12.1 versus 9.1 seconds on total puff time/cigarette. Also characteristic of all subjects in the study, these two subjects differed in the Activities and Internal States associated with their smoking. Figures 3, 4, 5, and 6 are scattergrams of the total puff time/cigarette measure for each cigarette smoked in the different Activities and Internal States categories for Subjects 3 and 4. These figures allow an examination of the overlap in distributions associated with the different categories. While in general there is considerable overlap, the distributions of a number of categories are strikingly disparate.
IO
DOROTHY K. HATSUKAMI et al
DISCUSSION
Situational factors associated with smoking behavior were studied in the natural environment. Activities and internal states associated with over 1300 cigarettes were recorded as six subjects smoked over IO consecutive days. Also, the number of puffs, mean puff time, total puff time, and prior intercigarette interval were obtained for each cigarette smoked. Each of the six subjects demonstrated that cigarette smoking behavior can vary with situational factors. Not only did subjects differ in the distribution of smoking across the various Activity and Internal States categories, but subjects were also found to smoke cigarettes differently as a function of the different situations. These differences were manifested in the number of puffs taken per cigarette, the average puff time per cigarette, and in the total puffing time per cigarette. The scatterplots of the total puff time/cigarette measure across categories of Activities and Internal States for the two representative subjects (Figures 3, 4, 5, and 6) demonstrate some fairly dramatic distributional differences. While it has been suggested that variations in smoking behavior may best be understood as attempts to regulate nicotine intake (e.g., Schachter, 1978), the present data demonstrate consistent and large differences in smoking behavior which seem unlikely to be totally accounted for by pharmacological factors. Visual examination of Figures 1 and 2 show that, in general, differences in smoking topography between categories cannot be simply explained by differences in the prior intercigarette intervals characteristic of the different categories. For example, categories associated with longer intercigarette intervals are not necessarily associated with larger mean values on the topography measures. Furthermore, although Schachter’s work suggests that situational influences are mediated by changes in the metabolism of nicotine, the naturalistic data collected here show little indication of such a pattern. Despite evidence that situational stress may increase the rate of excretion of nicotine (Schachter, Silverstein, & Perlick, 1977). for Subject 4 mouth level smoke exposure was substantially greater when smoking a cigarette while relaxed than when anxious or tense (Figure 5). In addition, across the five subjects who had a sufficient number of cigarettes represented in the “anxious, tense” and “relaxed” categories, there was no significant tendency for measures of smoking topography to differ as a function of those categories. On the other hand, since no biochemical measure of smoke exposure (e.g., expired CO, plasma nicotine, etc.) was obtained during the day, perhaps specific extension of the results to Schachter’s hypothesis may be limited. It is of interest that smokers may smoke with similar frequency in different situations but be quite dissimilar in other aspects of their smoking topography in those same situations. For example, Subject 4 smoked with a high frequency in situations described as “socializing” and “watching tv/relaxing,” but Figure 5 reveals that cigarettes falling into the two categories were smoked quite differently. Similarly, Subject 4 smoked a lower frequency of cigarettes in the categories “after a meal” or “on telephone,” but again those categories differed substantially in smoking topography. These contrasts raise the possibility that factors which are related to the initiation of a cigarette may be different than those controlling other aspects of smoking topography. There is supporting data from experimental studies suggesting that measures of smoking rate (number of cigarettes/time period) may vary independent of how cigarettes are smoked. For example, Epstein, Ossip, Coleman, Hughes, and Wiist (1981) demonstrated that manipulating a subject’s smoking frequency did not affect other parameters of smoking topography. Russell, Sutton, Feyerabend, and Salojee (1980) concluded that when nicotine content of cigarettes is reduced, subjects tend to increase their smoke intake per cigarette but tend not to show any change in number of cigarettes smoked. While it was impossible to insure subjects’ compliance in the study, our interactions with
Factors in cigarette smoking
11
the subjects gave little indications of non-compliance. Record keeping indicated a high commitment to accuracy (e.g., the subject’s recording of the time at which the cigarette was lit rarely deviated by more than a couple minutes from the time recorded by the smoking device). Also, the categories “socializing” and “working” were the two categories endorsed with the highest frequency, suggesting that subjects were not inhibited from using the smoking device while in social or work environments. It should be noted that a failure to use the device for a particular cigarette would only affect the frequency measure - that is, if the subject did not use the device on a cigarette while working, the measure of the total number of cigarettes smoked while working would be in error. The other measures of smoking topography, which are averaged across cigarettes smoked in this category, would be unaffected. There are several limitations involved in the study. First, although the smoking habits of the present sample were similar to those of the national sample (see Hughes & Hatsukami, 1986) there is still the question of the extent to which subjects who are willing to use the device are representative of the general population of smokers. Furthermore, the generalizability of the results may be limited due to the small sample size. Second, although the device has been found to minimally interfere with activities in previous studies, it is possible that the device may have been obtrusive in some situations compared to others (e.g., social situations). Thus, the obtrusiveness of the device associated with these situations may have affected the smoking pattern (i.e., shorter puff duration, shorter total cigarette duration, etc.). However, reports from subjects indicated that they did not find the use of the smoking devices embarrassing or difficult. Third, smoking topography measured in the natural environment has been found to vary as a function of time of day (Morgan et al., 1985). It is possible that particular situations occurred during particular time periods, thus confounding the results. That is, a specific smoking pattern may be as a result of the particular time periods which are associated with the occurrence of specific situations, or a result of the situation in and of itself. Fourth, puff volume, which would be the best estimate of smoke exposure, was not measured. However, the topographical features of smoking which were measured in the present study offer a more accurate measure of smoke exposure than previous investigations which have been limited to cigarette frequency. While further examination of the relationship between situational factors and smoking behavior offers hope of more precise behavioral interventions in the future, more detailed descriptive data regarding a smoker’s behavior may in and of itself be of value in treatment. For example, Subject 4 not only smoked fewer cigarettes when anxious as opposed to when she was relaxed, but she also smoked more intensely when relaxed. Thus, the advisability of using relaxation training as a component of a treatment program (e.g., Danaher & Lichtenstein, 1978) with such a subject is possibly questionable. In summary, the present data indicate that smoking behavior does vary as a function of situational factors in the natural environment. Across subjects, there was considerable variability in the distribution of cigarettes smoked across situational categories. Within subjects, it was demonstrated that a smoker’s smoking topography may differ fairly dramatically from situation to situation. The frequency with which cigarettes were smoked in a situation appeared unrelated to other features of smoking topography in that situation. This accentuates the importance of considering smoking behavior as a complex operant with many topographies. Future research to elucidate controlling factors relative to different features of smoking topography offers hope of improving behavioral intervention strategies for smoking cessation.
12
DOROTHY
K. HATSUKAMI
et al.
REFERENCES Ashton, H., & Watson, D.W. (1970). Puffing frequency and nicotine intake in cigarette smokers. British Medical Journal, 3, 679-681. Comer, A.K., & Cmighton, D.E. (1978). The effect of experimental conditions on smoking behavior. In R.E. Thornton (Ed.), Smoking behavior (76-86). New York: Churchill-Livingston. Danaber, B.G., & Lichtenstein, E. (1978). Become an ex-smoker. Englewood Cliis, NJ: Prentice Hall. Epstein, L.H., & Collins, F.L. (1977). The measurement of situational influences of smoking. Addictive Behaviors, 2, 47-53. Epstein, L.H., Ossip, D.J., Coleman, D., Hughes, J., & Wiist, W. (1981). Measurement of smoking topography during withdrawal or deprivation. Behavior Therapy, 12, 507-519. Frith, CD. (1971). Smoking behaviour and ita relation to the smoker’s immediate experience. British Journal of Social and Clinical Psychology, 10, 73-78. Fuller, R.G.C., & Forrest, D.W. (1973). Behavioral aspects of cigarette smoking in relation to arousal level. Psychological Reports, 33, 115 12 1. Glad, W., & Adesso, V.J. (1976). The relative importance of socially induced tension and behavioral contagion for smoking behavior. Journal of Abnormal Psychology, 85, 119-121. Hatsukami, D., Morgan, S.F., Pickens, R.W., & Hughes, J.R. (1987). Smoking topography in a non-laboratory environment. The International Journal of Addictions, 22, 719-725. Hughes, J.R., & Hatsukami, D. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43, 289-294. Hunt, W.A., & Bespelac. D.A. (1974). An evaluation of current methods of modifying smoking behavior. Journal of Clinical Psychology, 30, 431438. Ikard, F.F., Green, D.E., & Horn, D. (1969). A scale to differentiate between types of smoking as related to the management of affect. The International Journal of the Addictions, 4, 649-659. Ikard, F.F., & Ton&ins, S. (1973). The experience of affect as a determinant of smoking behavior: A series of vaiidity studies. Journal of Abnormal Psychology, 81, 172-181. McKennell, A.C. (1970). Smoking motivational factors. Brifish Journal of Social and Clinical Psychology, 9, 8-22. Morgan, S.F., Gust, SW., Pickens, R.W., Champagne, S.E., & Hughes, J.R. (1985). Temporal patterns of smoking topography in the natural environment. The International Journal of Addictions, 20, 613621. Ossip-Klein, D.J., Martin, J.E., Lomax, B.D., Pme, D.M., & Davis, C.J. (1983). Assessment of smoking topography generalization across laboratory, clinical, and naturalistic settings. Addictive Behaviors, 8, 1 l-17. Pechacek, T.F. (1979). Modification of smoking behavior. In N.A. Krasnegor (Ed.), The behavioral aspects of smoking. National Institute of Drug Abuse Research Monograph 26. Pickens, R.W., Gust, S.W., Catchings, P.M., & Svikis, D.S. (1983). Measurement of some topographical aspects of smoking in the natural environment. In J. Grabawski (Ed.), Measurement in the analysis and treatment of smoking behavior. National Institute on Drug Abuse Research Monograph 48. Russell, M.A.H., Sutton, S.R., Feyerabend, C., & Salojee, Y. (1980). Smokers’ response to shortened cigarettes: Dose reduction without dilution of tobacco smoke. Clinical Pharmacology and Therapeutics, 27, 210-218. Schachter, S. (1978). Pharmacological and psychological determinants of smoking. Annals of Inrernul Medicine, 88, 104-114. Schachter, S., Silverstein, B., & Perlick. D. (1977). Psychological and pharmacological explanations of smoking under stress. Journal of Experimental Psychology, 106, 314.