Smoking Patterns and Stimulus Control in Intermittent and Daily Smokers

Abstract

Intermittent smokers (ITS) – who smoke less than daily – comprise an increasing proportion of adult smokers. Their smoking patterns challenge theoretical models of smoking motivation, which emphasize regular and frequent smoking to maintain nicotine levels and avoid withdrawal, but yet have gone largely unexamined. We characterized smoking patterns among 212 ITS (smoking 4–27 days per month) compared to 194 daily smokers (DS; smoking 5–30 cigarettes daily) who monitored situational antecedents of smoking using ecological momentary assessment. Subjects recorded each cigarette on an electronic diary, and situational variables were assessed in a random subset (n = 21,539 smoking episodes); parallel assessments were obtained by beeping subjects at random when they were not smoking (n = 26,930 non-smoking occasions). Compared to DS, ITS' smoking was more strongly associated with being away from home, being in a bar, drinking alcohol, socializing, being with friends and acquaintances, and when others were smoking. Mood had only modest effects in either group. DS' and ITS' smoking were substantially and equally suppressed by smoking restrictions, although ITS more often cited self-imposed restrictions. ITS' smoking was consistently more associated with environmental cues and contexts, especially those associated with positive or “indulgent” smoking situations. Stimulus control may be an important influence in maintaining smoking and making quitting difficult among ITS.

Gender and Stimulus Control of Smoking Behavior

“…18,37 Briefly, participants were asked to record each time they smoked a cigarette (event-based sampling); on a randomlyselected subset of occasions (4-5 per day), participants were asked a series of questions about the situation they were in. Further, to compare participants' situations when they were not smoking (signalbased sampling), participants were also "beeped" 4-5 times a day at random and asked to complete parallel assessments of nonsmoking situations.…”

“…These mood data were characterized using factor analysis into the sub-scales: negative affect, positive affect, arousal and inattention. 18 Factor scores thus derived are standardized T-scores (M = 50, SD = 10).…”

“…These methods allow data to be collected on smokers' behavior in the real-world and in real-time, and across multiple occasions, thus reducing recall bias and ensuring ecological validity. EMA studies have demonstrated that smoking has systematic relationships with particular environmental contexts, prominent among them being alcohol consumption, other smokers, and smoking regulations (e.g., Shiffman et al 18 ). The few EMA studies, that have specifically analyzed gender differences in stimulus control of smoking found minimal gender differences.…”

“…The final sample comprised 107 men and 87 women. These smokers are a sub-sample of a larger study examining differences between daily and non-daily smokers (for details see Shiffman et al 18 and Shiffman, Ferguson, Dunbar, and Scholl 35 ). The demographic and smoking history characteristics-overall and separately for males and females-of the sample are presented in Table 1.…”

Right Here, Right Now: Situated Interventions to Change Consumer Habits

“…In support of this idea, research by Shiffman and colleagues showed that there were differences in the extent to which situational cues predicted smoking in occasional smokers compared to daily smokers, such that occasional smoking was more strongly associated with environmental cues (e.g. being away from home, in a bar, being with friends; Shiffman et al 2014). Thus, identifying how the content of consumers' situated conceptualizations differs according to key demographic factors is an important first step in the design of interventions that remove or reduce exposure to salient cues in the consumer environment.…”