Declining alternative reinforcers link depression to young adult smoking

Abstract

Aims Young adulthood represents a period of continued smoking progression and the establishment of regular and long-term smoking practices. Our understanding of the psychological processes that facilitate and solidify regular smoking patterns in this developmental period is limited. We sought to evaluate the role of depression symptoms in young adult smoking uptake and to evaluate whether non-smoking related alternative reinforcers was a mechanism by which depression symptoms influence smoking. Participants The sample was composed of 834 young adults who participated in a longitudinal study of smoking adoption (age 18 – 22 years old). Design and measurements In this prospective cohort study, smoking, depression, alternative reinforcers and several covariates were measured annually via telephone from emerging adulthood (age 18) to young adulthood (age 22). Findings Results of a parallel processes latent growth curve model showed that depression symptoms level (baseline age 18) had a significant negative effect on substitute alternative reinforcers trend (β = −.01, z=−3.17, p=.002) and that substitute reinforcers trend had a significant negative effect on smoking trend (β = −.62, z= −2.99, p=.003). An assessment of indirect effects revealed that depression symptoms level had a significant positive indirect effect on smoking trend through substitute alternative reinforcers trend (B = .01, z = 2.09, p=.04, 99% CI = .001, .02), such that greater depression symptoms at baseline predicted decreases in substitute reinforcers across time which in turn predicted increases in smoking uptake/rate from emerging to young adulhood. Conclusions Depression symptoms in emerging adulthood indirectly influence smoking and mitigating declines and/or promoting greater alternative reinforcers to smoking may prevent smoking uptake and further increases in smoking rate among young adults.

Depression and cigarette smoking behavior: A critical review of population-based studies

“…Compared to adults who smoke and do not have depression, adults who smoke and have depression more strongly endorse beliefs about smoking including smoking to relieve negative affect (71,72). Adult smokers with depression also respond more strongly to smoking cues (73,74) and report greater reward from smoking (75)(76)(77). Further, adult smokers with depression also report more withdrawal symptoms and more severe symptoms of withdrawal during quit attempts (73,(78)(79)(80).…”

Measuring Anhedonia in Adolescents: A Psychometric Analysis

“…We used a modified version of the PES for use in adolescents based on prior work (Audrain-McGovern, Rodriguez, Rodgers, & Cuevas, 2011). Participants rate 42 different typically pleasant activities (e.g., shopping, going to a movie) for both frequency of engagement (Never = 0, 1 – 6 times = 1; 7 or more times = 2) and pleasure (not pleasurable = 0; somewhat pleasurable = 1; very pleasurable = 2) in the past 30 days.…”

Reward and Affective Regulation in Depression-Prone Smokers

“…Alternative Reinforcers were measured by the adapted Pleasant Events Schedule (PES) (39), which was designed to assess reinforcers that occur in an individual's natural environment. The 78-items were rated once in terms of frequency (0=none to 2=often) and once in terms of enjoyability (0=none to 2=very) over the past 30 days, yielding a frequency score, an enjoyability score, and the cross product is the reinforcement from the activity (39, 97-100). …”