Addictive Behaviors. Vol. 16, pp. 467-479, Printed in the USA. All rights reserved.

1991 Copyright

0306-4603/91 $3.00 + .OO Q 1991 Pergamon Press plc

EXPOSURE TO SMOKING-RELEVANT CUES: EFFECTS ON DESIRE TO SMOKE AND TOPOGRAPHICAL COMPONENTS OF SMOKING BEHAVIOR THOMAS J. PAYNE Veterans Affairs and University

of Mississippi

Medical Centers

MITCHELL L. SCHARE Hofstra University

DONALD J. LEVIS and GEP COLLETII State University

of New York at Binghamton

cues (environmental; Abstract - The effects of exposure to two classes of smoking-relevant negative affect) on desire to smoke and smoking topography were evaluated. Sixty chronic smokers were randomly assigned to one of six groups in a two-way ANOVA design in which the salience of environmental cues and presence of negative affective cues were manipulated. This was followed by a 20-minute interval during which ad libitum smoking was videotaped in an unobtrusive manner. Results indicated that the experimental manipulations differentially influenced ratings of desire and topographical components of smoking behavior. Implications are raised regarding the role of cue reactivity in the maintenance of smoking behavior.

Information regarding the deleterious health-related effects of cigarette smoking are now widely available. Research over the past 25 years has firmly established an association between smoking and the incidence and/or exacerbation of many physical disorders, including cardiovascular disease, peptic ulcer and other gastrointestinal disease, pulmonary disorders, complications in pregnancy, and cancer (Lichtenstein & Brown, 1982; Prue, Scott, & Denier, 1985; USDHHS, 1984, 1988). Despite this well-documented body of evidence, an estimated 51.1 million individuals continue to smoke (USDHHS, 1988). An important step in the development of more effective treatment programs for addictive behaviors is the identification of factors which maintain the regular usage of addictive substances. The range of potential factors is broad and includes a variety of physiological, social, cognitive, and behavioral influences (Leventhal & Cleary, 1980; Lichtenstein & Brown, 1982; USDHHS, 1988). One hypothesis common to learning-based models of addictive disorders is that the presence of antecedent stimuli which have been associated with drug administration can elicit addiction-specific responses (i.e., psychophysiological, behavioral, and self-report). Predictions regarding the nature of these responses are specified in models based on tenets of classical conditioning theory (e.g., Poulos, Hinson, & Siegel, 1981; Siegel, 1983; Solomon & Corbit, 1973; Stewart, de Wit, & Eikelboom, 1984; Wikler, 1977), a two-factor formulation (Pomerleau, 1981), and more complex multiregulation models (e.g., Lever&al & Cleary, 1980; Pomerleau & Pomerleau, 1988). Proponents of social learning theory view addictive behaviors as acThis research was supported by a Biomedical Research Support Grant from the Foundation of SUNY-Binghamton and was based on the dissertation research of the fmt author. Portions of this research were presented at the meeting of the Society of Behavioral Medicine, Washington, DC 1987. Thanks to Stephen Lisman, PhD, Elize Botha, PhD, Cheryl Johnson, PhD, Wayne Kashinsky, Jennifer Guldi, Vinu Singn, Avi Landau, Terri Till, and Suzanne Sanders for their input and assistance. Requests for reprints should be sent to Thomas J. Payne, PhD, Psychology Service (116B), VA Medical Center, 1500 E. Woodrow Wilson Drive, Jackson, MS 39216. 467

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quired habit patterns as well and generally acknowledge the role of “situational and environmental antecedents, beliefs and expectations, the individual’s family history and prior learning experiences with the substance” as important “determinants of addictive habits” (Marlatt, 1985, p. 9; see also Marlatt & Gordon, 1980, 1985; Shiffman, 1982, 1986). Two general classes of antecedent stimuli or cues have received considerable attention in recent investigations of smoking behavior. The first class is comprised of environmental cues directly associated with smoking behavior (e.g., cigarettes, matches, ashtrays, smell of smoke, sight of another person smoking). Available data support that exposure to these cues can reliably influence smoking behavior, urges, and psychophysiological responses. Herman (1974) manipulated the salience of environmental smoking cues and observed that under high salience conditions, light smokers evidenced shorter latencies to initiation of smoking, smoked more cigarettes, and reported increased urge. Similarly, Richard-Figueroa and Ziechner (1985) found that smokers’ urge ratings increased under cue exposure conditions, and noted changes in heart rate variability and systolic and diastolic blood pressure. Payne, Etscheidt, and Corrigan (1990) conditioned cigarette smoke intake to audiovisual stimuli in a single smoker. While the results of this single-subject investigation must be interpreted with caution, the investigators reported a 20% increase in total puff duration of actual smoking and mock smoking under smoking cue conditions. The pattern of heart rate reactivity suggested specificity to the smoking cues manipulation; however, skin temperature produced a more ambiguous pattern. Abrams, Monti, Carey, Pinto, and Jacobus (1988) and Niaura, Abrams, Monti, and Pedraza (1989) found that greater heart rate reactivity to cue exposure was related to subsequent relapse. Abrams et al. (1988) acknowledged that further studies need to examine “the parameters of cue reactivity (e.g., sight vs. smell of cigarettes, with and without stress)” (p.232). Finally, Niaura, Abrams, DeMuth, Pinto, and Monti (1989) reanalyzed data from a cue exposure assessment procedure administered at pretreatment. These authors reported that based on 3-month follow-up of smoking status, relapsers had demonstrated a brief increase in cardiac interbeat interval in response to the cue presentation. Affective states comprise another set of cues thought to have an influential role on smoking behavior. Supporting data are available based on studies employing a wide variety of research methodologies. Pomerleau, Adkins, and Pertschuk (1978), Shiffman (1982), and Cummings, Gordon, and Marlatt (1980) have reported that relapse episodes are often related to the experience of dysphoric mood states. Geisser, Peterson, McNally, and Ryan (1989) found that the severity of environmental stress (as assessed via the Hassles Sc’ale; Kanner, Coyne, Schaefer, & Lazarus, 1981) was related to smoking rate in high nicotine-dependent smokers. Support for the capacity of affective cues to influence smoking behavior is also available from laboratory studies employing stressor reactivity paradigms. Although not all of these studies specifically assessed change in affect, it seems reasonable to assume that such experimental manipulations typically induce a negative emotional state. Thus, exposure to stressors such as public speaking (Dobbs, Strickler, & Maxwell, 1981), electric shock (Schachter, Silverstein, Kozlowski, Herman, & Liebling, 1977), and aversive levels of white noise (Golding & Mangan, 1982) have produced reliable changes in smoking behavior. Fuller and Forrest (1973) failed to find changes in smoking behavior for smokers who watched gory movies relative to controls. However, Ikard and Tomkins (1973) did find that the manipulation of affect resulted in changes in smoking behavior. In contrast to Fuller and Forrest (1973), these investigators categorized smokers as negative, mixed, or other smoker types (no pure positive affect smokers emerged) based on their responses to the Ton&ins-Ikard scale (developed for this study); subjects then watched a

Exposure to smoking-relevant

cues

469

film designed to evoke either negative or positive affect. Negative affect smokers were found to smoke more during the negative affect film relative to the positive affect film, while mixed smokers smoked with equal frequency under both conditions. Finally, Pomerleau and Pomerleau (1987) employed a mental arithmetic task under high versus low competitive pressure to induce differential levels of anxiety. Questionnaire assessment verified the success of the manipulation. Consistent with hypotheses, a topographic analysis of subjects’ subsequent smoking behavior revealed a significant increase in puff volume for the high-anxiety relative to low-anxiety condition. To summarize, the available research suggests that exposure to both environmental cues and negative affective cues (elicited via exposure to stressful circumstances) may produce reliable changes in psychophysiological, behavioral, and self-report responses related to smoking. The current study was designed to extend this line of research by attempting to determine (a) the independent impact to exposure to each of the two classes of cues (environmental; affective), and (b) the impact of simultaneous exposure to both classes of cues (i.e., presence of additive or interactive effects) on the experience of desire to smoke and smoking behavior. In addition to imposing greater control over the specific cues to which smokers were exposed, the impact of the manipulations was explored using finergrained analyses to topographic components of smoking behavior (cf. Pomerleau & Pomerleau, 1987). METHOD

Subjects Sixty smokers were recruited via a newspaper advertisement which offered eight dollars for participation in a study of “Smoking and Learning. ” The following screening criteria were employed: (a) 18 to 65 years of age, (b) minimum 3-year smoking history, (c) minimum smoking rate of 15 cigarettes per day, and (d) no history of cardiovascular or respiratory disorders. Design Subjects were randomly assigned to one of six groups in a 3 X 2 between-groups design: (a) negative affect induction (non-escape [NON-ESC], escape [ESC], and noise only [NOISE], in an aversive noise-escape task using a modified learned helplessness design, cf. Hiroto & Seligman, 1975); and (b) environmental smoking cue salience (high [HS], low [LS]). The learned helplessness design was chosen as the method for inducing negative affect based on the excellent experimental control over all variables while manipulating the response-reinforcement contingency. Apparatus Stimulus presentations and recording of subjects’ responses during the aversive noiseescape task were controlled via a Commmodore 64 computer. Visual stimuli were presented on a 19-in. (.48 m) color television at a distance of 6 ft. 6 in. (1.98 m) from the subject. Computer-generated audio output was fed into an integrated amplifier and delivered to the subject via headphones. The frequency and volume level of the audio signal were verified and checked periodically. Subjects were videotaped through a one-way mirror using a standard videocamera and recorder. Alveolar carbon monoxide (COa) levels were measured using an Energetics Science Ecolyzer, Model 2000. Procedure Znitial contact. Smokers who responded to the newspaper advertizement were told that the purpose of the study was to explore how one’s ability to learn might be influenced by deprivation from smoking. This description was employed to divert attention from the

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actual focus of the study on smoking behavior. Those subjects who agreed to participate were given an initial appointment. Session 1. Smoking history and demographic and health information were obtained. Individuals who met selection criteria completed an informed consent and the Fagerstrom Tolerance Questionnaire (FTQ; Fagerstrom, 1978), a measure of nicotine dependence. A research assistant (blind as to group assignment) assisted subjects in completing Session 1 requirements. This included an initial COa measurement (cf. Frederiksen &?zMartin, 1979), followed by having the subject smoke one of their own cigarettes, and then a second COa management. Subjects were told that the difference between the two COa measurements (i.e., COa boost) would provide a close estimation of their predicted COa level after 3 hours of abstinence, as would be requested from Session 2. Although COa measurements do not allow for such a prediction, this rationale was intended to convince subjects that noncompliance could be detected and thus provide the motivation to maintain abstinence for the requested period. The smoking of the first cigarette was videotaped without subjects’ knowledge to collect relatively naturalistic baseline smoking topography data. At the end of Session 1, subjects were scheduled for a second appointment within 2 to 5 days. Session 2. Subjects were greeted by a research assistant, who recorded the self-reported time of the most recently smoked cigarette and obtained breath samples for COa‘measurement. Self-report of three or more hours abstinence and a COa level indicating at least a 25% reduction relative to the Session 1 postcigarette reading was taken as an indication of compliance (based on the 3- to 4-hour half-life for carboxyhemoglobin). Four subjects were given an alternate second session appointment due to elevated COa readings, of whom two returned and produced levels which suggested compliance. Subjects completed a series of seven-point Likert scale ratings (1 = “not at all”; 7 = “very much”) assessing a variety of positive and negative emotions, general arousal, and desire to smoke. Subjects’ cigarettes were taken by the assistant, and instructions and practice trials for the experimental task were given. Upon completion of the noise-escape task (postmanipulation), the research assistant entered the experimental chamber and obtained Likert scale ratings of mood, arousal, desire to smoke, and perceived aversiveness of the tone. Subjects were then asked to remain in the room for 20 minutes until the second task could be administered. (This constituted a deception, as no second task existed.) Subjects were further informed that due to the nature of the second task, they would not be permitted to read or otherwise occupy themselves, although it was no longer necessary to refrain from smoking. Water was provided. Subjects were unobtrusively videotaped for the entire 20-minute period from behind the one-way mirror. At the conclusion of the 20minute smoking interval, the research assistant obtained Likert scale ratings for a third and final time (post-session). At this point, subjects were informed that the second task could not be administered due to equipment problems, although full remuneration for participation would be available. A questionnaire was administered to evaluate perceptions regarding the purpose of the study, followed by a brief interview to elicit any other related thoughts. An extensive debriefing was then conducted. All participants were given the option to have their data destroyed if they felt that their personal rights were unnecessarily violated via the deceptions or videotape procedures. Subjects received payment for their participation and were released.

Exposure to smoking-relevant cues

471

Conditions: I. Negative afect induction Escape. Subjects were told they would perform two learning tasks; the fust, a standard noise-escape task, measured problem-solving ability. Subjects were informed that smoking abstinence was necessary due to nicotine’s effects on reaction time, an important consideration in this task. The goal was to identify a correct four-button press sequence (using two buttons) to turn off the 3ooO Hz, 90 dB (A) tone, which was presented via headphones. Subjects heard one 5-second tone, the maximum possible duration per trial, before proceeding with further instructions. In all, three problems of 15 trials each were presented; one response was permitted per trial. Intertrial intervals ranged from 10 to 25 seconds (M = 17.5). The task was described as being “not too difficult,” with the assurance that “most” individuals tested have been able to solve the problems. Correct responses resulted in the immediate termination of the tone and a l-second presentation of the word “Right” in bold letters against a green background on the video screen. An incorrect response resulted in the presentation of the word “Wrong” against a red background for the remainder of that trial, while the tone remained on. Subjects in all conditions were provided with an escape button, which would immediately terminate that trial and remainder of the study without any penalty to the subject. Nonescape. These individuals received the same instructions as those in the escape group; however, no correct solution actually existed. Each subject was yoked to a subject in the escape condition, thus receiving the same total tone duration and percentage of correct reinforcement. Thus, reinforcement was not contingent on subjects’ responses. Noise only. Individuals in this group were auditory stimuli and were given the rationale these stimuli might affect performance on a escape subjects, thus receiving the same presentations.

asked to attend to the presented visual and that we were interested in how exposure to subsequent task. Individuals were yoked to total tone duration and pattern of screen

Experimental conditions: II. Environmental smoking cue salience High salience. For half of all subjects, the experimental chamber contained a variety of smoking-relevant environmental cues, such as ashtrays filled with smoked butts, packs of cigarettes, matches, and the odor of smoke. Upon entering the room, the subject’s own cigarettes and matches were placed in a clean ashtray on top of the monitor, in full view during the task. Low salience. The remaining subjects performed the experimental task in the same room devoid of any environmental smoking cues. Subjects observed while their cigarettes and matches were placed in a clean ashtray directly behind the monitor, thus not visible during the task.

Dependent measures Premanipulation variables. These data included standard demographic and smoking history information, FTQ scores, desire to quit rating, nicotine level of preferred cigarette, self-report of time since last cigarette, and COa measurement (Session 2). Self-report ratings. The affective dimensions rated (7-point Likert scales ranging from “not al all” to “very much”) were sad/depressed, angry/frustrated, good/happy, annoyed,

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-THOMAS J. PAYNE et al.

Table 1. Demographic

and smoking history variables

Age Education (years) Number of years smoking Mean smoking rate (per day) Cigarette nicotine level FTQ score’ Desire to quit rating (l-7) Session 2 ETLCb Session 2 COa level’ Gender

Mean

SD

28.38 13.12 13.58 26.05 0.87 6.85 5.13 4.60 18.03 42% female

10.27 1.98 9.65 8.36 0.30 1.82 1.91 2.89 9.59

‘Fagerstrom Tolerance Questionnaire. ‘Estimated time since last cigarette, in hours. ‘Measured in parts per million (ppm).

stressed, calm/relaxed, and tense/anxious. smoke, and aversiveness to the tone.

Subjects

Smoking topography. Measures of smoking the videotapes from both sessions, including mean interpuff interval. Additional measures to first cigarette, number of cigarettes smoked, first cigarette.

also rated arousal

level,

desire

to

topography were obtained from analyses of number of puffs, total puff duration, and obtained during Session 2 included latency and weight of unsmoked tobacco from the

RESULTS

Seventy-two eligible individuals were screened to obtain the 60 subjects current sample; 12 were replaced for reasons of failure to return (n = 10) and equipment problems (n = 2). No subject elected to use the suspected the actual purpose of the investigation, or requested to have their after debriefing.

included in the for Session 2 escape option, data destroyed

Premunipulation variables A series of 3 (Negative Affect Induction) X 2 (Environmental Cue Salience) ANOVAs conducted on demographics, smoking history information and measures of pre-Session 2 smoking behavior were nonsignificant (see Table 1 for overall sample means). Manipulation checks A series of 3 X 2 X 2 (Negative Affect Induction X Environmental Cue Salience X Time [Postmanipulation, Postsession]) mixed ANOVAs were performed on affect ratings to explore the efficacy of the affect induction procedure. Affect change scores were computed (difference from baseline) and combined into mean negative and mean positive change scores. All posthoc tests were Newman-Keuls. A main effect for negative affect induction emerged on mean negative affect change score, F(2, 52) = 6.86, p < .002. Posthoc tests indicated the NON-ESC and NOISE groups rated significantly greater change in negative affect than the ESC group (p < .Ol and p < .05, respectively); NON-ESC and NOISE did not differ. A significant main effect for time indicated a decrease in ratings from postmanipulation to postsession, F(1, 52) = 18.44, p < .OOl. A marginal main effect for cue salience suggested that LS subjects reported greater negative affect than HS subjects (p < .l). Also, a trend toward

Exposure to smoking-relevant cues

413

a negative affect induction X Time interaction @ < .l) suggested the NOISE group reported a greater decline in negative affect over time relative to the other groups. A main effect for negative affect induction was evident for the mean positive affect change score, F(2, 52) = 8.96, p < .04. ESC subjects demonstrated greater increases than both NON-ESC and NOISE subjects (p < .05). The main effect for time indicated that ratings increased over the session, F(l, 52) = 5.61, p < .02. A trend for an environmental cue salience effect suggested that HS subjects experienced greater positive affect than the LS subjects @ < .l). The main effect for negative affect induction and the Negative Affect Induction x Environmental Cue Salience interaction were significant for the arousal rating, F(2, 52) = 5.44, p < .007, and F(2, 52) = 3.8, p < .03, respectively. NOISE subjects showed less arousal than NON-ESC @ < .05) and ESC (p < .Ol) subjects. In addition, ESC/HS subjects reported more arousal than NOISE/I-IS subjects @ < .Ol). A main effect for time revealed a decrease in arousal over the session, F(l, 52) = 6.98, p < .Ol. Finally, no significant findings were evident for ratings of tone aversion. Desire to smoke The Negative Affect Induction x Time interaction was significant, F(2, 52) = 3.14, p < .05. Posthoc analyses revealed a significant decline in ratings of desire from post-

manipulation to postsession for all groups @ < .Ol). In addition, NON-ESC subjects reported greater desire than ESC (p < .05) and NOISE subjects (p < .Ol) at postmanipulation only. A main effect for time was evident as well, with ratings of desire decreasing over the session, F(l, 52) = 168.97, p C .OOl. Smoking topography These analyses were performed on the topographic components of the fust cigarette

smoked postmanipulation during Session 2, as well as all cigarettes smoked during Session 2. Analyses of the first cigarette were based on difference scores (Session 2 - Session 1). Reliability of videotape ratings. Two undergraduate psychology majors were trained to score the videotapes of subjects’ smoking behavior. A Commodore 64 computer was programmed to mark points in time from a continuously running clock (clock accuracy of l/60 second). Raters indicated, by depressing the enter key, when each cigarette was lit, the beginning and end of each puff, and when each cigarette was extinguished. Raters were trained to criterion interrater correlations for mean puff duration and mean interpuff interval of .80 or better, and agreement on number of puffs (count difference no larger than one) of 90% or higher. Interrater reliability was determined by having both raters code 14 samples chosen at random. For the number of puffs, the raters obtained 93.33% agreement, and correlations for mean puff duration and mean interpuff interval were r(13) = .89, p < .OOl, and r(13) = .96, p < .OOl, respectively. Latency to first cigarette. Latency data were log transformed to normalize the skewed distribution. Results indicated an environmental cue salience effect, with HS subjects lighting their first cigarette sooner than LS subjects, F( 1, 51) = 5.28, p < .03 (see Figure 1). Number of puffs. A main effect of negative affect induction emerged, F(2, 53) = 3.25, p < .05, and posthoc tests revealed that NON-ESC subjects took more puffs than ESC

subjects on the first Session 2 cigarette. The NOISE group mean was nonsignificantly

THOMAS J. PAYNE et al.

1.6

1.5 h 1.4 3

i

la 1.2

1.1

1.0

ENVIRONMENTAL CUE SALIENCE Fig. 1. Log-transformed

latencies to cigarette

1, Session 2.

different from the other two (see Figure 2). Analyses for number of puffs for all cigarettes smoked during Session 2 revealed a borderline effect for negative affect induction (p < .l), suggesting once again that NON-ESC subjects took more puffs. Puff duration. A main effect for environmental cue salience indicated that HS subjects puffed significantly longer overall on the first Session 2 cigarette, F(l, 51) = 5.14, p C .03 (see Figure 3a). Further analyses conducted on total puff duration for all Session 2 smoking revealed a main effect for the negative affect induction, F(2, 52) = 3.47, p < .04. NON-ESC subjects puffed more across the entire session relative to both ESC and NOISE groups (p < .OS); ESC and NOISE groups did not differ (see Figure 3b). Inrep@

interval. No main effects or interactions were evident.

Number of cigarettes. A chi-square analysis of the number of subjects within each group who smoked two or more cigarettes during Session 2 was nonsignificant. Weight of unsmoked tobacco. An analysis of the weight of unsmoked tobacco from subjects’ first Session 2 cigarette was conducted. Unfortunately, some data were missing 0.5

0.0

22 w 3

Bl

-0.5

“0 -1.0 i_ 1.5

2’

-2.0

-2.5

’ NON-ESCAPE

ESCAPE

NOISE

ONLY

NEGATIVE AFFECT INDUCTION Fig. 2. Number of puffs change score for cigarette

1, Session 2.

Exposureto smoking-relevant cues

415

2.0 1.5 1.0 0.5 B

0.0

c

-0.6

B

-1.0 - 1.5 - 2.0 -2.5 -3.0 -3.5

’

Low

High

ENVIRONMENTAL

CUE SALIENCE

s d 25

NON-ESCAPE

ESCAPE

NOISE

ONLY

NEGATIVE AFFECT INDUCTION

Fig. 3. Total puff duration (a) change score for cigarette 1, Session 2, and (b) for all Session 2 smoking.

as it was impossible at times to know which cigarette was the subject’s versus butts for the environmental cue salience manipulation. Results indicated a main effect for tive affect induction, F(2, 40) = 3.4, p < .OS. NON-ESC subjects left less tobacco tive to both ESC and NOISE groups (p < .05), while these groups did not differ each other (see Figure 4).

used negarelafrom

Additional analyses Correlational analyses were undertaken to explore the relationships among affect and desire ratings. Change in desire rating at postmanipulation was positively correlated with change in negative affect, r(B) = .30, p < .05, and negatively correlated with change in positive affect, r(58) = - .26, p < .05; similar relationships were evident at postsession, r(58) = .46, p < .OOl, and r(58) = - .28, p < .05, respectively. Further analyses explored the relationships among the FI’Q, desire rating, and topographical variables. FIQ scores were found to be related to the total number of puffs and total puff duration, r = .36, p < .Ol, and r = .34, p < .02, respectively. A marginal association between FIQ scores and latency to lighting the first cigarette also emerged,

476

THOMAS J. PAYNE et al.

100

NON-ESCAPE

ESCAPE

NOISE ONLY

NEGATIVE AFFECT INDUCTION Fig. 4. Weight of unsmoked

tobacco for cigarette

1, Session 2.

?-= - .24, p < .07, as smokers with higher FTQ scores lit their cigarettes significant relationships with desire ratings were evident.

sooner. No

DISCUSSION

The findings of this investigation provide evidence that the experience of negative affect and exposure to environmental smoking stimuli can produce reliable changes in desire to smoke and smoking behavior. In contrast with previous studies, these variables were manipulated independently within the same investigation, and smoking behavior was assessed at the level of topographical components. The procedure used to manipulate affective state appears to have been effective. The NON-ESC group reported greater increases in negative affect and decreases in positive affect relative to the ESC group. This effect does not seem to have been a function of differentially perceived aversion of the tone or level of general arousal. (Increased arousal was associated with active participation in the task; NON-ESC and ESC groups produced equivalent ratings, while the NOISE group was lower). NOISE subjects reported equivalent affect change at postmanipulation relative to NONESC subjects, but this effect appeared to dissipate more rapidly for the NOISE group. A likely explanation for this is that the deprived smokers were somewhat reactive to the moderately aversive tone; it probably constituted a minor stressor (Golding & Mangan, 1982). Thus, in the context of the current study, exposure to the tone seems to have been an important component of the affect induction, interacting with the response-reinforcement contingency to produce the more pronounced effects noted for the NON-ESC group. Exposure to affect cues had a significant impact on the report of desire to smoke. Subjects in the NON-ESC group indicated stronger urges following the manipulation than subjects in the other groups. The environmental cue salience manipulation did not affect desire to smoke. This would suggest that desire to smoke may be more strongly associated with affective states, a hypothesis further supported by significant correlations between desire and affect ratings. Of course, this hypothesis must be tempered in light of the unknown reliability of those ratings as well as the limited range of affects assessed. Further, two previous studies reported an increase in urges subsequent to exposure to salient environmental cues (Herman, 1974; Rickard-Figueroa & Zeichner, 1985), although the lack of a mood assessment renders it difficult to rule out the possibility that such factors were operative.

Exposure to smoking-relevant cues

477

Results suggest that exposure to each type of cue had differential effects on smoking behavior. The presence of salient environmental cues appeared to exert short-term effects on smoking behavior, as evidenced by a shorter latency to lighting the first cigarette, and increased total puff duration for the first cigarette. This effect is consistent with findings by Herman (1974), who ,observed that simply illuminating cigarettes with a desk lamp produced a similar effect. The affect induction procedure produced more varied changes in topography. NON-ESC subjects took more puffs on their first cigarette and smoked more of the cigarette; they also spent more total time puffing across the entire 20minute interval relative to the other conditions. Thus, under high environmental cue salience conditions not involving strong affective states, cigarettes may be smoked more automatically, without the experience of a particularly strong desire. Previous investigators have noted that the immediate proximity of smokers constitutes an important cue for smoking and is temporally related to a proportion of relapse episodes (Marlatt & Gordon, 1985; Shiffman, 1986). The experience of increased negative affect and/or reduced positive affect appeared to have an even greater influence on smoking behavior as well as desire ratings. A number of hypotheses may be put forth regarding why the affective manipulation had such as substantial impact. First, affective states may have a greater capacity to elicit relevant cognitive networks or schemata related to smoking than do environmental cues (Leventhal & Cleary, 1980; see Litz, Payne, & Colletti, 1987, for an example of an application of a schematic processing model to smoking). In addition, the administration of nicotine is known to attenuate affective experience (Gilbert, 1979; Leventhal & Cleary, 1980; Pomerleau & Pomerleau, 1984); higher nicotine dosing under conditions of high affective arousal may facilitate learning processes via its efficacy as a generally effective “coping response” (Pomerleau & Pomerleau , 1984). Of course, assumptions about the actual level of smoke/nicotine intake based on these data must tempered. There is considerable variability in the relationship between smoking behavior and nicotine uptake (Benowitz, 1988). Thus, future studies must include direct biochemical assays for nicotine and its metabolites. Despite these concerns, the current data do suggest that behavioral facets of smoking behavior can be under the control of certain antecedents. We did not find interactive effects to the simultaneous presentation of both types of cues. The lack of such findings may be related to specific parametric features of this study (duration of deprivation, intensity of affect change, length of measurement period, etc.). Additional research is needed to explore whether a modification of these parameters will produce an enhanced effect to exposure to multiple classes of cues. In sum, these results suggest that exposure to these two classes of smoking cues can have a substantial influence on rated desire to smoke and the smoking behavior of moderately deprived smokers. It provides greater experimental support for the notion that cue reactivity effects are an important factor maintaining smoking behavior. The use of treatment strategies and techniques designed to minimize contact with and/or the impact of various high-risk cues (e.g., avoidance, distraction, establishing no-smoking areas, relaxation exercises, etc.) has long been a basic component of smoking cessation programs. Our findings lend further support to this general therapeutic approach as a means of facilitating reduction and initial cessation efforts. Several directions for future research are suggested by these findings. One is to examine individual differences which may influence the effects noted. For example, correlational data indicating an association between the FTQ and smoking variables suggest the importance of nicotine dependence as a mediator of these effects (see Fagerstrom & Schneider, 1989, for a recent review of the FTQ). Another direction concerns the nature

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