Refining the tobacco dependence phenotype using the Wisconsin Inventory of Smoking Dependence Motives: II. Evidence from a laboratory self-administration assay

Associations Between the Wisconsin Inventory of Smoking Dependence Motives and Regional Brain Volumes in Adult Smokers

INTRODUCTION

The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) is a 68-item questionnaire to assess nicotine dependence as a multifactorial construct based on 13 theoretically derived smoking motives. Chronic smoking is associated with structural changes in brain regions implicated in the maintenance of smoking behavior; however, associations between brain morphometry and the various reinforcing components of smoking behavior remain unexamined. The present study investigated the potential association between smoking dependence motives and regional brain volumes in a cohort of 254 adult smokers.

AIMS AND METHODS

The WISDM-68 was administered to participants at the baseline session. Structural magnetic resonance brain imaging (MRI) data from 254 adult smokers (Mage = 42.7 ± 11.4) with moderate to severe nicotine dependence (MFTND = 5.4 ± 2.0) smoking for at least 2 years (Myears = 24.3 ± 11.8) were collected and analyzed with Freesurfer.

RESULTS

Vertex-wise cluster analysis revealed that high scores on the WISDM-68 composite, secondary dependence motives (SDM) composite, and multiple SDM subscales were associated with lower cortical volume in the right lateral prefrontal cortex (cluster-wise p's < .035). Analysis of subcortical volumes (ie, nucleus accumbens, amygdala, caudate, and pallidum) revealed several significant associations with WISDM-68 subscales, dependence severity (Fagerström Test for Nicotine Dependence), and overall exposure (pack-years). No significant associations between cortical volume and other nicotine dependence measures or pack-years were observed.

CONCLUSIONS

Results suggest that smoking motives may play a larger role in cortical abnormalities than addiction severity and smoking exposure per se, whereas subcortical volumes are associated with smoking motives, addiction severity, and smoking exposure.

IMPLICATIONS

The present study reports novel associations between the various reinforcing components of smoking behavior assessed by the WISDM-68 and regional brain volumes. Results suggest that the underlying emotional, cognitive, and sensory processes that drive non-compulsive smoking behaviors may play a larger role in gray matter abnormalities of smokers than smoking exposure or addiction severity.

Understanding contexts of smoking and vaping among dual users: analysis of ecological momentary assessment data

AIMS

To understand dual users' cigarette and e-cigarette use patterns, including the contexts in which they vape versus smoke and to understand how environmental and internal contexts and smoking patterns differ between dual users and exclusive smokers.

DESIGN

Longitudinal observational trial.

SETTING

Research center in Wisconsin, USA.

PARTICIPANTS

Adult dual users (n = 162) and adults who exclusively smoked (n = 143), with no plans to quit smoking or vaping in the next 30 days.

MEASUREMENTS

Participants carried smartphones for 2 weeks at baseline to record each use event for the two products and report on the context of their product use. The percentage of mornings where participants vaped first versus smoked were used to compute e-cigarette dependence.

FINDINGS

Hierarchical linear regression models with random slopes and intercepts examined the within- and between-subject effects of context on the likelihood of vaping (versus smoking); significant fixed effects were tested for moderation by e-cigarette dependence. Dual users reported significantly more puffs/cigarette [mean = 13.1, standard deviation (SD) = 10.2] than puffs/vape event (mean = 11.7, SD = 11.5; P = 0.01). E-cigarette dependence moderated the influence of social cues (t-ratio = 2.4, P = 0.02) and smoking restrictions (t-ratio = 3.1, P = 0.003) on the likelihood of vaping versus smoking [odds ratio (OR) = 2.30, P = 0.02]. Context was more related to which product was used in those of low versus higher e-cigarette dependence. Reports of strong cravings to smoke and positive expectancies for cigarettes were associated with a reduced likelihood of vaping, whereas strong cravings to vape and positive vaping expectancies were related to increased likelihood of vaping.

CONCLUSIONS

Among dual users of cigarettes and e-cigarettes with no motivation to quit, vaping appears to be related to internal cues and more highly linked with social contexts and smoking restrictions (i.e. under stronger external stimulus control) among those with low to moderate e-cigarette dependence compared with high e-cigarette dependence. These findings illustrate the importance of contextual factors in tobacco product use among dual users with the influence of context being reduced at high levels of e-cigarette dependence.

Relations among cigarette dependence, e-cigarette dependence, and key dependence criteria among dual users of combustible and e-cigarettes

Objective: The aim of this study was to examine dependence on combustible and e-cigarettes among users of both products (dual users), which may provide important insights into long-term use patterns. Method: Dual users (smoking daily for 3 months, using e-cigarettes at least once/week for the past month; N = 256; 45% women, 71% White, M age 39.0 years) not interested in quitting either product participated in a longitudinal, 2-year, observational study. At baseline, participants completed measures of combustible and e-cigarette dependence (Fagerström Test of Cigarette Dependence [FTCD], e-FTCD, Wisconsin Inventory of Smoking Dependence Motives [WISDM], e-WISDM, Penn State Cigarette Dependence Index, and Penn State E-Cigarette Dependence Index) and carried a study smartphone for 2 weeks to record cigarette and e-cigarette use events. Results: Most measures of dependence were product specific (e.g., FTCD and e-FTCD were not correlated, r = -0.003) and predicted product-specific outcomes (e.g., long-term use of that product). However, individuals used the two products for some of the same secondary dependence motives (e.g., weight control, cognitive and affective enhancement). These secondary, or instrumental, motives predicted use of both products at 1 year. Which product was used first in the morning was strongly related to product dependence scores and likelihood of continued product use at 1 year. Conclusions: Among dual users of combustible and e-cigarettes, measures of e-cigarette and cigarette dependence tended to be unrelated to one another, but dual users tended to use both products for the same instrumental motives. Which product is used first in the morning may serve as a valuable measure of relative dependence on the two products. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The associations of smoking dependence motives with depression among daily smokers

AIMS

To investigate how strongly smoking dependence and smoking dependence motives are associated with depressive symptoms among daily smokers and if these associations are independent of measured confounders and shared familial factors.

DESIGN

Cross-sectional individual-based and within-pair analyses.

SETTING

Fourth wave of the population-based Finnish Twin Cohort conducted in 2011.

PARTICIPANTS

918 daily smokers born 1945-1957 (48% men), mean age 59.5 years including 38 twin pairs discordant for depression.

MEASUREMENTS

Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale with a cut off value ≥20 for depression. Smoking dependence was assessed using the Fagerström Test for Cigarette Dependence (FTCD) and smoking dependence motives with three subscales from the multi-dimensional Brief Wisconsin Inventory of Smoking Dependence Motives (WISDM): primary dependence motives (PDM), affective enhancement (AE), and Taste. Logistic regressions, using standardized scores of independent variables and adjusted for multiple confounders with correction for sampling as twin pairs, were used in the individual-based analyses. Conditional logistic regression was used to control for shared familial factors in discordant twin pairs.

FINDINGS

Prevalence of depression was 18% (n = 163: 61 [14%] in men, n = 102 [22%] in women). Higher smoking dependence measured by the FTCD (OR 1.45; 95% CI 1.20, 1.75), and dependence motives measured by the PDM (1.56; 1.30, 1.87) and the AE (1.54; 1.28, 1.85) were associated with higher odds of depression. The associations remained after adjusting for individual confounders, except for neuroticism, which attenuated all associations. FTCD, PDM, and AE showed associations with depression within depression-discordant monozygotic pairs, suggesting an association independent of familial factors.

CONCLUSIONS

Depression appears to be associated with smoking dependence and smoking dependence motives related to heavy, automatic use and use to regulate affective states. The associations appear to be confounded or mediated by neuroticism but are independent of shared familial influences.

Roma Socioeconomic Status Has a Higher Impact on Smoking Behaviour than Genetic Susceptibility

It is a matter of speculation whether the high prevalence of smoking among Hungarian Roma (HR) is related to genetic, gene-environmental interactions or cultural factors. Our aim is to compare the genetic susceptibility and possible effects of determinants associated with smoking behaviours in the Hungarian general (HG) and Roma populations. A complex health survey including three pillars (questionnaire, physical and laboratory examinations) was carried out (N_HG = 412 and N_HR = 402). Risk allele frequencies of ten single-nucleotide polymorphisms (SNPs) were compared, and their combined effect was estimated by computing unweighted and weighted genetic risk scores (GRS, wGRS). The effects of genetic and environmental factors were investigated in regression analyses after confounders were introduced. Socio-economic status (SES) was calculated based on the Kuppuswamy scale 2019. Risk allele frequencies of only four SNPs were found to be different between populations (p < 0.01). Median values of GRS did not differ, while the wGRS median was slightly higher among Roma individuals (5.2 vs. 4.9; p = 0.02). Roma individuals were more likely to be heavy smokers (OR_males = 2.05, 95% CI [1.47–2.86]; OR_females = 1.89, 95% CI [1.58–2.25]. Smokers have lower SES compared to never smokers (SES β_HR = −0.039, p = 0.023; β_HG = −0.010, p = 0.049). An inverse relationship was found between SES and smoking behaviours (p < 0.0001) and was found to be a better predictor of smoking behaviours than genetic susceptibility. Our study findings suggest that the high prevalence of smoking behaviours and nicotine-dependence were not revealed to have a genetic susceptibility among HR individuals; therefore, the highest efforts should be focused on targeting SES-related factors in the Roma population. Strengths of the study: This is the first study carried out to investigate and detect the most relevant factors and the possible genetic background of the extremely high prevalence of smoking based in the Roma population. Limitations of the study: No standard instrument has been used to assess the intensity of addiction to nicotine. Because of some participants’ unwillingness to define themselves as Roma, the overall HR population was not represented by the sample of this study.

E-cigarette Dependence Measures in Dual Users: Reliability and Relations With Dependence Criteria and E-cigarette Cessation

BACKGROUND

Electronic cigarettes (e-cigarettes) have drastically changed the nicotine and tobacco product landscape. However, their potential public health impact is still unclear. A reliable and valid measure of e-cigarette dependence would likely advance assessment and prognostication of the public health impact of e-cigarettes. The aim of this research was to examine the internal consistency, structure, and validity of three e-cigarette dependence scales.

METHODS

Adult dual users (smokers who also vape, N = 256) enrolled in an observational cohort study (45.1% women, 70.7% white). At baseline, participants completed the e-cigarette Fagerström Test of Cigarette Dependence (e-FTCD), the e-cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM), and the Penn State Electronic Cigarette Dependence Index (PS-ECDI). All participants provided a urine sample for cotinine analysis and reported e-cigarette use at 1 year.

RESULTS

The e-WISDM subscales had the highest internal consistency (α = .81-.96), then the PS-ECDI (α = .74) and e-FTCD (α = .51). A single-factor structure for the e-FTCD and an 11-factor structure for the e-WISDM were supported, but the PS-ECDI did not have a single-factor structure. All three e-cigarette dependence scales were highly correlated with validation criteria including continued e-cigarette use at 1 year, but not with e-liquid nicotine concentration or cotinine.

CONCLUSIONS

The e-WISDM and PS-ECDI had stronger internal consistency than did the e-FTCD, despite the e-FTCD's single-factor structure, but all 3 measures appear to be valid measures of e-cigarette dependence as suggested by their significant relations with self-perceived addiction, heavy use, early use after overnight deprivation, and continued use over time.

IMPLICATIONS

This research provides empirical support for three e-cigarette dependence measures: the e-FTCD, the PS-ECDI, and the e-WISDM among dual users of e-cigarettes and combustible cigarettes. The PS-ECDI and e-WISDM are more reliable, but all three measures were strongly correlated with key dependence constructs such as heavy use and continued use over time.

Expanding the genetic architecture of nicotine dependence and its shared genetics with multiple traits

Cigarette smoking is the leading cause of preventable morbidity and mortality. Genetic variation contributes to initiation, regular smoking, nicotine dependence, and cessation. We present a Fagerström Test for Nicotine Dependence (FTND)-based genome-wide association study in 58,000 European or African ancestry smokers. We observe five genome-wide significant loci, including previously unreported loci MAGI2/GNAI1 (rs2714700) and TENM2 (rs1862416), and extend loci reported for other smoking traits to nicotine dependence. Using the heaviness of smoking index from UK Biobank (N = 33,791), rs2714700 is consistently associated; rs1862416 is not associated, likely reflecting nicotine dependence features not captured by the heaviness of smoking index. Both variants influence nearby gene expression (rs2714700/MAGI2-AS3 in hippocampus; rs1862416/TENM2 in lung), and expression of genes spanning nicotine dependence-associated variants is enriched in cerebellum. Nicotine dependence (SNP-based heritability = 8.6%) is genetically correlated with 18 other smoking traits (rg = 0.40-1.09) and co-morbidities. Our results highlight nicotine dependence-specific loci, emphasizing the FTND as a composite phenotype that expands genetic knowledge of smoking.

Dependence on e-cigarettes and cigarettes in a cross-sectional study of US adults

BACKGROUND AND AIMS

Cigarette smoking often results in nicotine dependence. With use of electronic cigarettes as an alternative source of nicotine, it is important to assess dependence associated with e-cigarette use. This study assesses dependence among current and former adult e-cigarette users on cigarettes and e-cigarettes, compared with dependence on cigarettes.

DESIGN

Cross-sectional data from the Population Assessment of Tobacco and Health (PATH) study from 2013-2016. Psychometrically assessed dependence was compared for cigarettes and e-cigarettes among current and former exclusive and dual users of the products and among e-cigarette users who had and had not recently stopped smoking. Setting A population-based representative sample of US adults. Participants Participants were 13 311 US adults (18+) in Waves 1-3 of PATH reporting current established smoking, current use of e-cigarettes, or stopping use of either product in the past year who were administered dependence assessments for cigarettes and/or e-cigarettes. Measurements A 16-item scale assessing tobacco dependence (on a 1-5 scale), previously validated for assessment and comparison of dependence on varied tobacco products, including cigarettes and e-cigarettes, with a variation assessing residual dependence among users who stopped in the past year. Findings Among current users, dependence on e-cigarettes was significantly lower than dependence on cigarettes, in within-subjects comparisons among dual users of both e-cigarettes and cigarettes (1.58 [SE = 0.05] vs. 2.76 [0.04]), P < 0.0001), and in separate groups of e-cigarette users and cigarette smokers (1.95 [0.05] vs. 2.52 [0.02], P < 0.0001), and among both daily and non-daily users of each product. Among former users, residual symptoms were significantly lower for e-cigarettes than cigarettes, both among former dual users (1.23 [0.07] vs. 1.41 [0.06], P < 0.001) and among users of one product (1.28 [0.03] vs. 1.53 [0.03], P < 0.0001). The highest level of e-cigarette dependence was among e-cigarette users who had stopped smoking (2.17 [0.08]). Conclusion Use of e-cigarettes appears to be consistently associated with lower nicotine dependence than cigarette smoking.

The Association of Lesbian, Gay, and Bisexual Identity Facets With Smoking Dependence Motives

Introduction

Lesbian, gay, and bisexual (LGB) adults have higher rates of smoking than heterosexual adults. LGB individuals face unique stressors, including challenges associated with having a LGB identity. The extent to which these unique stressors are related to dependence motives in LGB adult smokers, however, has not been previously explored. The current study was conducted to redress these gaps.

Methods

Participants (N = 52; Mage = 42.8; 55.8% Black/African American) were recruited from the local community. Identity facets were measured by the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). Dependence motives were measured by the Brief Wisconsin Inventory of Smoking Dependence Motives. Linear multiple regressions were calculated with the predictors of seven LGBIS subscales for primary and secondary dependence motives, respectively.

Results

Primary dependence motives (core nicotine dependence features) were predicted by affirmation of LGB identity (β = 0.44). Secondary dependence motives (eg, taste, cognitive/affective enhancement) were predicted by uncertainty of LGB identity (β = 0.43).

Conclusions

LGB identity affirmation was associated with primary dependence motives, suggesting that a positive view of one's sexual orientation is a risk factor for dependence. It may be that identity affirmation is related to stronger involvement with the LGB community, which has smoking-friendly norms. Identity uncertainty was associated with secondary dependence motives; this unique identity challenge may represent a stressor contributing to smoking dependence. Findings can help explain the higher rate of smoking in LGB populations and offer avenues to better tailor smoking cessation interventions.

Implications

The current study is the first to examine multidimensional aspects of LGB identity in explaining smoking dependence motives among LGB adults. Results reveal that LGB identity challenges are associated with dependence motives, suggesting that interventions targeting these challenges may be help reduce LGB smoking disparities. Specifically, reducing identity uncertainty may help reduce smoking dependence. Though identity affirmation was a smoking dependence correlate, it is counterproductive to reduce affirmation, given its association with other positive health outcomes. Rather, interventions to change LGB community norms around smoking appear warranted, given the documented high overlap between affirmation and community affiliation.

WISDM Primary and Secondary Dependence Motives: Associations With Smoking Rate, Craving, and Cigarette Effects in the Natural Environment

Introduction

The Wisconsin Inventory of Smoking Dependence Motives (WISDM) is a multidimensional measure of smoking motives that was developed to facilitate research aiming to refine the nomological network surrounding tobacco dependence. Recent evidence suggests that a composite of four subscales, termed the Primary Dependence Motives (PDM), may represent core features of advanced addiction, while the remaining nine subscales (Secondary Dependence Motives; SDM) represent instrumental motives for cigarette use that may be relevant at any stage of smoking.

Methods

A sample of 255 smokers (all regular alcohol users) participated in an ecological momentary assessment study in which they monitored smoking behavior and related experiences for 21 days. Multilevel regression analyses tested how PDM and SDM predicted daily smoking rate, cigarette craving, and appraisals of pleasure and relief of unpleasant feelings from smoking.

Results

When PDM and SDM were entered simultaneously, only PDM was related to daily cigarette count, and only SDM predicted reports of craving and relief from unpleasant feelings from smoking. SDM was associated with reports of greater pleasure from smoking and PDM was associated with lower pleasure ratings. The Fagerström Test for Nicotine Dependence (FTND) was related to daily smoking rate and craving, but WISDM composites contributed incremental prediction.

Conclusions

The findings confirm that PDM indexes heavier use that is relatively unrelated to immediate consequences of smoking. SDM is not uniquely related to smoking heaviness, but is associated with craving and reports of pleasure and relief of unpleasant feelings derived from smoking during ad lib use.

Implications

This study extends the evidence for the distinction between the WISDM PDM and SDM. PDM scores are associated with heavier smoking and are relatively unrelated to immediate consequences of smoking. SDM is more strongly related to craving and reports of smoking-derived pleasure and relief of unpleasant feelings during ongoing use in daily life.

Nicotine dependence is associated with functional variation in FMO3, an enzyme that metabolizes nicotine in the brain

A common haplotype of the flavin-containing monooxygenase gene FMO3 is associated with aberrant mRNA splicing, a twofold reduction in in vivo nicotine N-oxidation and reduced nicotine dependence. Tobacco remains the largest cause of preventable mortality worldwide. CYP2A6, the primary hepatic nicotine metabolism gene, is robustly associated with cigarette consumption but other enzymes contribute to nicotine metabolism. We determined the effects of common variants in FMO3 on plasma levels of nicotine-N-oxide in 170 European Americans administered deuterated nicotine. The polymorphism rs2266780 (E308G) was associated with N-oxidation of both orally administered and ad libitum smoked nicotine (P⩽3.3 × 10-5 controlling for CYP2A6 genotype). In vitro, the FMO3 G308 variant was not associated with reduced activity, but rs2266780 was strongly associated with aberrant FMO3 mRNA splicing in both liver and brain (P⩽6.5 × 10-9). Surprisingly, in treatment-seeking European American smokers (n=1558) this allele was associated with reduced nicotine dependence, specifically with a longer time to first cigarette (P=9.0 × 10-4), but not with reduced cigarette consumption. As N-oxidation accounts for only a small percentage of hepatic nicotine metabolism we hypothesized that FMO3 genotype affects nicotine metabolism in the brain (unlike CYP2A6, FMO3 is expressed in human brain) or that nicotine-N-oxide itself has pharmacological activity. We demonstrate for the first time nicotine N-oxidation in human brain, mediated by FMO3 and FMO1, and show that nicotine-N-oxide modulates human α4β2 nicotinic receptor activity in vitro. These results indicate possible mechanisms for associations between FMO3 genotype and smoking behaviors, and suggest nicotine N-oxidation as a novel target to enhance smoking cessation.

Offering smoking treatment to primary care patients in two Wisconsin healthcare systems: Who chooses smoking reduction versus cessation?

Smokers unwilling to make a quit attempt can still benefit from smoking intervention. However, it is unclear what proportion of smokers will enter such a Motivation phase intervention, and whether such an intervention attracts different types of smokers than does abstinence oriented treatment. We conducted a study from June 2010 to October 2013 based on a chronic care model of tobacco treatment among study eligible primary care patients (N=1579; 58% women, 89% White) presenting for regular health care visits in southern Wisconsin, U.S. Medical assistants, prompted via the electronic health record (EHR), invited smokers (n=10,242) to learn more about treatment options to help them either reduce their smoking or quit. Of those invited to learn more who were then reached by study staff, 10.2% (n=1046) reported interest in reduction treatment and 24% (n=2465) reported interest in cessation treatment. Patients who selected and ultimately entered reduction (n=492) versus cessation (n=1087) were more likely to report: older age; a history of anxiety; lower motivation to quit; lower primary dependence motives; more close friends or family who smoke; and a greater interval since their last quit attempt. Results suggest that Motivation phase treatment aimed at smoking reduction may increase the proportion and range of smokers inducted into tobacco treatment.

Indicators of dependence for different types of tobacco product users: Descriptive findings from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) study

BACKGROUND AND AIMS

With no established standard for assessing tobacco dependence (TD) across tobacco products in surveys, the Population Assessment of Tobacco and Health (PATH) Study provides a unique platform for examining the psychometric properties and validity of multiple indicators of tobacco dependence across a range of tobacco products.

PARTICIPANTS

A U.S. nationally representative sample from the 32,320 adult Wave 1 interviews with analyses focused on 14,287 respondents who were current established users of tobacco products.

FINDINGS

This analysis confirms a single primary latent construct underlying responses to TD indicators for cigarettes, e-cigarettes, cigars, hookah, and smokeless tobacco products. Mutually exclusive past year tobacco-user groups included: cigarette only (n=8689), e-cigarette only (n=437), cigar only (traditional, cigarillo, or filtered) (n=706), hookah only (n=461), smokeless tobacco only (n=971), cigarette plus e-cigarette (n=709), and multiple tobacco product users (n=2314). Differential Item Functioning (DIF) analyses supported use of 16 of the 24 examined TD indicators for comparisons across tobacco users. With cigarette users as a reference (mean=0.0, SD=1.0), we observed a range of TD with hookah (mean=-1.71) and cigar (mean=-1.92) only users being the lowest, and cigarette plus e-cigarette product users being the highest (mean=0.35). Regression models including sociodemographic factors supported concurrent validity with increased product use frequency and TD among cigarette-only (p<0.001), e-cigarette only (p<0.002), cigar (p<0.001), hookah only (p<0.001), and smokeless tobacco users (p<0.001).

CONCLUSION

The PATH Study Adult Wave 1 Questionnaire provided psychometrically valid measures of TD that enables future regulatory investigations of nicotine dependence across tobacco products.

P3 event-related potential reactivity to smoking cues: Relations with craving, tobacco dependence, and alcohol sensitivity in young adult smokers

The current study tested whether the amplitude of the P3 event-related potential (ERP) elicited by smoking cues is (a) associated with the degree of self-reported craving reactivity, and (b) moderated by degree of tobacco dependence. Because alcohol and cigarettes are frequently used together, and given recent evidence indicating that individual differences in alcohol sensitivity influence reactivity to alcohol cues, we also investigated whether alcohol sensitivity moderated neural responses to smoking cues. ERPs were recorded from young adult smokers (N = 90) while they participated in an evaluative categorization oddball task involving 3 types of targets: neutral images, smoking-related images, and images of drinking straws. Participants showing larger P3 amplitudes to smoking cues and to straw cues (relative to neutral targets) reported greater increases in craving after cue exposure. Neither smoking status (daily vs. occasional use) nor psychometric measures of tobacco dependence consistently or specifically moderated P3 reactivity to smoking cues. Lower alcohol sensitivity was associated with larger P3 to smoking cues but not comparison straw cues (relative to neutral targets). This effect was further moderated by tobacco dependence, with the combination of lower sensitivity and higher dependence associated with especially pronounced P3 reactivity to smoking cues. The findings suggest the smoking-cue elicited P3 ERP component indexes an approach-oriented incentive motivational state accompanied by a subjective sense of cigarette craving. Self-reported low sensitivity to the pharmacologic effects of alcohol may represent a marker of drug cue reactivity and therefore deserves attention as a potential moderator in smoking cue exposure studies. (PsycINFO Database Record

An initial investigation of associations between dopamine-linked genetic variation and smoking motives in African Americans

Nicotine dependence (ND) is a heterogeneous phenotype with complex genetic influences that may vary across ethnicities. The use of intermediate phenotypes may clarify genetic influences and reveal specific etiological pathways. Prior work in European Americans has found that the four Primary Dependence Motives (PDM) subscales (Automaticity, Craving, Loss of Control, and Tolerance) of the Wisconsin Inventory of Smoking Motives represent core features of nicotine dependence and are promising intermediate phenotypes for understanding genetic pathways to ND. However, no studies have examined PDM as an intermediate phenotype in African American smokers, an ethnic population that displays unique patterns of smoking and genetic variation. In the current study, 268 African American daily smokers completed a phenotypic assessment and provided a sample of DNA. Associations among haplotypes in the NCAM1-TTC12-ANKK1-DRD2 gene cluster, a dopamine-related gene region associated with ND, PDM intermediate phenotypes, and ND were examined. Dopamine-related genetic variation in the DBH and COMT genes was also considered on an exploratory basis. Mediational analysis was used to test the indirect pathway from genetic variation to smoking motives to nicotine dependence. NCAM1-TTC12-ANKK1-DRD2 region variation was significantly associated with the Automaticity subscale and, further, Automaticity significantly mediated associations among NCAM1-TTC12-ANKK1-DRD2 cluster variants and ND. DBH was also significantly associated with Automaticity, Craving, and Tolerance; Automaticity and Tolerance also served as mediators of the DBH-ND relationship. These results suggest that PDM, Automaticity in particular, may be a viable intermediate phenotype for understanding dopamine-related genetic influences on ND in African American smokers. Findings support a model in which putatively dopaminergic variants exert influence on ND through an effect on patterns of automatic routinized smoking.

Nondaily smokers' experience of craving on days they do not smoke

Nondaily, or intermittent smokers (ITS), represent a growing pattern in adult smoking that needs to be explained by models of drug dependence. ITS regularly and voluntarily abstain from smoking, yet have difficulty quitting. We examine potential accounts of ITS' smoking by exploring their experience of craving and withdrawal on the days they abstain. For 3 weeks, 146 ITS and 194 daily smokers used the Ecological Momentary Assessment (EMA) to monitor craving, withdrawal, and smoking in real-time. ITS' craving (p < .001) and arousal (p < .001) were significantly lower on the 34.4% of days when they abstained (compared with days they smoked), and they experienced no increases in withdrawal symptoms. ITS who abstained for longer experienced lower craving, even on their first day of abstinence (p < .001). Within strata defined by longest duration of abstinence (1, 2-3, 4-6, ≥7 days), craving did not change over time, demonstrating no increase as resumption of smoking approached. Craving increased only at the moment smoking resumed. Furthermore, duration of abstinence runs varied more within persons than across persons. These findings contradict the predictions of a model positing that craving recurs at fixed intervals. Findings are consistent with the hypothesis that ITS' smoking is cued or primed by particular stimuli rather than by temporal cycles. These analyses demonstrate that ITS do not experience increased craving or withdrawal on days they do not smoke, and show neither signs of classical dependence nor regular cycles of craving and smoking.

NCAM1-TTC12-ANKK1-DRD2 variants and smoking motives as intermediate phenotypes for nicotine dependence

RATIONALE

Nicotine dependence (ND) is a heterogeneous phenotype with complex genetic influences. The use of intermediate ND phenotypes may clarify genetic influences and reveal specific etiological pathways. Prior work has found that the four Primary Dependence Motives (PDM) subscales (Automaticity, Craving, Loss of Control, and Tolerance) of the Wisconsin Inventory of Smoking Motives (WISDM) represent heavy, pervasive smoking, which is a core feature of nicotine dependence, making these motives strong candidates as intermediate phenotypes.

OBJECTIVE

This study examines the WISDM PDM as a novel intermediate phenotype of nicotine dependence.

METHODS

The study used data from 734 European Americans who smoked at least 5 cigs/day [M = 16.2 (SD = 9.5) cigs/day], completed a phenotypic assessment, and provided a sample of DNA. Based on prior evidence of the role of genetic variation in the NCAM1-TTC12-ANKK1-DRD2 region on chromosome 11q23 in smoking behavior, associations among 12 region loci with nicotine dependence and PDM phenotypes were examined using haplotype and individual loci approaches. In addition, mediational analysis tested the indirect pathway from genetic variation to smoking motives to nicotine dependence.

RESULTS

NCAM1-TTC12-ANKK1-DRD2 region loci and haplotypes were significantly associated with the motive of Automaticity and, further, Automaticity significantly mediated associations among NCAM1-TTC12-ANKK1-DRD2 cluster variants and nicotine dependence.

CONCLUSIONS

These results suggest that motives related to automaticity are a viable intermediate phenotype for understanding genetic contributions to nicotine dependence. Further, NCAM1-TTC12-ANKK1-DRD2 variants may increase the likelihood that a person will become dependent via a highly automatic smoking ritual that can be elicited with little awareness.

The relationship between smoking motives and smoking urges experienced in response to a negative affect induction

INTRODUCTION

The present study attempted to further elucidate the relationship between self-reported smoking motives and affect in college students.

METHOD

Smoking motives were measured via self-report, and following a laboratory negative affect (NA) mood induction, urge to smoke was assessed via three questions. Participants were college students (N=84) who reported smoking an average of 8.74 (SD=5.36) cigarettes per day.

RESULTS

Results indicated that smoking motives for Positive Reinforcement and Automaticity significantly predicted participants' responses on two measures of urge to smoke immediately following the NA induction. Positive Reinforcement motives were predictive of urge to smoke, and Automaticity motives were predictive of the number of cigarettes participants stated that they would smoke if cigarettes were provided for free.

CONCLUSIONS

These findings indicate that (1) the association between NA and smoking is perhaps more complex than previously thought; and (2) merely two (Positive Reinforcement, Automaticity) of possibly thirteen smoking motives were identified as predictive of smoking urges. It is particularly surprising that other smoking motives (e.g., Negative Reinforcement) were not significant predictors of urge following the NA induction. Implications for relapse risk and treatment considerations among smokers experiencing elevated NA are considered.

Smoking behavior: a cross-sectional study to assess the dimensionality of the brief Wisconsin inventory of smoking dependence motives and identify different typologies among young daily smokers

INTRODUCTION

The present study aims to investigate the dimensionality of the brief version of the Wisconsin Inventory of Smoking Dependence Motives (B-WISDM) and identify different smoking motivational profiles among young daily smokers (N = 375).

METHODS

We tested 3 measurement models of the B-WISDM using confirmatory factor analysis, whereas cluster analysis was used to identify the smokers' motivational profiles. Furthermore, we compared clusters toward dependence level and the number of cigarettes smoked per day using analysis of variance tests.

RESULTS

The results confirmed that the B-WISDM measures 11 first-order intercorrelated factors. The second-order model, originally proposed for the longer version of the questionnaire, showed adequate fit indices but fitted the data significantly worse than the first-order model. Five motivational clusters were identified and differed in terms of tobacco addiction and the number of cigarettes smoked per day. Although each cluster had specific features, 2 main smoker groups were distinguished: Group A (composed of 3 clusters), which was mainly characterized by high levels of secondary dependence motives, and Group B (composed of 2 clusters), in which the primary and secondary dependence motives reached similar levels. In general, the clusters of Group B were more addicted to cigarettes than Group A clusters.

CONCLUSIONS

Using the B-WISDM to identify different smoking motivational profiles has important practical implications because they might help characterize addiction, which represents the first step to help an individual quit smoking.

Examination of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) Factor Structure in a Sample of Pregnant Smokers

INTRODUCTION

Smoking during pregnancy poses known risks to fetal and infant development. Women who continue to smoke during pregnancy exhibit higher levels of nicotine dependence than women who quit. Increased understanding of the construct of nicotine dependence in pregnant smokers may aid in the development of effective treatments. Research has suggested that nicotine dependence is a multifaceted construct, driven not only by withdrawal and tolerance processes, but also by reinforcement, sensory, and contextual processes. The Wisconsin inventory of smoking dependence motives (WISDM-68) assesses 13 varied smoking motives in order to assess processes that may lead to nicotine dependence.

METHODS

The factor structure of the WISDM-68 was explored using an ethnically diverse sample of 294 pregnant women who had been screened and/or enrolled in a smoking cessation treatment study. Confirmatory analyses were conducted with previously published models. An exploratory factor analysis and exploratory structural equation modeling (ESEM) were conducted to develop and validate a measurement model for the WISDM-68 in this sample.

RESULTS

Previously established models were not a good fit for the present data. Using ESEM, a 9-factor model exhibiting both predictive and concurrent validity emerged. Two factors predicted abstinence 6 months posttreatment. Several factors were associated with smoking heaviness, the Fagerström test for cigarette dependence and time to first cigarette.

CONCLUSIONS

In contrast to previously published studies, a 9-factor model best characterizes the WISDM in the present sample. These findings may reflect smoking motivations unique to young, pregnant women who continue to smoke during pregnancy.

Anhedonia as a component of the tobacco withdrawal syndrome

Animal research suggests that anhedonia is a tobacco withdrawal symptom, but this topic has not been addressed definitively in research with humans. This research sought to determine whether anhedonia is (a) an element of the tobacco withdrawal syndrome in humans and (b) an impediment to successful tobacco cessation. Data were from 1,175 smokers (58.3% women; 85.5% White) participating in a randomized double-blind, placebo-controlled trial of smoking cessation pharmacotherapies. Ecological momentary assessments for 5 days before and 10 days after the target quit day were used to assess anhedonia and other established withdrawal symptoms. Consistent with drug withdrawal, anhedonia showed an inverted-U pattern of change in response to tobacco cessation and was associated with the severity of other withdrawal symptoms and tobacco dependence. Postquit anhedonia was associated with decreased latency to relapse (hazard ratio = 1.09, 95% confidence interval [CI] [1.02, 1.17]) and with lower 8-week point-prevalence abstinence (odds ratio = .91, 95% CI [.86, .97])-relations that remained significant when other withdrawal symptoms were included as predictors. Finally, nicotine replacement therapy nearly fully suppressed the increase in abstinence-related anhedonia (β = -.66, p < .001), suggesting agonist suppression of withdrawal. Results suggest that anhedonia is a unique and motivationally significant element of the tobacco withdrawal syndrome in humans. These results have implications for defining and assessing tobacco use disorder and for understanding and treating tobacco addiction.

Nicotine dependence, "background" and cue-induced craving and smoking in the laboratory

BACKGROUND

Nicotine dependence has been associated with higher "background" craving and smoking, independent of situational cues. Due in part to conceptual and methodological differences across past studies, the relationship between dependence and cue-reactivity (CR; e.g., cue-induced craving and smoking) remains unclear.

METHODS

207 daily smokers completed six pictorial CR sessions (smoking, negative affect, positive affect, alcohol, smoking prohibitions, and neutral). Individuals rated craving before (background craving) and after cues, and could smoke following cue exposure. Session videos were coded to assess smoking. Participants completed four nicotine dependence measures. Regression models assessed the relationship of dependence to cue-independent (i.e., pre-cue) and cue-specific (i.e., pre-post cue change for each cue, relative to neutral) craving and smoking (likelihood of smoking, latency to smoke, puff count).

RESULTS

Dependence was associated with background craving and smoking, but did not predict change in craving across the entire sample for any cue. Among alcohol drinkers, dependence was associated with greater increases in craving following the alcohol cue. Only one dependence measure (Wisconsin Inventory of Smoking Dependence Motives) was consistently associated with smoking reactivity (higher likelihood of smoking, shorter latency to smoke, greater puff count) in response to cues.

CONCLUSION

While related to cue-independent background craving and smoking, dependence is not strongly associated with laboratory cue-induced craving under conditions of minimal deprivation. Dependence measures that incorporate situational influences on smoking correlate with greater cue-provoked smoking. This may suggest independent roles for CR and traditional dependence as determinants of smoking, and highlights the importance of assessing behavioral CR outcomes.

A pilot study of pain-related anxiety and smoking-dependence motives among persons with chronic pain

Complex interactions between pain and tobacco smoking have been of increasing interest to researchers and clinicians from a variety of disciplines. There is also recent evidence to suggest that pain-related anxiety may play an important role in the maintenance of tobacco dependence among persons with comorbid pain disorders. The goal of the current study was to evaluate the explanatory relevance of pain-related anxiety in relation to tobacco dependence among a sample of daily smokers with current chronic pain. Participants were recruited from the general population to complete an online survey that was developed to examine interrelations between chronic pain and tobacco smoking. Fifty-six of 129 (43%) daily smoking respondents met criteria for current chronic pain. Results indicated that pain-related anxiety accounted for a significant portion of the unique variance in total smoking dependence scores, and both primary and secondary dependence composite scores (as measured by the Wisconsin Inventory of Smoking Dependence Motives; Piper et al., 2004). It is noteworthy that these effects were observed above and beyond the variance accounted for by relevant sociodemographic factors, generalized anxiety, and pain severity. Pain-related anxiety was observed to be strongly associated with secondary dependence motives, which is consistent with a conceptualization of pain-related anxiety as an instrumental or situational motivator of smoking. These results suggest that tobacco smokers with comorbid pain disorders may be at risk for maintaining or exacerbating their dependence on tobacco, possibly due to individual differences in pain-related anxiety. These findings may help inform the development of tailored interventions for smokers with comorbid chronic pain.

Smoking motives of daily and non-daily smokers: a profile analysis

BACKGROUND

Non-daily or intermittent smoking is becoming common, but little is known about smoking patterns of intermittent smokers (ITS). This study assesses differences in the profile of smoking motives of non-daily, ITS and daily smokers (DS).

METHODS

Participants were 218 DS and 252 ITS (152 converted ITS [CITS], who previously smoked daily, and 80 native ITS [NITS] who did not), not currently quitting, recruited by advertisement. ITS were defined as smoking 4-27 days per month; DS as smoking daily, 5-30 cigarettes per day. Participants completed the Wisconsin Inventory of Smoking Dependence Motives (WISDM), yielding scores for 13 different motives. The within-profile standard deviation expressed profile scatter (differentiation among motives), and profile shape was assessed on scores standardized for within-profile mean and standard deviation.

RESULTS

There was no difference between ITS and DS on profile scatter. ITS and DS differed in the shape of the standardized score profile, with DS scoring higher on Tolerance, Craving, Automaticity, Loss of Control and Behavioral Choice motives, and ITS scoring higher on Cue Exposure, Weight Control, and Positive Reinforcement motives. CITS did not differ from NITS in profile scatter or profile shape.

CONCLUSION

ITS differ from DS in the relative importance of motives, with ITS emphasizing motives associated with acute, situational smoking, and DS emphasizing dependence-related motives. Among ITS, history of daily smoking did not influence the profile of motives.

Are tobacco dependence and withdrawal related amongst heavy smokers? Relevance to conceptualizations of dependence

Measured tobacco dependence is typically only modestly related to tobacco withdrawal severity among regular smokers making a quit attempt. The weak association between dependence and withdrawal is notable because it conflicts with core theories of dependence and because both measures predict cessation outcomes, suggesting they both index a common dependence construct. This study used data from a smoking cessation comparative effectiveness trial (N = 1504) to characterize relations of tobacco dependence with craving and negative affect withdrawal symptoms using multiple dependence measures and analytic methods to detect both additive and interactive effects and to determine whether withdrawal meaningfully mediates the influence of dependence on smoking cessation. We conclude: (a) Although univariate analyses suggest dependence and withdrawal measures are only modestly interrelated, more powerful analytic techniques show they are, in fact, meaningfully related and their shared variance is associated with cessation likelihood; (b) there are clear differences between craving and negative affective withdrawal symptoms, with the former more related to smoking heaviness and the latter related to trait measures of negative affect; moreover, craving more strongly mediates dependence effects on cessation; and (c) both craving and negative affect withdrawal symptoms are strongly related to a pattern of regular smoking that is sensitive to the passage of time and powerfully affected by smoking cues. These findings support models that accord an important role for associative processes and withdrawal symptoms, especially craving, in drug dependence. The findings also support the use of withdrawal variables as criteria for the evaluation of dependence measures.

Relations of alcohol consumption with smoking cessation milestones and tobacco dependence

OBJECTIVE

Alcohol consumption is associated with smoking cessation failure in both community and clinical research. However, little is known about the relation between alcohol consumption and smoking cessation milestones (i.e., achieving initial abstinence, avoiding lapses and relapse). Our objective in this research was to examine the relations between pretreatment alcohol consumption patterns (non/infrequent drinker, moderate drinker, binge drinker) and smoking cessation milestones and tobacco dependence.

METHOD

Data were collected from 1,504 smokers (58.2% women; 83.9% White; mean age = 44.67 years, SD = 11.08) making an aided smoking cessation attempt as part of a clinical trial. Alcohol consumption pattern was determined with the Composite International Diagnostic Interview. Tobacco dependence was assessed with the Wisconsin Inventory of Smoking Dependence Motives (WISDM).

RESULTS

Alcohol consumption pattern was significantly associated with initial cessation and lapse, and these findings remained after controlling for the effects of treatment, race, gender, and cigarettes per day. Relative to moderate drinkers, both non/infrequent drinkers and binge drinkers were less likely to achieve initial cessation (p < .05), and binge drinkers were more likely to lapse (p < .01). When drinking categories were compared on tobacco dependence indices, results showed that relative to moderate drinkers, non/infrequent drinkers scored higher on several WISDM Primary Dependence Motives subscales (Tolerance, Loss of Control, and Automaticity) and binge drinkers scored higher on WISDM Secondary Dependence Motives subscales (Cue Exposure and Social-Environmental Goads).

CONCLUSIONS

Non/infrequent drinkers' smoking cessation difficulties may be particularly related to core features of tobacco dependence, whereas binge drinkers' difficulties may be related to environmental and social influences.

DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5

AIMS

This paper aims to identify appropriate criteria for tobacco dependence assessment, evaluate relevant research and suggest revisions that may be incorporated into DSM-5.

METHODS

Desirable conceptual and psychometric features of tobacco dependence assessments were identified, including the types of outcomes against which such assessment should be validated. DSM-IV criteria were matched against these criteria and compared with other dependence measures.

RESULTS

DSM-IV criteria were found to be ambiguous, little used in tobacco research, and have relatively low predictive validity. Other dependence measures were found to have greater validity in the prediction of important dependence features such as relapse likelihood. Strength of urges to smoke on typical smoking days and during abstinence, markers of nicotine intake or frequency of smoking and latency to smoke soon after waking were found to be useful dependence measures.

CONCLUSION

The use and utility of DSM-5 will be enhanced by eliminating most DSM-IV criteria and adding new ones based on smoking pattern, smoking heaviness, and the severity of craving during periods of smoking and withdrawal.

Neighborhood perceptions are associated with tobacco dependence among African American smokers

INTRODUCTION

The animal and human research literatures suggest that deprived environmental conditions may be associated with drug dependence, but the relation of neighborhood perceptions with a multidimensional measure of tobacco dependence has not been previously studied. The purpose of this study was to examine the associations between neighborhood perceptions (neighborhood problems and neighborhood vigilance) and tobacco dependence among smokers as measured by the Wisconsin Inventory of Smoking Dependence Motives-68 (WISDM).

METHODS

Participants were 384 African American smokers (49% men, 80% < $30,000 annual household income) enrolled in a randomized clinical trial of a smoking cessation intervention. A series of regression models were conducted to examine the associations between neighborhood perceptions and tobacco dependence using a generalized estimating equation approach, which accounted for potential correlation in tobacco dependence between participants from the same neighborhood.

RESULTS

Results indicated that more self-reported neighborhood problems and greater neighborhood vigilance were significantly associated with tobacco dependence as measured by the WISDM total score in analyses adjusted for age, gender, income, education, employment status, and partner status (p ≤ .002). Neighborhood perceptions were related to both primary and secondary dependence motives (p ≤ .005).

CONCLUSIONS

Results suggest that the neighborhood context is associated with dependence on tobacco among African American smokers but longitudinal studies are needed to assess causation. Future research should also explore the mechanisms that account for the associations between neighborhood perceptions and tobacco dependence to better inform intervention development.

The relationship of childhood trauma to nicotine dependence in pregnant smokers

Pregnant women with high levels of nicotine dependence are the least likely to quit smoking spontaneously during pregnancy or to benefit from smoking cessation interventions. In the general population, there is increasing evidence of a relationship between smoking, nicotine dependence, and exposure to childhood trauma. We examined the relationship of childhood trauma to several measures of nicotine dependence and evaluated whether this relationship was mediated by major depressive disorder or depressive symptom severity in pregnant smokers. Moderate to extreme levels of childhood trauma were significantly related to smoking within 5 minutes or less of waking, and to the Behavioral Choice-Melioration, Negative Reinforcement, and Tolerance subscales of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) scale. The relationships between childhood emotional abuse and the WISDM-68 Total and Negative Reinforcement subscale were partially mediated by depressive symptoms. Results suggest that childhood trauma may be a risk factor underlying nicotine dependence in pregnant smokers. Increased understanding of the relationship of affect regulation to smoking in individuals with childhood trauma histories may aid in the development of more effective treatments of nicotine dependence for this population of smokers.

Nicotine withdrawal-induced negative affect is a function of nicotine dependence and not liability to depression or anxiety

INTRODUCTION

Individuals who quit smoking frequently experience symptoms of anxiety and/or depression. It is not clear whether these symptoms index liability to negative affect generally or whether such symptoms are a function of nicotine withdrawal and are thus indexed by nicotine dependence (ND).

METHODS

A population-based sample of twins (N = 4,777 individuals) reported their lifetime history of psychopathology, ND, and symptoms of anxiety and depression experienced after attempts to quit smoking. Co-twin phenotype was used to predict withdrawal-induced symptoms of negative affect and to test whether genetic factors influence liability to these symptoms.

RESULTS

Co-twin's ND was significantly associated with nicotine withdrawal-induced symptoms of anxiety and depression. Furthermore, monozygotic co-twins more strongly predicted outcome than did dizygotic co-twins, indicating that genetic factors contribute to risk. Co-twins' history of psychopathology did not predict outcome, suggesting that liability to withdrawal-induced negative affect is independent of a liability to negative affect outside the context of nicotine withdrawal.

CONCLUSIONS

These findings indicate that symptoms of anxiety or depression experienced in the context of nicotine withdrawal are best conceptualized as a component of the withdrawal syndrome, with the severity of symptoms indexed by level of ND. Genetic influences underlying ND contribute to the liability to these symptoms. Though psychopathology might be indirectly related to withdrawal-induced symptoms through its correlation with ND, it is not directly predictive of withdrawal symptoms.

WISDM primary and secondary dependence motives: associations with self-monitored motives for smoking in two college samples

The Wisconsin Inventory of Smoking Dependence Motives (WISDM) assesses 13 domains of smoking motivation emphasized by diverse theoretical perspectives. Emerging findings support a distinction between four primary dependence motives (PDM) indexing core features of tobacco dependence and nine secondary dependence motives (SDM) indexing accessory features. The current study explored the validity of this distinction using data from two samples (Ns=50 and 88) of college smokers who self-monitored their reasons for smoking with electronic diaries. PDM scores were associated with diary endorsement of habitual or automatic motives for smoking individual cigarettes, which are conceptually consistent with the content of the PDM subscales. SDM did not clearly predict conceptually related self-monitored motives when tested alone. However, when these two correlated scale composites were co-entered, PDM predicted being a daily vs. nondaily smoker, being higher in nicotine dependence, and smoking individual cigarettes because of habit or automaticity. Conversely, after PDM-SDM co-entry, the unique variance in the SDM composite predicted the tendency to report smoking individual cigarettes for situational or instrumental motives (e.g., to control negative affect). The results suggest that the PDM composite may reflect core motivational features of nicotine dependence in these young smokers. The relative prominence of primary motives in advanced or dependent use may be even clearer when motives for smoking are assessed in real time rather than reported via questionnaire.

Psychometric properties and construct validity of the brief Wisconsin inventory of smoking dependence motives in an Internet-based sample of treatment-seeking Hungarian smokers

INTRODUCTION

Both full and brief versions of the Wisconsin Inventory of Smoking Dependence are promising new measurement tools for studying tobacco dependence. We assessed the psychometric properties and construct validity of the Wisconsin Inventory of Smoking Dependence Motives (WISDM)-68 and WISDM-37.

METHODS

Participants were adult, treatment-seeking Hungarian daily smokers (N = 720) with Internet access who were also registered on a smoking cessation Web site. Using confirmatory factor analyses (CFAs), we tested the measurement models of both WISDM-68 and WISDM-37, internal consistency of subscales of WISDM-37, and gender invariance. We tested the associations between heaviness of smoking, tobacco dependence symptoms, smoking environment, and subscales of WISDM-37.

RESULTS

Although the measurement model of WISDM-68 did not fit adequately, the measurement model of WISDM-37, including 11 correlating factors (affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, cue exposure/associative processes, social/environmental goads, taste, tolerance, weight control, affective enhancement), satisfactorily represents the data. Latent structures are equal in both genders. Internal consistency of subscales of WISDM-37 ranges between 0.67 and 0.90. Tobacco dependence symptoms were significantly linked with all motives, heaviness of smoking was related significantly only to affiliative attachment, automaticity, loss of control, cognitive enhancement, craving, and tolerance, while tobacco dependence symptoms and gender were controlled. Gender was associated only with the weight control motive.

CONCLUSIONS

Concurring with previous reports using other types of sample, WISDM-37 has sufficient psychometric properties and good construct validity to make it useful in measuring the multidimensional nature of tobacco dependence even in Internet-based research. Without precedent, gender equality of WISDM-37 is also supported.

Tobacco Dependence: Insights from Investigations of Self-Reported Smoking Motives

The Wisconsin Inventory of Smoking Dependence Motives (WISDM) assesses 13 theoretically-derived dimensions of smoking motivation. These 13 subscales were intended to index comprehensively the severity of tobacco dependence and provide insight into the disorder. Recent studies indicate that four subscales (Automaticity, Craving, Loss of Control, and Tolerance) represent the core features of tobacco dependence and have been dubbed the Primary Dependence Motives (PDM). The remaining nine subscales, the Secondary Dependence Motives (SDM), may be clinically relevant but index less essential features of dependence.