CHAPTER V1

   EFFECTS OF NICOTINE
THAT MAY PROMOTE TOBACCO
           USE

377


CONTENTS

Tobacco Use, Nicotine, and Human Performance ....... .382
  Attention ....................................................... 382
     Sustained Attention ................................... 382
     Selective Attention .................................... 385
     Distraction ............................................... 385
  Learning and Memory ...................................... 386
    Learning ................................................. 386
     Immediate Memory ................................... 388
    Comparison of Immediate and Delayed
      Recall .................................................. 388
    State-Dependent Memory ............................ 389
  Problem Solving .............................................. 391
  Motor Control ................................................. 392
     Tremor ................................................... .392
    Simple Reaction Time ................................ 392
     Choice Reaction Time ................................ 392
  Implications for Tobacco Use ............................ .393

Tobacco Use, Nicotine, Stress, and Mood Regulation.. .394
Subjective Well-Being, Stress, and Mood
  Regulation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
  Perceived Functions of Smoking.. . . . . . . . . . . . . . . . . . . . . . . . 395
  Stress and Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
     Stress and Smoking Initiation.. . . . . . . . . . . . . . . . . . . . 399
    Stress and Cigarette Consumption . . . . . . . . . . . . . . .401
Do Smoking and Nicotine Reduce Stress and Im-
   prove Mood?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .405
    Self-Reported Stress Reduction and Affect
     Modulation.. . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . .405
    Behavioral Indices of Stress Reduction and
      Af feet Modulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
Suggested Mechanisms Underlying Nicotine's Ef -
    fects on Stress and Mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
    An Emphasis on Nicotine Withdrawal
     Symptoms.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408
     Neurochemical Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .408
    Biphasic Action on the Sympathetic Nervous
     System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .409

379


     Altered Body Activity ............................... .410
     Hedonic Systems Model ............................. 411
     Lateralized Affective Processors Model ......... 412
    Hypothalamic Consummatory Drive Model ... .412
    Indirect Models: Psychological Enhancement
       and Sensory Gratification ........................ 413
  Implications for Tobacco Use ............................. 413
Tobacco Use, Nicotine, and Body Weight ................. .414
The Relationship Between Smoking and Body
   Weight.. ...................................................... 414
    Cross-Sectional Evaluations of Smoking and
     Body Weight ......................................... 415
    Longitudinal Evaluations of Smoking and
     Body Weight ......................................... 431
     The Role of Nicotine.. ............................... 432
  Mechanisms Underlying the Relationship Between
   Smoking and Body Weight.. .......................... ,432
    Dietary Intake ......................................... .432
    Physical Activity ...................................... .434
     Metabolic Rate ......................................... 435
    Summary of Mechanisms Literature ............ 437
  Does the Relationship Between Smoking and
   Weight Promote Either the Initiation or Mainte-
     nance of Smoking Behavior?. ......................... .438
  Implications for Tobacco Use ............................. 440

Summary and Conclusions.. . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .441

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .442

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Despite the well-known health hazards associated with cigarette
smoking and tobacco use, more than 50 million Americans continue
to use these products. (See Chapter I for a brief review of health
hazards and Appendix A for prevalence of use data.) Chapter IV
presents evidence that tobacco use is an orderly form of drug-seeking
behavior that involves nicotine self-administration. It is clear from
Chapter IV that tobacco use involves several biobehavioral processes
of drug dependence, including nicotine reinforcement and withdraw-
al. The initiation and maintenance of this dependence process may
be promoted by other actions of nicotine. For example, some
cigarette smokers report that smoking helps them to think better, to
cope with stress, and to keep body weight under control. The fact
that people believe that tobacco use has these effects may contribute
to initiation, maintenance, and relapse.

This Chapter examines the evidence on the following three effects
of nicotine:

o enhancement of human performance
0 control of stress responses
o control of body weight.
These particular topics are presented because there is scientific

literature relevant to each topic and because nicotine has been
suggested to be central to each of these effects.

The three topics are discussed separately in this Chapter because
the substantive material and relevant data are distinctly different
for each topic. Also, the research on each topic is at a markedly
different evidentiary stage at this time. Whereas studies on nicotine
and performance are intriguing, there are some serious methodologi-
cal concerns that force caution in the interpretation of the available
experimental investigations. In contrast, the relationship between
stress and smoking (i.e., that stress increases smoking) is well
documented by self-report data, and several investigators have
offered detailed theoretical explanations and mechanisms to account
for this phenomenon. However, much of this speculation has
preceded experimental investigations. In still another stage of
investigation, extensive data have been gathered on the relationship
between cigarette smoking and body weight, and laboratory studies
have carefully assessed the role of nicotine. Explanations for the
relationship between nicotine and body weight are based on investi-
gations that were designed to test specific variables involved in this
relationship. All three topics are currently receiving research
attention and are considered to be important areas for more
extensive investigation. This Chapter is meant to complement the
information presented in Chapter IV to provide a more complete
understanding of tobacco use. Most of the studies discussed in this
chapter have examined effects of cigarette smoking. Some studies
present data on effects of nicotine alone. The similarity in findings of

381


these two types of studies supports the conclusion that nicotine is
responsible for the effects of cigarette smoking.

Tobacco Use, Nicotine, and Human Performance

Some cigarette smokers believe and report that smoking helps
them to think and to concentrate (Russell, Peto, Pate1 1974). These
possibilities have been studied in the laboratory using several
different tasks. Unfortunately, this research literature has method-
ological limitations. Most of the published studies compare smokers
smoking with smokers not smoking. Few studies have included
nonsmokers not smoking as a control group. When smokers smoking
perform better than smokers not smoking, it is impossible to know if
smoking actually improved performance, if abstinence from smoking
impaired performance, or both. In addition, most studies allowing
smoking and evaluating performance did not measure nicotine levels
in the subjects. Therefore, the role of nicotine generally is inferred
but not directly assessed. A few studies administered nicotine by oral
tablets to smokers and to nonsmokers. This Section examines the
effects of cigarette smoking and nicotine on attention, learning and
memory, problem solving, and the control of motor function.
Implications of these effects for tobacco use are discussed.

Attention

Effects of cigarette smoking on attention have been examined in
the laboratory using sustained attention tasks, selective attention
tests, and perceptual intrusion or distraction measures. The results
using each measure are reviewed separately.

Sustained Attention

Vigilance tasks are the fundamental paradigm in the laboratory
for defining sustained attention. Attention is directed to one or more
sources of input for long periods of time. The subject is required to
detect and respond to small, infrequent changes in the input.
Performance in vigilance situations is often assessed in terms of the
detection rate, i.e., the proportion of signals correctly detected, and
the false-alarm rate, i.e., the number of occasions on which a signal is
reported when one has not been presented. Measures of stimulus
sensitivity and response criterion can be derived from the detection
rate and the false alarm rate using the Theory of Signal Detectabil-
ity (Green and Swets 1966) in order to assess performance. During a
typical vigilance session, the detection rate decreases (the vigilance
decrement), but it is also important to know if there is a decrease in
false alarms, which would mean a criterion shift. If the rate at which
a subject detects the stimuli falls, but there are no changes in false
alarms, then there is a reduction in stimulus sensitivity.


In a study of smoking and visual vigilance, the Mackworth Clock
(Mackworth 1950) was used because it produces a reliable vigilance
decrement. Cigarette smokers who were allowed to smoke at 20-min
intervals throughout the 80-min vigilance task maintained their
stimulus sensitivity to experimental targets (Wesnes and Warburton
1978). In contrast, sensitivity was reported to drop for a group of
nonsmokers and for a group of smokers who were not allowed to
smoke. This finding suggests that smoking helped t.o maintain
vigilance, but it could be that abstinence from smoking contributed
to the performance decrement for smokers who were not allowed to
smoke.
Tong and coworkers (1977) studied the performance of nonsmok-
ers, smokers not smoking, and smokers smoking on a 60-min
auditory vigilance task. While nonsmokers and smokers not smoking
detected fewer signals as the test progressed, smokers smoking
increased their number of detections. Again, it seems that smoking
improved vigilance. However, this conclusion is tempered by the fact
that the nonsmokers generally performed better than did the
smokers on this task. Wesnes and Warburton (1978) reported that
smokers maintained their initial level of stimulus sensitivity to
auditory targets over an 80-min vigilance session when they smoked
cigarettes at 20-min intervals. When they performed the task while
smoking nicotine-free cigarettes, their sensitivity decreased over
time. A similar study with a higher target density found a similar
result: smoking was accompanied by maintained stimulus sensitivity
(Mangan 1982). Whether smoking increased vigilance or whether
abstinence decreased vigilance is not clear.
To determine whether nicotine was responsible for these effects of
cigarette smoking on attention, Wesnes, Warburton, and Matz (1983)
gave subjects nicotine tablets under the tongue and examined visual
vigilance. The tablets consisted of nicotine placed on an alkaline
matrix material to permit buccal absorption. Nicotine helped reduce
the vigilance decrement by maintaining stimulus sensitivity. The
nicotine tablets produced the same effects in nonsmokers, light
smokers, and heavy smokers (Wesnes, Warburton, Matz 1983).
Wesnes and Warburton (1978) found a similar effect of nicotine
tablets on smokers but found no effect on performance by nonsmok-
ers. Wesnes and Warburton (1984b) reported a small improvement in
performance by nonsmokers given 1.5-mg-nicotine tablets; l.O-mg-
and O.Bmg-nicotine tablets did not improve performance.
The effects of smoking on sustained reaction time performance,
which has a vigilance component, were studied by Frankenhaeuser
and others (1971). The experimental sessions lasted 80 min during
which subjects continually performed a simple visual reaction time
test. In the nonsmoking condition, the speed of reaction decreased
over time; in the smoking condition, there was little change over the


session. Subjects abstained from smoking the night before participat-
ing in this study. Therefore, the smokers in the nonsmoking
condition were deprived for many hours.

Wittenborn (1943) factor analyzed attention tests and found that
picking out various sequences of numbers or letters from an array
was most heavily loaded on what he called an "attention" or "mental
concentration" factor. Williams (1980) assessed the effects of smok-
ing by smokers on a test of this sort that involved crossing out each
letter "E" found in sheets of randomly ordered letters arranged in
lines of 30 letters. Smoking cigarettes produced significant improve-
ment in performance of the letter cancellation task compared to
sham smoking an unlit cigarette (Williams 1980). Because the
subjects had abstained from smoking overnight before the experi-
ment, it is not clear whether smoking improved performance or
whether deprivation caused a decrease in performance.

A computer version of the letter crossing test is the Bakan task
(Bakan 19591, in which a series of digits is presented at the rate of
l/set from which subjects are required to detect certain specified
three-digit sequences. Measures of both the speed and the accuracy
of detection rate are made! Performance on this rapid visual
information processing task after smoking was improved in both
speed and accuracy above baseline levels, whereas either not
smoking or smoking nicotine-free cigarettes resulted in a decline in
speed and accuracy below baseline levels (Wesnes and Warburton
1983). The improvement in both speed and accuracy indicates that
there is no speed and accuracy tradeoff. Higher-yield cigarettes
improved performance more than low-yield ones, suggesting that
nicotine is involved in these effects (Wesnes and Warburton 1984a).
This interpretation is supported by studies with cigarettes with
similar nicotine content but varying levels of tar and carbon
monoxide (CO); cigarettes with the same nicotine content have the
same effect on speed and accuracy (Warburton, in press). However,
these conclusions must remain tentative until nicotine levels in the
body are measured.

Analyses of performance during cigarette smoking indicate a 15-
percent increase in speed and accuracy (Wesnes 1987) and improve-
ment puff by puff (Warburton, in press). Rapid visual information
processing has been studied during cigarette smoking puff by puff.
Even with one puff, the probability of correct detections in the
smoking conditions was higher than in the nonsmoking condition,
and a single puff produced a change in reaction time (Warburton, in
press). These findings suggest that smoking improves performance.
However, these within-subject analyses need to be replicated and
compared to nonsmoker control groups.

384


Selective Attention

Selective-attention tasks involve either focused or divided atten-
tion. Focused-attention tasks require subjects to attend to one source
of information to the exclusion of others. Divided-attention tasks
require subjects to divide their monitoring between two or more
sources of information.

One study of selective attention (Tarriere and Hartemann 1964)
combined central guiding with peripheral visual monitoring. The
task lasted for 2.5 hr, and the measure of performance reported was
the percentage of the peripheral visual signals that were missed
during the session. Monitoring performance was maintained by
smoking, in contrast to the large increase in t,he percentage of signal
omissions when the subjects (all of whom were smokers) were not
smoking.

In a study of divided attention, a test was based on the rapid visual
information task (Warburton and Walters, in press; Wesnes and
Warburton 1984a). Subjects were presented with digits at a rate of
50/min in both the visual and auditory modalities, with a different
sequence for each modality. The detection of sequences in both parts
of the divided attention task improved significantly after the
smoking of one cigarette in comparison with not. smoking. Smoking a
cigarette also prevented the increase in reaction times that occurred
in the control condition (smokers not smoking).

These studies show that smokers who smoke before selective
attention tasks perform better than smokers who abstain from
smoking before these tasks. Both the sustained and selective
attention data indicate that smoking helps the smoker to perform.

Distraction

The Stroop test has been used in smoking research to examine
distraction effects. The Stroop test uses three sets of displays: a list of
color words printed in black, a set of color patches, and a list of color
words with the words printed in incongruent colors (e.g., the word
"Green" printed in blue). Subjects' word reading is faster than color
naming, while naming the incongruently printed color words takes
much longer than naming the patches. The time difference between
naming the colors in the two conditions is the Stroop effect. This
score indicates the subject's ability to focus attention on a relevant
stimulus dimension of print color and to ignore an irrelevant
semantic one.

The effects of nicotine on the Stroop performance of smokers and
nonsmokers have been studied (Wesnes and Warburton 1978;
Wesnes and Revel1 1984). Wesnes and Warburt,on (1978) reported
that nicotine reduced the size of the Stroop effect and that there
were no differences between smokers and nonsmokers in the amount

385


of improvement produced by nicotine. This finding supports the
argument that the effects of nicotine on attention are similar in
smokers and nonsmokers. However, only six smokers and six
nonsmokers participated in this study. Also, the performance by
nonsmokers was not improved by nicotine tablets in the Wesnes and
Bevel1 (1984) study. Therefore, conclusions must be tentative until
the findings of Wesnes and Warburton (1978) are replicated.

Evidence from the few distraction studies that have been reported
is consistent with the results for sustained and selective attention. It
may be that smoking and nicotine improve a general attentional
processing capacity including improved attention to relevant stimuli
(sustained and selective attention data) and ability to disregard
irrelevant stimuli (distraction data). However, until studies include
nonsmoker control groups and measure nicotine levels in the body,
the conclusion that smoking improves attention remains plausible
but equivocal. It is reasonable to conclude that the attention of
smokers is better after smoking than after deprivation from ciga-
rettes.

Learning and Memory

Numerous animal studies have demonstrated that nicotine im-
proves learning and memory when it is administered pretrial and
posttrial (Battig 1970; Bovet-Nitti 1965; Castellano 1976; Erickson
1971; Evangelista, Gattoni, Izquierdo 1970; Stripling and Alpern
1974; Szekely, Borsy, Kiraly 1974). The effects of smoking and
nicotine on human learning and memory are surprisingly complex
in comparison with the effects described in reports of animal studies.
Some studies of the effects of smoking on human learning and
memory have shown that smoking improves this aspect of mental
ability (Mangan 1983; Mangan and Golding 1978; Warburton et al.
1986). Studies of the effects of pure nicotine on human learning and
memory have shown that nicotine improves memory just as smoking
does (Warburton et al. 1986). However, Hull (1924) found evidence of
impairment in auditory memory and in the efficiency of rote
learning immediately after smoking, and later studies also have
found that smoking can interfere with learning and memory,
especially immediate memory (Gonzales and Harris 1980). The
effects of smoking and nicotine on learning, immediate memory,
delayed recall, and state-dependent memory are addressed separate-
IY.

Learning

There is no evidence for improved acquisition of information (i.e.,
general learning) after smoking. For example, Carter (1974) reported
a higher number of correct responses from 10 smoking subjects than

386


from 10 nonsmoking subjects on a letter-digit substitution task for
the second of 2 lo-trial blocks given in the first 2 sessions (7 days
apart). However, there was no difference between groups in savings
(number of trials) for serial learning of a letter-digit substitution
task.

Kleinman, Vaughn, and Christ (1973) had nonsmokers, 24-hr
deprived smokers, and nondeprived smokers do paired-associate
learning of a low- or high-meaningful list of nonsense syllables.
There was no difference in learning among the groups on both trial
and errors to a criterion. However, deprived smokers performed
better on the high-meaningful list and worse on the low-meaningful
list than did either of the other two groups.

The effects of nicotine on learning also have been investigated.
Andersson and Post (1974) compared the effects of nicotine cigarettes
with those of nicotine-free cigarettes in subjects learning a nonsense
syllable list. Significant increases in heart rate indicated that
nicotine was absorbed from the nicotine cigarettes. The first
cigarette was given after the first 10 trials of learning the list, and a
second cigarette, of the same kind, was given after 20 trials. The
learning curves were identical for the two conditions prior to
smoking. After nicotine, the number correct decreased and remained
below the scores in the nicotine-free condition, but the learning
curves were parallel. Thus, the rate of learning was not changed by
smoking. After the second nicotine cigarette, the number of correct
syllables increased significantly to the same level of acquisition
performance as in the nicotine-free cigarette condition. Relative to
the previous performance, nicotine had improved recall of the
syllables. The difficulty in interpreting the effects of nicotine in this
study is that learning and recall occurred over a 20-min period, while
plasma and brain levels of nicotine would be expected to fall well
below their peak levels. These data give no evidence of nicotine
impairing acquisition, because the learning curves are parallel after
the nicotine cigarette. However, it appeared that after the first
nicotine cigarette, the information stored in the non-nicotine state
was less available in the nicotine state, a phenomenon known as
state-dependent learning. (See "State-Dependent Memory" below for
a fuller discussion of this phenomenon.)

In another study, Andersson (1975) examined the effects of
smoking on verbal rote learning using a similar procedure. Ten
smokers were tested on two occasions during which they were
initially given 10 successive trials followed by an B-min break. In one
condition, the subjects smoked a 2.1-mg-nicotine-delivery cigarette
during this period, and in the other they simply rested. Then,
another 10 trials took place, after which a 45-min break was given,
followed by a final learning trial. As in the previous study, recall was
significantly lower immediately after smoking. This lowered recall

387


tended to recover on successive trials. After the 45-min break, the
recall in the two conditions was again identical.

Immediate Memory

In a study of immediate memory (Williams 19801, subjects were
tested within 15 min after smoking one cigarette. They were given
lists of numbers to memorize and then were immediately asked to
recall them in the correct sequence (constrained recall). No main
effects were significant. Controlling for presmoking performance,
the number of errors increased with strength of cigarettes smoked.

Houston, Schneider, and Jarvik (1978) had 23 heavy smokers,
deprived of cigarettes for 3 hr, read a list of words. The subjects were
matched on a free-recall test prior to smoking. Each member of one
group smoked a 1.5-mg-nicotine cigarette, and each member of the
other group smoked a non-nicotine cigarette. The subjects were given
three lists with free recall tests after each one. The immediate recall
scores showed that the nicotine group had significantly less recall
than the placebo group did. When testing was given once just after
the input, however, facilitation was seen (Warburton et al. 1986).
After smoking a 1.4-mg-nicotine cigarette, each of these subjects was
shown a list of nouns and immediately asked to write down as many
as possible. Measures of immediate recall were improved in smokers
after smoking compared with not smoking.

Comparison of Immediate and Delayed Recall

Gonzales and Harris (1980) assessed the effects of smoking or
abstinence on immediate and delayed memory of new and old
(previously presented) words, as well as category clustering. Smokers
smoking showed significantly poorer immediate and delayed recall
of old words and less clustering of words into categories on the
delayed recall test as compared with smokers who were not allowed
to smoke before the tasks.

Mangan (1983) examined the effects of smoking a low- (0.7 mg) and
a middle- (1.3 mg) nicotine-yield cigarette on paired-associate and
serial learning and retention. Conditions included high and low
intralist interference. Cigarettes improved retention in paired-a&o-
ciate learning, with task difficulty apparently having little rele-
vance. Smoking impeded learning under low-interference conditions,
but facilitated learning of high-interference sets.

Mangan and Golding (1983) studied the effects on memory of
smoking deprivation and of smoking a single cigarette immediately
after acquisition of a paired-associate learning task. Subjects were
retested for retention of the memorized material at intervals of 30
min, 1 day, 1 week, and 1 month. At 30-min retest, nonsmokers
showed superior recall compared with all smokers. After 1 month,

388


subjects who each smoked a low- and medium-nicotine cigarette were
better than those who smoked high-nicotine cigarettes. They also
achieved superior recall compared with nonsmokers.

Peeke and Peeke (1984) tested the effects of smoking one cigarette
on verbal memory and attention in four experiments. In one study,
subjects were allowed to smoke before the test ("pretrial smoking"),
after the test ("posttrial smoking") or not at all ("no smoking").
Recall of a 50-word list was tested immediately after intervals of 10
and 45 min. Pretrial smoking resulted in improved recall 10 and 45
min after learning, but not immediately. Posttrial smoking was
ineffectual. Tests at 1,5, and 30 min after presentation of a 20-word
list were compared with results from pretrial smoking. Improved
recall occurred for pretrial smoking. The high-nicotine cigarette
produced improved recall on both immediate- and delayed-recall
tests. The low-nicotine cigarette was less effective. Light and heavy
smokers did not differ in the effect of smoking on recall.

Andersson and Hockey (1977) presented words in different posi-
tions on a computer screen to smokers allowed to smoke or not
allowed to smoke. In one condition, subjects had to remember the
words in presentation order. In the second condition, subjects were
asked to remember words, word order, and location. There were no
differences between the smoking and no-smoking conditions in the
percentage of words that were recalled in the correct order or for the
percentage of words that were recalled correctly, regardless of word
order. However, recall of position on the screen was poorer for the
smoking group. When the subjects were asked to attend to all three
aspects of the material, the groups did not differ significantly in
their recall, although there was a trend for location to be recalled
better after nicotine use than after deprivation. This study suggests
that nicotine can enhance storage of information only if the subjects
perceive that the information is relevant.

State-Dependent Memory

In a state-dependent design, one group of subjects learns after a
dose of drug while a second group learns after a placebo or nothing.
For the recall test both groups are divided: half of each group is
tested with the agent presented during learning and half is switched
to the other condition. If the recall scores are better for those groups
that learned in the same chemical state, then state-dependent
learning is said to have occurred. Numerous animal studies have
provided evidence of state dependency with cholinergic drugs
(Warburton 1977). The possibility that nicotine produces state-depen-
dent learning in human subjects has been investigated in several
studies.

Kunsendorf and Wigner (1985) examined state-dependent recall on
text material. Subjects spent 15 min studying a 550-word article on

389


education and answered 6 factual questions based on the article after
a lo-min break. The treatment conditions were smoking versus no
smoking during the study period and during testing. When studying
and testing were conducted for the same subject state (either
smoking or no smoking), memory was better than when study and
testing were conducted for different states.
Other investigators also have found evidence for state-dependent
learning with smoking. Peters and McGee (1982) used the state-
dependent design t.o test smoking's effect on recall and recognition
memory. After smoking a 1.4-mg-nicotine cigarette, each subject was
shown a list of nouns and immediately asked to write down as many
as possible. There was no evidence of any difference in immediate
recall, a finding in agreement with Andersson and Hockey (1977)
and Houston, Schneider, and Jarvik (1978). However, on the
following day, there was a state-dependent effect on the recognition
test but no difference between the same-state groups.
In another recognition study (Warburton et al. 1986), smokers who
were deprived of cigarettes for more than 10 hr were each given a
1.6mg-nicotine cigarette or nothing immediately before serial pre-
sentation of a set of Chinese characters. Subjects were divided into
four equal groups: Those who did not smoke prior to learning or
recall; those who did not smoke prior to learning, but had a cigarette
prior to recall; those who had a cigarette prior to both learning and
recall; and those who had a cigarette prior to learning, but none
prior to recall. Subjects who smoked prior to learning had signifi-
cantly better recognition scores than the subjects who did not smoke
in the first part of the experiment. There was no effect of smoking on
recall performance. A significant interaction term indicated that
changing the chemical state interfered with recognition.
Warburton and colleagues (1980) used nicotine tablets in the state-
dependent design. After ingesting the tablet, each subject listened to
words and then performed successive subtractions for 1 min to
prevent rehearsal. Immediate free recall was improved. One hour
later, the subjects were given either nicotine or placebo tablets. They
were asked to recall as many of the words as they could in another
lo-min free recall test. Long-term recall was significantly better
when subjects had taken nicotine prior to learning, but was not when
taken prior to recall. A significant interaction term gave evidence for
a state-dependent effect of nicotine and showed that nicotine was
facilitating the input of information to storage, but had no direct
effect on storage or retrieval.
These findings suggest that there is a state-dependent effect of
smoking on cognitive performance. The seeming impairment of
immediate memory, however, complicates any simple generaliza-
tions about smoking and memory or nicotine and memory. As with
the attention literature, studies need to include nonsmokers as


controls to determine whether smoking or abstinence from smoking
affects learning or memory. In addition, task characteristics and
individual differences among subjects must be considered in future
investigations. Based on the available evidence, there are no clear
effects of smoking on learning or memory.

Problem Solving

Human problem-solving capabilities involve both attention and
memory. Attention is important because distraction from the task
will cause a deterioration in problem-solving performance. Memory
also plays a critical role in thought, both guiding the operations of
the thought processes and limiting their power. Problems can be
broadly categorized as well defined and ill defined. A well-defined
problem has a clearly stated goal with a clear method to ascertain if
the problem solving will lead to the correct solution. A well-defined
problem can be solved by convergent thinking that produces
logically correct answers. A simple example of a well-defined
problem is addition. Ill-defined problems are solved by divergent
thinking that leads to inventive solutions.

Hull (1924) found that smoking increased the rate of complex
mental addition, but had no measurable effect on the accuracy of
addition. Kucek (1975) found that the reduced efficiency of mental
addition that was produced by doing a tracking task was ameliorated
by smoking. The improvement was especially manifested in the most
neurotic subjects. One interpretation of this improvement is that the
attentional effects of nicotine enabled the filtering out of the
distracted thoughts that interfered with performance.

A task that has elements of both convergent and divergent
thinking is the Luchins Jar test (Luchins 1942), in which subjects are
asked to solve a number of "numerical problems" involving the
measurement of a quantity of water by means of a set of measuring
jars. For the first six trials, exactly the same solution can be used,
but after trial six, both the old formula and a new, easier formula are
appropriate. A measure of convergent thinking is performance on
the first six trials, while divergent thinking is assessed from the time
taken to discover the new, easier solution. Smokers who were
allowed to smoke performed better on the first half of the test in
which subjects used the same solution repeatedly (convergent
thinking), but were slower to change to a simpler solution when it
was available, divergent thinking (Warburton 1987). While it could
be argued that nicotine had impaired divergent thinking, it has been
argued that it is more efficient for a subject to use a known strategy,
no matter how clumsy it might be, than to attempt to invent, a new
one, i.e., to maintain attention (Norman 1980).

391


Motor Control

The effects of smoking on motor control were investigated in the
early laboratory study of Hull (1924). He found a marked increase in
hand tremor, a slight increase in resistance to muscular fatigue and
in speed of reading reaction time, and no measurable effect on the
rate of tapping or on the rate or accuracy of eye-hand reaction.
These reports have received support from more recent studies (Lyon
et al. 1975; Smith, Tong, Leigh 1977). West and Jarvis (1986)
reported that nasal administration of nicotine increases tapping rate
in nonsmokers.

Tremor

Lippold, Williams, and Wilson (1980) recorded finger tremor
during a control period, sham smoking, or cigarette smoking with a
strain gauge and an accelerometer. Smoking increased tremor
amplitude at least twofold.

Simple Reaction Time

Cotten, Thomas, and Stewart (1971) investigated the immediate
effects of smoking one cigarette on simple reaction time after each
subject smoked a cigarette with a 1.5-mg nicotine yield. The mean
reaction times immediately following and 5 min after smoking were
significantly slower than for all other test intervals. Reaction times
for the 40- and 55-min intervals were significantly faster than the
reaction time before smoking.

Morgan and Pickens (1982) examined whether reaction time
performance after smoking varied as a function of cigarette smoking.
Twelve regular smokers were tested on a reaction time task
immediately after smoking on three different. occasions. In each
session, they were allowed ad libitum smoking of their own cigarette,
or ad libitum smoking of a standard cigarette, or they had to smoke a
standard cigarette with a prescribed puff pattern. Reaction time
performance was significantly faster after smoking under the latter
two of the three conditions. Mean reaction times were significantly
shorter for the smokers smoking than for the smokers not smoking.

Choice Reaction Time

Myrsten and Andersson (1978) compared the effects of smoking for
both simple and complex reaction time tasks. In the simple reaction
time testing periods, smoking prevented the significant increase in
reaction time that occurred over time in the nonsmoking condition.
In the complex reaction time periods, smoking significantly reduced
reaction time, whereas reaction time increases were not significant
in the nonsmoking condition.

392


Decision time and motor time scores on a choice reaction time task
were measured after smoking (Lyon et al. 1975; Smith, Tong, Leigh
1977). Decision time scores were significantly decreased by smoking,
and the high-nicotine cigarette had the greatest effect. Motor time
scores were not improved, and hand steadiness was significantly
impaired by smoking.

Smokers, deprived smokers, and nonsmokers performed a compen-
satory tracking task while simultaneously performing a cross-adap-
tive loading task (Schori and Jones 1975). With the cross-adaptive
technique, the size of the subject's total work load (tracking and
loading tasks combined) was individually tailored to use each
subject's entire attentional capacity. No differences were detected as
a function of smoking either in tracking or in loading task
performance.

Smokers, deprived smokers, and nonsmokers performed a complex
motor task, consisting of five subtasks, for an extended period of time
at two levels of task complexity (Schori and Jones 1974). On only one
subtask, on one of the two performance measures obtained, were
differences as a function of smoking condition evident. Specifically,
response latencies for nonsmokers were shorter than those for
smokers and deprived smokers at the high level of task complexity,
but were longer at the lower level. Because the performance
differences were small, Schori and Jones (1974) concluded that for all
practical purposes, smoking had no effect on performance.

Implications for Tobacco Use

Some cigarette smokers report that smoking helps them to think
and perform. Laboratory studies of attention and state-dependent
learning are generally consistent with this perception, but studies of
memory and learning do not support this perception. Data on
problem solving are too limited to allow clear conclusions. The
improvement in attention, statedependent learning, and some
motor performance tasks are, in most cases, superior in smokers who
are allowed to smoke compared with a smoking abstinence condition.
Therefore, these effects may, in part, reflect reversal of the
deleterious effects of smoking abstinence. In contrast to this cautious
interpretation, however, it should be noted that the experiments
that administer nicotine and report similar improvements in non-
smokers and smokers are consistent with the interpretation that
smoking improves some cognitive performance. In light of these
data, smokers' self-reports and perceptions may be correct that
smoking helps them to attend, think, and perform. However, until
more careful investigations are reported, conclusions concerning the
effects of smoking and nicotine on human performance must remain
tentative. Future studies should include nonsmokers as controls and
should measure nicotine levels after smoking or abstinence.


Current methods in cognitive psychology indicate that different
paradigms for evaluating memory and performance (e.g., datadepen-
dent versus context-dependent memory measures) produce opposite
effects in many cognitive tasks (Richardson-Klavehn and Bjork
1988). The effects of smoking and nicotine on these different types of
tasks need to be evaluated. A recent presentation on smoking and
performance, for example, reported that smoking improved perfor-
mance on simple reaction tasks but impaired performance on more
complex comprehension and motor performance tasks (Spilich 1987).
Tasks requiring different levels of demand must be examined.
Moreover, future research should evaluate performance over time to
determine whether any short-term effects of smoking or nicotine on
performance persist or are reversed later on. Nonetheless, the fact
that smokers smoking generally perform better on some cognitive
tasks (especially attention tasks) than do smokers not smoking may
encourage smokers to continue smoking and may encourage relapse.

Tobacco Use, Nicotine, Stress, and Mood Regulation

Cigarette smokers commonly report that they smoke in response
to stressful situations and that smoking calms them. In addition,
many smokers report that smoking helps to regulate dysphoric mood
or affect. Reports of a relationship between stress and smoking
generally have been regarded as puzzling in light of the sympathomi-
metic effects (i.e., sympathetic nervous system (SNS) activating
actions) of nicotine, but the consistency of these claims has brought
research attention to these topics. The possibility that smoking may
help to regulate dysphoric moods that involve low arousal states is
easier to understand. This Section reviews the relevant research
literature and presents current thinking to help explain these
phenomena.

Subjective Well-Being, Stress, and Mood Regulation

The state of subjective well-being is construed as one in which
positive affect (pleasure, happiness) is high and negative affect
(frustration, anger, tension) is low (Watson and Tellegen 1985).
Departures from an optimal state may occur because of internally
generated affect (worry, anxiety) or through environmental events
that strain the coping ability of the individual (Dohrenwend and
Dohrenwend 1981). A state of subjective stress is postulated to be a
joint function of the current environmental demands and the
current coping abilities of the individual (Lazarus and Launier 1978;
Lazarus and Folkman 1984). When demands exceed coping ability, a
state of subjective st,ress may arise that manifests at the psychologi-
cal level as symptoms of psychological distress and at the physiologi-
cal level as changes in (SNS) arousal, changes in endocrine systems,

394


and decrements in specific task performance (Baum, Grunberg,
Singer 1982; Cohen, Kamarck, Mermelstein 1983). In natural
settings, stress may occur because of discrete events that cause a
transient peak in subjective distress or in conditions that persist over
considerable periods of time and thus present sources of chronic
strain to affected individuals (Pearlin and Schooler 1978; Pearlin et
al. 1981).

Overall mood states are related to independent contributions by
dimensions of positive affect and negative affect: well-being is
determined by low negative affect and by high positive affect (Diener
1984). Studies of mood states in natural settings over intermediate
time periods of 1 day to 1 week show that the dimensions of negative
and positive mood are independent, that is, they both occur on a
regular basis in daily life and both contribute to overall mood states
(Stone, Helder, Schneider 1987). Mood may be regulated both by
reduction of negative affect and by increase of positive affect
(Tomkins 1962, 1963; Wills and Shiffman 1985).

Subjective well-being could be improved through reducing the
perceived environmental demands, through physiologically influenc-
ing stress-related arousal states, through reducing perception of
unpleasant physical states, or through altering the balance of
positive/negative affect in daily life. These mechanisms are relevant
to understanding the relationship between stress and cigarette
smoking (Tomkins 1965).

Perceived Functions of Smoking

A number of epidemiological studies have examined the perceived
functions that smoking provides for users by employing large
samples that are usually representative of communities; in some
cases, representative national samples have been obtained. These
studies ask respondents about various functions that smoking is
perceived to provide for them, and the researchers aim to determine
basic functional dimensions through factor analysis or cluster
analysis of the motive reports. The questionnaire items used to elicit
smoking functions vary considerably, including items that elicit
agreement/disagreement with statements about smoking, items that
elicit the frequency or likelihood of smoking in defined situations, or
items that ask about a desire to smoke in certain settings. Although
the methodology and sampling procedures have varied considerably
across studies, there is consistency in the results. One higher order
domain of inter-correlated motive dimensions indicates that smoking
is perceived to provide negative affect reduction; another domain
indicates that smoking is perceived to provide positive affect
enhancement. Findings from the relevant studies, classified in terms
of these higher-order domains, are presented in Table 1. (Survey
studies also indicate that many smokers report that smoking keeps

395


weight down and that weight control is one of their major concerns
(Charlton 1984a,b; Feldman, Hodgson, Corber 1985; Page 1983).
However, for purposes of expositional clarity, this Section focuses on
affect regulation and stress. Smoking and body weight are discussed
in the next Section of this Chapter.)
A typical study of perceived functions was conducted in the United
States by Ikard, Green, and Horn (1969) with a representative
national sample of 2,094 adult respondents. In this study, subjects
were presented with a list of 23 statements about smoking, repre-
senting various combinations of situation and emotion and were
asked to indicate their agreement or disagreement about whether
the statement was true for them. Orthogonal factor analysis of the
items indicated that six basic motives were represented in the data.
A factor termed "Reduction of Negative Affect" was loaded by items
such as "When I feel upset about something, I light up a cigarette"
and "Few things help better than cigarettes when I'm feeling upset."
The domain of positive affect enhancement was represented by a
factor dimension termed "Pleasurable Relaxation," which included
items such as "Smoking cigarettes is pleasant and relaxing." This
factor was not correlated with any of the other five factors found in
the study, indicating that it is an independent functional dimension.
A factor concerning addictive smoking, which included items report-
ing a strong desire or craving for cigarettes, was substantially
correlated with the negative affect factor and for that reason is
included under the domain of negative affect reduction.
Other studies of smoking motives have replicated the two domains
of negative- and positive-affect regulation. Under the general domain
of negative affect reduction, McKennell (1970) surveyed a represen-
tative national sample of 1,140 adolescents and adults in Great
Britain and found that three factors termed "Nervous Irritation
Smoking," "Smoking Alone," and "Food Substitution" were strongly
intercorrelated, all representing an increased probability of smoking
during unpleasant states. Coan (1973) and Leventhal and Avis (19761,
in studies with college students, found almost identical factors
termed "Negative Affect Reduction" and "Anxiety Reduction,"
which in each case were substantially correlated with another factor
representing addictive smoking. Additionally, Coan (1973) found a
factor termed "Distraction," which included items suggesting that
smoking was sometimes used as a means of diverting attention from
disturbing stimuli. (This self-report is consistent with the discussion
of distraction studies presented in the first Section of this Chapter.)
Best and Hakstian (1978) surveyed a sample of 331 adult commuters
with an inventory about the relative strength of their urge to smoke
in each of 63 situations. Intercorrelated dimensions termed "Ner-
vous Tension," "Frustration," "Embarrassment," "Discomfort,"


TABLE l.-Summary of studies of perceived functions of smoking

Domain/Factors

Ikard et al.
(1969)

MeKennel
(1970)

Cam (1973)

Leventhal and
Avis (1976)

Best and
Hakstian (1978)

Saumann and
Chenoweth (1964)

Negative affect
reduction

Negative affect
  reduction
Addictive smoking

Nervous irritation

Food substitution
Smoking alone

Negative affect
reduction

Addiction

Distraction
Agitated state

Anxiety reduction

  Addiction

Nervous tension

Frustration
Discomfort
Anger/Impatience
Restlessness

n.a.'

Positive affect         Pleasurable
enhancement          relaxation

Relaxation

Social confidence
  smoking

Pleasurable
relaxation
Dependence on
mental state

Sensorimotor
pleasure

Pleasure/Taste

Relaxation

Pleasure

Other functions

Habitual smoking
Stimulation

Senaorimotor
manipulation

Activity
accompaniment

Social smoking

Habitual action
Stimulation

Concentration

  Habit

Stimulation

Fiddling

Social reward

Automatic smoking
Sensory stimulation

Concentration

Social smoking

Habit

Unpleasant habit

Inactivity/Boredom
Time structuring

Positive peer
relationships

     NOTE: Factors of comparable content are on the same line.
     ' ma. =fackm not available because relevant items not in study.
%
4


"Restlessness," and "Anger/Impatience" all indicated elevated rates
of smoking in different types of negative affect situations.
Under the domain of positive-affect enhancement, findings are less
consistent because studies typically included relatively few items on
pleasurable aspects of smoking. Despite this methodological limita-
tion, each of the studies contains one or two factors that represent a
function of smoking to produce positive affect. A factor termed
"Pleasurable Relaxation" found by Coan (1973) indicated smoking in
circumstances that were relaxed and comfortable, and comparable
factors termed "Pleasure" were found among adults (Leventhal and
Avis 1976) and adolescents (Baumann and Chenoweth 1984). In each
case, these dimensions were uncorrelated with negative affect
factors or with other dimensions found in the study. Factors that
were termed "Relaxation" by two investigators (Best and Hakstian
1978; McKennell 1970) represent smoking in conditions where one is
alone or wants to cheer up.
The studies have indicated some additional functional dimensions
not included within the two affective domains. Some dimensions
represent habitual or automatic smoking that occurs without
conscious attention. These self-reported dimensions are consistent
with the data presented in Chapter IV that address compulsive drug-
seeking properties of nicotine and tobacco use. Another common
dimension represents smoking to increase stimulation, typically in
conditions of inactivity or boredom; sometimes another dimension is
included, indicating that smokers report that smoking helps improve
concentration (Best and Hakstian 1978; Coan 1973; Leventhal and
Avis 1976). This latter perceived effect is discussed in detail in the
first Section of this Chapter. Dimensions representing smoking in
social situations indicate that smoking occurs primarily at parties or
social gatherings, and these factors typically are uncorrelated with
affective dimensions.
With regard to individual differences in motives for smoking,
there are some consistencies across studies. Amount of smoking
tends to be greater for persons scoring high on negative affect
reduction (Ikard, Green, Horn 1969; McKennell 19701, although
persons scoring high on habitual smoking may have a greater
frequency of smoking (Ikard, Green, Horn 1969; Leventhal and Avis
1976). Sex differences are sometimes found in functional dimensions,
with females scoring higher on negative-affect reduction (Frith 1971;
Ikard, Green, Horn 1969; Ikard and Tomkins 19731, whereas males
score higher on habitual, relaxation, or stimulation smoking (Frith
1971; Ikard, Green, Horn 1969; McKennell 1970). Findings on
external correlates of motive dimensions indicate that adolescents
who score high on the Pleasure dimension are more likely to initiate
or increase smoking over time (Baumann and Chenoweth 19&Q, and
adult smokers who score high on Negative Affect reduction are more


likely to relapse after smoking cessation treatment (Pomerleau,
Adkins, Perstchuk 1978).

McKennell (1970) found 65 to 75 percent of adults reporting that
they perceived smoking to reduce nervous irritation, and comparable
levels of endorsement were found for other dimensions of negative-
and positive-affect regulation factors. Some data indicate that
endorsement rates for habitual, stimulation, sensorimotor manipula-
tion, and social confidence smoking are low in absolute terms (Ikard,
Green, Horn 1969; McKennell 1970). A study of young children
(Eiser, Walsh, Eiser 1986) found that mood regulation effects of
smoking were clearly perceived by subjects in the 7- to 8- and lo- to
11-year-old age ranges; this suggests that perceived functions of
smoking may be learned partly by observation rather than through
direct experience.

The conclusion from this literature is that in the general popula-
tion, persons perceive that smoking has functions that are relevant
for mood regulation. Persons report that they smoke more in
situations involving negative mood, and they perceive that smoking
helps them to feel better in such situations. Additionally, smoking is
perceived to increase positive mood in some situations. These data do
not necessarily indicate that the various functions characterize
different types of smokers; rather, they suggest that most functions
are salient to an individual but are operative at different times or in
different situations. Similar to the discussion of smoking and
performance in the first Section of this Chapter, self-reports by
smokers that they smoke under stress may indicate direct effects of
smoking and nicotine or may reflect effects of smoking deprivation
that are relieved by smoking. Whichever interpretation is correct,
individuals certainly report that stress is associated with smoking.

Stress and Smoking

There is evidence that stress can increase the likelihood of
initiation of smoking if cigarettes are available. Further, consider-
able evidence exists to link negative-affect states to smoking
behavior. The database includes studies of stress as a risk factor for
smoking initiation during adolescence and studies on stress and
rates of smoking among adults.

Stress and Smoking Initiation

Several studies have shown stress to be related to the onset of
smoking in early adolescence. Studies of smoking initiation typically
survey a large sample of adolescents beginning at approximately 12
years of age, because the onset of cigarette smoking is greatest
during the junior high school period (Fishburne, Abelson, Cisin 1980;
Green 1979). Measures of psychosocial risk factors are obtained from


questionnaire scales, and indices of smoking status are usually
obtained from self-report by respondents, sometimes accompanied by
a biochemical index of smoking. There is evidence indicating that
self-reports of smoking by adolescents are generally accurate,
although the accuracy of self-report data may be increased by
administration of biochemical measures (Murray et al. 1987).
Convergent results from cross-sectional and prospective studies show
that stress is antecedent to substance use onset and is not a
consequence of the initiation of smoking (Gorsuch and Butler 1976;
Kandel 1978; Kandel, Kessler, Margulies 1978; Kaplan et al. 1986).

The most direct evidence linking smoking to negative mood states
is based on measures of subjective stress. A cross-sectional study by
Mitic, McGuire, and Neumann (1985) surveyed a random sample of
1,684 school students in grades 7 through 12 in a medium-sized
Canadian community and obtained measures indexing whether
students felt nervous, anxious, or worried as a result of 12 potential
problem areas. Analyses for the total sample indicated that regular
and heavy smokers scored higher on perceived stress, compared with
nonsmokers. A related study by Hirschman, Leventhal, and Glynn
(1984) employed as the criterion variable a retrospective report of
smoking experiences during the previous 2 years. Data were
obtained from a stratified sample of 386 students in grades 2 through
10 in a midwestern community. Analyses of data on smoking
transitions indicated that a measure of affective distress was related
to rapid transitions from experimental to regular smoking. These
results were obtained in multivariate analyses with control for other
variables including age, peer and parental smoking, and risk-taking
tendency.

Comparable findings occurred in a prospective study by Wills
(1985, 1986) of a population sample of 675 students in the 7th grade
in a New York City school district. Analyses for a 1Citem scale of
subjective stress reactions showed that high stress was related to
increased levels of smoking over a 2-year period. Additional data
from this cohort and a replication cohort of 901 students were
obtained with measures of everyday negative events and major life
events. Multivariate analyses of these data indicated that all three
measures of stress were related to smoking, with major negative
events being the statistically strongest predictor. These analyses
indicated that the effect of stress on smoking was not attributable to
other variables including sex, race, locus of control, self-esteem,
social activity, and assertiveness. These findings are consistent with
laboratory data indicating that females under stress are more
willing to try additional cigarettes after an initial smoking experi-
ence (Silverstein et al. 1982).

It should be noted that adoption of cigarette smoking has been
shown to be a risk factor for subsequent adoptions of other types of

400