Effects of a body image challenge on smoking motivation among college females.

Tobacco smoking is the leading cause of preventable mortality and morbidity in women (Husten, 1998; United States Department of Health and Human Services [USDHHS], 2001). The decline in smoking prevalence over the past three decades has been slower among women than among men (Escobedo & Peddicord, 1996, 1997; National Center for Health Statistics, 1993; Ockene, 1993), with 19.2% of women smoking as of 2003 (Centers for Disease Control and Prevention [CDC], 2005). Females are not only initiating at higher rates than males, but they appear to have more difficulty in quitting and remaining abstinent (Bjornson et al., 1995; Blake et al., 1989; CDC, 1994; Cepeda-Benito, Reynoso, & Erath, 2004; Ockene, 1993; Ortner, Schindler, Kraigher, Mendelsohn, & Fischer, 2002; Swan, Ward, Carmelli, & Jack, 1993; Ward, Klesges, Zbikowski, Bliss, & Garvey, 1997; Wetter et al., 1999). Gender differences are also found among smokers’ outcome expectancies. Outcome expectancies are beliefs about the consequences of one’s actions, and are posited to play a motivational role in behavior (Bandura, 1977). Smoking outcome expectancies, specifically, are beliefs about the consequences or effects of smoking, and there is substantial correlational and experimental evidence that these expectancies influence smoking behavior (Brandon, Juliano, & Copeland, 1999). One key gender difference concerns expectancies regarding weight and body image. Women report weight control as a perceived benefit of smoking (Cepeda-Benito & Reig Ferrer, 2000; Ward et al., 1997). Women, more so than men, appear to tie their smoking behavior to reasons of weight control, weight loss, fear of weight gain, or actual, post-cessastion weight gain (Killen, 1998; Klesges & Klesges, 1988; Klesges et al., 1998; M. D. Levine, Perkins, & Marcus, 2001; Ogden, 1994; Perkins, Levine, Marcus, & Shiffman, 1997; Ward et al., 1997). Thoughts about weight, eating disorder symptoms, weight control attempts, body image disturbances, and general weight concerns are predictive of females – but not males – initiating smoking (French, Perry, Leon, & Fulkerson, 1994; Killen, 1998; Stice & Shaw, 2003). Younger women smokers are up to 4 times more likely than men to report weight gain as a cause of relapse (Swan et al., 1993). And in general, women hold higher outcome expectancies than men of cigarette’s utility for controlling appetite and weight (Brandon & Baker, 1991). Whereas these relationships appear across women of all ages, college students represent a particularly important subpopulation. First, individuals in the age group of 18–24 have not decreased their prevalence of smoking and continue to have among the highest smoking prevalence (CDC, 2002). In addition, the prevalence of current smoking increased among those aged 20–24 with 13 or more years of education. There is also evidence suggesting that university females report greater body dissatisfaction and beliefs of being overweight than they had as high school seniors (Vohs, Heatherton, & Herrin, 2001). Within the college student population, it is a high priority to achieve and maintain an ideal weight, and the use of dieting strategies of all types are extremely high in this group (Klesges & Klesges, 1988; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). In addition to these risk factors, college females are often transitioning from occasional to regular smoking (Lantz, 2003; Ling & Glantz, 2002); thus, understanding this specific population may lead to the development of secondary prevention interventions. Although the descriptive, correlational, and quasi-experimental findings reviewed above suggest a general relationship between smoking and weight concerns among women, direct evidence of a causal relationship between weight concerns or body image and smoking motivation is lacking. Moreover, it is not known whether phasic fluctuations in body image influence situational cravings for cigarettes, and if this relationship is moderated by a woman’s general body satisfaction. Such a relationship would be consistent with a causal influence of body image on smoking motivation.