Mood Variability and Cigarette Smoking Escalation among Adolescents

Although a considerable proportion of youth experiment with smoking, with 26% of 8thgraders and 50% of 12th graders reporting having ever smoked cigarettes (Johnston, O’Malley, Bachman, & Schulenberg, 2006), fewer adolescents progress to heavier levels of smoking; 14% of 12th graders report smoking on a daily basis (Johnston et al., 2006). Understanding the factors that differentiate adolescents who progress beyond experimentation with smoking versus those who engage in experimentation but never escalate to heavier levels of cigarette use can greatly inform prevention and intervention efforts. To this end, the current study utilized ecological momentary assessment methods (EMA; Stone & Shiffman, 1994) to examine adolescent mood variability as a predictor of longitudinal smoking patterns. Researchers have increasingly focused on the role of self-regulation of emotions as a risk factor for smoking initiation and escalation among youth. Emotional self-regulation refers to the involuntary as well as effortful processes involved in initiating and maintaining affective responses, as well as attempts to modify the intensity and quality of such responses (Forbes & Dahl, 2005; Thompson, 1994). Adolescence is a period of refinement of affect regulation systems (Kovacs et al., 2006; Spear, 2000) and maladaptive affect regulation during this period may confer risk for substance use. As posited by the self-medication model, individuals with self-regulation vulnerabilities, including dysfunctional affect regulation processes and emotional lability, engage in substance use as a means of regulating and alleviating emotional distress (Khantzian, 1997). Further, the mood-regulatory effects of smoking and nicotine (Brody, 2006; Delfino, Jamner, & Whalen, 2001; Mermelstein, Hedeker, Flay, & Shiffman, 2007) may reinforce the use of cigarettes to cope with affective distress. Consistent with the self-medication model, the current study investigated the role of affect dysregulation - operationalized as the level of within-individual fluctuation in negative moods (i.e., negative mood variability) - as a risk factor for smoking escalation. Mood variability reflects the intensity and frequency of intraindividual fluctuations in momentary affective states (Eid & Diener, 1999). Affect regulation and mood variability have been conceptualized as intertwined processes, such that maladaptive regulation of affect manifests in more variable negative emotional states (Forbes & Dahl, 2005; Hoeksma, Oosterlaan, & Schipper, 2004). That is, an individual with limited affect regulation is expected to experience varying intensities of negative emotions, with greater peak intensities, yielding a variable affective profile over a period of time; in contrast, an emotionally regulated individual would exhibit a more stable affective profile. We thus conceptualize high levels of negative mood variability as a byproduct of affect dysregulation. Evidence suggests an association between affect dysregulation and substance use in adolescence, although conceptualizations of affect regulation vary across studies. Wills and colleagues (Wills, Walker, Mendoza, & Ainette, 2006) found that poor emotional control (as indexed by global self-report questionnaire measures of affective lability, rumination, and emotional reactivity) was positively related to the frequency of marijuana, alcohol and cigarette use in adolescence, although effects were mediated by proximal influences such as exposure to negative events and motives for substance use. In addition, deficient emotional regulation (indexed via global self-report questionnaires assessing the ability to control extreme affect and to regulate negative moods) predicted adolescent experimentation with cigarettes as well as progression to regular use (Novak & Clayton, 2001). Moreover, a series of studies by Simons and colleagues demonstrated significant relationships between affect lability (assessed by subjective global questionnaire on the frequency and extremity of mood shifts) and alcohol- and marijuana-use problems among college students (Simons & Carey, 2002; Simons, Carey, & Gaher, 2004). Taken together, theory and research suggest that labile youth who lack internal regulation resources may use substances as a means of mood regulation. However, additional research is needed to better understand the role of affect dysregulation in predicting smoking behavior. First, previous studies examining affect dysregulation as a predictor of smoking have been cross-sectional (e.g., Novak & Clayton, 2001; Wills et al., 2006). Longitudinal research is needed to examine prospective relations between mood variability and smoking patterns, as well as to investigate dynamic, reciprocal relationships between mood variability and smoking over time. In line with the self-medication model of substance use, we expect that if mood variability improves or stabilizes with increased smoking, such mood improvement may reinforce cigarette use and influence continued use beyond experimentation. An additional gap in the literature concerns the assessment of mood variability. Each of the previous studies examining affect dysregulation-smoking relations utilized global retrospective self-report questionnaires. Such reports required the adolescent to rate their global experience of emotional lability (e.g., “one minute I can be OK and the next minute I feel tense and nervous”; Wills et al., 2006) or their overall ability to regulate negative emotions (e.g., Novak & Clayton, 2001). Retrospective reports of mood and coping abilities may be subject to recall difficulties and judgment biases (Stone et al., 1998; Stone & Shiffman, 1994), and may not reflect actual fluctuations in moods. Real-time data capture procedures, such as Ecological Momentary Assessments (EMA; Stone & Shiffman, 1994), sample mood in the moment and therefore minimize retrospective bias or summary judgments of affective experience. Moreover, the random and frequent assessment of mood via EMA allows for the examination of intraindividual fluctuations across individual mood reports, yielding a finer grained and more objective index of actual variability in moods. Ecological momentary assessments have been used effectively in prior studies to study adolescent (e.g., Larson, Csikszentmihalyi, & Graef, 1980; Larson, Rafaelli, Richards, Ham, & Jewell, 1990; Silk, Steinberg, & Morris, 2003), as well as adult (Penner, Shiffman, Paty, & Fritzche, 1994; Ilies & Judge, 2002) mood variability. The goal of the current study was to explore how mood variability relates to longitudinal smoking patterns in adolescence. Mood variability is defined as the intraindividual standard deviations of mood assessments across EMA observations. Standard deviations have been used to measure mood variability in the majority of experience sampling/ecological momentary assessment studies (e.g., Eid & Diener, 1999; Hoeksma et al., 2004; Larson et al., 1980, 1990; Penner, Shiffman, Paty, & Fritzsche, 1994; Silk et al., 2003). This index of mood variability quantifies the tendency to experience a range of intraindividual fluctuation in negative mood levels within a typical week, such that larger values reflect the experience of frequently varying and intense levels of negative affect. A wider range of fluctuation in negative affect is conceptualized as the result of dysfunctional emotion regulation abilities. We examined the broad continuum of smoking patterns - including adolescents who never smoked, those who experimented, and those who progressed to more frequent smoking - to better understand the factors influencing escalation in cigarette use. Specifically, we addressed the following questions: (1) Do high levels of intraindividual variability in negative moods predict smoking escalation? and (2) Do levels of negative mood variability change as smoking patterns escalate over time? We hypothesized that baseline levels of negative mood variability would predict future smoking patterns, specifically escalation, and would differentiate youth who progressed to heavier levels of smoking from those who never progressed beyond experimentation. Second, as predicted by the self-medication model of cigarette use (Khantzian, 1997), we expected that increased cigarette use over time would be associated with stabilization of affect regulation (i.e., reduced negative mood variability).