The effect of body image threat on smoking motivation among college women: mediation by negative affect.

The prevalence of tobacco use in the United States has declined significantly over the past few decades to about 20 percent of adults, but smoking rates among females have declined less than among males (Husten, 1998; USDHHS, 2001). Although smoking is the leading cause of preventable death and disease in both men and women (USDHHS, 2004), smoking may confer greater risks on women than on men and also increases risk for diseases unique to females such as cervical cancer (USDHHS, 2001). In addition, women seem to be less aware of these risks than men, as seen in their less frequent reporting of health concerns when discussing their motivations to quit smoking (Curry, Grothaus, & McBride, 1997). These findings underscore the importance of understanding female smoking behavior. Research has suggested that men and women may differ in underlying motivations and outcome expectancies related to smoking initiation, maintenance, and cessation. In particular, women, more so than men, appear to associate their smoking behavior to reasons of weight control (Killen, 1998; Klesges et al., 1998; Ogden, 1994; Ward, Klesges, Zbikowski, Bliss, & Garvey, 1997), weight loss (Klesges & Klesges, 1988; Ogden, 1994; Perkins, Levine, Marcus, & Shiffman, 1997), and/or fear of or actual post-cessation weight gain (Klesges & Klesges, 1988; Levine, Perkins, & Marcus, 2001; Perkins et al., 1997). Furthermore, although nearly all females report having concerns about their appearance (Cash, Winstead, & Janda 1986), smoking women are more likely than nonsmoking women to have concerns about their weight (Feldman, Hodgson, & Corber, 1985), to use diet pills (Gritz & Crane, 1991), to view their body weight as important to their self-esteem (Bruckner, Spring, & Pingitore, 1994), to be dissatisfied with their weight (Bruckner et al., 1994), to be higher in dietary restraint (Bruckner et al., 1994; Meyers et al., 1997), to feel unattractive (King, Matacin, Marcus, Bock, & Tripolone, 2000), and to internalize the cultural standard of the thin ideal, which leads to body shame that plays a role in smoking behavior (Fiissel & Lafreniere, 2006). Although understanding the relationship between body image and smoking motivation among women of all ages is important in developing appropriate interventions, university students are of particular interest because college females are often transitioning from occasional to regular smoking (Lantz, 2003; Ling & Glantz, 2002), and almost half of female college smokers report smoking as a weight control strategy (Camp, Klesges, & Relyea, 1993; Klesges & Klesges, 1988). Additionally, among college women, elevated dieting concerns are a significant risk factor for smoking initiation (Saules et al., 2004), having ever smoked is associated with feeling pressured to maintain a healthy weight, and current smoking is related to weight loss intention (Carroll et al., 2006). Also, among women smokers, younger women have the least intention to quit (Perkins et al., 2001), and women are up to four times more likely than men to report weight gain as a cause of smoking relapse (Swan, Ward, Carmelli, & Jack, 1993). Therefore, understanding this specific population may lead to the development of secondary prevention interventions, ultimately decreasing smoking rates among all women. Despite the association between smoking and body image concerns among women, little research has focused on understanding the possible causal influence of body image on smoking motivation. To our knowledge, only one study has experimentally tested whether phasic fluctuations in body image influence situational cravings for cigarettes, and whether a woman’s general trait body satisfaction moderates this relationship (Lopez, Drobes, Thompson, & Brandon, 2008). In that study, college female smokers were presented with images of thin women, smoking cues (e.g., cigarettes, lighters), and neutral images (e.g., office supplies). The images were displayed in a series of pairs, such that some trials included both a thin woman and a smoking cue. Results indicated that the thin model images produced increases in state body dissatisfaction and greater urges to smoke than did the neutral images, independently of whether they were paired with smoking cue images. Additionally, in the absence of smoking cues, trait body dissatisfaction moderated the effect of the thin model images on smoking. That is, women with higher trait body dissatisfaction showed greater urge responses to the images of thin model. Regulation of negative affect appears to be a potent motivator of smoking behavior (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004). Moreover, past research has demonstrated that negative affect produces smoking urge in the laboratory (Brandon, Wetter, & Baker 1996; Payne, Schare, Levis, & Colletti,1991); women, more so than men, report that they smoke to manage their mood (Cepeda-Benito & Reig Ferrer, 2000; Ward et al., 1997); and threats to body image can increase negative affect (Pinhas, Toner, Ali, Garfinkel, & Stuckless, 1999; Stice & Shaw, 1994). Therefore, it seems reasonable to hypothesize that negative affect mediates the relationship between threats to a woman’s body image and her smoking behavior. Alternatively, it is possible that state body image influences smoking motivation without negative affect mediation by, for example, directly activating expectancies that smoking will control weight. However, consistent with the mediational hypothesis, Lopez et al. (2008) found that negative affect increased after viewing the thin model images. But negative affect was measured with a single-item visual analog scale (VAS), and the study design did not allow for formal testing of mediation effects. The current study addresses the limitations of Lopez et al. (2008). Rather than the within-subject design of that study, in which the body image manipulation involved brief presentations of photos of thin women, the current study uses another body image manipulation that is compatible with a between-subjects design. This design allows for more psychometrically sound measurement of both smoking urge and negative affect, and subsequent testing for mediation. The study was presented to participants under the guise of marketing research. Participants in the experimental group evaluated an item intended to increase body dissatisfaction—a bathing suit. Those in the control group evaluated a neutral product -- a purse. Previous research has found that trying on a bathing suit in front of a mirror elicits feelings of body shame in women of various ethnicities, including Caucasian, African American, Hispanic, and Asian American (Hebl, King, & Lin, 2004). The first goal of this study was to replicate the results of Lopez et al. (2008). It was hypothesized that a main effect would be found for the body image manipulation, such that participants who tried on the bathing suit would experience greater increases in body dissatisfaction and smoking urge than those who evaluated the purse. The second and primary goal of the current study was to test whether negative affect would mediate the effect of the body image manipulation on smoking urge. Specifically, it was hypothesized that trying on the bathing suit would induce negative affect and negative affect-related urge to smoke, and that participants who reported the greatest increases in negative affect after trying on the bathing suit would show the greatest increases in smoking urge.