Daily hassle effects on daily cigarette and/or e-cigarette use: the moderating effect of daily uplifts

Abstract

Background

Daily hassles, as minor stressful events, are common in life. However, they have received less attention in previous studies on relationships between stressful events and nicotine product use. Meanwhile, daily uplifts have also been investigated less in research on nicotine use.

Purpose

The current study was conducted to explore the relationships between daily measures of hassles, uplifts, and the use of nicotine products (ie, cigarettes, e-cigarettes).

Methods

This was a daily diary study. Participants completed 1 diary each day for up to 7 days. One hundred and eighty-one adults who currently use cigarettes or e-cigarettes solely or co-use both completed a total of 886 daily diary entries. Multilevel modeling was used to predict the daily use of the above nicotine products from daily hassles, daily uplifts, and their interactions.

Results

Daily hassles were positively associated with any daily nicotine use. There were no significant associations between daily hassles and daily cigarette use or between daily hassles and daily e-cigarette use. Daily uplifts were not directly associated with any behaviors, but daily hassles and daily uplifts showed a significant interaction in affecting any daily nicotine use, daily cigarette use, and daily e-cigarette use. In each use pattern, increasing levels of uplifts were associated with an attenuation of the relationship between hassles and the use of nicotine products.

Conclusions

It may be worthwhile to explore further the effects of daily hassles and daily uplifts on nicotine product use through ecological momentary assessments.

Smoking/vaping was more likely on days with more compared to less hassles, although the presence of more daily uplifts removed this effect.

Introduction

Cigarettes and electronic cigarettes (e-cigarettes) are currently commonly used nicotine products that are harmful to health.¹ Cigarette smoking increases the risk of many diseases, including lung cancer, cardiovascular disease, and stroke.² Research has shown that smoking prevalence among young adults has risen since COVID-19.³ Additionally, e-cigarettes have become popular in recent years.⁴ They have been considered by many as a safe alternative to conventional cigarettes, but cumulative evidence has suggested that e-cigarette use also has adverse impacts on respiratory and cardiovascular health.^5–7 Given the health harms of cigarettes and e-cigarettes, a growing number of studies investigated factors that motivate the use of these 2 nicotine products in order to better develop interventions that reduce or eliminate use.^8–10 In existing studies, stressful events have been found to play an important role in stimulating nicotine use.^8,11

Common explanations for the relationships between stressful events and cigarette or e-cigarette use are the self-medication hypothesis and the stress-coping model, both of which suggest that the use of nicotine products is an effective strategy for coping with stressful events because it alleviates negative emotions resulting from stressful experiences.^12,13 Nicotine intake can increase dopamine levels, leading to rapid improvement in emotional states, although this strategy is maladaptive in the long term.¹⁴ In addition, it has been found that the hyperactivation of the hypothalamic-pituitary-adrenal axis in the face of stressors can increase individuals’ dependence on addictive substances as well as adversely influence future health.^15,16 Previous empirical studies have shown that individuals with more stressful experiences were more likely to initiate smoking or vaping and that those who already smoked or vaped increased smoking or vaping amount when encountering stressful events.^17–20 Notably, the large majority of these studies measured major life events. Fewer studies have examined the influences of minor stressful events in everyday life (ie, daily hassles) on cigarette use, and especially on e-cigarette use, as well as the daily variations in the use of each.

Hassles are “events, thoughts or situations which, when they occur produce negative feelings such as annoyance, irritation, worry or frustration, and/or make you aware that your goals and plans will be more difficult or impossible to achieve” [see²¹, p. S20]. Examples of daily hassles include inclement weather, being stuck in traffic jams, having an argument with others, facing a work deadline, financial concerns, and disciplining children.²² Daily hassles are quite common in life. Most stress actually stems from these small unpleasant events.²³ Compared to major life events, daily hassles have been found to be more strongly associated with physical and psychological health problems.^24,25 Previous research has shown that one of the pathways in which daily hassles influence health is that they can change individuals’ health behaviors.²⁶ There has been evidence suggesting that even in normal populations, the accumulation of minor stressful events can disrupt adjustment processes, resulting in a strong negative emotional state (stress response) that may further trigger risky health behaviors, such as nicotine use.^10,21,27 Furthermore, in addition to daily hassles, the use of nicotine products may also be influenced by daily uplifts, which are defined as “being the opposite to a daily hassle – a positive experience such as the joy derived from manifestations of love, relief at hearing good news, the pleasure of a good night’s rest and so on” [see²⁸, p. 3]. Daily uplifts, compared to daily stressful events, have been less researched, and limited available findings on their relationships with cigarette use have not been consistent. Twisk et al.²⁹ found that individuals with higher levels of daily uplifts were less likely to initiate smoking. However, in the study by Baker³⁰, daily uplifts were not related to smoking status (smoked or not) or smoking amount. Veilleux et al.³¹ demonstrated that positive experiences can elicit higher cravings for cigarettes in continuing smokers. To date, no studies have been conducted to explore relationships between daily uplifts and e-cigarette use.

Some researchers have proposed that daily hassles and daily uplifts should be considered simultaneously, given that negative events and positive events may have different effects and may interact to influence behaviors.^28,32–34 The buffering hypothesis has argued that positive events can provide a buffer against the effects of stressful events.^35,36 Experiencing positive events contributes to improved emotional states and resilience, which can mitigate stress and help individuals recover from it.^35,37,38 Supporting this view, Moss et al.³² found that daily uplifts significantly reduced relationships between daily hassles and unhealthy snacking. However, it has been unclear whether daily hassles and daily uplifts can interact to influence the use of nicotine products. Given daily hassles and daily uplifts occur frequently and may exert a larger impact on health behaviors and health,²⁴ the current study filled the above gap by adopting a daily diary design, which not only aimed to deepen the understanding of how daily events influence nicotine use but also addressed a methodological shortcoming of the existing research. Past studies mainly used cross-sectional or prospective methodologies with one-off measures to assess stressful or pleasant experiences (events). Such approaches failed to capture changes in within-person day-to-day experiences, which have been found important for understanding relationships between them and behaviors.^28,39–41 A daily diary design can achieve this by examining relationships between hassles, uplifts and use of cigarettes, e-cigarettes dynamically in a naturalistic setting, while also taking into account the influences of between-person differences on cigarette or e-cigarette use. To date, there has been no research using daily diary approaches to simultaneously measure daily hassles, daily uplifts, and daily nicotine use (ie, daily cigarette use, daily e-cigarette use).

To summarize, the aim of this daily diary study was to explore the individual effects of daily hassles and daily uplifts as well as their interaction effects on the daily use of nicotine products among adults who solely use cigarettes or solely use e-cigarettes or use both cigarettes and e-cigarettes at the moment. We focused on 3 different patterns of nicotine use, which were: any nicotine use, cigarette use, and e-cigarette use. In this study, any nicotine use referred to using cigarettes or e-cigarettes by participants; cigarette use referred to using cigarettes by participants who solely use cigarettes or use both cigarettes and e-cigarettes; e-cigarette use referred to using e-cigarettes by participants who solely use e-cigarettes or use both cigarettes and e-cigarettes. We predicted that daily hassles would be positively associated with each of the 3 patterns of nicotine use. In terms of the main effect of daily uplifts, this study adopted an exploratory approach to the assessment of relationships between daily uplifts and use of nicotine products given that there has been limited and inconsistent findings in this area. However, we did predict that daily uplifts would attenuate relationships between daily hassles and daily use of all nicotine products based on the research cited earlier.

Methods

Design and participants

This was a daily diary study using a convenience sampling method that recruited individuals who were 18 years old or older and currently use cigarettes or e-cigarettes solely or co-use cigarettes and e-cigarettes. Participants were recruited via posters and flyers distributed in public places and advertisements published on social media and University Participant Pool (a database of potential undergraduate student volunteers). Participants completed a baseline questionnaire first and then 1 online diary each day for 7 consecutive days, which asked them to record daily hassles, daily uplifts, as well as daily smoking, vaping behaviors. Ethical approval for this study was granted by the University Department Research Ethics Committee in the United Kingdom and all standard APA ethical procedures were followed. A total of 278 participants completed the baseline questionnaire. Of these, 181 participants started diaries (ie, submitted at least 1 diary), and therefore were eligible to be included in data analyses. A total of 886 daily diaries were analyzed: 80 participants completed 7 diaries, 18 completed 6 diaries, 14 completed 5 diaries, 11 completed 4 diaries, 9 completed 3 diaries, 14 completed 2 diaries, and 49 completed 1 diary. A total of 38 diary starters solely used cigarettes, 51 solely used e-cigarettes, and 92 used both cigarettes and e-cigarettes. Of the 130 diary starters who used cigarettes, 92% of them had low to moderate addiction levels for cigarettes (Mean_FTCD = 1.06, SD = 1.99, range: 0-9). Of the 143 diary starters who used e-cigarettes, 90% of them had low to moderate addiction levels for e-cigarettes (Mean_e-FTCD = 2.69, SD = 2.70, range: 0-10). The age of all diary starters ranged from 18 to 69 years old (Mean = 22.02, SD = 8.15). The majority of them were women (76.8%, N = 139), White (72.4%, N = 131), at the undergraduate level or had a bachelor’s degree (81.2%, N = 147), and were recruited from the university participant pool (78.5%, N = 142). Chi-square tests were conducted to examine whether there were differences in sociodemographic variables between participants who did and did not start diaries. Significant differences were found in age, χ² (df = 2) = 9.15, P = .01, and recruitment source, χ² (df = 1) = 12.89, P < .001. Participants who started the study but did not complete diaries were younger and were more likely to be recruited from the community. No significant differences were found in gender, ethnicity, education, patterns of nicotine product use, cigarette or e-cigarette addiction levels (Ps > .05). Participants recruited from the participant pool were granted credits for their participation. Other participants were entered into a prize draw with a chance to win £50 (approximately $60) voucher. The main study hypotheses and analysis plan were pre-registered at AsPredicted.

Measures

Baseline questionnaire

Demographic questions were included in the baseline questionnaire: age, gender, ethnicity, and education. Furthermore, questions related to smoking and vaping from the study by Conner et al. [⁴², p. 366] were used in the current study to assess whether participants currently use cigarettes (“Which ONE of the following is closest to describing your experience of cigarettes? I have never smoked; I have only tried smoking once; I used to smoke sometimes, but I never smoke cigarettes now; I sometimes smoke cigarettes now, but I don’t smoke as many as 1 a week; I usually smoke between 1 and 6 cigarettes a week; I usually smoke more than 6 cigarettes a week”), currently use e-cigarettes (“Which ONE of the following is closest to describing your experience of e-cigarettes or vaporizers? I have never used them; I have tried them once or twice; I use them sometimes (more than once a month but less than once a week); I use them often (more than once a week)”), family cigarette and e-cigarette use (“Who smokes/uses e-cigarettes in your family now? Tick all the people who smoke at the moment. None; Father; Mother; Brother; Sister; Grandfather; Grandmother; Others”), as well as friend cigarette and e-cigarette use (“How many of your friends smoke/use e-cigarettes? None of them; Only a few; Half and half; Most but not at all; All of them”).

Fagerström Test of Cigarette Dependence [FTCD^43] was used in the baseline questionnaire to assess participants’ cigarette addiction (dependence). It is a widely used scale that consists of 6 items: the number of cigarettes usually smoked per day, time for the first cigarette of the day, the difficulty of not smoking in no-smoking areas, the cigarette that they would most hate to give up, whether they smoke more frequently in the first hour after waking, and whether they smoke when ill in bed. The higher the score, the greater cigarette addiction was reflected (scores ranged from 0 to 10). The reliability and validity of FTCD have been demonstrated in previous research.⁴⁴ In the current study, the Cronbach’s alpha of FTCD was 0.80. E-cigarette addiction was evaluated by the E-cigarette Fagerström test of Cigarette Dependence [e-FTCD⁴⁵], which was adapted from the FTCD. E-FTCD is a reliable and valid scale used for assessing e-cigarette addiction and also consists of 6 items.⁴⁵ These items are similar to those in the FTCD. A higher score indicated a higher level of e-cigarette addiction. In the current study, the Cronbach’s alpha of e-FTCD was 0.69.

Daily questionnaire

In the daily questionnaires, participants were first asked “How many hassles did you have today?” and “How many uplifts did you have today?” (Definitions of daily hassles and uplifts outlined above in Introduction were provided in each daily questionnaire). Participants were also asked to describe each hassle and uplift, fill in when each event occurred and rate how intense each event was on a scale ranging from “not intense” (0) to “very intense” (4). The above open-ended measurement of daily hassles and uplifts references the measurement originally used by Conner et al.⁴⁶ The open-ended diary design can allow participants to freely report experiences on daily hassles and daily uplifts, which has the advantage of not restricting participants’ responses to a limited number of and fixed kinds of events. Good reliability and validity of this design have been shown in multiple studies [see^21,28,41,47]. Results for the number of daily hassles/uplifts and the intensity of daily hassles/uplifts were similar, therefore only the results for the number of daily hassles/uplifts were reported.

Additionally, participants were asked to report their cigarette and/or e-cigarette use each day, including the number of times they smoked and/or vaped, the specific time of each smoking and/or vaping, the brand of cigarettes and/or e-cigarettes and the amount of cigarettes and/or e-cigarettes they used each time. Their responses were categorized into 3 patterns of use: use of any nicotine products (ie, using cigarettes or e-cigarettes), use of cigarettes, or use of e-cigarettes in a day. Use behaviors of each pattern were predicted separately in relation to daily hassles and uplifts plus their interaction. As participants’ responses on the frequency and amount of daily any nicotine use, daily cigarette use, and daily e-cigarette use were skewed (skewness values ranged from 2.95 to 6.31), they were dichotomized as 0 (did not use any nicotine products/did not use cigarettes/did not use e-cigarettes in a day) or 1 (used any nicotine products/used cigarettes/used e-cigarettes in a day) for the main analyses.

Procedure

The whole study was conducted online via Qualtrics. Participants were asked to complete a baseline questionnaire first. They were required to sign a consent form at the beginning of the questionnaire indicating that they had understood the purpose and the procedure of this study and were volunteering to participate. At the end of the baseline questionnaire, participants were required to fill in an email address. One daily questionnaire was sent to participants via email every evening at 8 o’clock for 7 days starting on the following Monday after the completion of the baseline questionnaire. Participants needed to complete daily questionnaires before going to bed.

Statistical analysis

Analyses were conducted with Hierarchical Linear Modeling Version 7 software. Eight hundred and eighty-six diaries from 181 participants who completed at least 1 diary were included in analyses. Three sets of analyses using Bernoulli models were conducted for: any daily nicotine use (in all participants), daily cigarette use (in those who solely used cigarettes or co-used cigarettes and e-cigarettes), and daily e-cigarette use (in those who solely used e-cigarettes or co-used cigarettes and e-cigarettes). Daily hassles and daily uplifts were Level 1 (within-person) predictor variables in each of these analyses. According to previous studies on smoking and vaping behaviors,^42,48 age, gender, ethnicity, education, the number of families and friends smoking and/or vaping, cigarette and/or e-cigarette addiction were included as covariates at Level 2 (between-person variables). Each outcome variable was examined by entering all Level 2 variables plus either daily hassles (step 1a) or daily uplifts (step 1b). Both daily hassles and uplifts were entered at step 2, with the daily hassle × daily uplift interaction entered at step 3. Significant interactions (ie, daily hassles × daily uplifts with P-values less than .05) were decomposed using Preacher’s procedure (https://www.quantpsy.org/interact/hlm2.htm; case 1) to explore simple slopes for daily hassles at different levels of daily uplifts.

Results

Descriptive statistics

In this study, 181 participants used nicotine products (all diary starters); 130 participants used cigarettes (diary starters who solely used cigarettes or co-used cigarettes and e-cigarettes); 143 participants used e-cigarettes (diary starters who solely used e-cigarettes or co-used cigarettes and e-cigarettes). Across the 886 daily diaries included in the analysis, 58.4% of diaries (days, N = 517) reported using nicotine products; 30% (N = 266) reported using cigarettes; 43.6% (N = 386) reported using e-cigarettes; 62.4% (N = 553) reported the occurrence of hassles; 71.1% (N = 630) reported the occurrence of uplifts. Descriptive statistics for main variables were reported in Table 1.

Table 1.

| Descriptive statistics for main study variables (N = 181).

Variable	Mean	Standard deviation	Range
Hassles per day (pieces/day)	1.14	1.36	0-10
Uplifts per day (pieces/day)	1.19	1.22	0-10
Cigarettes used per day (cigarettes/day)	5.5	46.6	0-75
E-cigarettes used per day (puffs/day)	19.0	11.6	0-525

Main effects of daily hassles and daily uplifts

A significant positive association between daily hassles and any daily nicotine use was shown (ie, cigarette or e-cigarette use; Table 2, step 1a: OR = 1.14, P = .03). This relationship was slightly attenuated but still significant without controlling for covariates. Daily uplifts were not associated with any daily nicotine use (step 1b: OR = 1.11, P = .11). The effect sizes of daily uplifts were similar before and after controlling for covariates, and neither was significant. Participants who were older showed higher levels of e-cigarette addiction and had more friends vaping were more likely to use nicotine daily (ORs ranged from 1.08 to 1.58, Ps < .05). No main effects of daily hassles and uplifts were found on any daily nicotine use when entered simultaneously (step 2: ORs ranged from 1.07 to 1.11, Ps > .05).

Table 2.

| Predictors of any daily nicotine use (N = 181).

	Step 1a		Step 1b		Step 2		Step 3
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Age	1.08 (1.04, 1.12)	<.001	1.08 (1.04, 1.12)	<.001	1.07 (1.04, 1.10)	<.001	1.07 (1.04, 1.10)	<.001
Gender	1.21 (0.84, 1.73)	.31	1.25 (0.87, 1.80)	.23	1.25 (0.88, 1.76)	.21	1.21 (0.86, 1.69)	.28
Ethnicity	1.02 (0.78, 1.32)	.91	1.01 (0.78, 1.31)	.95	1.02 (0.80, 1.31)	.88	1.03 (0.80, 1.32)	.84
Education	1.04 (0.61, 1.76)	.89	1.04 (0.61, 1.79)	.88	1.04 (0.62, 1.74)	.89	1.02 (0.61, 1.69)	.95
Family Smoking	0.72 (0.52, 1.00)	.05	0.72 (0.53, 1.00)	.05	0.73 (0.54, 1.00)	.05	0.73 (0.54, 0.99)	.04
Family Vaping	1.58 (1.06, 2.35)	.03	1.58 (1.06, 2.34)	.03	1.53 (1.06, 2.21)	.02	1.51 (1.05, 2.19)	.03
Friend Smoking	0.91 (0.68, 1.21)	.51	0.94 (0.71, 1.25)	.67	0.94 (0.72, 1.24)	.65	0.90 (0.69, 1.18)	.46
Friend Vaping	1.24 (0.93, 1.66)	.14	1.23 (0.92, 1.64)	.16	1.21 (0.92, 1.60)	.17	1.23 (0.94, 1.62)	.13
Cigarette Addiction	0.92 (0.75, 1.13)	.44	0.92 (0.75, 1.13)	.41	0.94 (0.78, 1.14)	.53	0.96 (0.80, 1.15)	.66
E-cigarette Addiction	1.27 (1.14, 1.41)	<.001	1.28 (1.14, 1.42)	<.001	1.26 (1.15, 1.40)	<.001	1.25 (1.14, 1.37)	<.001
Hassles	1.14 (1.02, 1.29)	.03			1.11 (0.99, 1.25)	.07	1.20 (1.07, 1.34)	.002
Uplifts			1.11 (0.98, 1.26)	.11	1.07 (0.94, 1.23)	.30	1.14 (0.99, 1.30)	.06
Hassles × Uplifts							0.86 (0.80, 0.93)	<.001

Step 1a, −2LL = −1103.8; Step 1b, −2LL = −1104.0; Step 2, −2LL = −1097.1; Step 3, −2LL = −1093.3.

Table 3 shows the results related to daily cigarette use. When controlling for Level 2 covariates, there were no significant relationships between daily hassles and daily cigarette use (step 1a: OR = 1.16, P = .08) or between daily uplifts and daily cigarette use (step 1b: OR = 1.16, P = .12). Daily hassles or daily uplifts were similarly not associated with daily cigarette use without controlling for covariates. However, daily cigarette use was more likely to occur in participants who were older and had more friends smoking (ORs ranged from 1.07 to 1.45, Ps < .05). Daily hassles and daily uplifts did not simultaneously exert main effects on daily cigarette use at step 2 (ORs ranged from 1.11 to 1.13, Ps > .05).

Table 3.

| Predictors of daily cigarette use (N = 130).

	Step 1a		Step 1b		Step 2		Step 3
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Age	1.07 (1.04, 1.11)	<.001	1.07 (1.04, 1.11)	<.001	1.07 (1.04, 1.10)	<.001	1.07 (1.04, 1.09)	<.001
Gender	0.68 (0.41, 1.14)	.15	0.69 (0.41, 1.17)	.17	0.70 (0.42, 1.16)	.16	0.71 (0.43, 1.16)	.17
Ethnicity	1.10 (0.87, 1.38)	.42	1.10 (0.87, 1.38)	.42	1.09 (0.87, 1.37)	.44	1.10 (0.88, 1.38)	.41
Education	0.75 (0.44, 1.29)	.30	0.75 (0.43, 1.30)	.30	0.75 (0.45, 1.27)	.29	0.76 (0.46, 1.27)	.30
Family Smoking	0.77 (0.56, 1.07)	.12	0.78 (0.56, 1.08)	.13	0.79 (0.58, 1.08)	.13	0.81 (0.60, 1.09)	.16
Friend Smoking	1.41 (1.02, 1.94)	.04	1.45 (1.05, 2.00)	.02	1.40 (1.03, 1.91)	.03	1.38 (1.02, 1.86)	.04
Cigarette Addiction	1.10 (0.89, 1.36)	.36	1.10 (0.89, 1.36)	.38	1.11 (0.92, 1.34)	.29	1.11 (0.92, 1.33)	.26
Hassles	1.16 (0.98, 1.38)	.08			1.13 (0.96, 1.34)	.14	1.16 (1.00, 1.36)	.05
Uplifts			1.16 (0.96, 1.39)	.12	1.11 (0.92, 1.33)	.27	1.16 (0.95, 1.41)	.15
Hassles × Uplifts							0.90 (0.84, 0.97)	.006

Step 1a, −2LL = −778.4; Step 1b, −2LL = −777.8; Step 2, −2LL = −772.4; Step 3, −2LL = −769.0.

Similar results were found for daily e-cigarette use (see Table 4). Daily hassles (step 1a: OR = 1.04, P = .55) or daily uplifts (step 1b: OR = 1.01, P = .84) did not influence daily e-cigarette use after controlling for covariates. These results were substantively the same when covariates were not included. Woman participants and those with higher addiction levels of e-cigarettes were more likely to use e-cigarettes daily (ORs ranged from 1.26 to 1.66, Ps < .05). Daily hassles and daily uplifts did not have main effects on daily use of e-cigarettes simultaneously (step 2: ORs ranged from 1.00 to 1.05, Ps > .05).

Table 4.

| Predictors of daily e-cigarette use (N = 143).

	Step 1a		Step 1b		Step 2		Step 3
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Age	1.04 (0.99, 1.10)	.10	1.05 (0.99, 1.10)	.08	1.05 (0.99, 1.10)	.07	1.05 (0.99, 1.10)	.08
Gender	1.57 (1.02, 2.41)	.04	1.66 (1.08, 2.57)	.02	1.63 (1.08, 2.47)	.02	1.50 (1.00, 2.26)	.05
Ethnicity	1.05 (0.75, 1.47)	.77	1.04 (0.74, 1.45)	.83	1.04 (0.76, 1.44)	.81	1.08 (0.79, 1.47)	.62
Education	0.96 (0.48, 1.92)	.92	1.03 (0.52, 2.02)	.94	1.04 (0.54, 2.02)	.90	0.95 (0.49, 1.85)	.87
Family Vaping	1.33 (0.82, 2.17)	.25	1.38 (0.85, 2.23)	.19	1.38 (0.89, 2.13)	.15	1.36 (0.92, 2.01)	.12
Friend Vaping	1.29 (0.92, 1.81)	.14	1.28 (0.92, 1.80)	.15	1.27 (0.91, 1.77)	.15	1.26 (0.92, 1.74)	.15
E-cigarette Addiction	1.26 (1.13, 1.40)	<.001	1.26 (1.14, 1.41)	<.001	1.26 (1.14, 1.39)	<.001	1.26 (1.14, 1.38)	<.001
Hassles	1.04 (0.91, 1.21)	.55			1.05 (0.91, 1.21)	.53	1.15 (0.98, 1.34)	.08
Uplifts			1.01 (0.88, 1.17)	.84	1.00 (0.86, 1.16)	.99	1.02 (0.88, 1.18)	.82
Hassles × Uplifts							0.89 (0.82, 0.96)	.005

Step 1a, −2LL = −857.0; Step 1b, −2LL = −857.3; Step 2, −2LL = −853.9; Step 3, −2LL = −855.6.

Moderating effects of daily uplifts

Results of Step 3 in Tables 2–4 indicated that daily uplifts consistently significantly interacted with daily hassles influencing any daily nicotine use, daily cigarette use, and daily e-cigarette use. The effects of daily hassles on any daily nicotine use, daily cigarette use, and daily e-cigarette use were buffered by daily uplifts. Simple slope analyses showed that as daily uplifts increased from the low (low level = M − 1 SD; B = 0.35, SE = .08, P < .001) to the mean (B = 0.17, SE = 0.05, P = .002), to the high (high level = M + 1 SD; B = −0.01, SE = .06, P = .85) level, the effects of daily hassles on any nicotine use decreased, becoming nonsignificant at the high level of daily uplifts. Similar results were found for daily cigarette use. The relationship between daily hassles and daily cigarette use decreased in strength from low uplifts (B = 0.29, SE = 0.08, P = .001) to mean uplifts (B = 0.16, SE = 0.07, P = .04) and became nonsignificant at high uplifts (B = 0.03, SE = 0.09, P = .75). In terms of daily e-cigarette use, the effect of daily hassles on it was only significant at the low level of uplifts (B = 0.28, SE = 0.16, P = .02). Hassles did not significantly influence e-cigarette use at the mean (B = 0.13, SE = 0.08, P = .10) or high (B = -.02, SE = .06, p = .72) levels of uplifts.

In a sensitivity analysis, the above multilevel regressions were repeated for those who simultaneously used cigarettes and e-cigarettes (N = 92), solely used cigarettes (N = 38), or solely used e-cigarettes (N = 51), with an additional examination of the co-use for those who simultaneously used cigarettes and e-cigarettes. In participants who simultaneously used cigarettes and e-cigarettes, the effect sizes of daily hassle × daily uplift interactions on any nicotine use (ie, used cigarettes or e-cigarettes) and on the co-use of cigarettes and e-cigarettes were OR = 0.93, 95% CI = 0.85, 1.03, P = .146 and OR = 0.92, 95% CI = 0.82, 1.03, P = .144, respectively. In participants who used one type of nicotine products solely, the effect sizes of daily hassle × daily uplift interactions were OR = 0.80, 95% CI = 0.72, 0.89, P < .001 on solely using cigarettes and were OR = 0.77, 95%CI = 0.68, 0.87, P < .001 on solely using e-cigarettes.

Discussion

The current study was conducted to investigate how minor events in daily life influence nicotine use. To the researchers’ knowledge, this was the first study simultaneously exploring the individual effects of daily hassles, daily uplifts as well as their interactive effects on the daily use of nicotine products. We found that daily hassles exerted significant main effects on any daily nicotine use (ie, cigarette or e-cigarette use) and marginal main effects on daily cigarette use, but we did not find any main effects of daily hassles on daily e-cigarette use. Individuals were more likely to report any nicotine use on days with a higher number of daily hassles. This finding was similar to the results from previous daily diary studies, which showed that more daily hassles were related to greater smoking amount.^10,41 Our study indicated that even minor stressful events can also influence nicotine product use, adding new empirical evidence to theories that stressors trigger substance use, such as self-medication theory.¹²

In this study, daily uplifts did not exert main effects on any use behaviors, however, they interacted with daily hassles to influence daily use behaviors in each pattern. Uplifts attenuated the impacts of hassles; relationships between hassles and any nicotine use, cigarette use, and e-cigarette use became gradually weaker with increasing levels of uplifts. To date, there has been limited research examining relationships between daily uplifts and risky health behaviors, and there has been a lack of consensus on the role of daily uplifts. On the one hand, researchers have found that similar to negative events, positive events can also produce emotional states that increase the likelihood of substance use [see^49]. After pleasant or exciting events, individuals may act rashly under heightened emotional states, succumbing to urges and increasing risk-taking behaviors, for example, substance use.⁵⁰ On the other hand, it has been found that positive events result in beneficial changes that may directly decrease risky health behaviors or indirectly decrease behaviors by buffering the effects of stressful events.^35,51 According to Fredrickson’s⁵¹ broaden and build theory, the occurrence of positive emotions after positive events contributes to broadening novel thoughts and activities, building enduring personal resources, and increasing well-being, all of which have a direct link to good health and health-related outcomes. However, Cohen et al.³⁵ argued that positive events affect individuals in an indirect way. Their buffering hypothesis stated that experiencing positive events generates positive feelings and sustains coping efforts, which can protect individuals against the negative influences of stressful events.^35,36

This theoretical divergence is also reflected in empirical findings outlined in the Introduction section. Previous empirical studies showed that positive events or experiences can decrease the likelihood of smoking,²⁹ increase the urge to smoke,³¹ or have no effects on smoking amount.³⁰ The main effects of daily uplifts on behaviors were not found in the present study, but the moderating effects found supported the view by Cohen et al.³⁵ and were consistent with findings from Moss et al.³² that daily uplifts attenuated relationships between daily hassles and another risky health behavior (unhealthy snacking). The interactions of daily hassles and daily uplifts on any nicotine use (ie, cigarette or e-cigarette use) and on the co-use of cigarettes and e-cigarettes disappeared in participants who used both cigarettes and e-cigarettes. This might be due to the poorer psychological health of this group. There has been research showing that individuals who used both cigarettes and e-cigarettes had higher depression and psychological distress compared to individuals who used cigarettes solely or used e-cigarettes solely.^52,53 Therefore, the positive role of daily uplifts (minor pleasant events) might be less apparent in the group that used these 2 types of nicotine products simultaneously.

Overall, the investigation of daily hassles, daily uplifts, and their interactions was important for several reasons. First, it addressed the lack of understanding of whether daily minor events, including minor positive events, can influence nicotine product use. Previous studies mainly examined relationships between major stressful events in life and nicotine use. Second, the significant results found in this study were a reminder that although daily hassles and uplifts are minor events, they can influence engagement in a risky health behavior. And, these minor daily events are quite common, and thus we cannot ignore their existence and their impacts. Findings in this study also contributed to further thinking about interventions that can reduce nicotine use. A possible study for future interventions might be testing whether increasing daily pleasant or positive experiences would help reduce the nicotine product use stimulated by stressful events. There has been research demonstrating that gratitude interventions, such as gratitude lists, can enhance individuals’ life satisfaction and well-being.^54,55 However, it is unclear whether providing gratitude interventions among individuals who use cigarettes or e-cigarettes can help quit smoking or vaping. Additionally, as inconsistent results on the effect of daily uplifts were found in existing studies, it is necessary to replicate the effects of daily uplifts observed here.

This study had some strengths, for example, dynamic assessments of effects over 7 days in naturalistic settings, an open-ended measurement design that does not restrict participants’ responses, exploration of covariates and conducting analyses for multiple patterns of nicotine product use. There were also several weaknesses. First, this study lacked a measure of individual differences, for example, different coping styles. Certain individual traits can work together with individual experiences to influence outcomes.⁵⁶ For example, active coping styles (eg, problem-solving, securing social support) may reduce the impacts of stressful events and increase positive experiences, whereas passive coping styles (eg, rumination, avoidance) may maintain stressed feelings and weaken the impacts of positive events.⁵⁷ Therefore, future studies ought to consider adding a measurement of individual coping styles. Second, the majority of participants were current undergraduate students from the University Participant Pool. Recruiting more participants with diverse backgrounds from the community would improve the representativeness of results. Third, in order not to increase the burden on participants and so dropping out of the study, participants were only asked to complete 1 diary per day before bedtime. However, this might lead to recall bias on daily experiences or behaviors. Future studies can consider a design that combines ecological momentary assessments with open-ended diaries, which can improve the accuracy of participants’ responses and enable qualitative analyses of daily experiences. The specific analyses for the contextual information of nicotine use behaviors may help further understand whether different types of daily hassles or daily uplifts can influence daily nicotine product use differently, or the directional relationships between daily experiences and daily nicotine use.

Conclusion

In conclusion, this study suggested that individuals were more likely to use nicotine products (ie, used cigarettes or e-cigarettes) on days with greater daily hassles. Daily uplifts attenuated positive relationships between daily hassles and any daily nicotine use, daily cigarette use, daily e-cigarette use. Future research should attempt to replicate these findings given this was the first daily diary study investigating the individual and interactive effects of daily hassles and daily uplifts on daily nicotine product use.

Author contributions

Yitong Lin (Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing—original draft [lead]), Daryl O'Connor (Formal analysis, Investigation, Methodology, Supervision, Writing—review & editing [supporting]), and Mark Conner (Formal analysis, Investigation, Methodology [supporting], Supervision, Writing—review & editing [lead])

Funding

There was no funding for this study.

Conflicts of interest

There were no conflicts of interest.

Data availability

The data are available from the first author upon reasonable request.

Ethical approval

This study has been pre-registered on AsPredicted (#122145). Ethical approval for this study was granted by the School of Psychology Research Ethics Committee at University of Leeds (Ethics Reference Number: PSYC-865).

Transparency statements

Study registration: The study was pre-registered at Aspredicted (https://aspredicted.org/26X_NPH). Analytic plan pre-registration: The analysis plan was registered prior to beginning data collection at Aspredicted (https://aspredicted.org/26X_NPH). Data availability: De-identified data from this study are not available in a public archive. De-identified data from this study will be made available (as allowable according to institutional IRB standards) by emailing the corresponding author. Analytic code availability: There is not analytic code associated with this study. Materials availability: This study does not include any stimuli or intervention protocols. Survey instruments and items will be made available by emailing the corresponding author.