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. Author manuscript; available in PMC: 2026 Jan 20.
Published in final edited form as: Psychol Addict Behav. 2019 Jun 27;33(6):574–579. doi: 10.1037/adb0000481

Emotion dysregulation and smoking outcome expectancies among Spanish-speaking Latinx adult cigarette smokers in the United States

Michael J Zvolensky a,b,c, Justin M Shepherd a, Jafar Bakhshaie a, Lorra Garey a, Andres G Viana a, Natalia Peraza a
PMCID: PMC12813732  NIHMSID: NIHMS2132954  PMID: 31246070

Abstract

Although smoking expectancies are associated with numerous aspects of smoking among non-Latinx Whites, far less is known about how individual differences in emotion dysregulation relate to smoking expectancies among Latinx smokers. The present investigation therefore evaluated the role of emotion dysregulation in smoking outcome expectancies among Latinx adult smokers. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, Mage = 33.3 years, SD = 9.81). Emotion dysregulation was significantly related to both negative reinforcement and negative personal consequences for smoking. These effects were moderate in magnitude and evident after adjusting for the variance associated with a wide range of factors. Unexpectedly, emotion dysregulation was also related to expectancies of appetite control and positive reinforcement. This study provides the first empirical evidence that emotion dysregulation is associated a broad-range of smoking outcome expectancies among Latinx smokers. Emotion dysregulation may be an important, yet underrecognized, smoking cessation treatment target for Latinx smokers.

Keywords: Emotion Dysregulation, Smoking, Latinx, Smoking Expectancies, Tobacco

Latinx cigarette smokers in the United States (U.S.) evince tobacco-related health inequities (American Cancer Society, 2018). Cigarette smoking remains relatively common among the Latinx population, especially among specific subgroups, including Latinx from Puerto Rico (Haynes, Harvey, Montes, Nickens, & Cohen, 1990; Martell, 2016; Navarro, 1996; Sauer, Siegel, Jemal, & Fedewa, 2017). Latinx cigarette smokers are less likely than non-Latinx Whites to seek or receive evidenced-based smoking cessation treatment (Levinson, Pérez-Stable, Espinoza, Flores, & Byers, 2004) and struggle with personal and life stressors that interfere with smoking cessation efforts (Morales, Lara, Kington, Valdez, & Escarce, 2002; Vega & Sribney, 2008; Zvolensky et al., 2019). Consequently, Latinx cigarette smokers are at risk for tobacco-related disease and mortality (American Cancer Society, 2018).

Research on cognitive-based smoking processes has indicated that the expected consequences of smoking are consistently related to several aspects of smoking among non-Latinx Whites, including relapse and tobacco withdrawal (Brandon, Juliano, & Copeland, 1999). Smoking outcome expectancies include both positive and negative reinforcement expectancies as well as beliefs related to the negative consequences and appetite-weight control effects of smoking (Brandon & Baker, 1991). Research focused on Latinx smokers has found that such persons endorse expectations that smoking will be personally dangerous (Marin, Marin, Perez-Stable, Otero-Sabogal, & Sabogal, 1990; Marin, Marin, Perez-Stable, Sabogal, & Otero-Sabogal, 1990). Additionally, expectancies for the positive effect of smoking (i.e., expectation that smoking can improve positive mood [positive reinforcement] or down regulate negative mood [negative reinforcement]) are related to smoking withdrawal and relapse in this population (Cepeda-Benito & Reig Ferrer, 2000; Reig-Ferrer & Cepeda-Benito, 2007; Vidrine et al., 2009). These findings have also been replicated among smokers from Spain (Cepeda-Benito & Reig Ferrer, 2000; Reig-Ferrer & Cepeda-Benito, 2007).

Yet, work is needed to identify individual difference factors that are related to specific smoking outcome expectancies among Latinx smokers. Such research can contribute to the field by uncovering malleable targets for personalized intervention among Latinx smokers plagued by tobacco-related health disparities. Emotion dysregulation is one promising and theoretically-relevant construct in this context. Emotion dysregulation reflects difficulties in the self-regulation of emotional states and difficulties in self-control over emotion-driven behaviors (Aldao, Nolen-Hoeksema, & Schweizer, 2010). Research among non-Latinx White smoking samples have found that emotion dysregulation is related to coping-oriented smoking (Rogers et al., 2018b), biased attention for salient smoking stimuli (Fucito, Juliano, & Toll, 2010), urge to smoke (Szasz, Szentagotai, & Hofmann, 2012), more severe nicotine withdrawal (Rogers et al., 2018a), less success in quitting (Farris, Zvolensky, & Schmidt, 2016), and negative reinforcement expectancies (Rogers et al., 2018b). Yet, research on emotion dysregulation among Latinx smokers is nonexistent.

Latinx smokers with higher (vs. lower) emotion dysregulation may experience a greater degree of negative affect reduction from smoking (e.g., via attention reallocation, nicotine-based pharmacological effects) or be more attentive to affect-related change associated with smoking. Emotion dysregulation theoretically could alter the experience of affect-related distress among Latinx smokers. Further, Latinx smokers with higher (vs. lower) emotion dysregulation may be particularly likely to expect smoking-related symptoms to lead to negative consequences (e.g., personal health risks) because they may catastrophize physical symptoms they experience in response to smoking or have difficulty regulating emotion related to their interpretation (Chong, Reinschmidt, & Moreno, 2010; Pina & Silverman, 2004). Thus, the present study sought to evaluate emotion dysregulation in terms of smoking outcome expectancies among Latinx adult cigarette smokers in the U.S. It was hypothesized that emotion dysregulation would be significantly related to expectancies about negative reinforcement and negative personal consequences for smoking. Given the paucity of data, no specific hypotheses were made regarding appetite control and positive reinforcement expectancies.

Method

Participants

Participants were 363 Spanish-speaking Latinx daily smokers in the U.S. (58.7% female, Mage = 33.3 years, SD = 9.81). Eligible participants were current daily smokers between 18–64 years old. Participants were excluded if they were younger than age 18, non-Latinx, a non-Spanish speaker, or were unable to give informed, voluntary, written consent to participate. In terms of national origin, 35.8% of participants reported being born in Mexico, 22.6% were born in the U.S., 17.4% were born in Puerto Rico, 9.1% in Cuba, 5.5% in South America, 2.2% in the Dominican Republic, 2.2% in Central America, and 5.2% reported being born in other regions. Regarding education, 42.1% reported more than 12 years of education, 24.5% reported 12 years (completion of high school) of education, 15.2% 6–11 years of education, and the remaining 18.2% of participants reported less than 6 years of education. The median income bracket fell within the range of $35,999 to $49,999. In terms of alcohol consumption, 40.5% reported drinking monthly or less, 29.5% 2 to 4 times per month, 20.7% 2 to 3 times per week, and 9.4% 4 or more times per week (Babor, Higgins-Biddle, Saunders, Monteiro, & WHO, 2001). The average number of years of daily smoking was 11.4 years (SD = 9.7). Participants smoked an average 9.3 (SD = 8.7) cigarettes per day and reported an average of 4.1 (SD = 6.4) prior failed quit attempts. Based on Fagerström Test for Cigarette Dependence (Heatherton, Kozlowski, Frecker, & Fagerström, 1991), participants average cigarette dependence rate was 7.6 (SD = 3.5), which is indicative of a high level of dependence.

Measures

Demographics Questionnaire.

Demographic data including gender, national origin, age, educational level (1= 6 years or less to 4= more than 12 years), and annual income (1= $0-$4,999 to 9= $100,000 or higher) was collected from participants. Participants were asked to select their national origin from response options that included, “American/ Born in the U.S., Mexican/Mexican-American, Cuban, South American, Puerto Rican, Dominican, Central American, or Other”

The Medical History and Present Medical Condition Questionnaire (Precision, 2012).

This questionnaire assesses for history of medical conditions and a sum score of medical conditions is calculated (Zvolensky et al., 2019).

The Hospital Anxiety and Depression Scale (Herrero et al., 2003).

The Hospital Anxiety and Depression Scale (HADS) is a psychometrically valid 14-item self-report screening scale for anxiety and depression (Zigmond & Snaith, 1983). The HADS includes a 7-item anxiety subscale and a 7-item depression subscale. The Spanish version of HADS has demonstrated good psychometric properties among Spanish-speaking samples (Herrero et al., 2003). The depression subscale of HADS was used in the current study (α = .68).

Drug Abuse/Dependence Screener (Rost, Burnam, & Smith, 1993).

The Drug Abuse/Dependence Screener is a 3-item questionnaire for commonly used substances (e.g. cannabis, stimulants, sedatives) and has been successfully used in past studies among Spanish-speakers (Watkins, Paddock, Zhang, & Wells, 2006). The answer to the question “Have you ever used one of these drugs on your own more than 5 times in your life?” was used.

The Alcohol Use Disorders Identification Test (Babor et al., 2001).

The Alcohol Use Disorders Identification Test (AUDIT) is a psychometrically valid 10-item self-report measure to assess problematic alcohol use. The AUDIT consumption subscale is used as a problem drinking screener (Bush, Kivlahan, McDonell, Fihn, & Bradley, 1998) and has been successfully used in past studies among Spanish-speakers (Cremonte, Ledesma, Cherpitel, & Borges, 2010). The AUDIT-consumption subscale was used as a covariate (α = .82).

Fagerström Test for Cigarette Dependence (Fagerström, 2012).

The Fagerström Test for Cigarette Dependence (FTCD) is a psychometrically validated 6-item scale that assesses gradations of tobacco dependence (Fagerström, 2012; Heatherton et al., 1991). As in past work (Korte, Capron, Zvolensky, & Schmidt, 2013), items 2, 5, and 6 were scored on a 4 point Likert type scale ranging from 0 (never) to 3 (always). The FTCD was used to characterize cigarette dependence and the internal consistency was adequate (α = .64).

Difficulties in Emotion Regulation Scale-16 (Bjureberg et al., 2016).

The Difficulties in Emotion Regulation Scale-16 (DERS-16) is a 16-item self-report measure, that assesses emotion dysregulation (Bjureberg et al., 2016). The DERS-16 has strong psychometric properties (Bjureberg et al., 2016). The total score was employed and the internal consistency of DERS was excellent (α = .97).

Short Form-Smoking Consequences Questionnaire (Myers et al., 2003).

The Short Form-Smoking Consequences Questionnaire (S-SCQ) is a 21-item self-report measure of cigarette smoking expectancies. The S-SCQ consists of four factors and has well demonstrated psychometric validity (Myers et al., 2003). The four factors demonstrated good internal consistency: Negative Consequences (α = .81); Positive Reinforcement (α = .83); Negative Reinforcement (α = .84); Appetite-Weight Control (α = .81).

Procedure

Participants were recruited nationally across 32 states using Qualtrics, an online survey management system. This survey method has been validated in past research (Heen, Lieberman, & Miethe, 2014; Walter, Seibert, Goering, & O’Boyle, 2018) and has been successfully used across a diverse range of populations (Zvolensky, Mayorga, & Garey, 2018). Adults with a Qualtrics Panels account that endorsed current daily smoking and smoked tobacco within the past week were sent a survey advertisement. Respondents were screened for eligibility, which included identifying as a Latinx individual and as a Spanish-speaker. Participants provided informed consent prior to completing the survey, which took approximately 20 minutes. All measures were administered in Spanish. Participants could opt to receive their compensation in varying forms (e.g., cash-based incentives [i.e., gift cards], rewards miles, rewards points, etc.). Although the forms were different, the level of compensation remained consistent across respondents and was typically 20% to 35% of the total cost per completed survey ($7.50). The study protocol was approved by the Institutional Review Board at the University of Houston.

Analytic Strategy

Sample descriptive statistics and zero-order correlations among study variables were analyzed. To evaluate the incremental predictive power of emotion dysregulation, four separate two-step hierarchical regressions were conducted for each of the criterion variables. Step 1 included clinically and theoretically relevant covariates including, gender, income, education, number of medical conditions, depression, non-alcohol drug use, and alcohol consumption (Gregor & Borrelli, 2012; Lorenzo-Blanco & Cortina, 2013; Noonan et al., 2016; Winkleby et al., 1995; Zvolensky et al., 2014). Step 2 included the emotion dysregulation total score.

Results

Bi-variate Relations

Emotion dysregulation was positively related to all smoking expectancies at the bivariate level (r’s ranging from .25 to .41). All smoking expectancies positively correlated (r’s ranging from .64 to .89).

Primary Analyses

For negative reinforcement, the overall model was significant (F (8, 354) = 4.70, p < .001, R2 = .10). Alcohol consumption emerged as a significant predictor in step 1. Greater alcohol consumption was associated with greater beliefs related to negative reinforcement expectancies. In step 2, emotion dysregulation was a significant predictor (ΔR2=.12; see Table 1). Higher emotion dysregulation was associated with increased endorsement of beliefs related to negative reinforcement expectancies.

Table 1.

Hierarchical regression results

S-SCQ: Negative Reinforcement
Model F Statistic ΔR2 B SE t p-value sr 2
1 Alcohol Consumption 4.70 .10 0.98 0.24 4.16 <.001 0.044
2 DERS-16 51.41 .12 0.30 0.04 7.17 <.001 0.115
S-SCQ: Negative Consequences
Model F Statistic ΔR2 B SE t p-value sr 2
1 Alcohol Consumption 4.74 .10 0.62 0.15 4.06 <.001 0.042
2 DERS-16 43.09 .10 0.18 0.03 6.57 <.001 0.098
S-SCQ: Positive Reinforcement
Model F Statistic ΔR2 B SE t p-value sr 2
1 Depression 3.47 .07 −0.41 0.13 −3.15 .002 0.026
Alcohol Consumption 0.42 0.18 2.32 .021 0.014
2 DERS-16 23.44 .06 0.16 0.03 4.84 <.001 0.058
S-SCQ: Appetite-Weight Control
Model F Statistic ΔR2 B SE t p-value sr 2
1 Alcohol Consumption 2.96 .06 0.53 0.18 2.97 .003 0.023
2 DERS-16 42.58 .10 0.21 0.03 6.53 <.001 0101
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Note. N=363; Covariates in step 1 included gender, income, education, number of medical conditions, depression, non-alcohol drug use, and alcohol consumption; Alcohol Consumption = AUDIT-Consumption subscale as per the Alcohol Use Disorders Identification Test (Babor et al., 2001); Depression = Depression as per the sum score of the depression subscale of the Hospital Anxiety and Depression Scale (Herrero et al., 2003); DERS-16 = Total score as per the Difficulties in Emotion Regulation Scale-16 (Bjureberg et al., 2016); S-SCQ = Smoking Consequences Questionnaire-Short Form (Myers et al., 2003).

For negative consequences, step 1 of the model was significant (F (8, 354) = 4.74, p < .001, R2 = .10). Alcohol consumption was a significant predictor of negative consequences in step 1 such that increased alcohol consumption was associated with higher beliefs related to negative consequences. In step 2, emotion dysregulation was a significant predictor (ΔR2=.10; see Table 1). Higher emotion dysregulation was associated with increased endorsement of beliefs related to negative consequence expectancies.

In terms of positive reinforcement expectancies, step 1 was significant (F (8, 354) = 3.47, p = .001, R2 = .07). Depression and alcohol consumption emerged as significant predictors in step 1. Greater depression associated with lower endorsement of beliefs related to positive reinforcement while greater alcohol consumption was associated with increased positive reinforcement beliefs. In step 2, emotion dysregulation was a significant predictor (ΔR2=.06; see Table 1). Greater emotion dysregulation was related to an increased endorsement of beliefs related to positive reinforcement expectancies.

In predicting appetite-weight control expectancies, the overall model was significant (F (8, 354) = 2.96, p = .003, R2 = .06); alcohol consumption emerged as a significant predictor. In step 2, emotion dysregulation was a significant predictor (ΔR2=.10; see Table 1). Higher emotion dysregulation was associated with increased endorsement of beliefs related to appetite-weight control expectancies.

Discussion

The present study evaluated emotion dysregulation in relation to smoking outcome expectancies among Spanish-speaking Latinx adult cigarette smokers. Emotion dysregulation was significantly related to both negative reinforcement and negative personal consequences for smoking. The amount of variance accounted for by emotion dysregulation was greater (negative reinforcement) or equal (negative personal consequences) to that observed for all the modeled covariates. Latinx smokers with greater difficulty regulating emotion may be more apt to smoke to mitigate aversive internal states. Additionally, Latinx smokers with greater emotion dysregulation also may believe that smoking is personally harmful or dangerous, as emotion dysregulation is related to cognitive biases for personal threat (Bardeen, Daniel, Hinnant, & Orcutt, 2017) and emotional pathology more generally (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & Van Ijzendoorn, 2007). Future research is needed to extend the present findings to other tobacco-related constructs related to the maintenance and relapse of smoking among Latinx smokers, such as withdrawal and craving (Piñeiro et al., 2014).

Emotion dysregulation was related to smoking expectancies of appetite control (10% of variance) and positive reinforcement (6% of variance) after adjusting for the effects of covariates. Thus, emotion dysregulation appears to have a broad-band relation to negative and positive outcome expectancies for smoking. One possible interpretation of these results may be related to the emotion dysregulation-depression relation observed in the current data. Specifically, emotion dysregulation was significantly related to depression at the bivariate level (r = .30) and depression was a significant univariate predictor of positive reinforcement smoking expectancies. It is possible that emotion dysregulation is related to positive expectancies because Latinx smokers are more prone to negative (low-arousal) mood states (i.e., depression; Alegria, Canino, Stinson, & Grant, 2006; Pratt & Brody, 2016). As a result, smoking may function to elevate negative mood.

Although not primary study aims, it is noteworthy that alcohol consumption was significantly related to emotion dysregulation at the bivariate level (r = .40) and was significantly related to all smoking outcome expectancies. These data suggest future research should explore the explanatory relevance of alcohol use among Latinx smokers. For example, research could usefully test whether alcohol consumption moderates the relationship between emotion dysregulation and smoking outcome expectancies among Latinx smokers.

To the extent emotion dysregulation is related to smoking outcome expectancies, it may be clinically useful to target intervention efforts on this construct to change expectancies of positive and negative smoking consequences. Presently, there are no treatments for emotion dysregulation-smoking cessation in general or for Latinx smokers specifically. Yet, several psychosocial treatments have shown promise in reducing emotion dysregulation (Gratz, Bardeen, Levy, Dixon-Gordon, & Tull, 2015; Gratz, Weiss, & Tull, 2015) and a large literature has found that emotion dysregulation is a mediator of affective distress (Moriya & Takahashi, 2013) among non-Latinx Whites (Wong et al., 2018) and Latinx persons (Zvolensky et al., 2017). Building from such research, there could be utility in developing smoking cessation programs for that explicitly address the construct of emotion dysregulation for Latinx smokers.

There are several study caveats. First, because of the cross-sectional study design, the directionality of the observed effects cannot be explicated. Thus, it is important for future research to further the study of emotion dysregulation among Latinx smokers through alternative methodological designs. Second, we sampled a broad range of Latinx adult smokers to aid in the generalizability of the study findings in an area where there is limited research. Yet, because Latinx smokers vary in their smoking behavior by country of origin (Sauer et al., 2017), future research oriented on specific subpopulations of Latinx smokers may be a worthwhile pursuit. Further, we did not assess immigration status, which could be useful to document in future research. Additionally, as these findings pertain specifically to Latinx adult smokers, they cannot be generalized to other groups of smokers. Third, to the extent emotion dysregulation is related to smoking expectancies, it is possible that culturally-specific factors could moderate or mediate such relations. Finally, as non-daily smoking is on the rise in the U.S. (Inoue-Choi et al., 2019), there may be merit to extending these findings among non-daily Latinx smokers.

Funding:

This work was not supported by any funding.

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