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Published in final edited form as: Eat Behav. 2012 Jun 7;13(4):10.1016/j.eatbeh.2012.05.009. doi: 10.1016/j.eatbeh.2012.05.009

Unique Relationships between Facets of Mindfulness and Eating Pathology among Female Smokers

Claire E Adams a,b,*, Megan Apperson McVay b,c, Jessica Kinsaul b, Lindsay Benitez b,d, Christine Vinci b, Diana W Stewart a,b, Amy L Copeland b
PMCID: PMC3837528  NIHMSID: NIHMS522131  PMID: 23121795

Abstract

Female smokers often have higher levels of eating disorder symptoms than non-smokers, and concerns about eating and weight might interfere with smoking cessation. Thus, it is critical to identify factors to promote healthier eating and body image in this population. Initial research suggests that specific aspects of trait mindfulness predict lower body dissatisfaction and eating disorder symptoms among non-smokers. However, these relationships are unknown among smokers. The current study examined associations between facets of trait mindfulness and eating disorder symptoms in 112 college female smokers (83% Caucasian; mean age 20 years, SD = 1.69). After controlling for relevant sociodemographic variables, Describing and Nonjudging facets of mindfulness predicted lower bulimic symptoms and body dissatisfaction (ps < .05), while Acting with Awareness predicted lower bulimic and anorexic symptoms, ps < .05. Observing predicted higher anorexic symptoms, p < .05. These results suggest that specific mindfulness facets are related to lower eating disorder symptoms among smokers, whereas other facets are not associated or have a positive relationship with these symptoms. Mindfulness-based interventions focusing on Describing, Nonjudging, and Acting with Awareness may help to reduce eating pathology among female smokers, which could potentially improve smoking cessation rates in this population.

Keywords: Mindfulness, Smoking, Anorexia Nervosa, Bulimia Nervosa, Body Dissatisfaction

1. Introduction

Female smokers report more body dissatisfaction and other eating disorder symptoms than their non-smoking counterparts (Cavallo et al., 2010; Kendzor, Adams, Stewart, & Copeland, 2009; Pomerleau & Saules, 2007), and these concerns may interfere with smoking cessation (Copeland, Martin, Geiselman, Rash, & Kendzor, 2006; Jeffery, Hennrikus, Lando, Murray, & Liu, 2000). Promoting healthier eating and body image among female smokers is therefore critical.

Mindfulness, defined as paying attention to the present moment with an attitude of nonjudgmental acceptance (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006; Kabat-Zinn, 1990, 1994), has been linked to improved emotion regulation (Arch & Craske, 2006). Whereas eating pathology is associated with attempts to avoid or escape emotional distress (Heatherton & Baumeister, 1991; Wilson, 2004), mindfulness involves observing and accepting unpleasant emotions (Baer et al., 2006; Bishop et al., 2004). Mindfulness interventions may reduce eating pathology and body dissatisfaction (Dalen et al., 2010; Delinsky & Wilson, 2006; Kristeller, Baer, & Wolvever, 2006; Tapper et al., 2009). However, there is little research on associations between eating disorder symptoms and trait mindfulness (an individual’s tendency to observe and accept present-moment experiences in day-to-day life; Brown & Ryan, 2003).

Importantly, Baer et al. (2006) presented evidence that trait mindfulness has five facets: 1) Nonreactivity (perceiving thoughts/feelings without reacting), 2) Observing (paying attention to internal and external sensations), 3) Acting with Awareness (staying focused on present-moment experience and acting deliberately), 4) Describing (describing/labeling thoughts/feelings with words), and 5) Nonjudging (accepting thoughts/feelings without evaluating them). Whereas most subscales were inversely related to psychological symptoms, Observing predicted more symptoms.

Two studies have shown unidimensional trait mindfulness to be associated with lower eating disorder pathology in college populations (Lavender et al., 2009; Masuda & Wendell, 2010), however only one known study has examined facets of mindfulness in relation to eating behavior. Lavender, Gratz, and Tull (2011) found that Nonreactivity, Acting with Awareness, and Nonjudging each uniquely predicted lower anorexic symptoms, whereas Describing was related to higher symptoms. Given the potential importance of mindfulness in promoting healthier eating and body image in smokers, it is important to investigate these associations among smokers.

The present study investigated unique relationships between facets of mindfulness and eating disorder symptoms (anorexic symptoms, such as restricting food intake; bulimic symptoms, such as bingeing and purging; and general body dissatisfaction) in female smokers. Based on past research (Baer et al., 2006; Lavender et al., 2011), it was hypothesized that most mindfulness facets would predict lower eating pathology and body dissatisfaction, but Observing would not show unique benefits in this respect.

2. Method

2.1. Participants

Participants (N = 112) were female college students (ages 18–26) who self-identified as smokers. As the sample included non-daily smokers, smoking frequency was defined as number of cigarettes smoked per week.

2.2. Materials

The Five-Factor Mindfulness Questionnaire (FFMQ; Baer et al., 2006) is a 39-item self-report questionnaire of trait mindfulness that yields five factors (described above): 1) Nonreactivity, 2) Observing, 3) Acting with Awareness, 4) Describing, and 5) Nonjudging. The overall scale and subscales have shown good psychometric properties (Baer et al., 2006).

The Smoking Status Questionnaire (SSQ) assesses demographics and smoking status.

The Eating Attitudes Test-26 (EAT-26; Garner et al., 1982) is a 26-item self-report measure designed to assess symptoms of Anorexia Nervosa. Garner and colleagues (1982) found that total scores ≥ 20 were associated with a diagnosis of Anorexia Nervosa. As EAT-26 items represent symptoms common to Anorexia Nervosa (APA, 2000), the EAT-26 is utilized in the present study as primarily a measure of anorexic symptoms.

The Bulimia Test – Revised (BULIT-R; Thelen, Farmer, Wonderlich, & Smith, 1991) is a 36-item self-report measure of Bulimia Nervosa symptoms. Scores ≥ 104 have been associated with a diagnosis of Bulimia Nervosa (Thelen et al., 1991). The BULIT-R has shown good psychometric properties (Thelen et al., 1991; Thelen, Mintz, & Vander Wal, 1996) and is utilized in the present study as an index of bulimic symptoms.

The Body Shape Questionnaire (BSQ; Cooper, Taylor, Cooper, & Fairburn, 1987) is a 34-item self-report measure of body shape concern over the past four weeks. BSQ scores of less than 81 suggest little or no worry about body shape, scores of 81–110 suggest slight worry, scores of 111–140 suggest moderate worry, and scores greater than 140 suggest extreme worry about body shape (Cooper & Taylor, 1988). The BSQ has shown good psychometric properties (Cooper et al., 1987) and is used in the current study as a measure of body dissatisfaction.

2.3. Procedure

All procedures were reviewed and approved by the Institutional Review Board of the large southeastern university where this study was conducted. Participants were recruited through campus fliers and the undergraduate psychology participant pool for part of a larger study examining mindfulness, smoking, and body image. Participants chose to be compensated either with course credit or monetary compensation ($10). Participants completed the FFMQ, SSQ, EAT-26, BULIT-R, and BSQ. Height and weight were measured, and body mass index (BMI) was calculated. Participants who indicated clinical levels of anorexic symptoms, bulimic symptoms, or extreme worry about body shape were referred to a local psychological services center for further evaluation but were still included in the analyses, as they are part of a representative sample of female college smokers.

2.4. Statistical Analyses

Before primary analyses, unadjusted analyses examined differences in eating pathology and body dissatisfaction as a function of trait mindfulness (based on tertiles of total FFMQ scores). Analyses of variance (ANOVAs) and Chi Square analyses were conducted with continuous and categorical variables, respectively. To identify covariates for later analyses, bivariate correlations were conducted between potential covariates (age, minority status, BMI, smoking frequency), mindfulness facets, and eating disorder symptoms. Potential covariates that were associated with mindfulness facets or eating disorder symptoms at the .05 level were controlled in relevant analyses (Tabachnick & Fidell, 2007; Weinfurt, 2004).

A series of hierarchical multiple regression analyses was conducted to test unique relationships between mindfulness facets, eating pathology, and body dissatisfaction. Covariates were entered on Step 1, and the five FFMQ factors (Observing, Describing, Acting with Awareness, Nonreactivity, and Nonjudging) were entered on Step 2. Dependent variables were: anorexic symptoms (EAT-26), bulimic symptoms (BULIT-R), and body dissatisfaction (BSQ). Outliers greater than 3.3 standard deviations from their predicted mean were removed (Tabachnick and Fidell, 2007). Analyses were conducted using IBM SPSS Statistics version 19.

3. Results

3.1. Participant Characteristics

Participants were 83% Caucasian and had a mean age of 20 (SD = 1.69). The mean BMI was in the normal range (M = 24.00, SD = 4.91). Seventy-nine participants (70.5%) reported daily cigarette smoking (M = 8.53 cigarettes/day, SD = 5.02). The total sample reported smoking 45.23 (SD = 38.05) cigarettes per week. Unadjusted analyses indicated that participants with higher total trait mindfulness scores reported less concern about body shape and lower symptoms of Bulimia Nervosa (Table 1).

Table 1.

Participant Characteristics by Tertiles of Trait Mindfulness (Five-Factor Mindfulness Questionnaire [FFMQ]; standard deviations in parentheses)

Variable Total Sample (N = 112) Low Mindfulness (n = 36) Medium Mindfulness (n = 36) High Mindfulness (n = 40) p
Sociodemographics
Age 19.96 (1.69) 19.75 (1.65) 19.75 (1.75) 20.35 (1.64) .20
% Caucasian 83% 77.8% 85.7% 87.2% .50
BMI 24.00 (4.91) 23.80 (4.14) 24.28 (6.29) 23.92 (4.22) .91
Smoking Frequency 45.23 (38.05) 42.06 (44.33) 48.11 (36.85) 45.55 (33.46) .80
Eating Disorder Measures
EAT-26 8.10 (8.10) 10.33 (10.26) 7.44 (7.26) 6.68 (6.16) .12
 % Elevated EAT-26 6.3% 11.1% 5.6% 2.5% .30
BULIT-R 53.39 (19.00) 63.53 (22.94) 49.17 (15.27) 48.07 (14.32) <.001
 % Elevated BULIT-R 1.8% 5.6% 0% 0% .12
BSQ 92.38 (35.98) 110.31 (35.50) 84.00 (33.33) 83.80 (33.47) .001
 % Moderate or Extreme Worry about Body Shape (BSQ) 28.6% 47.2% 25.0% 15.0% .01
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Note. BMI = Body Mass Index; EAT-26 = Eating Attitudes Test-26; BULIT-R = Bulimia Test-Revised; BSQ = Body Shape Questionnaire.

3.2. Identification of Covariates

Age was related to lower bulimic symptoms, r = −.21, p = .03. BMI was correlated with higher bulimic symptoms (r = .28, p = .003) and body dissatisfaction, r = .31, p = .001. Smoking frequency was related to lower anorexic symptoms, r = −.22, p = .02. Covariates were included in multiple regression analyses as appropriate (Weinfurt, 2004; Tabachnick & Fidell, 2007).

3.3. Anorexic Symptoms

After controlling for smoking frequency, Step 2 significantly predicted EAT-26 scores, p = .02. Whereas Observing predicted higher anorexic symptoms (p = .04), Acting with Awareness predicted lower anorexic symptoms, p = .045 (Table 2).

Table 2.

Hierarchical Multiple Regression Analysis Predicting Eating Disorder Symptoms

Anorexic Symptoms (EAT-26)
 Variable Fchange R2change t β sr2 p
Step 1 1.89 .02 .17
 Smoking Frequency . −.13 .03
Step 2* 2.78 .12 .02
 Smoking Frequency −1.86 −.18 .03 .07
 Nonreactivity .70 .07 .004 .49
 Observing* 2.11 .22 .04 .04
 Acting with Awareness* −2.03 −.21 .04 .045
 Describing −.74 −.07 .01 .46
 Nonjudging .47 .05 .002 .64
Bulimic Symptoms (BULIT-R)
  Variable Fchange R2change t β sr2 p
Step 1*** 10.55 .17 < .001
 Age** −3.40 −.31 .09 .001
 BMI*** 3.87 .35 .12 < .001
Step 2*** 8.59 .25 < .001
 Age** −2.82 −.23 .05 .006
 BMI*** 4.04 .32 .09 <.001
 Nonreactivity 1.35 .11 .01 .18
 Observing 1.17 .10 .01 .25
 Acting with Awareness* −2.41 −.21 .03 .02
 Describing** −2.65 −.22 .04 .009
 Nonjudging** −2.66 −.24 .04 .009
Body Dissatisfaction (BSQ)
  Variable Fchange R2change t β sr2 p
Step 1** 11.09 .09 .001
 BMI** 3.33 .31 .09 .001
Step 2*** 7.36 .24 < .001
 BMI*** 3.59 .29 .08 .001
 Nonreactivity .40 .04 .001 .69
 Observing 1.67 .15 .02 .10
 Acting with Awareness −1.79 −.16 .02 .08
 Describing** −2.84 −.24 .05 .005
 Nonjudging* −2.10 −.20 .03 .04
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Note. Sociodemographic variables significantly correlated with the outcome variable were entered in Step 1 of each regression analysis. Five-Factor Mindfulness Questionnaire (FFMQ) subscales were entered in Step 2.

EAT-26 = Eating Attitudes Test-26; BULIT-R = Bulimia Test-Revised; BSQ = Body Shape Questionnaire

*

p < .05

**

p < .01

***

p < .001

3.4. Bulimic Symptoms

After controlling for age and BMI, Step 2 was significant in predicting BULIT-R scores, p < .001. Describing (p = .009), Acting with Awareness (p = .02), and Nonjudging (p = .009) each independently predicted lower bulimic symptoms (Table 2).

3.5. Body Dissatisfaction

After controlling for BMI, Step 2 significantly predicted BSQ scores, p < .001. Higher ratings of Describing (p = .005) and Nonjudging (p = .04) each uniquely predicted lower concern about body shape (Table 2).

4. Discussion

The present study examined unique roles of mindfulness facets in predicting eating disorder symptoms in female smokers. Consistent with hypotheses, results indicate that distinct facets of mindfulness differentially predict eating pathology. Describing (the tendency to describe or label experiences in words) and Nonjudging (accepting thoughts and feelings without judging them) predicted lower symptoms of Bulimia Nervosa and lower body dissatisfaction. Higher reports of Acting with Awareness (focused concentration on present-moment activities) were related to lower symptoms of Anorexia Nervosa and Bulimia Nervosa. However, Observing predicted higher anorexic symptoms. This is consistent with our hypothesis and with past findings that although most aspects of mindfulness predict better psychological outcomes, Observing does not (Baer et al. 2006; Lavender et al., 2011). This suggests that simply observing present-moment experience (a key component of mindfulness) is not necessarily beneficial to psychological health unless it is combined with other aspects of mindfulness (i.e., Describing, Acting with Awareness, and Nonjudging).

Female smokers with higher total trait mindfulness were less likely to report eating disorder symptoms. Whereas almost half (47.2%) of participants with low trait mindfulness indicated significant worry about body image, only 15% of those with high mindfulness scores reported this same level of concerns. While 5.6% of participants with low mindfulness scores reported at-risk Bulimia Nervosa symptoms, no participants with high trait mindfulness reported clinical levels of these symptoms.

The results pertaining to the EAT-26 may be compared to those of Lavender et al. (2011), who used the same measure in non-smoking female undergraduates. Both studies indicate that Acting with Awareness predicted lower EAT-26 scores. However, whereas Lavender et al. found that Nonreactivity and Nonjudgment predicted lower EAT-26 scores, these factors did not uniquely predict EAT-26 scores in the current sample. Although Lavender et al. found no relation between Observing and EAT-26, Observing predicted higher EAT-26 scores in the present sample. Perhaps FFMQ facets have different associations with eating disorder symptoms in smokers versus non-smokers. As these are the only two known investigations of mindfulness facets and eating pathology in college women, more research is needed to elucidate the roles of each facet for smoking vs. non-smoking women.

Several limitations of the present study are noted. The cross-sectional design and correlational nature of analyses preclude implications of causality; longitudinal studies are needed to clarify the temporal nature of relationships. This study included a relatively small sample size, and the results may only generalize to female undergraduates who tend to be light smokers. This study utilized a non-treatment seeking sample and assessed extent of eating disorder symptoms rather than clinical eating disorder diagnoses. Future research is needed to investigate whether these findings extend to clinical samples. The present study is also limited by reliance on self-report measures of smoking and eating habits.

Despite limitations, the current study is strengthened by an in-depth examination of different facets of mindfulness, rather than simply viewing mindfulness as a unidimenional construct. In addition, while the only known study of relationships between unique facets of mindfulness and eating pathology utilized a single measure of eating pathology (Lavender et al., 2011), the current study furthered this research by assessing multiple eating disorder symptoms (i.e., anorexic symptoms, bulimic symptoms, and body dissatisfaction).

As smokers often have elevated levels of eating pathology and body dissatisfaction, mindfulness-based interventions that simultaneously target smoking cessation, eating pathology and body dissatisfaction might be particularly helpful for smokers prone to eating disorder symptoms. Mindfulness-based treatments have received empirical support for promoting healthier eating and body image (Dalen et al., 2010; Delinsky & Wilson, 2006; Kristeller et al., 2006; Tapper et al., 2009) and smoking cessation (Brewer et al., 2011; Davis, Fleming, Bonus, & Baker, 2007). Mindfulness may be one strategy to target emotional dysregulation underlying both smoking and eating disorder pathology, perhaps improving smoking outcomes and also promoting healthier eating and body image among smokers. Mindfulness-based interventions that focus on increasing Describing, Acting with Awareness, and Nonjudging skills might be particularly effective for reducing eating pathology and weight concerns among female smokers.

Highlights.

  • We examined associations between mindfulness and eating pathology in female smokers.

  • Describing, Nonjudging, and Acting with Awareness predicted less eating pathology.

  • The Observing facet of mindfulness predicted higher anorexic symptoms.

  • Certain aspects of mindfulness might promote healthier eating in female smokers.

Acknowledgments

This research was conducted at Louisiana State University and supported in part by a grant to the first author (CEA) from the American Psychological Association. The first and sixth authors (CEA and DWS) are now at the University of Texas MD Anderson Cancer Center and are supported in part by a cancer prevention fellowship through the National Cancer Institute (NCI R25T CA57730, PI: Shine Chang) and a Community Based Participatory Research Traineeship from the Latinos Contra el Cancer Community Networks Program Center (NCI U54CA153505; PIs: David W. Wetter, Maria E. Fernandez, Lovell Jones). The authors would like to thank Allyson Barbry and Alexa Thibodeaux for their work in data collection for this study.

Footnotes

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