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. Author manuscript; available in PMC: 2024 Apr 1.
Published in final edited form as: Addict Behav. 2022 Dec 17;139:107593. doi: 10.1016/j.addbeh.2022.107593

Anxiety Sensitivity and Reasons for Smoking among Black Smokers

Lorra Garey 1,3, Amy R Senger 1,2, Tanya Smit 1, Pamella Nizio 1, Cameron T Matoska 1, Brooke Kauffman 1, Michael S Businelle 3,4,6, Matthew W Gallagher 1,2,3, Michael J Zvolensky 1,3,5
PMCID: PMC9897199  NIHMSID: NIHMS1860323  PMID: 36563479

Abstract

Black smokers demonstrate higher nicotine dependence and experience higher rates of smoking-related diseases and mortality relative to European American/White smokers. A potential factor relevant to race-specific smoking health disparities may be smoking motives (i.e., motivational basis of smoking). Yet, little research has been conducted to understand psychological factors that may be associated with specific smoking motives among Black smokers. To address this gap in the literature, the current study explored the association between anxiety sensitivity and smoking motives within a subset sample of Black smokers who were interested in participating in a smoking cessation trial (N = 105; 70.5% male; Mage = 44.8 years, SD = 11.6 years). Hierarchical regression analyses indicated anxiety sensitivity was associated with smoking motives related to habit (β = .39, p < .001), negative affect reduction (β = .32, p < .001), stimulation (β = .31, p < .001), and sensorimotor manipulation (β = .26, p = .008). Limited support was found for the effect of motives on past quit attempt engagement. These results may broaden understanding of the psychological mechanisms related to smoking motivation among Black smokers and may inform future intervention efforts to reduce smoking motivation among this health disparities population.

Keywords: African American, Black, Smokers, Anxiety Sensitivity, Smoking Motives

1. Introduction

Black smokers smoke fewer cigarettes per day and tend to begin smoking later in life compared to European Americans/White smokers (Caraballo et al., 1998; Schoenborn et al., 2013). Despite smoking at lower rates, Black smokers evince greater levels of nicotine dependence (Webb Hooper et al., 2013) and exposure (i.e., serum cotinine; Caraballo et al., 1998; Hooper et al., 2013; Wagenknecht et al., 1990) compared to White/Caucasian and Latinx smokers. Black smokers are also less likely to successfully quit smoking relative to European American/White and Hispanic/Latino smokers (Babb et al., 2017), despite being more likely to initiate a quit attempt and having more frequent quit attempts (Babb et al., 2017; Bacio et al., 2014). As a result, Black smokers experience disproportionate tobacco-related disease and death and have a higher incidence and mortality rate from lung cancer compared to European American/White smokers (Haiman et al., 2006; Howlader et al., 2013). These data have informed the recognition of Black smokers as a tobacco-related health disparities group and serve as the rationale for research within Black communities on smoking behavior (Martell et al., 2016).

Motives for smoking have been identified as a central cognitive process implicated in smoking continuation and quit difficulty (Shiffman, 1993). Some common smoking motives are habitual use (i.e., smoking because it is a part of routine), negative affect reduction (i.e., smoking to cope with negative emotions), addiction (i.e., smoking to avoid withdrawal), pleasure (i.e., smoking for positive reinforcement), stimulation (i.e., smoking for its stimulant effects), and sensorimotor manipulation (i.e., enjoying the physical steps of smoking such as lighting up; Ikard et al., 1969). Black smokers who evince stronger motives to smoke perceive greater barriers to quitting, experience more quit difficulty, and indicate more severe withdrawal symptoms when attempting to quit (Kelly et al., 2020). Notable, Black smokers tend to report lower motives to smoke relative to European American/White smokers (Bacio et al., 2014; Piper et al., 2008), which should, theoretically, be related to less severe use and greater quit success. Yet, less robust motives to smoke (specifically motives related to positive reinforcement, negative reinforcement, and taste/sensory processes) are related to more quit difficulty, as evinced by more failed quit attempts among Black smokers, which differs from what has been observed among White smokers (Bacio et al., 2014). Yet other work has found that more severe smoking motives (across specific domains) relate to increased likelihood of relapse among Black smoking following treatment (Smith et al., 2010). Thus, more work is needed to understand how smoking motives may relate to quit behavior among Black smokers as well as factors that may relate to stronger motives to smoking among this group.

Anxiety sensitivity, a malleable, cognitive-affective factor reflecting the tendency to respond to interoceptive distress with anxiety and fear of the consequences of anxiety-related distress (Zinbarg et al., 1997), may be related to stronger smoking motives among Black smokers. Anxiety sensitivity is related to, yet distinct from, negative affectivity and trait anxiety among European American/White samples (Rapee & Medoro, 1994) and Black adults (Zvolensky et al., in press). Additionally, anxiety sensitivity has demonstrated racial/ethnic, gender, age, and time invariance (Chorpita et al., 2000; Forsyth & Zvolensky, 2001; Silverman et al., 2003; Zinbarg et al., 1999; Zvolensky et al., 2003). Within primarily European American/White samples, anxiety sensitivity has consistently related to multiple positive and negative domains of smoking motives, which highlights the relevance of this construct in the motivational process of smoking (Battista et al., 2008; Brown et al., 2001; Leyro et al., 2008). Specifically, anxiety sensitivity has been associated with the motives of habitual use, addiction, and negative affect reduction (Leyro et al., 2008). In a sample of Black smokers, anxiety sensitivity related to overall smoking motives (Kelly et al., 2020). Yet, the associative pattern among anxiety sensitivity and specific smoking motives has not been examined within a sample of Black smokers. Elucidating how malleable mechanisms such as anxiety sensitivity relate to specific smoking motives among Black smokers is important to help address the unique needs of this smoking-related health disparities population and develop culturally-appropriate interventions for this smoking-related health disparities group.

This study examined the relations between anxiety sensitivity and smoking motives as well as the association between smoking motives and past quit experience among Black smokers. As in extant research (Battista et al., 2008; Brown et al., 2001; Leyro et al., 2008), the Reasons for Smoking Scale (Ikard et al., 1969) was used to capture smoking motives and includes 6 subscales that were independently examined: habitual, addictive, negative affect reduction, pleasure, stimulation, and sensorimotor. Guided by prior work on the association between anxiety sensitivity and Reasons for Smoking subscales (Leyro et al., 2008), anxiety sensitivity was expected to be a robust positive predictor of the habitual, addictive, and negative affect reduction subscales after accounting for clinically relevant factors of age (Mauro et al., 2018), sex (Herrmann et al., 2015), education (Lowry & Corsi, 2020) and nicotine dependence (Dierker et al., 2018). Further, given inconsistent findings for the association between smoking motives and quit outcomes among Black smokers, we examined these relations in exploratory analyses.

2. Materials and Methods

2.1. Participants

A sample of 105 (70.5% male; Mage = 44.8 years, SD = 11.6 years) African American/Black adult daily cigarette smokers were included in the study. The current project is a secondary analysis of a subset of baseline data from individuals who were interested in participating in a randomized controlled pilot trial of a computer-delivered integrated smoking cessation treatment targeting anxiety sensitivity (Garey et al., 2021). Eligibility included: (1) reporting daily cigarette use for at least the past year; (2) being between 18–65 years of age; (3) ability to provide written, informed consent; (4) computer literacy (e.g., answered “Very comfortable” or “comfortable” to “How comfortable do you feel using a computer?” or indicated that they would prefer to complete surveys on the computer); and (5) reported smoking at least one cigarette in the past week. Although the intervention targeted anxiety sensitivity, participants were not excluded based on anxiety sensitivity severity. Exclusion criteria included: (1) current treatment for an alcohol/drug problem including smoking cessation; (2) being presently engaged in a quit attempt or mental health treatment; (3) active suicidality (i.e., suicidal ideation, intent, or plan; Osman et al., 2001); (4) psychosis; (5) not being fluent in English (to ensure comprehension of study materials); and (6) currently being pregnant (self-reported); (7) not currently using non-cigarette tobacco products or illicit substances regularly (defined as three or more times per week). The current study focused on a subset of participants who identifying as African American/Black and provided baseline data for the parent study. Of the current sample, 68 participants were eligible and participated in the larger trail.

Regarding education, 13.3% reported completed less then high school, 32.4% graduated high school, and 54.2% completed some college or more. Regarding income, 68.6% of participants reported total annual household incomes less than $35,000. Participants smoked an average of 16.9 cigarettes per day (SD = 22.1) and reported being a regular, daily smoker for an average of 21.5 years (SD = 11.7). Participants reported medium nicotine dependence on average according to the Fagerström Test for Nicotine Dependence (FTND; Heatherton et al., 1991; 4.97, SD = 2.22). Although participants were not excluded based on anxiety sensitivity, according to the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007), approximately half (48.57%) of the sample met the clinical cutoff (≥ 17) for moderate-to-high anxiety sensitivity (Allan et al., 2014). Additionally, the current sample’s mean ASI-3 score was 20.3, which is moderately high, as individuals with anxiety disorders have reported mean scores in the range of 25–32 (Wheaton et al., 2012).

2.2. Procedures

Adult daily cigarette smokers were recruited from the Houston community to participate in a randomized controlled pilot trial of a novel, computer-delivered integrated smoking cessation treatment (Garey et al., 2021). Participants were recruited via community postings, newspaper advertising, and online media sites targeting smokers. Interested individuals called the laboratory and completed a phone-screener which assessed initial eligibility. Callers found eligible at the phone-screener who were willing to participate in the study were scheduled for an in-person baseline appointment, wherein eligibility was further assessed. Upon arrival at the baseline appointment, a trained researcher obtained written informed consent from each participant, conducted a brief interview assessment to assess suicidality and/or psychosis to determine study eligibility. Following the brief intervention, each participant completed a self-report survey in a private room. Current analyses are based on baseline data (pre-intervention) from a subset of participants who provided complete data for the variables of interest; five participants were excluded for incomplete data. The study protocol was approved by the Institutional Review Board at the sponsoring institution.

2.3. Measures

2.3.1. Demographics Questionnaire and Screener Items

Demographic information collected included sex, age, race, education, and income. The Smoking History Questionnaire (SHQ; Brown et al., 2002) was used to assess smoking history (e.g., onset of regular daily smoking, years smoked, quit attempts), and pattern (e.g., number of cigarettes consumed per day; Brown et al., 2002). The past quit engagement item (“Since you started smoking, have you ever quit for a period of at least 24 hours [coded 0 = no, 1 = yes]?”) was collected via the SHQ. Additionally, participants were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV (Bell, 1994) to screen for suicidality and psychosis. Sex, age, and education were included as covariates.

2.3.2. Fagerström Test for Nicotine Dependence (FTND)

The FTND is a 6-item scale that assesses gradations in tobacco dependence (Heatherton et al., 1991). Higher scores reflect high levels of physiological dependence on nicotine. The FTND has adequate internal consistency, positive relations with key smoking variables (e.g., saliva cotinine), and high test-retest reliability (Heatherton et al., 1991; Pomerleau et al., 1994). In the current sample, the FTND total score characterized nicotine dependence and served as a covariate. Internal consistency was low (α = .59), which is not uncommon for this measure (Korte, Capron, Zvolensky, & Schmidt, 2013).

2.3.3. Anxiety Sensitivity Index-3 (ASI-3)

The ASI-3 is an 18-item self-report measure of sensitivity to and fear of the potential negative consequences of anxiety-related symptoms and sensations (Taylor et al., 2007). Respondents are asked to indicate, on a 5-point Likert scale (0 = “very little” to 4 = “very much”), the degree to which they are concerned about these possible negative consequences (possible range 0–72). Average ASI-3 scores in adults from North America (n = 4,720) are 12.8 (SD = 10.6), whereas clinical samples of adults with anxiety disorders present with average ASI-3 scores ≥ 25 (Taylor et al., 2007). The ASI-3, derived in part from the original ASI (Reiss, 1985), has sound psychometric properties, including excellent internal consistency, predictive validity, and reliability among treatment-seeking smokers (Farris et al., 2015) and across race (Jardin et al., 2018). In the present study, we utilized the total ASI-3 score as the predictor (α = .95).

2.3.4. Reasons for Smoking Scale (RFS)

The RFS (Ikard et al., 1969) was used to assess motives for smoking. The psychometric properties of this scale, including measures of factor structure, internal consistency, and test–retest reliability, have been well-established (Shiffman, 1993). The current study utilized the 23-item version of the RFS, which is comprised of six subscales: habitual (e.g., “I’ve found a cigarette in my mouth and didn’t remember putting it there”), addictive (e.g., “Between cigarettes, I get a craving only a cigarette can satisfy”), negative affect reduction (e.g., “When I feel uncomfortable or upset about something, I light up a cigarette”), pleasure (e.g., “I find cigarettes pleasurable”), stimulation (e.g., “I like smoking when I am busy and working hard”), and sensorimotor (e.g., “Part of the enjoyment of smoking a cigarette comes from the steps I take to light up”). Items are rated on a 1 (never) to 5 (always) scale. In the present study, we utilized each of the RFS subscales as criterion variables. Each subscale demonstrated acceptable to excellent internal consistency in the present study (habitual: α = 0.77; addictive: α = 0.77; negative affect reduction: α = 0.89; pleasure: α = 0.81; stimulation: α = 0.82; sensorimotor: α = 0.85).

2.4. Data Analysis

SPSS version 28.0 was used to conduct the current analyses. First, descriptive and zero-order correlations were examined among study variables. Then, six separate two-step hierarchical regression analyses were conducted with the six RFS subscales as the criterion: (1) habitual; (2) addictive; (3) negative affect reduction; (4) pleasure; (5) stimulation; and (6) sensorimotor. In the first step, covariates were entered into the model and included age (Mauro et al., 2018), sex (Herrmann et al., 2015), education (Lowry & Corsi, 2020), and nicotine dependence (Dierker et al., 2018), due to their theoretically relevance to the proposed models. In the second step, anxiety sensitivity was added to the model. For each model, the F statistic was utilized to measure model fit and squared semi-partial correlations (sr2) were utilized as an indicator of effect size, with correlations of .01, .09, and .25 indicated a small, moderate, and large effect size (Cohen et al., 2014), respectively. The sr2 value for anxiety sensitivity in step 2 of each model is equivalent to the overall change in R-squared due to adding anxiety sensitivity as a predictor in step 2. Statistical significance was set at p ≤ .008 to adjust for multiple tests. Finally, for the exploratory aim, simple correlations and a multivariate logistic regression were conducted to examined the relation between smoking motives and past quit attempt engagement.

3. Results

3.1. Correlations

Zero-order correlations are presented in Table 1. Anxiety sensitivity was statistically and positively related to all RFS subscales except the Pleasure subscale. All RFS subscales statistically and positively correlated.

Table 1.

Correlations, Means, Standards Deviations, Frequencies for Main Study Variables (N = 105).

Variable 1 2 3 4 5 6 7 8 9 10 11
1. Age -
2. Sex (% Female) −.108 -
3. Education −.018 .116 -
4. Nicotine Dependence .125 .110 −.114 -
5. Anxiety Sensitivity .169 −.124 .065 .132 -
6. RFS-Habitual .096 −.034 −.126 .403*** .425*** -
7. RFS-Addictive .151 −.126 −.114 .343*** .297** .616*** -
8. RFS-Negative Affect Reduction .278** −.188 −.059 .392*** 414*** .574*** .809*** -
9. RFS-Pleasurable Relaxation .124 −.151 −.046 .262** .151 .331*** .665*** .696*** -
10. RFS-Stimulation .082 −.068 −.054 .316** .353*** .614*** .659*** .670*** .565*** -
11. RFS-Sensorimotor Manipulation .016 −.077 −.063 .316** .289** .513*** .530*** .530*** .456*** .726*** -
M/[n] 44.8 [31] 3.4 5.0 20.3 8.6 14.7 17.8 6.5 7.7 7.1
SD/[%] 11.6 [29.5] 1.2 2.0 17.1 4.0 5.1 6.7 2.5 3.4 3.5
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Note.

*

p <.05

**

p <.01

***

p < .001.

Sex was coded as 1 = female and 0 = male; Education was coded as follows: 1 = Graduate School, 2 = College Graduate, 3 = Partial College, 4 = High School Graduate, 5 = Partial High School, 6 = Junior High School, and 7 = Less than 7 years of school; Nicotine Dependence: Fagerström Test for Nicotine Dependence (FTND; Heatherton et al., 1991); Anxiety Sensitivity: Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007); RFS: Reasons for Smoking Scale (Ikard et al., 1969).

3.2. Hierarchical Regression Analyses

The range of variance explained by covariates in step 1 of the hierarchical regression analyses was .071 to .220. Hierarchical regression results are presented in Table 21. Anxiety sensitivity was positively associated with all the smoking motives in the predicted direction; see step 2 in Table 2). For the habitual subscale, step 2 of the model was statistically significant (adjusted R2 = .282, ΔF(1, 99) = 20.363, p < .001) and accounted for a statistically significant increase in variance (ΔR2 = .141, p <.001). For the addictive subscale, step 2 of the model was statistically significant (adjusted R2 = .169, ΔF(1, 99) = 6.560, p = .012) but accounted for a non-significant increase in variance (ΔR2 = .052, p = .012). For the negative affect reduction subscale, step 2 of the model was statistically significant (adjusted R2 = .313, ΔF(1, 99) = 14.594, p < .001) and accounted for a statistically significant increase in variance (ΔR2 = .096, p <.001). For the pleasure subscale, step 2 of the model was statistically significant (adjusted R2 = .069, ΔF(1, 99) = .773, p = .381); the addition of anxiety sensitivity did not account for more variance in the outcome (ΔR2 = .007, p = .381). For the stimulation subscale, step 2 of the model was statistically significant (adjusted R2 = .163, ΔF(1, 99) = 11.398, p = .001) and accounted for a significant increase in variance (ΔR2 = .092, p = .001). Lastly, for the sensorimotor subscale, step 2 of the model was statistically significant (adjusted R2 = .133, ΔF(1, 99) = 7.288, p = .008) and accounted for a statistically significant increase in variance (ΔR2 = .061, p = .008).

Table 2.

Hierarchical Regression Results of Reasons for Smoking and Anxiety Sensitivity.

RFS-Habitual
Step b SE β t p sr2 *
1 Age −0.023 0.032 −0.065 −0.705 .482 .004
Sex 0.338 0.812 0.038 0.416 .678 .001
Education −0.250 0.319 −0.072 −0.784 .435 .005
Nicotine Dependence 0.801 0.187 0.398 4.274 < .001 .151
2 Age −0.004 0.030 −0.012 −0.145 .885 <.001
Sex −0.134 0.750 −0.015 −0.178 .859 <.001
Education −0.384 0.293 −0.111 −1.309 .194 .012
Nicotine Dependence 0.691 0.173 0.343 3.984 < .001 .110
Anxiety Sensitivity 0.091 0.020 0.388 4.513 < .001 .141
RFS-Addictive
Step b SE β t p sr2
1 Age −0.065 0.042 −0.148 −1.570 .120 .021
Sex 1.032 1.048 0.092 0.984 .327 .008
Education −0.247 0.411 −0.056 −0.600 .550 .003
Nicotine Dependence 0.879 0.242 0.342 3.633 < .001 .112
2 Age −0.051 0.041 −0.115 −1.247 .215 .013
Sex 0.664 1.030 0.059 0.645 .520 .003
Education −0.351 0.403 −0.080 −0.872 .385 .006
Nicotine Dependence 0.793 0.238 0.308 3.333 .001 .089
Anxiety Sensitivity 0.071 0.028 0.237 2.561 .012 .052
RFS-Negative Affect Reduction
Step b SE β t p sr2
1 Age −0.120 0.051 −0.211 −2.378 .019 .042
Sex 2.997 1.277 0.206 2.347 .021 .041
Education 0.076 0.501 0.013 0.152 .880 <.001
Nicotine Dependence 1.300 0.295 0.391 4.409 < .001 .146
2 Age −0.095 0.048 −0.167 −1.988 .050 .026
Sex 2.353 1.210 0.162 1.945 .055 .025
Education −0.107 0.473 −0.019 −0.226 .822 <.001
Nicotine Dependence 1.149 0.279 0.346 4.112 < .001 .112
Anxiety Sensitivity 0.125 0.033 0.321 3.820 < .001 .096
RFS-Pleasurable Relaxation
Step b SE β t p sr2
1 Age −0.038 0.021 −0.175 −1.807 .074 .029
Sex 0.389 0.527 0.071 0.737 .463 .005
Education 0.014 0.207 0.006 0.067 .946 <.001
Nicotine Dependence 0.344 0.122 0.273 2.824 .006 .071
2 Age −0.035 0.021 −0.163 −1.668 .099 .025
Sex 0.323 0.533 0.059 0.607 .545 .003
Education −0.005 0.208 −0.002 −0.022 .982 <.001
Nicotine Dependence 0.328 0.123 0.261 2.668 .009 .064
Anxiety Sensitivity 0.013 0.014 0.086 0.879 .381 .007
RFS-Stimulation
Step b SE β t p sr2
1 Age −0.029 0.028 −0.099 −1.031 .305 .009
Sex 0.230 0.709 0.031 0.324 .747 .001
Education −0.015 0.278 −0.005 −0.054 .957 <.001
Nicotine Dependence 0.546 0.164 0.322 3.337 .001 .099
2 Age −0.017 0.027 −0.057 −0.611 .543 .003
Sex −0.091 0.682 −0.012 −0.133 .894 <.001
Education −0.106 0.266 −0.036 −0.398 .691 .001
Nicotine Dependence 0.471 0.157 0.278 2.993 .003 .072
Anxiety Sensitivity 0.062 0.018 0.313 3.376 .001 .092
RFS-Sensorimotor
Model b SE β t p sr2
1 Age −0.035 0.029 −0.117 −1.211 .229 .013
Sex −0.288 0.721 −0.038 −0.399 .690 .001
Education −0.036 0.283 −0.012 −0.127 .899 <.001
Nicotine Dependence 0.573 0.166 0.332 3.444 .001 .105
2 Age −0.024 0.028 −0.082 −0.867 .388 .006
Sex −0.553 0.706 −0.073 −0.784 .435 .005
Education −0.111 0.276 −0.038 −0.403 .688 .001
Nicotine Dependence 0.511 0.163 0.296 3.133 .002 .082
Anxiety Sensitivity 0.051 0.019 0.255 2.700 .008 .061
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Note. Reasons for Smoking (RFS). N for analysis is 105.

*

Semi-squared partial correlations are reported.

3.3. Exploratory Analyses for RFS and Past Quit Attempt Engagement

Past quit attempt engagement was significantly and negatively correlated with habitual (r = −.21, p = .03), negative affect reduction (r = −.21, p = 03), stimulation (r = −.21 p = .03), and sensorimotor (r = −.12, p = .24) subscales. Multivariate logistic regression results indicated that smoking motives did not significantly predict past quit attempt engagement (habitual: B = −.08, SE =.08, p = .31; addictive: B = .13, SE = .09, p = .13; negative affect reduction: B = −.11, SE = .07, p = .11; pleasurable relaxation: B = .04, SE = .13, p = .79; stimulation: B = −.05, SE = .11, p = .65; sensorimotor: B = −.06, SE = .09, p = .53).

4. Discussion

The present study builds upon past work Kelly et al., (2020) to provide additional empirical evidence for anxiety sensitivity as a psychological vulnerability factor for higher motives to smoke among Black smokers interested in smoking cessation treatment. Partially consistent with expectation, anxiety sensitivity was positively associated with smoking motives related to the habitual behavior and negative affect reduction. Unexpectedly, anxiety sensitivity was also statistically and significantly related to the stimulation and sensorimotor domains of smoking motives. In contrast to expectation, anxiety sensitivity did not relate to motives for use associated with the addictive properties of smoking after adjusting for the number of analyses. The magnitude of the effect size for the statistically significant pathways, although small to moderate, are potentially clinically significant given they were present after controlling for age, sex, education, and nicotine dependence (sr2 ranged from .061 to .141). Additionally, simple correlation analyses revealed that the habitual, negative affect reduction, stimulation, and sensorimotor subscales related to not having a past quit attempt that lasted at least 24 hours. When entered into a model simulateously, no specific motive uniquely predicted past quit attempt engagement.

The findings that anxiety sensitivity was related to the habitual and negative affect reduction aspects of smoking motives were consistent with previous research (Leyro et al., 2008) and have now been replicated in a Black smoking sample. Unexpectedly, anxiety sensitivity was also related to greater sensorimotor and stimulation motives for smoking. Although speculative, one potential explanation for the relationship between anxiety sensitivity and sensorimotor motives could be that an individual who is particularly sensitive to their interoceptive cues (i.e., anxiety sensitivity) may also be more sensitive to the interoceptive process of smoking (Leyro et al., 2008) and thereby exhibit greater motives to smoke related to such experiences. Although sensorimotor motives may appear to be primarily focused on external stimuli, to some extent, they involve the bodily senses (e.g., watching the cigarette smoke being exhaled, touching/handling of the cigarette, the smell associated with lighting a cigarette; Ikard et al., 1969). Additionally, the relationship between anxiety sensitivity and stimulation motives is in line with previous research linking anxiety sensitivity to stimulant use (Buckner et al., 2011; Raines et al., 2021). Specifically, higher anxiety sensitivity may be a result of stimulant use, or in this case, using nicotine (a stimulant) instead of a cause of smoking itself (Raines et al., 2021) whereby greater anxiety sensitivity then serves to further contribute and maintain smoking-related stimulation motives. Additionally, past research has examined the role of smoking-related positive reinforcement and its association with anxiety sensitivity for these motives (Battista et al., 2008; Wong et al., 2013). Although some results were unexpected, they extend previous findings to a Black sample and fit into the larger context of extant research that has explored motives for use in White substance users (Battista et al., 2008; Brown et al., 2001; Leyro et al., 2008) and Black smokers who have experienced greater positive affect related to abstinence (Bello et al., 2016).

The current findings highlight the clinical relevance of anxiety sensitivity on motives to smoke for Black smokers. Specifically, targeting and reducing anxiety sensitivity among Black smokers may result in weaker motives to smoke. This pattern should be monitored, however, given the current association between smoking motives and quit attempt engagement as well as past reported associations between smoking motives and quit behavior among Black smokers (Bacio et al., 2014). Nevertheless, anxiety sensitivity reduction treatments have been found efficacious for smoking cessation (Smits et al., 2021). Moreover, due to the adaptable nature of anxiety sensitivity treatments, they could be further culturally tailored (e.g., target stress related to discrimination) to better help Black smokers quit smoking (Businelle et al., in press). Indeed, examining culturally-tailored treatments to reduce anxiety sensitivity in the context of smoking has the potential to address smoking-related health disparities experienced by Black smokers (Businelle et al., in press). Furthermore, anxiety sensitivity reduction programs for Black smokers could include content on the relation between anxiety sensitivity and smoking motives as well as how this relation and the underlying belief processes implicated in these relations may maintain smoking severity and interfere with quit success. Discussing these associations may have the potential to lessen the strength of smoking motives and ultimately lead to improved smoking and mental health outcomes. Finally, anxiety sensitivity attenuation interventions can be administered via in-person (Schmidt et al., 2014), remote (Norr et al., 2014), and digital formats (Garey et al., 2021), which provides an even greater opportunity to alleviate health disparities.

The findings should be considered within the context of the study limitations. First, these data are cross-sectional, which limits conclusions that can be drawn in terms of causality in the observed relations. Future work is needed to determine if the observed relationships are observed in a longitudinal context. Additionally, most of the sample was male, and the overall sample consisted of treatment-seeking smokers. Additionally, while participants in these data were not excluded based on anxiety sensitivity scores, approximately half the sample (48.57%) met the clinical cut-off for moderate-to-high anxiety sensitivity (Allan et al., 2014). As such, these findings may not generalize to the general population of Black smokers. Further, we did not include additional risk factors that may contribute to smoking motivation, such as negative affect (Gonzalez et al., 2008; Osman et al., 2010), in our models due to the limited sample size. Future work would benefit from examining multi risk models (e.g., including both anxiety sensitivity and negative affect in a single model) in predicting motives for smoking within a larger sample of Black smokers. Finally, all constructs of interest were examined via self-report. Thus, findings from the current study may be due, in part, to share method variance. Future work is needed to examine the proposed findings utilizing multi-method approaches (e.g., laboratory-based smoking paradigms).

Overall, the present findings uniquely build from past research on anxiety sensitivity and Black smokers by demonstrating that individual differences in this construct are consistently and relatively robustly associated with several smoking motives. Further, anxiety sensitivity was associated with smoking motives above and beyond other theoretically-relevant factors (i.e., age, sex, education, and nicotine dependence). Further, given mixed findings for the relation between smoking motives and cessation behavior among Black smokers, future research is needed clarify these relations and examine how smoking motives may relate to smoking cessation processes, including withdrawal, as well as the precise role of anxiety sensitivity in these relations.

Highlights.

  • Anxiety sensitivity was significantly related to habit motives

  • Anxiety sensitivity was significantly related to affect reduction motives

  • Anxiety sensitivity was significantly related to sensorimotor and stimulant motives

  • These results are novel especially for a Black smoker sample

Role of Funding Sources

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities to the University of Houston (U54MD015946) and the National Institute on Drug Abuse (F31DA043390; PI: Lorra Garey). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Conflict of Interest

All authors declare no conflicts of interest.

1

The unadjusted models for anxiety sensitivity on RFS subscales were as follows: habitual (R2 = .181, ΔF(1, 103) = 22.709, p < .001), addictive (R2 = .088, ΔF(1,103) = 9.946, p = .002), negative affect reduction (R2 = .171, ΔF(1,103) = 21.279, p < .001), pleasurable relaxation (R2 = .023, ΔF(1,103) = 2.394, p = .125), stimulation (R2 = .124, ΔF(1,103) = 14.631, p < .001), and sensorimotor (R2 = .084, ΔF(1,103) = 9.418, p = .003),

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