Anger and Cigarette Smoking

Transcription

1 122 ISSN: Anger and Cigarette Smoking Anuradha Bhandari* ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ABSTRACT A 4 2 factorial design was employed to study the effect of smoking status and gender on the experience, expression and control of anger in adult smokers. For this purpose 400 (200 males and 200 females) subjects were selected from four smoking status, that is, heavy smokers, light smokers, ex-smokers and non-smokers. They were administered Spielberger s State Trait Anger Expression Inventory. The findings revealed the role of anger in cigarette smoking in adult male and female smokers. INTRODUCTION Cigarette smoking is one of the most serious and widespread forms of addiction in the world. In 2000, World Health Organisation (WHO) study estimated that there were nearly 1.1 billion smokers in the world, 80% of them being in the developing countries. The South East Asian Region has the unhealthy distinction of having the second highest annual per capita growth rate in tobacco consumption among the six WHO regions. The current consumption rates for cigarettes range from 29% to 60% of men and 4% to 26% of women. In India, there are an estimated 240 million tobacco users, with 45 million of them being women tobacco users. The rates of tobacco use among children are also quite alarming in the region. India reports 5 million child smokers with 55,000 children starting regular tobacco use every year. Tobacco use and tobacco related illness is a serious public health problem. Worldwide, tobacco use is estimated to kill about 5 million people annually, accounting for 1 in every 5 male deaths and 1 in 20 female deaths of those over age 30. On current smoking patterns, annual tobacco deaths will rise to 10 million by Smoking kills more people every year than alcohol, other drug use, * Professor, Department of Psychology, Panjab University, Chandigarh.

2 Anger and Cigarette Smoking 123 homicide, suicide, motor vehicle accidents, fires and AIDS combined (Centers of Disease Control and Prevention, 1994). Research into the initiation and uptake of smoking have established the role of genetic factors (Eysenck, & Eaves, 1980; Heath & Madden, 1995); psychosocial and interpersonal factors (Chatrou, Maes, Dasseldor & Seeges, 1999; Killen, Robbinson, Heydel, Hayward, Wilson, Hammer, Litt & Taylor, 1997; Robinson, Klesges, Zbikowski & Glaser, 1997; Williams & Covington, 1997 and Wolfson, Claxton & Murray, 1997) and intrapersonal factors (Augustine & Mrinal, 1996; Chatrou, Maes, Dusseldorp & Seeges 1999; Gilbert & Gilbert, 1995; Kassel, Shiffman, Gnys & Paty, 1994; Lipkus, Barefoot, Redford & Seigler, 1994; McCann & Lester, 1996; Pomerleau, 1997; Robinson, Klesges, Zbikowski & Glasser, 1997; Schifano, Forza & Gallimberti, 1994; Spielberger, Foreyt, Goodrick & Reheiser, 1995 and Stacy, Sussman, Dent, Burton & Flay, 1992). In the context of latter perspective the role of anger has been examined by researchers in the recent past. Research evidence has demonstrated the relationship between anger and cigarette smoking. Gilbert and Hagen (1980) found that nicotine dampened down the body s stress response and calmed people down when they were watching a video showing horrible mutilation scenes. Individuals who are temperamentally prone to anger may find smoking rewarding because it provides them with relief from frequently occurring aversive states of anger or irritation (Gilbert, 1988). Cherek, Bennett and Grabowsky (1991) found increases in aggressive responding of smokers in nicotine abstinence conditions when compared to baseline ad lib smoking, whereas in nicotine gum conditions, no differences with baseline smoking could be established. Another set of studies (Elbert & Rockstroh, 1990; Spielberger, 1986) indicate that smokers derive reinforcing or emotional effects from smoking when in state of anger or irritation. Muller (1992) studied the more specific behavioural traits of aggression, controlled affect, guilt and social inhibition in two independent samples using the anger questionnaire. He found a significant difference between smokers and non-smokers on controlled affect. He further found that light smokers and non-smokers were less able to express anger in a socially accepted manner than medium smokers. Smokers also reported higher trait anger scores than non-smokers (Spielberger et al., 1995; Forgays, Forgays, Wrzcsniewski & Bonaiuto, 1993; and Pritchard & Kay, 1993). Spielberger et al. (1995) found that higher trait anger scores were associated with smokeless tobacco users and cigarette smokers as compared to nontobacco users. Cigarette smokers were more likely to suppress their anger than non-smokers. Forgays et al. (1993) found that smokers had a characteristic personality profile which included being anxious, angry and Journal of Indian Health Psychology

3 124 Anuradha Bhandari impulsive/antisocial. However, the findings of Reiter (1970) and Simon, Williams & Louis (1976) have failed to provide support for a positive association between smoking and anger/aggression. Witt, Kaelin, & Stoner (1988) showed no differences on the Anger-in and Anger-Control scores of Anger-Expression Scale between occasional smokers, current smokers, ex-smokers and nonsmokers. The current study attempts to replicate, refine and extend the research in this area by incorporating gender in its purview because ignoring gender was a serious methodological flaw in most of the earlier researches. METHOD Design A 4 2 factorial design was employed incorporating four categories of smoking status groups, namely, heavy smokers, light smokers, ex-smokers and non-smokers; and two gender groups, namely, males and females, with 50 subjects in each category. Sample The sample for the present investigation comprised of 400 subjects (200 males and 200 females) taken from the cities of New Delhi and Chandigarh. The subjects were selected according to their smoking status, that is, heavy smokers, light smokers, ex-smokers, and non-smokers; with 100 subjects in each category. Heavy smokers were defined as smokers who smoked more than 10 cigarettes per day; light smokers were defined as smokers who smoked less than 10 cigarettes per day; ex-smokers were subjects who had quit smoking at least three months before the study; and non-smokers were subjects who had never smoked. The age range of the subjects was 20 to 35 years. The subjects had an urban background, and generally belonged to the middle socio-economic status group. Tools The State Trait Anger Expression Inventory (STAXI: Spielberger, 1988) was administered to measure the experience, expression and control of anger (Kassinove, Sukhodolsky, Eckhardt & Isytsarev, 1997). The STAXI is a 44 item inventory, consisting of six subscales, namely, State Anger, Trait Anger, Anger-in, Anger-out, Anger-control and Anger Expression. The factor structure of the STAXI has received strong empirical support in a number of studies; Fuqua, Leonard, Masters, Smith, Campbell & Fischer, 1991; Spielberger, 1988; Spielberger, et al. 1995). Internal consistency coefficients for the subscales range from 0.70 to 0.89 indicating strong relationships among the scales items. The anger

4 Anger and Cigarette Smoking 125 experience and expression scales have good test-retest reliability, internal consistency, content, concurrent and discriminant validity and have a factor structure which is relatively uniform across criterion groups (Deffenbacher, 1992; Fuqua et al., 1991; Spielberger, 1988). Procedure The subjects were contacted personally and requested to volunteer for the study. They were assured that the results and any information they would give would be kept strictly confidential. The State Trait Anger Expression Inventory consists of three parts. The respondents were required to describe themselves in response to how they feel right now, for the state anger; how they generally feel, for the trait anger; and how they react when angry or furious, for the anger-in, anger-out and anger-control subscales respectively. The response format is a 4 point Likert scale, ranging from not at all, somewhat, moderately to very much so for part-1; and from almost, never, sometimes, often, to almost always, for part-2 and part-3, respectively. RESULTS AND DISCUSSION The data were analysed by using 4x2 analysis of variance and where required Scheffe s test of multiple comparisons was applied. Table 1 shows the means and standard deviations of the experience, expression and control of anger for the four smoking status groups (heavy smokers, light smokers, ex-smokers and non-smokers) and two gender groups. For state anger, the analysis of variance results revealed significant main effect for smoking status [F (3,393)=6.13, p<.01]. Use of Scheffe s test for multiple comparisons revealed that there were significant differences between heavy smokers and non-smokers (22.56, p<0.01), light smokers and nonsmokers (14.93, p<0.05). The main effect of gender and the interaction effect of smoking status and gender was found to be nonsignificant. For trait anger, the main effect of smoking status was found to be significant [F(3,392)=5.07, p<.01]. Also, the main effect of gender was found to be significant [F(3,392)=6.42, p<.05]. The interaction effect of smoking status and gender was found to be insignificant. For anger-in, only the main effect for smoking status was found to be significant [F(3,392)=3.88, p<.01]. The main effect of gender and the interaction effect of smoking status and gender was found to be insignificant for anger-in subscale of STAXI. Journal of Indian Health Psychology

5 126 Anuradha Bhandari TABLE 1 Comparison of Variables Across Smoking Status Groups, Gender Groups and the Interaction Effect (SS X G) Smoking Status Group Comparisons (SS) Gender Group Comparisons (G) Interaction Heavy Light Ex-smokers Non-smokers F P< Male Female F P< F P< Smokers Smokers Smokers Smokers A-State 15.36(6.6) 13.83(5.1) 13.18(4.0) 12.46(3.8) (4.8) 14.75(6.8) 0.05 NS 1.21 NS A-Trait 21.75(6.1) 21.52(5.0) 19.45(5.5) 19.66(5.0) (5.3) 22.06(5.9) NS AX/IN 18.00(5.0) 17.37(4.7) 15.95(3.9) 16.60(4.5) (4.1) 18.16(5.5) 0.98 NS 0.73 NS AX/OUT 17.44(4.7) 16.75(4.2) 16.21(3.6) 15.50(3.7) (4.0) 17.90(4.7) AX/CRL 20.44(5.6) 21.30(5.6) 23.14(5.8) 22.14(4.9) (6.0) 20.23(5.2) AX/EXP 31.00(9.4) 28.82(9.6) 25.02(8.7) 25.95(8.1) (9.3) 31.83(9.4) Note: Means (SDs) for smoking status and gender groups, analysis of variance and levels of significance for main effects and the interaction effect.

6 Anger and Cigarette Smoking 127 For anger-out, the main effect of smoking status [F(3,392)=4.29, p<.01] and gender [F(1,392)=12.10, p<.01] was significant. However, the main effects were modified by the significant interaction effect of smoking status and gender [F(3,392)=3.23, p<.05]. For anger control, the analysis of variance revealed significant main effects of smoking status [F(3,392)=4.66, p<.01], and gender [F(1,392)=19.29, p<.01]. These significant main effects, however, were moderated by the significant interaction effects of smoking status and gender [F (3,392)= 3.16, p <.05]. For anger expression, the main effect of smoking status [F(3,392)= 10.03, p<.01], and gender [F(1,392)= 23.44, p<.01] were significant. These significant main effects, however, are moderated by the significant interaction effects of smoking status and gender [F(3,392)=2.97, p<.05]. Perusal of the analysis of variance suggests that smokers differed significantly from ex-smokers and non-smokers on all the subscales of STAXI, namely, state anger, trait anger, anger-in, anger-out, anger-control and anger expression. Scheffe s test of multiple comparisons further revealed that heavy smokers scored significantly higher than ex-smokers and non-smokers on state anger, anger-out and anger expression. Heavy smokers were found to score significantly lower than ex-smokers on control of anger. For trait anger, the results are in line with the findings of Spielberger et al. (1995); Forgays et al. (1993); Pritchard and Kay (1993) who found that heavy smokers are higher on trait anger than non-smokers. The plausible reason derived from these studies emphasises that smoking provides relief to the individual from frequently occurring aversive states of anger or irritation. Elbert and Rockstroh (1990) postulated that reduction of aggression or feeling of anger and negative affects seems to be a motivational factor in smoking. Spielberger (1986) found that smokers smoke more when angered than in most other emotional and non-emotional states thereby indicating that smokers derive reinforcing effects from smoking when in a state of anger or irritation. The main effect of gender was found to be significant for trait anger, anger-out, anger-control and anger expression subscales of STAXI. Mean comparisons revealed that females were found to be higher than males on trait anger, anger-out and anger expression; and lower than males on the control of anger. McCann, Woolfolk, Lehrer & Schwarez (1987) found that women were more typified by the anger-in profile than men and were less likely to engage in aggression or outward expression of anger. These findings lend support to the inclusion of gender in the purview of the study for examining the relation between anger and smoking status. Journal of Indian Health Psychology

7 128 Anuradha Bhandari The interaction effect of smoking status and gender was significant for anger-out, anger-control and anger expression. A perusal of the results reveals that females in general scored higher than males on the outward expression of anger. Heavy smokers scored the highest and non-smokers scored the lowest on anger-out subscale. Female heavy smokers scored the highest followed by female ex-smokers and light smokers. Female non-smokers scored the least. The outward expression of anger increases with the level of smoking that is, when she is making a shift from light to heavy smoking. There is an increase in the outward expression of anger in female ex-smokers. This may be attributable to the stress associated with quitting smoking in females. The trend in males is different from that of females, where male light smokers scored the highest followed by male heavy smokers, male non-smokers and male ex-smokers. A perusal of the interaction effect of smoking status and gender on anger control reveals that males were higher than females on the control of anger. Females tend to be constant across the smoking status categories. The control of anger in males tends to rise as one progresses from heavy smokers to exsmokers. Male ex-smokers were highest on the anger control scores, suggesting the effective control and reduction of anger. They tend to invest a great deal of energy in monitoring and preventing the expression of anger. The interaction effect of smoking status and gender on anger expression reveals that females were higher on anger expression than males along the smoking status groups. Female heavy smokers were highest on anger expression followed by female light smokers, female ex-smokers and female non-smokers, there is a decreasing trend towards the non-smokers group. The anger expression in males tend to be varied along the smoking status groups, with the male ex-smokers scoring comparatively lower than the other smoking status group. These low scores on anger expression by male exsmokers could be attributable to more effective control and reduction of anger. The study clearly highlights the role of anger in cigarette smoking in adult male and female smokers. Further, smoking status and gender conjointly affect anger-out, anger-control and anger expression scores. REFERENCES Augustine, B., & Mrinal, N.R. (1996). Temperament type and sex roles of smokers. Indian Journal of Clinical Psychology, 23, Chatrou, M., Maes, S., Dusseldorp., E. & Seeges, G. (1999). Effects of the Brabant Smoking Prevention Programme: A replication of the Wisconsin Programme. Psychology and Health, 14,

8 Anger and Cigarette Smoking 129 Cherek, D.R., Bennett, R.H., & Grabowski, J. (1991). Human aggressive responding during acute tobacco abstinence: Effects of nicotine and placebo gum. Psychopharmacology, Deffenbacher, J.L. (1992). Trait anger: Theory, findings and implications. In Spielberger, C.D. & Butcher, J.N. (Ed.), Advances in Personality Assessment. Hillsdale, N.J.: Erlbaum, Elbert, T., & Rockstroh, B. (1990). Psychopharmakologie. New York: Springer. Eysenck, M., & Eaves, L. (1980). The Causes and Effects of Smoking. London: Maurice- Temple Smith. Forgays, D.G., Forgays, D.K., Wrzcsniewski, K., & Bonaiuto, P. (1993). Personality dimensions and cigarette smoking behavior in Polish and U.S. adolescents. Psychology and Health, 8, Fuqua, D.R., Leonard, E., Masters, M.A., Smith, R.J., Campbell, J.L., & Fischer, P.C. (1991). A structural analysis of the State-Trait Anger Expression Inventory. Educational and Psychological Measurement, 51, Gilbert, D.G., (1988). EEG and personality differences between smokers and non-smokers. Personality and Individual Differences, 9, Gilbert, D.G., & Hagen, R.L. (1980). The effects of nicotine and extraversion on selfreport, skin conductance, electromyographic and heart responses to emotional stimuli. Addictive Behaviours, 5, Gilbert, D.G., & Gilbert, B.O. (1995). Personality, psychopathology and nicotine response as mediators of the genetics of smoking. Behavior Genetics, 25, Heath, A.C., & Madden, P.A.F. (1995). Genetic influences on smoking behavior. In Turner, J. R., Cardon, I.R. and Hewitt, J.K. (Eds.), Behavior Genetic Approaches in Behavioral Medicine, Kassel, J.D., Shiffman, S., Gnys, M., & Paty, J. (1994). Psychosocial and personality differences in chippers and regular smokers. Addictive Behaviors, 19, Kassinove, H., Sukhodolsky, D.G., Eckhardt, C.L., & Isytsarev, S.V. (1997). Development of a Russion State-Trait Anger Expression Inventory. Journal of Clinical Psychology, 53, Kendler, K.S., Neale, M.C., Sullivan, P., Corey, L.A., Gardner, C.O., & Prescott, C.A. (1999). A population based twin study in women of smoking initiation and nicotine dependence. Psychological Medicine, 29, Killen, J.D., Robinson, T.N., Haydel, K.F. Hayward, C., Wilson, D.M., Hammer, L.D., Litt, I.F., & Taylor, C.B. (1997). Prospective study of risk factors for the initiation of cigarette smoking. Journal of Consulting and Clinical Psychology, 65, Lipkus, I.M., Barefoot, J.C., Redford, B.W., & Seigler, I.C. (1994). Personality measures as predictors of smoking initiation and cessation in the UNC Alumini Heart Study. Health Psychology, 13, Journal of Indian Health Psychology

9 130 Anuradha Bhandari McCann, B.S., Woolfolk, R.L., Lehrer, P.M., & Schwarez (1987). Gender differences in the relationship between hostility and the Type A behavior pattern. Journal of Personality Assessment, 51, McCann, N., & Lester, D. (1996). Smoking and stress: Cigarettes and marihuana. Psychological Reports, 79, 366. Muller, M.M. (1992). Do smokers differ from non-smokers in anger and anger coping? The investigation of a more specific and trait in the search for a smokers personality. Personality and Individual Differences, 13, Pomerleau, C.S. (1997). Co-factors for smoking and evolutionary psychobiology. Addiction, 92, Pritchard, W.S., & Kay, D.L. (1993). Personality and smoking motivation of U.S. smokers as measured by the State-Trait Personality Inventory, The Eysenck Personality Questionnaire and the Spielberger s Smoking Motivation Questionnaire. Personality and Individual Differences, 14, Reiter, H.M. (1970). Some E.P.P.S. differences between smokers and non smokers. Perceptual and Motor Skills, 30, Robinson, L.A., Klesges, R.C., Zbikowski, S.M., & Glaser, R. (1997). Predictors of risk for different stages of adolescent smoking in a biracial sample. Journal of Consulting and Clinical Psychology, 65, Schifano, F., Forza, G., & Gallimberti, L. (1994). Smoking habit and psychological distress in adolescent female students. The American Journal of Addictions, 3, Spielberger, C.D. (1986). Psychological determinants of smoking behavior. In Tollison, R.D. (Eds.). Smoking and Society: Toward a more balanced assessment. Lexington: D.C. Heath and Company, Spielberger, C.D. (1988). Professional manual for the State Trait Anger Expression Inventory. Odessa, Florida: Psychological Assessment Resources. Spielberger, C.D., Foreyt, J.B., Goodrick, G.K., & Reheiser, E.C. (1995). Personality characteristics of users of smokeless tobacco compared with cigarette smokers and non-users of tobacco products. Personality and Individual Differences, 19. Stacy, A., Sussman, S., Dent, C., Burton, D., & Flay, B. (1992). Moderators of peer social influence in adolescent smoking. Personality and Social Psychology Bulletin, 18, Williams, J.G., & Covington, C.J. (1997). Predictors of cigarette smoking among adolescents. Psychological Reports, 80, Williams, S., & Louis (1976). The personality of the cigarette smoker. International Journal of the Addictions II. Witt, E.M., Kaelin, J.A., & Stoner, S.B. (1988). Smoking behavior and anger. Psychological Reports, 63, Wolfson, M., Forstar, J.L., Claxton, A.J., & Murray, D.M. (1997). Adolescent smokers provision of tobacco to other adolescents. American Journal of Public Health, 87,