Relationships Between Stress, Negative Emotions, Resilience, and Smoking: Testing a Moderated Mediation Model

ABSTRACT

Objective: More effective tobacco prevention and cessation programs require in-depth understanding of the mechanism by which multiple factors interact with each other to affect smoking behaviors. Stress has long been recognized as a risk factor for smoking. However, the underlying mediation and moderation mechanisms are far from clear. The purpose of this study was to examine the role of negative emotions in mediating the link between stress and smoking and whether this indirect link was modified by resilience. Methods: Survey data were collected using audio computer-assisted self-interview (ACASI) from a large random sample of urban residents (n = 1249, mean age = 35.1, 45.3% male) in Wuhan, China. Perceived stress, negative emotions (anxiety, depression), resilience were measured with reliable instruments also validated in China. Self-reported smoking was validated with exhaled carbon monoxide. Results: Mediation analysis indicated that two negative emotions fully mediated the link between stress and intensity of smoking (assessed by number of cigarettes smoked per day, effect =.082 for anxiety and.083 for depression) and nicotine dependence (assessed by DSM-IV standard, effect =.134 for anxiety and.207 for depression). Moderated mediation analysis demonstrated that the mediation effects of negative emotions were negatively associated with resilience. Conclusions: Results suggest resilience interacts with stress and negative emotions to affect the risk of tobacco use and nicotine dependence among Chinese adults. Further research with longitudinal data is needed to verify the findings of this study and to estimate the effect size of resilience in tobacco intervention and cessation programs.

KEYWORDS:

• Cigarette smoking
• stress
• resilience
• moderated mediation
• nicotine dependence

Funding

This work was supported by the National Institutes of Health [grant number R01 MH086322].

Additional information

Notes on contributors

Yan Wang

Yan Wang, PhD, is a postdoctoral fellow of epidemiology at University of Florida. With doctoral training in developmental psychology and postdoctoral in public health, her research work focuses on applying contemporary social cognitive psychology theories and cutting-edge analytical strategies to advance health research, including but not limited to developing more accurate measurement of sensitive questions, investigating the interactive relationships between multiple risk/protective factors in health behaviors, and improving intervention programs by integrating both implicit and explicit systems of thinking. Her work has been published in the top-rated peer review journals such as Journal of Adolescence, Drug, and Alcohol Dependence.

Xinguang Chen

Xinguang Chen, MD, PhD, is a full professor of epidemiology at University of Florida. As a grants funded research, his work focuses on the behavioral etiology and prevention intervention strategies for chronic disease and health behavior, particularly substance use, internet addiction and HIV-related behaviors with over 190 peer-reviewed publications. He also devotes his efforts to developing cutting-edge measurement and modeling methodologies for epidemiological research. In addition to his busy research agenda, Dr. Chen serves on the editorial boards for several journals as Academic Editor, Associated Editor, and Guest editor.

Jie Gong

Jie Gong, MD, PhD, is a full professor of epidemiology and Vice Director, Wuhan Center for Disease Prevention and Control (Wuhan CDC), Wuhan. China. Her work focuses on the epidemiology and intervention for chronic diseases prevention and control through public health policies and community based programs. Her areas of interests include substance use, internet addiction, and physical activities as they related to health and disease and prevention intervention. She also devotes her efforts to develop public health strategies for infectious and chronic noninfectious diseases. She is funded researcher with long-term international collaboration with a total of more than 200 peer-reviewed articles in Chinese and English.

Yaqiong Yan

Yaqiong Yan, MD, PhD, is an associate chief physician at Wuhan Centers for Diseases Prevention and Control, Wuhan, China and currently serves on the Youth Commission of the National Health Statistics Branch of Chinese Health Information Institution. Dr. Yan received her MD from Wuhan University and PhD from Huazhong University of Science and Technology. Her work focuses on the chronic and noninfectious disease prevention and control, monitoring and evaluation of behavioral risk factors, and prevention intervention. Guided with various health behavior theories, she participated in research to develop and evaluate a series of behavioral interventions to reduce tobacco use and to encourage physical activities for chronic disease prevention.