Examining the Relationship Between Social Anxiety and Cigarette Smoking: Smoking to Cope -- N. L. Watson; J. P. Dempsey; J. VanderVeen; J. C. Gottlieb; L. M. Cohen
Smoking rates are higher among individuals diagnosed with social anxiety disorder when compared to the general population (NIDA, 2009; Lasser et al., 2000). In fact, previous research suggests that social anxiety disorder and sub-threshold social anxiety may be risk factors for nicotine dependence later in life (Sonntag, Wittchen, Hofler, Kessler, & Stein, 2000). It has been suggested that such individuals may initiate smoking to cope with their anxiety and that smoking behaviors may be maintained as a result of such smoking expectancies (Morissette, Tull, Gulliver, Kamholz, & Zimering, 2007). However, only one study to date has been conducted examining this relationship. Further, results from this study indicate that individuals with social anxiety report smoking to cope (STC) with their symptoms (Junghans, Lovett, Eldridge, Grant, & Dempsey, 2009). Therefore, the primary aim of the present study was to further elucidate the relationship between symptoms of social anxiety and smoking to cope. METHODS: 1800 undergraduates enrolled in Introduction to Psychology courses completed surveys that included an assessment of self-reported levels of social anxiety (LSAS; Heimberg et al., 1999) and a questionnaire on smoking to cope with social anxiety (STC) based upon the Drinking to Cope Questionnaire (Thomas, Randall, Book, & Randall, 2008). Additionally, they were asked to rate the degree to which they engage in 12 STC behaviors designed to alleviate symptoms of social anxiety. Participants were excluded if they were not tobacco users (n = 1546) or had illogical response patterns (n = 39). Thus, 215 participants were included in the present analyses, with a classification of being socially anxious (SA; n = 34) or not (NSA; n = 181). RESULTS: 57.2% of the sample reported STC behaviors. Analyses indicated a significant between-groups difference in the proportion of situations in which participants engaged in STC behaviors [F (1, 121) = 21.18, p < .001]. Further, SA participants reporting engaging in STC behaviors in 62.41% (SD = 33.67) of social situations and NSA participants reporting these behaviors 37% of the time (SD = 23.19). Additionally, SA participants reported avoiding social situations significantly more often than NSA participants [F (1, 120) = 6.190, p < .05]. Groups were then tested for differences on average goal endorsement, with 9 of the 12 STC-related goals being significantly different between groups. These goals included “to avoid making eye contact” [F (1, 119) = 19.296, p < .001] and “to have an excuse to temporarily leave the social situation” [F (1, 119) = 14.990, p < .001], with SA individuals reporting using STC behaviors to achieve these goals to a higher degree. These results provide evidence for the notion that a large proportion of socially anxious individuals who smoke do, in fact, smoke to cope with their symptoms of social anxiety. This study also highlights the specific smoking expectations that these individuals may have. Further, these findings suggest that more research is needed to better understand the underlying mechanisms of smoking acquisition, maintenance, cessation, and relapse in order to improve upon prevention and intervention efforts targeting this population of smokers.