Differential Effects of Anxiety Sensitivity and Distress Tolerance on Cigarette Dependence across Black and White Racial Groups: Evidence from a Treatment-Seeking Sample
Introduction
Rates of smoking-related cancers and mortality are greater among Black individuals who use cigarettes when compared to White users. Current research also indicates Black cigarette users are less likely, relative to White cigarette users, to quit smoking cigarettes. The coupling of these trends is of great concern from a public health perspective. Such findings also highlight a need for further research on risk and resiliency factors related to cigarette dependence within the Black community. Accordingly, this investigation was developed to examine two relevant yet understudied psychological constructs - anxiety sensitivity (AS) and distress tolerance (DT) - as predictors of cigarette dependence across Black and White subgroups of treatment-seeking cigarette users. It was hypothesized that the predictive power of AS and DT on cigarette dependence scores would be greater among Black cigarette users versus White cigarette users. Group differences in AS, DT, and cigarette dependence were also explored.
Methods
The current sample consisted of 134 adult cigarette users (Mage = 45.7, SDage = 12.3; 57% Male) seeking smoking cessation treatment. Data used for analyses were derived from baseline screenings of a parent clinical trial presented as a smoking cessation protocol developed to help cigarette users who experience difficulties related to anxiety or depression successfully quit cigarettes. Participants completed a battery of well-validated self-report measures assessing demographic characteristics, anxiety sensitivity (Anxiety Sensitivity Inventory – Short Scale), distress tolerance (Distress Tolerance Scale), and cigarette dependence (Fagerström Test for Cigarette Dependence).
Results
When controlling for sex and age, no statistically significant differences in AS, DT, and cigarette dependence were observed between Black (n = 87) and White (n = 47) subsamples (p’s > .05). When testing the entire available sample together (N = 134), both AS (sr2 = .06, b = .08, p = .018, 95%CI[.01, .15]) and DT (sr2 = .08, b = -.55, p = .007, 95%CI[-.95, -.15]) were significantly associated with cigarette dependence scores. Directionally, the pattern of these effects was similar when retesting the model within the all-Black subsample. Whereas AS was positively and significantly associated with cigarette dependence (sr2 = .12, b = .11, p = .010, 95%CI[.03, .19]), DT was significantly and inversely associated with cigarette dependence scores (sr2 = .11, b = -.67, p = .011, 95%CI[-1.18, -.16]). In contrast, when testing the proposed models within the all-White subsample, neither AS (b = .03, p = .552, 95%CI[-.08, .15) nor DT (b = -.39, p = .271, 95%CI[-1.10, .32]) shared a statistically significant association with cigarette dependence scores when controlling for age and sex.
Conclusion
Findings suggest that as a population, Black cigarette users may be especially at risk of developing or maintaining dependence due to affect-driven smoking behavior (e.g., smoking to soothe anxious arousal, unwillingness to sit with withdrawal-related distress). The observed effects offer important clinical and theoretical considerations while providing direction for future research. For example, Black cigarette users may find cessation-related treatments that target emotion regulation processes to be more relevant to their experiences relative to White cigarette users with equal degrees of AS and DT. Future research is encouraged to explore these possibilities and to determine the replicability of these observed effects.