Negative affect, stress, and smoking in college students: Unique associations independent of alcohol and marijuana use

Introduction: Stress and negative affect (NA) figure prominently in theoretical models of smoking initiation, maintenance and relapse, yet few studies have examined these associations among college students. Further complicating examination of these associations, smoking often occurs in the context of other substance use (e.g., alcohol, marijuana) in college populations. Thus. it remains unclear whether stress and NA are associated with cigarette use among college students, and if so, whether these associations are evident after controlling for effects of other substance use. The goals of this study were: a) to examine whether several aspects of stress (objective events, subjective experiences) and NA (sad mood, general emotional distress) were associated with cigarette smoking among college students and b) whether associations remained after accounting for alcohol and marijuana use. Sample: A large sample of college freshmen (N=633) followed longitudinally over 35 weeks via internet assessments. Results: Results of hierarchical linear modeling demonstrated that measures of subjective stress and NA were positively related to cigarette use, whereas measures of objective stressful events were negatively related to cigarette use. When alcohol and marijuana use were added to the models, associations between smoking and stress/NA were diminished. Associations between NA and smoking remained significant; however, associations between subjective stress/stressful events and smoking were no longer significant. Conclusions: This is the first study to comprehensively examine links between subjective and objective measures of stress and smoking behavior among college students while also considering the influence of other substance use. Negative affect was the most robust correlate of smoking among college students. Subjective and objective stress do not appear to be strongly associated with college smoking above and beyond alcohol and marijuana use. Stress may not be an important etiological factor for relatively low levels of cigarette use among college students. Given that relations between NA/stress and cigarette smoking were diminished when concurrent alcohol and marijuana use was considered, it is imperative for future studies of college students to consider other substance use. (C) 2009 Elsevier Ltd. All rights reserved.