A new questionnaire designed to measure tobacco dependence, the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68), has uncovered surprising variability in the reasons people smoke.
"There is a great deal we don't know about tobacco dependence," says Megan Piper, a University of Wisconsin-Madison researcher and lead author of the article. "This measure helps us understand why people smoke and points us toward more individualized treatment for tobacco users."
Previous measures concentrated primarily on physical dependence, including questions about number of cigarettes smoked, smoking upon waking and smoking when ill. The WISDM-68 provides a more complete picture of smokers by rating responses to questions in 13 areas, including emotional attachment to smoking (cigarettes are my best friends), response to other smokers (most of the people I spend time with are smokers), smoking to relieve stress, smoking for mental stimulation (I smoke to keep my mind focused), and smoking automatically (I smoke without thinking about it). The 68-question measure was developed by the University of Wisconsin Transdisciplinary Tobacco Use Research Center.
Of special interest in this study were two groups of smokers-novice and experienced. Novice smokers (those who smoked fewer cigarettes over their lifetime) seemed to be more influenced by environment and sensation. Their motivations to smoke included: being in a smoking environment, cues (sights or smells) that encourage someone to smoke, and the taste and sensation of smoking. The experienced smokers were more influenced by cravings, automatic smoking, the need to smoke even when knowing the negative health effects, the use of smoking to enhance mental activity, and emotional attachment to smoking.
Components of the WISDM-68 also predicted relapse to smoking during a quit attempt. The motives most connected to smoking relapse were automatic smoking, smoking to enhance mental activity, smoking to alleviate distress, and being in a smoking environment.
"Using heaviness of smoking as our main criteria for determining tobacco dependence has limited our treatment options," Piper says. "Ultimately, being able to link certain motives with potential smoking relapse could help us prevent relapse during a quit attempt by better targeting and timing treatments." Currently, a "cold turkey" attempt has a 5 percent or less chance of success. With medication and counseling, the success rate jumps to 20-30 percent. The ultimate goal is a significantly higher success rate.
The WISDM-68 was developed using multiple dependence theories and tested using 775 participants in Madison and Milwaukee, Wis. Participants were at least 18 years old and had to have smoked at least one cigarette in the past 14 days. They were: 82 percent white, 11 percent African American, 1 percent American Indian and 2 percent Asian/Pacific Islander. Three percent were Hispanic.
Participants completed a longer form of the WISDM-68, two other dependence questionnaires, a smoking history questionnaire and a carbon monoxide analysis. The longer form was designed to ensure an adequate sampling of the entire motive. It was then statistically analyzed and reduced to 68 questions in 13 topic areas.
At this point, the WISDM-68 was used with two other dependence surveys as part of a smoking cessation study conducted in Madison and Milwaukee to determine its consistency with other current measures and its ability to predict important outcomes of tobacco dependence, such as relapse to smoking.
The University of Wisconsin Transdisciplinary Tobacco Use Research Center (TTURC) is one of seven centers funded by the National Cancer Institute and the National Institute on Drug Abuse to investigate new ways of combating tobacco use and nicotine addiction, using an innovative, integrated approach. The Robert Wood Johnson Foundation also funds the TTURCs at these institutions through the Partners with Tobacco Use Research Centers program. The Partners program supplements the TTURC research by supporting tobacco-related policy research and communications activities.