USING THE SOCIAL ECOLOGICAL MODEL AS A FRAMEWORK TO UNDERSTAND PSYCHOSOCIAL ENVIRONMENTAL VARIABLES THAT MEDIATE OR MODERATE NICOTINE ADDICTION

Despite increased awareness of the harms of cigarette smoking as well as improved prevention efforts, tobacco and smoking-related morbidity and mortality continue to be a leading cause of death and disability in the United States. This study used the Social Ecological Model (SEM) as a framework to explore four levels of influence on smoking behaviors. The SEM allows for an understanding of the complex and interactive effects of individual, relationship, community, and societal levels of influence that may contribute to behaviors like cigarette smoking. Understanding these effects may help clinicians, researchers, and educators to identify behavioral and community leverage points for health promotions within society. This study used archival data to explore the influence of several psychosocial environmental variables on cigarette smoking behaviors and uncover potentially causal (i.e., mediation) and relational (i.e., moderation) pathways present in the data. In the current study, negative binomial regression was utilized to explore whether specific psychosocial environmental variables at the different levels of influence outlined in the SEM act as mediators or moderators between participants' level of addiction to nicotine and their smoking cessation efforts in the last 12 months. Results indicated that mental health disorder status was a significant mediator and employment status, age at smoking initiation, history of a substance use disorder, and whether participants worked in a smoke-free environment each acted as moderators for the relationship between participants' level of addiction to nicotine and their number of quit attempts in the last year. These results have implications for understanding smoking behaviors and treating nicotine addiction. This analysis may be used to guide counselor education, smoking cessation interventions, and public policy as it relates to cigarette smoking and addiction