Cognitive and affective predictors of smoking after a sentinel health event

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type



Behavior and Behavior Mechanisms | Emergency Medicine | Psychiatry | Substance Abuse and Addiction


Objective: This study examined how smoking-related causal attributions, perceived illness severity, and event-related emotions relate to both intentions to quit and subsequent smoking behavior after an acute medical problem (sentinel event).

Methods: Three hundred and seventy-five patients were enrolled from 10 emergency departments (EDs) across the USA and followed for six months. Two saturated, manifest structural equation models were performed: one predicting quit attempts and the other predicting seven-day point prevalence abstinence at 14 days, three months, and six months after the index ED visit. Stage of change was regressed onto each of the other predictor variables (causal attribution, perceived illness severity, event-related emotions) and covariates, and tobacco cessation outcomes were regressed on all of the predictor variables and covariates.

Results: Non-White race, baseline stage of change, and an interaction between causal attribution and event-related fear were the strongest predictors of quit attempt. In contrast, abstinence at six months was most strongly predicted by baseline stage of change and nicotine dependence.

Conclusion: Predictors of smoking behavior after an acute medical illness are complex and dynamic. The relations vary depending on the outcome examined (quit attempts vs. abstinence), differ based on the time that has progressed since the event, and include significant interactions.


Tobacco, tobacco cessation, motivation, stage of change, reliability, validity

DOI of Published Version



Boudreaux ED, Abar B, O'Hea E, Sullivan AF, Cydulka R, Bernstein SL, Camargo CA Jr. Cognitive and affective predictors of smoking after a sentinel health event. Psychol Health Med. 2014 Aug;19(4):402-9. doi: 10.1080/13548506.2013.832781. Epub 2013 Sep 10. Link to article on publisher's site

Journal/Book/Conference Title

Psychology, health and medicine

Related Resources

Link to Article in PubMed

PubMed ID