Tobacco consumption is usually considered to be a double-edged sword which has negative impacts on public health and human longevity regardless of its positive effect on economic growth. Studies have found that as an unhealthy lifestyle, cigarette smoking could reduce people’s life span by an average of 7 years due to the complex compounds that cigarettes may contain, while most of which are carcinogens in human [1]. Those who got used to smoke in public not only undermined their own physical health, but also had the health of people around them endangered when they were smoking.
Cigarette smoking is presently found to be positively associated with nearly 40 diseases and causes of death for human, such as vascular diseases, oral diseases, chronic obstructive pulmonary disease (COPD), cancer of the lung, cancer of the liver, cancer of pancreas, cancer of renal pelvis and so on [2]. Smokers who have already formed the smoking habits are more likely to suffer from lung cancers than never smokers [3]. However, never smokers who expose themselves to environmental tobacco smoke (ETS) are also at high risks of various chronic diseases and cancers [4].
China is the country with the biggest tobacco consumption in the world [5]. The number of smokers in China had reached at least three hundred million in 2011 [6]. It was reported that the overall prevalence of tobacco smoking in China was up to 31.4% accounting for a quarter of the world’s total smokers, while the total premature mortality resulting from cigarette smoking was 7.9% and the tobacco-related deaths were estimated to be 1 million annually in China [7, 8]. These reported data may suggest that the tobacco control in China still needs improvement.
Generally speaking, the more the tobacco is consumed and the earlier the individual smokes, the greater the harm to the body as well as the higher the addiction will be. In terms of the incidence of different cancers in China, the incidence of lung cancer ranked fourth in the 1970s and 1990s, whereas the incidence of lung cancer was constantly upgrading and had reached the highest among all kinds of cancers since 2000, the death rate from lung cancer had increased by 465% in the last 30 years accompanying with the remarkable increase of tobacco consumption [9].
The relation between physical health and cigarette smoking has been revealed in many studies, these studies have also indicated the current situation of smoking control in China is not optimistic, especially for Chinese youths and college students [10, 11]. College students in China are more likely to smoke than others for some reasons. Firstly, Chinese culture is featured by Confucian and collectivism [12]. Given this kind of cultural influence, college students commonly prefer to imitate peers’ smoking behaviors in order to socially integrate into the surroundings. Smoking has become the social label and peer bond for their relationships with others. Moran [13] has identified these young smokers as “social smokers” who show less intentions to quit smoking; secondly, college students are usually interested in the things they have never come across. The curiosity on the new things and new experiences may lead them easily to smoke; thirdly, college students in China have to face fierce competition and learning stress at school. The competition and learning stress can increase the risks of smoking through which college students enable themselves to control and relieve their feelings of tension and stress [14].
In most cases, cigarette smoking is usually viewed as the method to mitigate one’s anxiety and depression. For example, Hong et al. [15] applied different questionnaires to investigate 1068 fishermen, the impact of nicotine dependence upon negative emotions was revealed that nicotine dependence could partially counteract the negative effect of work stress upon depression and anxiety. With heavy work stress, fishermen often exhibited high levels of depression and anxiety. By the inhaling of cigarettes, the levels of depression and anxiety could be reduced for fishermen. Picciotto et al. [16] had also argued that the mitigation of negative emotions through cigarette smoking existed from the perspective of physiology, it was concluded that the physiological mechanism of cigarette smoking was due to the broad expression of nicotinic acetylcholine receptors (nAChRs), which further ascertained the positive effect of tobacco use upon emotional adjustment.
Despite the positive effect of tobacco use through which one can alleviate the levels of depression and anxiety, tobacco use is still harmful to the body. Moreover, excessive nicotine intake always produces biological adaption that could lead to the opposite effect and strengthen the smokers’ existing depressions and anxieties, or even induce smoking-abstinence-related negative affect [16, 17]. Therefore, due to plenty of hazards of smoking behaviors, effective tobacco prevention programs conducted in China especially for Chinese college students are necessary.
The present study
Although many studies have explored the impact of cigarette smoking upon emotion and cognition [15,16,17,18], few of them have discussed whether negative emotions could contribute to the enhanced susceptibility of smoking behavior or not. In other words, appropriate cigarette smoking will certainly help regulate negative emotions while the likelihood of emotion-induced smoking behavior is not yet unveiled.
In order to verify the conviction that negative emotions could facilitate college students’ smoking behaviors, learning burnout and psychological distress are taken into consideration in this article as the predictors of smoking behavior. Stoliker and Lafreniere [19] have pointed out that stressors such as learning burnout have become a common problem among students and something that they usually encounter during their educational career. Learning burnout is mainly the internal threat giving rise to college students’ mental health problems and unhealthy behavioral habits. Not only is learning burnout defined as a negative emotional state but also does it relate to psychological distress [19, 20]. The Chinese students who were haunted in the learning burnout usually failed the academic performance as well [21]. As a result, they would have to bear the enormous pressure from outside and inside, followed by the high levels of psychological distress and the increased inclinations of smoking.
However, due to a variety of factors including learning burnout and mental health problems might contribute to the inclination of cigarette smoking in theory, the influence of more possible variables would be explored in this article. This article aimed at building a multivariate logistic model to predict the smoking behaviors of college students based on a wide range of independent variables such as age, gender, majors, socioeconomic status (SES), family environment (FE), peer influence, learning burnout and psychological distress so that college students’ smoking behaviors could be accurately predicted and intervened. Among all these variables, learning burnout and psychological distress were expected to be strongly associated with smoking behaviors. Therefore, we will explore the relationships among learning burnout, psychological distress and smoking behavior through empirical research, discover the possible mediation mechanism behind these variables and figure out the predictive power of different variables on smoking behavior. For these purposes, we further made three assumptions as follows.
Hypothesis 1: Various demographic variables would predict smoking behavior
Previous literature had confirmed that smoking behavior was significantly associated with age, gender, majors, SES, FE, peer influence [22,23,24]. Those people featured with high age (versus low age), male (versus female), art majors (versus science and engineering majors), high SES (versus low SES), disharmonious and broken FE (versus harmonious and complete FE) were more likely to smoke. Thus, age, gender, majors, SES and FE would be the demographic variables included in this article to verify the findings of previous studies.
In addition, Wang et al. [24] had argued that friendship was also an inescapable factor that influence people’s smoking decisions. Based on the data they collected, Wang et al. [24] compared people who had the increased number of smoking friends from 1989 to 1993 with those who had the decreased number of smoking friends during the same period, they found that people with the increased number of smoking friends were more likely to smoke. It seems not only does the quality of the friendship matter, but also what kind of friends people usually choose to make may to some extent determine the smoking behaviors. Thus, for purpose of verifying the conviction that the type of friends college students chose to make would affect their smoking behaviors, the predictive power of peer influence on smoking behavior was evaluated by setting up an item like this: do you have any friends who usually smoke around you.
Hypothesis 2: Learning burnout and its different dimensions significantly affect smoking behavior
According to the theory of planned behavior (TPB) that was first come up with by Ajzen in 1988, perceived behavioral control (PBC), subjective norm (SN) and attitude, were constructed as the essential factors to predict individual’s specific intention and behavior [25]. PBC refers to people’s perception of the ease or difficulty of performing the behavior of interest. It was treated as the concept of self-efficacy which was first proposed by Bandura and his associates within a general framework [26]; Correlated with PBC in the TPB model, SN is a social factor that refers to the perceived social pressure to perform or not to perform the behavior, and attitude refers to the degree to which a person has a favorable or unfavorable appraisal of the behavior [26]. It was convinced that all of these constructs in TPB model were available to predict a variety of health behaviors in many specific contexts [27]. In term of smoking behavior, TPB had already been confirmed to be the effective model to predict smoking behavior with all of its contents including PBC, SN and attitude significantly related to smoking behavior [28].
Although TPB was useful to predict smoking behavior, the effect sizes between TPB constructs and smoking behavior were relatively small [29]. As Mohiyeddini et al. [30] have argued, while TPB commonly shows high predictive power with respect to intention, it often falls short in the prediction of behavior, the key role in bridging the intention-behavior gap is emotion. In this sense, emotion should be added as the antecedent variable of smoking behavior in the TPB model.
Following this clue, we assumed that learning burnout as an emotional factor might relate to smoking behavior closely. Ling et al. [31] have concluded that learning burnout has three dimensions: emotional exhaustion, cynicism and learning efficacy. Emotional exhaustion refers to students’ feelings of tiredness after learning. The individual who undergoes emotional exhaustion will excessively consume the inner cognitive resource and thus perform a sense of fatigue. He or she will eventually exhibit no extra enthusiasm and energy on learning and possibly other behaviors such as smoking. So theoretically, it was predicted that emotional exhaustion would lead to the decreased inclination of smoking behavior.
Besides the emotional exhaustion, the remaining dimensions of learning burnout are similar to the whole constructs in TPB model (as shown in Fig. 1). Since TPB model has been proven to be useful in the prediction of smoking behavior [29], it is thereby crucial to find out the theoretical connections between the dimensions of learning burnout and TPB model. However, these connections are made possible. Specifically, the three constructs in TPB model are found to correspond respectively to the two remaining dimensions of learning burnout.
As one of the dimensions of learning burnout, learning efficacy shares the common origin with PBC though their directions vary. That is, PBC in this case refers to the perceived ease or difficulty of smoking behavior management whereas learning efficacy points to the perceived ease or difficulty of learning. Due to the conceptual similarity between these two variables, we contended that learning efficacy could affect smoking behavior through PBC for people’s disposition of transferring similar knowledge from one area to another [32].
Cynicism, as another dimension of learning burnout, resembles the attitude and SN in TPB model. Cynicism by definition contains two meanings: one is that it represents the preference of learning or to what extent students hate to study, which can be regarded as the construct of attitude in TPB model; The other meaning that cynicism embodies is the students’ reflections on what kind of social influence learning would produce and what kind of social pressure they would have to face once the poor academic performances happen. Thus, SN which represents the perceived social pressure to quit smoking and cynicism which embodies social pressure to keep learning are the intertwined variables with conceptual similarity. From this point of view, cynicism can be regarded as SN or attitude toward learning behavior, with its highly probable influence on smoking behavior through SN and attitude toward smoking by transfer learning.
In sum, learning efficacy and cynicism are two dimensions of learning burnout corresponding to PBC, SN and attitude in TPB model. Meanwhile, according to the viewpoint that people’s knowledge gained from one specific case can then be transferred to the novel situation naturally [32], it is reasonable to predict that learning efficacy and cynicism can affect smoking behavior through PBC, SN and attitude. Consistent with the above-mentioned inferences, we hypothesize that learning burnout and all its different dimensions could affect smoking behavior.
Hypothesis 3: Learning burnout and its dimensions mediate the relation between psychological distress and smoking behavior
The self-medication hypothesis postulates that individuals always turn to smoking to alleviate the symptoms and therefore suggests that symptoms of depression and anxiety may lead to smoking [33]. Individuals with mental illness and symptoms of depression and anxiety tended to start smoking at an earlier age, smoke more heavily, and were more addicted to cigarettes than the general population [33]. Therefore, mental illness may play an important role on tobacco use, the link has often been taken to reflect a causal relationship, with poor mental health predisposing to regular tobacco use [34]. This phenomenon was specifically found in White individuals and pregnant women instead of Black or Hispanic individuals [28, 35].
Given the relation between mental health and smoking behavior, there is a plausible prospect that psychological distress which synthesizes all kinds of mental health problems is capable of affecting the occurrence of smoking behavior.
Although learning burnout and psychological distress are both likely to influence smoking behavior, in TPB model, learning burnout and all its dimensions are closer to smoking behavior than psychological distress. Likewise, some studies have shown that mental disorders can lead to lowered academic achievement, college dropout, and worse functioning in later life [36, 37], so we hypothesize psychological distress could affect the inclination of smoking behavior through learning burnout and its dimensions for the same purpose of revealing the concealed mechanism behind emotion-induced smoking behaviors for college students.
