In addition, early symptoms may serve as ��cues to action�� (Abraham & Sheeran, 2005), motivating smoking moreover cessation. Early physical symptoms associated with smoking occur in people with limited smoking histories and worsen over time (USDHHS, 1990, 1994). Arday et al. (1995) found that smoking-related symptoms, including coughing, wheezing, and shortness of breath without exercising, were greater in adolescents with a 4-year history of regular smoking than in never-smokers. Generally, the negative health consequences of smoking exhibit a dose�Cresponse relationship (Arday et al., 1995; Newcomb & Bentler, 1987). Psychosocial factors may worsen smoking-related symptoms Two prominent psychosocial factors have been associated with both smoking and long-term health outcomes: stress and depression (cf.

, Kassel, Stroud, & Paronis, 2003). Stress. Smokers experience greater stress levels than do nonsmokers (Parrott, 1999), a relationship also found among Black smokers (Romano, Bloom, & Syme, 1991; Webb & Carey, 2008). The elevated stress levels among urban Blacks (Ewart & Suchday, 2002) who are exposed to multiple sources of daily stress (Geronimus, 1992) also may affect the experience of smoking-related physical symptoms. Stress is an important consideration, given its relationship with disease onset and course (Harris, 2001) and cardiovascular health (Black & Garbutt, 2002). Depression. Substantial evidence supports the association between smoking and depression. The likelihood of depression among smokers is threefold that among nonsmokers (Murphy et al., 2003).

In addition, a history of depression is related to increased withdrawal symptoms (Breslau, Kilbey, & Andreski, 1992) and a reduced likelihood of cessation (Anda et al. 1990; Hall, Mu?oz, Reus, & Sees, 1993). However, the relationship between depression and smoking abstinence is still under debate, with a recent meta-analysis demonstrating no relationship (Hitsman, Borrelli, McChargue, Spring, & Niaura, 2003) and research among Blacks showing a negative association (Catley et al., 2005). Among Black women, depression is associated with both smoking and high blood pressure (Artinian, Washington, Flack, Hockman, & Jen, 2006). Alcohol use and smoking Alcohol use also has been implicated as a correlate of smoking (e.g., Dierker et al., 2006) and as a risk factor for negative health consequences, such as cancer and cardiac disease (Schlecht et al.

, 1999). Alcohol use also is positively associated Dacomitinib with smoking among Black women (Webb & Carey, 2008). Previous research has not examined the influence of alcohol use on short-term, smoking-related symptoms among Blacks. Theoretical model The biopsychosocial model provides a framework for examining relationships among physical symptoms and psychosocial and behavioral factors.