Quitting smoking: The importance of non-smoker identity in predicting smoking behaviour and responses to a smoking ban

Objective: We examined how ‘smoker’ and ‘non-smoker’ self- and group-identities and socio-economic status (SES) may predict smoking behaviour and responses to antismoking measures (i.e. the Dutch smoking ban in hospitality venues). We validated a measure of responses to the smoking ban.

Design: Longitudinal online survey study with one-year follow-up (N = 623 at T1 in 2011; N = 188 at T2 in 2012) among daily smokers.

Main outcome measures: Intention to quit, quit attempts and ‘rejecting’, ‘victimizing’, ‘socially conscious smoking’ and ‘active quitting’ responses to the smoking ban.

Results: Non-smoker identities are more important than smoker identities in predicting intention to quit, quit attempts and responses to the smoking ban, even when controlling for other important predictors such as nicotine dependence. Smokers with stronger non-smoker identities had stronger intentions to quit, were more likely to attempt to quit between measurements, and showed less negative and more positive responses to the smoking ban. The association between non-smoker self-identity and intention to quit was stronger among smokers with lower than higher SES.

Conclusion: Antismoking measures might be more effective if they would focus also on the identity of smokers, and help smokers to increase identification with non-smoking and non-smokers.     

Predictors of smoking cessation in Taiwan: using the theory of planned behavior

This study aimed to explore the factors predicting the intention to quit smoking and the subsequent behavior 6 months later using the theory of planned behavior (TPB). Data were obtained from 145 smokers who attended a smoking cessation clinic in a community hospital. All participants completed a questionnaire which included demographic information, TPB-based items, perceived susceptibility and previous attempts to quit. The actual quitting behavior was obtained by follow-up phone calls 6 months later. The TPB constructs explained 34% of the variance in intention to quit smoking. By adding perceived susceptibility, the explained variance was significantly improved to 40%. The most important predictors were perceived behavior control and perceived susceptibility, followed by attitude. Subjective norm did not contribute to the prediction of intention. Attitude and perceived behavior control contributed to the prediction of actual quitting behavior, but intention, subjective norm and perceived susceptibility did not. Our findings support that the TPB is generally a useful framework to predict the intention to quit smoking in Taiwan. The inclusion of perceived susceptibility improved the prediction of intention. With regards to successfully quitting, attitude and perceived behavior control played more crucial roles than other TPB constructs. Smoking cessation promotion initiatives focusing on reinforcing cessation belief, enhancing a smoker’s perception of their capability to quit smoking, and persuading smokers that they can overcome cessation barriers to cessation could make subsequent interventions more effective.     

Stages of readiness to quit smoking: population prevalence and correlates.

We examined the population prevalence and correlates of stages in smokers' readiness to quit, using data from 1,048 smokers recruited in a self-weighting, multistage, systematic clustered area sample from 0.44% of South Australian dwellings, with an 89% response rate. Smokers in the precontemplation stage comprised 24.1% of the sample, smokers in the contemplation stage comprised 47.2%, and smokers in the preparation stage comprised 28.7%. No sociodemographic variables (i.e., age, sex, marital status, educational level) were found to be significant independent predictors of membership in the different stages. The five significant independent predictors of being in the precontemplation stage (vs. the contemplation stage) were (a) having a higher confidence of quitting, (b) seeing fewer health risks associated with smoking, (c) not having made an attempt to quit, (d) seeing quitting as more difficult, and (e) smoking 25 or more cigarettes a day. The two significant independent predictors of being in the contemplation stage (vs. the preparation stage) were (a) having lower confidence of quitting and (b) not having tried to quit. We discuss implications for the understanding of smoking behavior in populations and also consider how cessation campaigns might address the factors associated with different stages of readiness to quit.     

The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation

Presents evidence for the validity of the Contemplation Ladder, a measure of readiness to consider smoking cessation. Analyses of data collected from more than 400 smokers at two worksites before and during a 10-month intervention indicate that Ladder scores were significantly associated with reported intention to quit, number of previous quit attempts, perceived co-worker encouragement to quit, and socioeconomic status. Ladder scores predicted subsequent participation in programs designed to educate workers about their smoking habit and its contingent risks. The Ladder did not predict biochemically validated abstinence of 24 hr or more. To assess its ability to distinguish between groups known a priori to differ in readiness, we administered the Ladder to 36 participants in a clinic-based smoking cessation program. As predicted, clinic patients scored significantly higher than the workers on the Ladder. The importance of distinguishing between smokers at the lowest stages of readiness to quit is discussed.     

Adolescent reasons for quitting smoking: initial psychometric evaluation.

Most adolescent smokers report intentions to quit, and the majority attempt cessation. However, little is known regarding the relationship between adolescent motives for cessation and smoking cessation efforts. To this end, the present study describes an initial evaluation of the psychometric characteristics of the Adolescent Reasons for Quitting scale (ARFQ), a measure of adolescent motives for smoking cessation. Participants were 109 current smoking high school students assessed at baseline and 6-month follow-up. The ARFQ item content and format was developed in a separate qualitative study with 36 high school students who had previously attempted to quit smoking. Exploratory factor analyses of ARFQ items yielded 3 subscales: Short-Term Consequences, Social Disapproval, and Long-Term Concerns. Validation analyses were conducted in relation to concurrent intentions to stop smoking and prospective smoking cessation attempts, providing evidence of concurrent, predictive, and discriminant validity. In particular, the Social Disapproval and Long-Term Concerns subscales significantly predicted subsequent cessation attempts. As such, the ARFQ may prove valuable for informing interventions to encourage adolescent smoking cessation.     

The role of prior quitting experience in the prediction of smoking cessation

Aims: In the Transtheoretical Model (TTM), the preparation stage (as applied to smoking cessation) is defined as planning to quit in the next 30 days plus having quit for at least 24 h in the last year. This study examined the value of prior quitting experience as a stage classification criterion by investigating whether prediction of making a quit attempt differed as a function of prior quitting experience. Participants: One thousand and forty-six participants, all planning to quit in the next 30 days, in a randomised trial of the effectiveness of a telephone counselling and computer-generated tailored advice intervention were followed up at 3 months. Findings: A multivariate predictive model had markedly greater capacity to predict making a quit attempt among participants with prior quitting experience (as defined in several different ways), compared to analyses of the overall sample. A previous attempt of 24 h in the previous month was associated with the greatest difference in prediction. A quit attempt in the previous year (the TTM definition) did not discriminate. Conclusions: Recent prior quitting experience moderated the predictive capacity of some variables that influence smoking cessation. The findings provide some support for a stage model of smoking cessation but not its operationalisation by the TTM.     

The effects of beliefs about smoking and health on smoking cessation

The purpose of this study was to examine whether beliefs of an American sample about smoking and health, as defined by cognitive orientation theory, would determine those smoking cessation program participants who would become abstainers and those who would not. Although the smoking cessation program was not designed to influence the specific kinds of beliefs studied, subscales measuring two of the four types of beliefs differentiated participants who would become abstainers from those who would not. Abstainers tended to have stronger goal beliefs about their desire to quit smoking, and stronger beliefs about the health-related implications of smoking. Participants' beliefs that they could resist an urge to smoke, which implied the use of coping skills, were more important in determining who would abstain from smoking than was their confidence that they could quit smoking, which implied the use of willpower.     

Simulating demand for cigarettes among pregnant women: A Low‐Risk method for studying vulnerable populations

A substantive obstacle to experimentally studying cigarette smoking and use of other tobacco products in pregnant women is the risk of adverse effects on mother and fetus from experimenter administration of the product of interest. The purpose of this study is to investigate bypassing that obstacle by using behavioral economic simulation tasks. In the present study we used the Cigarette Purchase Task (CPT) to simulate changes in demand for hypothetical cigarettes as a function of varying cigarette prices. Participants were 95 pregnant women who completed the CPT prior to participation in a smoking‐cessation trial. Aggregate and individual participant demand varied as an orderly function of price and those changes were well fitted by an exponential equation. Demand also varied in correspondence to two well‐validated predictors of individual differences in smoking cessation among pregnant women (cigarettes smoked per day, pre‐pregnancy quit attempts). Moreover, CPT indices were more effective than these two conventional variables in predicting individual differences in whether women made a quit attempt during the current pregnancy. Overall, these results represent a promising step in demonstrating the validity and utility of the CPT for experimentally examining demand for cigarettes, and potentially other tobacco and nicotine delivery products, among pregnant women.     

Personality traits, perceived risk, and risk-reduction behaviors: a further study of smoking and radon.

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12-month follow-up (p < .05). Risk perceptions also predicted reductions in the total number of cigarettes smoked in the home for participants in the video intervention who had high or moderate levels of extraversion (p < .01). Greater perceived risk predicted whether highly or moderately conscientious women quit smoking (p < .05). The moderating effects of personality traits should be considered when evaluating risk-reduction interventions.     

Demographic variables, smoking variables, and outcome across five studies.

OBJECTIVE: Intervention effectiveness can potentially be affected by membership in different demographic subgroups (race, ethnicity, gender, age, and education level) or smoking behavior variables (time to first cigarette, longest previous quit attempt, number of attempts in the past year, number of cigarettes, and stage of change). Previous research on these 2 sets of variables has produced mixed results. DESIGN: This secondary data analysis combined data from 5 effectiveness trials (a random-digit-dial sample [N=1,358], members of an HMO [N=207], parents of students recruited for a school-based study [N=347], patients from an insurance provider list [N=535], and employees [N=175]) in which smokers were all proactively recruited from a defined population and all received the same expert system intervention. The intervention produced a consistent 22% to 26% point prevalence cessation rate across the 5 studies. MAIN OUTCOME MEASURES: The main outcome measures were 24-hr point prevalence, 7-day point prevalence, 30-day prolonged abstinence, and 6-month prolonged abstinence. RESULTS: There were no significant differences in outcome across gender, race, and ethnicity subgroups. There were significant differences and small effect sizes for age and education subgroups. There were significant differences and large effect sizes for all 5 smoking behavior variables. DISCUSSION: Demographic variables are static variables, whereas the smoking variables are more dynamic, that is, open to change. Given the dynamic nature of the smoking variables and the large effect sizes, interventions tailored on the smoking variables should be more successful.     

Sex differences in predictors of adolescent smoking cessation.

Sex differences in predictors of smoking cessation were investigated among 337 male and 490 female participants in the RAND adolescent panel study. Participants reported smoking at least 11-20 times during the past year at Grade 10, with cessation defined as not smoking during the past year at Grade 12. Controlling for demographics, sex-specific analyses indicated that girls who quit smoking within 2 years had friends who smoked less frequently, perceived less parental approval of their smoking, had weaker intentions to continue smoking, used marijuana less frequently, attended fewer different schools, were more likely to have an intact nuclear family, experienced greater peer support, and rated themselves as healthier. Similar analyses for boys yielded results that were generally weaker and nonsignificant, with smoking quantity accounting for several associations in the sex-specific models. Despite these differences, interaction tests revealed significant sex differences for only three predictors. Implications of these results for understanding adolescent smoking cessation are discussed.     

The Relationship Between Attitudinal Ambivalence and Desire to Quit Smoking Among College Smokers1

Growing evidence shows that attitudes can exist on a bivariate rather than a bipolar plane. This conceptualization provides a more dynamic approach to studying how attitudinal ambivalence (i. e., evaluating an attitude object as both positive and negative) affects smoking‐related behaviors. Based on a sample of 157 college smokers, we obtained preliminary validational support for a smoking‐specific felt attitudinal ambivalence scale. Felt attitudinal ambivalence correlated positively with potential for ambivalence, negative attitudes, and negative as well as positive outcome expectancies related to smoking. Smokers who felt more ambivalent reported a greater desire to quit and were more likely to be contemplators, as defined by the transtheoretical model of behavioral change. In multivariate analyses, felt ambivalence toward smoking predicted desire to quit after controlling for positive and negative attitudes and negative smoking consequences. These results provide promising support for the smoking‐specific felt‐ambivalence scale, and suggest that attitudinal ambivalence should be investigated further as a motivational mechanism to affect smoking cessation.     

Specifying the determinants of the initiation and maintenance of behavior change: an examination of self-efficacy, satisfaction, and smoking cessation.

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.     

Self-efficacy expectations with regard to different tasks in smoking cessation

Abstract

Self-efficacy expectations are important psychological determinants of smoking cessation. The present study aimed at exploring different sorts of self-efficacy. The following self-efficacy scales were composed: Emotional self-efficacy, Social self-efficacy, Skill self-efficacy, Relapse self-efficacy and Try self-efficacy. In a sample of 752 smokers with low motivation to quit, two subsequent self-report measurements of self-efficacy were conducted. Firstly, we investigated to what extent potential sources of self-efficacy - quitting history and smoking behavior -were related to the types of self-efficacy. The explained variance in self-efficacy scores ranged from 4.4% to 23.1%, and in all five types of self-efficacy, smoking behaviour explained a higher percentage of self-efficacy than quitting history. The number of past quit attempts was only related to Relapse self-efficacy. Secondly, we investigated to what extent the different types of self-efficacy at T1 were predictive of quitting behavior measured at T2. The results showed that only Skill self-efficacy was predictive of quitting activity between Tl and T2. Point prevalence quitting at T2 was predicted by Skill self-efficacy and Relapse self-efficacy. The latter type of self-efficacy, however, was a negative predictor of quitting. The different types of self-efficacy can be mapped on two dimensions: The extent to which the means to accomplish a certain task are specified in the questionnaire item; and the phase of behavior change to which the self-efficacy tasks are relevant. Based on the findings from the predictive validity, it is concluded that the more clearly the means to accomplish the task are specified, the more valid the self-efficacy judgements are.     

Pretreatment task persistence predicts smoking cessation outcome

R. Eisenberger's (1992) learned industriousness theory states that individuals display differing degrees of persistence depending on their history of reinforcement for effortful behavior. These differences may influence the development, maintenance, and cessation of addictive behaviors. In cross-sectional studies, E. P. Quinn, T. H. Brandon, and A. L. Copeland (1996) found that cigarette smokers were less persistent than nonsmokers, and R. A. Brown, C. W. Lejuez, C. W. Kahler, and D. R. Strong (2002) found that smokers who had previously abstained for 3 months were more persistent than those who had never quit. The present study extended these findings by using a prospective design. A pretreatment measure of task persistence (mirror tracing) completed by 144 smokers predicted sustained abstinence throughout 12 months of follow-up. Moreover, persistence predicted outcome independent of other significant predictors: gender, nicotine dependence, negative affect, and self-efficacy.     

Self-efficacy and social support as predictors of smoking after a quit attempt

Abstract

The current study examined self-efficacy and social support as predictors of maintenance after an attempt to stop smoking. As in previous studies, self-efficacy at the end of treatment was a significant predictor of reported smoking during the follow-up period. At 3 months after treatment the prediction from self-efficacy was weaker than a prediction from the level of post-treatment smoking. However at 10 months self-efficacy was the strongest predictive variable assessed in the study. In contrast, social support for the quit attempt was not a significant predictor of maintenance at any stage. The results provided qualified support for the contention that self-efficacy can often be a more powerful predictor than previous performance attainments, especially under conditions of greater situational change.     

Implicit associations between smoking and social consequences among smokers in cessation treatment

Explicit expectations of the negative and positive social consequences of smoking are likely to have substantial influence on decisions regarding smoking. However, among smokers trying to quit, success in smoking cessation may be related not only to the content of expectancies about smoking's social effects but also to the ease with which these cognitive contents come to mind when confronted with smoking stimuli. To examine this possibility, we used the implicit association test (IAT) [Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74, 1464-1480] to assess implicit cognitive associations between smoking and negative vs. positive social consequences among 67 heavy social drinkers seeking smoking cessation treatment in a randomized clinical trial. Results showed that the relative strength of implicit, negative, social associations with smoking at baseline predicted higher odds of smoking abstinence during treatment over and above the effects of relevant explicit measures. The only variable that significantly correlated with IAT scores was the density of smokers in participants' social environment; those with more smoking in their social environment showed weaker negative social associations with smoking. Results suggest implicit cognition regarding the social consequences of smoking may be a relevant predictor of smoking cessation outcome.     

Mediation analysis of the association between use of NRT for smoking reduction and attempts to stop smoking

Objectives: Use of nicotine replacement therapy (NRT) for smoking reduction (SR) is linked to higher quit attempt rates than SR without NRT. This study aimed to assess the possible mediating roles of confidence in ability to quit, enjoyment of smoking and motivation to quit in this association.

Design: Cross-sectional survey.

Main outcome measures: Smokers were asked if they were currently attempting SR, and if they were, whether they were using NRT. Motivation to stop, enjoyment of smoking, confidence in ability to stop, and previous quit attempts, were also assessed.

Results: There was no evidence that confidence in ability to quit or enjoyment of smoking mediated the association between the use of NRT for SR and attempts to quit. Only motivation to stop partially mediated between the use of NRT for SR and attempts to stop (indirect effect: odds ratio 1.08, p?<?0.001).

Conclusion: Although this study is limited by its cross-sectional design, the findings point towards the possibility that the use of NRT to aid SR may promote attempts to stop through increasing motivation to quit but not by increasing confidence or by reducing enjoyment of smoking. Longitudinal studies are required to draw firmer conclusions about the possible mediating effects of motivation to quit.     

Investigating the Big Five Personality Factors and Smoking: Implications for Assessment

Global personality dispositions may be important for understanding population-based individual differences in smoking outcomes, yet few studies have been executed using measures of these global dispositional constructs from the contemporary field of personality. This study explored whether the Big Five personality factors (Extraversion, Neuroticism, Agreeableness, Conscientiousness, and Intellect) were concurrently associated with key smoking (e.g., nicotine dependence, smoking rate, age at first cigarette) and cessation (e.g., self-efficacy to quit, motivation to quit, number of prior quit attempts, length of most recent quit) variables in a sample of regular smokers (n = 130). Of the 35 correlations computed, only 2 were significant: Intellect was positively correlated with motivation to quit and number of 24-hr quit attempts in the last year. These results have implications for using trait variables to study individual differences in smokers.     

Smoking is ok as long as I eat healthily: Compensatory Health Beliefs and their role for intentions and smoking within the Health Action Process Approach

Compensatory Health Beliefs (CHBs) are defined as beliefs that the negative consequences of unhealthy behaviours can be compensated for by engaging in healthy behaviours. CHBs have not yet been investigated within a framework of a behaviour change model, nor have they been investigated in detail regarding smoking. Thus, the aim of this study was to investigate on a theoretical basis whether smoking-specific CHBs, as a cognitive construct, add especially to the prediction of intention formation but also to changes in smoking behaviour over and above predictors specified by the Health Action Process Approach (HAPA). The sample comprised 385 adolescent smokers (mean age: 17.80). All HAPA-specific variables and a smoking-specific CHB scale were assessed twice, 4 months apart. Data were analysed using structural equation modelling. Smoking-specific CHBs were significantly negatively related to the intention to stop smoking over and above HAPA-specific predictors. Overall, 39% of variance in the intention to quit smoking was explained. For the prediction of smoking, CHBs were not able to explain variance over and above planning and self-efficacy. Thus, smoking-specific CHBs seem mainly important in predicting intentions but not behaviour. Overall, the findings contribute to the understanding of the role of smoking-specific CHBs within a health-behaviour change model.