Value change and relapse following a decision to quit or reduce smoking

Ainslie (1975) suggested a model according to which values change subsequent to decision and in which the value of a smaller, immediately available, reward increases at a faster rate than that of a later reward. The rank orde between the two rewards may therefore become reversed, leading to impulsive behavior. The assumptions of this model as applied to addition are discussed. As an alternative, it is suggested that values and beliefs may be more indicative of stereotypical, biased thinking during the course of an attempt to quit. A study of 23 smokers who tried to quit or reduce smoking supported the latter view rather than the Ainslie model However, neither approach was successful in accounting of relapses. This may be because action is hard to predict from beliefs and values, and it may more suitably be accounted for by desires and emotional states, the latter most importantly because they affect the ability of self-monitoring.     

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.     

Perceived health: a test of incremental validity in relation to smoking outcome expectancies, motivation to smoke and desire to quit smoking

This study examined the role of perceived health in predicting theoretically-relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.     

Persuasive constraint and expert versus non‐expert influence in intention to quit smoking

In a 2 × 2 design, after listing important personal reasons for smoking, 70 smokers were randomly told either that they had sufficient reasons for smoking (low internal constraint to change) or that they did not have sufficient reasons (high internal constraint to change) and were exposed to an anti‐smoking message from a source with either expert (high external constraint to change) or non‐expert (low external constraint to change) status. The main dependent variable was change in intention to give up smoking. The analyses revealed the predicted interaction between external and internal constraint: High internal constraint increased non‐expert influence but not expert influence. Supplementary analysis showed that, when internal constraint was high, non‐expert influence was related to the perceived quality of the message whereas when internal constraint was low, expert influence was related to the source's perceived motivation to inform, i.e. rather than to convince. These results were predicted on the basis of the link that targets establish in social influence settings between constraints to change that are internal (i.e. related to their personal beliefs, feelings or attitudes) and those that are external (i.e. related to the characteristics of the persuasive communication such as the status of the source). Copyright © 2002 John Wiley & Sons, Ltd.     

Predicting increases in readiness to quit smoking: A prospective analysis using the contemplation ladder

Abstract

Most smokers are not motivated to quit. The transtheoretical model posits mechanisms (processes of change and pros and cons) by which smokers might increase their stage of readiness to quit. While cross-sectional relationships among the stages of change, processes of change, and pros and cons are well established, there is little evidence that processes of change and pros and cons predict progressive stage movements. This study uses data from a large worksite-based cancer prevention study (the Working Well Trial) to test the hypothesis that processes of change and the pros and cons of smoking predict progressive movement up the contemplation ladder, which is an alternative measure of motivation to quit smoking based on social cognitive theory. The results indicate that experiential processes of change promote increases in readiness to quit smoking. This study provides further evidence for the predictive validity of the contemplation ladder and sheds light on how unmotivated, nonvolunteer smokers can be motivated to consider cessation.     

Effects of escalating and descending schedules of incentives on cigarette smoking in smokers without plans to quit

Contingent incentives can reduce substance abuse. Escalating payment schedules, which begin with a small incentive magnitude and progressively increase with meeting the contingency, increase smoking abstinence. Likewise, descending payment schedules can increase cocaine abstinence. The current experiment enrolled smokers without plans to quit in the next 6 months and compared escalating and descending payments schedules over 15 visits. In the larger incentive condition (LI, n = 39), the largest possible incentive was $100, and in the smaller incentive condition (SI, n = 18), the largest possible incentive was $32. In both conditions, more participants in the descending groups initiated abstinence. A higher proportion of participants in both the escalating and descending groups initiated abstinence in the LI than in the SI. Although participants in the descending groups had more abstinent visits during the first five contingent visits than those in the escalating groups, these differences were not maintained.     

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.     

Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves

This article examines data from 10 longterm prospective studies (N greater than 5,000) in relation to key issues about the self-quitting of smoking, especially those discussed by Schachter. When a single attempt to quit was evaluated, self-quitters' success rates were no better than those reported for formal treatment programs. Light smokers (20 or less cigarettes per day) were 2.2 times more likely to quit than heavy smokers. The cyclical nature of quitting was also examined. There was a moderate rate (mdn = 2.7%) of long-term quitting initiated after the early months (expected quitting window) of these studies, but also a high rate (mdn = 24%) of relapsing for persons abstinent for six months. The number of previous unsuccessful quit attempts was unrelated to success in quitting. Finally, there were few occasional smokers (slips) among successful long-term quitters. We argue that quitting smoking is a dynamic process, not a discrete event.     

A closer look at decisions to quit

Aspects of March and Simon’s (1958) subjective expected utility model and a prediction of Lee and Mitchell’s (1994) unfolding model of voluntary employee turnover were tested. A policy capturing simulation that varied high, moderate, and low levels of five job characteristics was used to model voluntary turnover decision processes for 532 nurses. Survey measures of these job characteristics obtained over the next 2 years were multiplied by weights derived from nurse simulations to yield turnover likelihood estimates. These estimates exhibited 80%, 127%, and 190% more predictive power (depending on turnover operationalization) than post-employment survey estimates of turnover intention, job satisfaction, and job availability. Groups of nurses with homogeneous voluntary turnover decision models were also identified, though no groups with homogeneous job perceptions were observed. Evidence suggested nurses responded to “shocks” as predicted. March and Simon’s model of voluntary turnover was supported and implications drawn for managing voluntary nursing turnover.     

How to be able to do things without really trying

Philosophical Studies -     

Early cessation success or failure among women attempting to quit smoking: trajectories and volatility of urge and negative mood during the first postcessation week

Aversive symptoms of abstinence from nicotine have been posited to lead to smoking relapse and research on temporal patterns of abstinence symptoms confirms this assumption. However, little is known about the association of symptom trajectories early after quitting with postcessation smoking or about the differential effects of tonic (background) versus phasic (temptation-related) symptom trajectories on smoking status. The current study examined trajectories of urge and negative mood among 300 women using the nicotine patch during the first postcessation week. Ecological momentary assessments collected randomly and during temptation episodes were analyzed using hierarchical linear modeling yielding four individual trajectory parameters: intercept (initial symptom level), linear slope (direction and rate of change), quadratic coefficient (curvature), and volatility (scatter). Early lapsers, who lapsed during the first postcessation week, exhibited more severe tonic urge and phasic negative mood immediately after quitting, and more volatile tonic and phasic urge compared to abstainers. Late lapsers, who were abstinent during the first week but lapsed by 1 month, exhibited more severe tonic urge immediately after quitting compared to abstainers. These results demonstrate the importance of early postcessation urge and negative affect and highlight the value of examining both tonic and phasic effects of abstinence from nicotine.     

Technology‐based contingency management and e‐cigarettes during the initial weeks of a smoking quit attempt

Contingency management (CM) interventions are among the most effective behavioral interventions for smoking. This study assessed the effects of CM and electronic cigarettes (ECs) on smoking reductions and abstinence for durations of 30‐36 days. Twelve participants were exposed to Baseline, EC alone, and EC + CM conditions. An internet‐based platform was used to monitor smoking via breath carbon monoxide (CO) and deliver CM for smoking abstinence (CO ≤4 ppm). A Bluetooth‐enabled EC monitored daily EC puffs. Abstinence rates were equivalent between EC (34.4%) and EC + CM (30.4%) conditions. Both conditions promoted smoking reductions. We observed an inverse correlation between smoking and EC puffs (r = ‐.62, p < .05). Results suggest the use of electronic cigarettes can promote smoking reductions and abstinence, and CM did not improve these outcomes. Larger magnitude consequences or tailoring EC characteristics (e.g., flavor) may have improved outcomes. Technology‐based methods to collect intensive, longitudinal measures of smoking and electronic cigarette use may be useful to characterize their environmental determinants.     

Retrieval attempts enhance learning regardless of time spent trying to retrieve

Attempting to retrieve information from memory is an engaging cognitive activity. We predicted that people would learn more when they had spent more time attempting to retrieve. In experiments 1a and 1b, participants were shown trivia questions for 0, 5, 10, or 30 seconds and then the answer was revealed. They took a final test immediately or after 48 hours. Retrieval enhanced learning, but the length of the retrieval attempt had no effect (i.e., final test performance was equivalent in the 5-, 10-, and 30-second conditions and worse in the 0-second condition). During the initial retrieval attempt, more time did increase recall, suggesting that participants continued to engage in productive retrieval activities when given more time. Showing the answer for longer (7 versus 2 seconds) increased learning in Experiments 2a and 2b. Experiment 3 examined the effect of retrieval success and Experiment 4 replicated the results using different materials. These results have direct implications for current theories of retrieval.