The motivational effects of thinking and worrying about the effects of smoking cigarettes

We tested a strategy to encourage cigarette smokers to think more frequently about the negative consequences of smoking, reasoning that increased thought might lead to greater worry and motivation to quit. College students who smoked daily were randomly assigned to one of three conditions in which they wore watches for one week that sounded an alarm randomly four times each day. When alerted, the students read one of eight cards that either had a written statement about studying (control condition), a statement about the negative effects of smoking behaviour (text condition), or a negative smoking statement accompanied by a picture (e.g., a blackened lung; image condition). Measures collected at week's end revealed that the smoking cards had no effects on perceived risk, but they increased worry and reports of intrusive thoughts, and had a small but reliable effect on plans to quit. Correlational data also supported the relationship between worry and motivation to quit, and we discuss the possible benefits of “normal” worrying and strategies for capitalising on the worry–motivation relationship to encourage smokers to abandon cigarettes.     

Warning! The following packet contains shocking images: The impact of mortality salience on the effectiveness of graphic cigarette warning labels

This research looks at a recent initiative to encourage smokers to quit smoking and to discourage nonsmokers from starting to smoke. Evidence has shown that text‐based warning labels are ineffective in drawing attention to the dangers of tobacco consumption; therefore, some governments are looking to draw current smokers and potential smokers away from cigarettes by displaying graphic images of various smoking ailments. This research draws on Terror Management Theory as a means of understanding the effects of graphic visual images in cigarette packaging and offers implications for public health researchers, social marketers, and antismoking campaigners to help smokers to quit and reduce the likelihood of potential smokers becoming smokers. Copyright © 2012 John Wiley & Sons, Ltd.     

A national survey of older smokers: treatment needs of a growing population

Examined smoking and quitting patterns among 289 smokers ages 50 to 74 years who took part in a nationwide survey of American Association of Retired Persons members. Respondents were predominantly chronic, heavy smokers. They had smoked for an average of 45 years, more than one third smoked 25 or more cigarettes per day, and more than two thirds showed evidence of high nicotine addiction. Nonetheless, most were interested in quitting smoking and reported plans to quit in the next year. Concerns about missing or craving cigarettes; losing a pleasure; and being nervous, tense, or irritable after quitting were the most common barriers to quitting reported. These problems were rated as more serious by heavier, longer term smokers and by smokers with lower quitting self-efficacy. The variables most strongly associated with "contemplating" quitting were beliefs in quitting health benefits, recent attempts to quit or cut down, prior attempts to quit, and high self-efficacy. Limitations of these findings are discussed along with implications for the design of treatments geared to the special needs of older smokers.     

Anxiety sensitivity: association with intensity of retrospectively-rated smoking-related withdrawal symptoms and motivation to quit

The present cross-sectional study evaluated the associations between anxiety sensitivity, intensity of retrospectively-rated nicotine withdrawal symptoms, and motivation to quit smoking. Participants were 127 young adult (mean age 20.4 years (SD 4.6)) regular smokers (mean cigarettes per day 10.2 (SD 5.1)). Anxiety sensitivity predicted intensity of retrospectively rated withdrawal symptoms during the first week of the most recent quit attempt as well as concurrent and lifetime indices of motivation to quit smoking even after controlling for theoretically-relevant smoking (e.g. nicotine dependence) and affect (e.g. panic attack history) factors. These results are discussed in relation to better understanding panic-related vulnerability factors in smoking cessation.     

The role of patients' ability to pay, gender, and smoking history on public attitudes toward cardiac transplant allocation: an experimental investigation.

This study assessed public attitudes toward organ allocation through vignettes that were varied by patient's ability to pay (insured or uninsured), gender, and smoking history (current, former, or never). Participants were 681 adults contacted at a state driver's license office who read a vignette about a heart transplant candidate and subsequently rated their likelihood and priority of offering transplantation. Results revealed main effects for patient smoking history exclusively. Post hoc analyses for likelihood of offering transplantation revealed that participants gave higher ratings for never smokers than current smokers. For priority of transplantation, analyses revealed higher ratings for never smokers than for both former smokers and current smokers. Results suggest that public opinion about organ allocation may include the consideration of smoking history but not ability to pay or gender.     

吸烟利弊权衡对戒烟计划的预测作用：一个有调节的中介模型

考察吸烟利弊权衡对戒烟计划的预测,以及戒烟意愿的中介作用和未来取向的调节作用。对340名吸烟者进行问卷调查结果的统计分析发现：（1）吸烟利弊权衡显著正向预测戒烟计划;（2）戒烟意愿对吸烟利弊权衡和戒烟计划的关系起完全中介作用;（3）未来取向负向调节吸烟利弊权衡和戒烟计划的关系,但对吸烟利弊权衡和戒烟意愿关系的调节不显著。这些结果说明,吸烟者戒烟计划发展经历前决策和前行动阶段,且该过程受未来取向的调节。     

Are most precontemplators contemplating smoking cessation? Assessing the validity of the stages of change.

OBJECTIVE: To assess the validity of the stages of change (SOC) algorithm for current smokers. DESIGN: This study was a mail-based, cross-sectional survey study of 242 adult smokers. MAIN OUTCOME MEASURES: The main outcome measures were the SOC algorithm and a variety of alternative questionnaire items measuring motivation to quit smoking. RESULTS AND CONCLUSION: The results revealed that the SOC algorithm systematically underestimated motivation to quit smoking relative to a variety of other measures. Further, the stages of change do not appear to be qualitatively distinct categories. More than half the precontemplators were contemplating cessation, and many precontemplators intended to quit. Most contemplators were not merely contemplating cessation but rather were trying to quit currently. In summary, there is a divergence between the concepts underlying the SOC - precontemplation, contemplation, and preparation - and the operational definitions of these concepts.     

戒烟治疗中的药物疗法研究进展

停止尼古丁摄入造成的戒断症状是每个戒烟者都要面对的困难。我国的吸烟者很少采用戒烟药物作为辅助,而且国内目前尚无戒烟药物的临床应用研究。本文旨在向国内的医务工作者介绍国外近年来戒烟药物在临床应用的概况,给有戒烟打算的吸烟者提供有效的药物治疗方案。目前国外的研究均肯定了尼古丁替代制剂和盐酸安非他酮缓释片在戒烟治疗中的疗效,且治疗1年后的随访结果显示,这两种药物均能有效提高戒烟率。使用盐酸安非他酮缓释片的效果稍好一些,可能与避免尼古丁替代制剂继续维持戒烟者的尼古丁依赖有关。由盐酸安非他酮缓释片存在不良反应和安全性的问题,在临床应用时多采用两者联用的方法,以求最大程度增加戒烟成功率。     

Attitudinal and Social Factors in Adolescent Smoking: In Search of Peer Group Influence1

The smoking attitudes and behavior of two samples of British 15-year-olds (N = 278) were studied by questionnaire. “Smokers” (anyone who had smoked at all within the previous week) held less negative attitudes about smoking, were more likely to have a father who smoked, and anticipated less parental disapproval of their smoking. When asked to name their five best friends among their classmates, smokers were more likely to name other smokers than were nonsmokers. On the basis of these results, we argue that the notion of “peer group influence” should be reconceptualized in terms of intergroup processes and social identity concerns within the peer group.     

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.     

NICOTINE FADING AND SELF-MONITORING FOR CIGARETTE ABSTINENCE OR CONTROLLED SMOKING

This study compared four treatment approaches to cigarette smoking: (1) a nicotine fading procedure, in which subjects changed their cigarette brands each week to ones containing progressively less nicotine and tar; (2) a self-monitoring procedure in which subjects plotted their daily intake of nicotine and tar; (3) a combined nicotine fading/self-monitoring procedure; and (4) a slightly modified American Cancer Society Stop Smoking Program. Thirty-eight habitual smokers were assigned to one of the treatment groups. The study had two goals: (1) to achieve a clinically significant percentage of abstinence, and (2) to reduce the nonabstainers' smoking to a “safer” level by having them smoke low tar and nicotine cigarettes. The 18-month followup results showed that the nicotine fading/self-monitoring group was the most successful: 40 per cent were abstinent and all who had not quit were smoking cigarettes lower in tar and nicotine than their baseline brands. Half the nonabstainers had decreased their rate of smoking relative to baseline while the other half had increased. Furthermore, the fading/self-monitoring group achieved the largest reductions from baseline in daily nicotine and tar intake (61% and 70% respectively). The results suggest that the study's goals were achieved and that the nonaversive combined procedure could be used to treat not only habitual smokers but also smokers with severe cardiovascular and respiratory problems, because it does not have some of the inherent limitations of the successful aversive smoking cessation procedures.     

Predictors of Smoking Status After Eight Years: The Interaction of Stages of Change and Addiction Variables

Abstract

With a smoking rate of 30% of the population Switzerland has one of the highest rates of all industrialised countries. Changes in smoking status over eight years are examined by analysing the course of non-smokers, former smokers and current smokers between 1987 and 1995. Stages of change and addiction variables, as well as their interaction, are analysed for 1987 as predictors of smoking status in 1995.A sample of 953 non-smokers and former and current smokers was interviewed in 1987 and followed up in 1995. Between 1987 and 1995 every fifth non-smoker (20.9%) began smoking. The higher one is in the stage hierarchy the higher the probability of forward than of backward movement. Within the stages of change the likelihood of cessation is moderated by addiction variables. Thus, in the case of contemplating smokers in 1987, the more cigarettes they smoked daily at that time the less likely they were to be former smokers by 1995, but for preparating smokers who had already made an attempt to quit the converse holds - the more they smoked in 1987, the more likely they were to be non-smokers eight years later. The same holds for former smokers in 1987: former moderate smokers then were more likely to relapse than former heavy smokers. The implications for prevention and intervention are discussed.     

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.     

Predicting attempts and sustained cessation of smoking after the introduction of workplace smoking bans

Examined predictors of smoking cessation attempts and predictors of the outcome of those attempts after the introduction of a workplace smoking ban. Smokers were surveyed in the month before the ban came into force, and variables collected at that time were used to predict outcomes 6 months later. Data from 491 respondents who were smokers at the time of the initial survey were used, and a set of potential predictor variables was chosen on both theoretical and empirical grounds. Making a cessation attempt was predicted by the strength of desire to quit and, to less extent, by not having been subject to extensive restrictions on smoking before the mandated ban, having tried to quit before, perceiving oneself high in ability to quit, and being worried about smoke at work. For the outcome of cessation attempts among those who tried, success was best predicted by low levels of a composite habit strength variable and, to less extent, by desire to quit, no previous attempts to quit, the existence of social supports for quitting, and educational status. Although cognitive variables were important in predicting attempts, they played only a minor role in predicting maintenance. Behavioral and environmental variables contributed slightly to prediction of attempts and strongly to prediction of maintenance.     

Social Influence in Personally Relevant Contexts: The Respect Attributed to the Source as a Factor Increasing Smokers’ Intention to Quit Smoking1

The study examined the effects of the status of the source in personally relevant persuasion contexts. Smokers (N= 117) with either weak or strong identity as smokers were exposed to an anti‐smoking message, targeting either the tobacco industry or smokers, and attributed either to a health institute or a neighborhood association. The main dependent variable was the change in intention to quit smoking. As expected, the neighborhood association was considered more respectful of the freedom of choice of the target than was the health institute. In high personal relevance conditions (i.e., participants with strong identities as smokers and message explicitly targeting smokers), smokers strengthened their intention to quit smoking when the source was the neighborhood association, but decreased it when the source was the health institute. Implications for health campaign implementation are discussed.     

Mood as a resource in dealing with health recommendations: How mood affects information processing and acceptance of quit-smoking messages

Objective: An experimental study tested the effects of positive and negative mood on the processing and acceptance of health recommendations about smoking in an online experiment. It was hypothesised that positive mood would provide smokers with the resources to systematically process self-relevant health recommendations.

Design: One hundred and twenty-seven participants (smokers and non-smokers) read a message in which a quit smoking programme was recommended. Participants were randomly assigned to one of four conditions: positive versus negative mood, and strong versus weak arguments for the recommended action.

Main outcome measures: Systematic message processing was inferred when participants were able to distinguish between high- and low-quality arguments, and by congruence between attitudes and behavioural intentions. Persuasion was measured by participant's attitudes towards smoking and the recommended action, and by their intentions to follow the action recommendation.

Results: As predicted, smokers systematically processed the health message only under positive mood conditions; non-smokers systematically processed the health message only under negative mood conditions. Moreover, smokers’ attitudes towards the health message predicted intentions to quit smoking only under positive mood conditions.

Conclusion: Findings suggest that positive mood may decrease defensive processing of self-relevant health information.     

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.     

Stages of Change in Smoking Cessation: A Comparison of Expectancies Among Precontemplators and Contemplators

Previous research has shown that smokers progress through a series of stages of change as they attempt to quit their habit. This study evaluated smokers in the precontemplation and contemplation stages in order to explore how we can effectively facilitate positive stage transition. Precontemplators (n = 71) and contemplators (n = 30) were compared in terms of two types of expectancies: self-efficacy beliefs and response outcome expectancies. Stage of change was defined according to both categorical and continuous dimensions, each of which led to different results. The findings are discussed in terms of their potential applications to smoking cessation programs and their implications regarding the stage model of change.     

Cigarette Smoking in Popular Films: Does It Increase Viewers' Likelihood to Smoke?1

The effect of viewing smoking in popular films was investigated. Participants were instructed to rate main characters in scenes from popular films on 12 characteristics (e. g., attractive, sexy, sociable). One group watched 6 scenes from popular films in which the main character they rated was smoking. The other group watched scenes from the same 6 films in which they rated the same main characters who were not smoking. The participants rated the female characters shown smoking less favorably on all rated characteristics, but not the male characters. The male regular and occasional smokers had a higher current desire to smoke if the film characters they had viewed smoked. Both female and male participants who viewed the characters smoking were more likely to indicate a likelihood to smoke than were the participants who viewed the nonsmoking scenes.