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.     

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample

The purpose of this investigation was to evaluate carefully smoking-related knowledge and beliefs and their relationships to smoking status in a large, heterogeneous sample of smokers and nonsmokers in two settings: (a) a large, biracial southern city and (b) a small midwestern community. Participants were 611 (198 male, 413 female) adult respondents to a random-dialing telephone survey in Fargo, North Dakota (n = 200), and Memphis, Tennessee (n = 411). Each participant was given the Smoking Attitudes Survey, which assesses generalized health beliefs as well as health-related problems associated with smoking. Participants' knowledge of smoking-associated diseases (e.g., lung cancer) and of diseases not associated with smoking (e.g., kidney stones) was assessed. Stepwise regression analysis of composite knowledge scores revealed four independent predictors of the health consequences of smoking: education, race, smoking status, and income. Smokers, compared to nonsmokers, reported less knowledge related to the health consequences of smoking, were more likely to be male, were less concerned with the health consequences of smoking, and were more concerned about the health consequences of cholesterol. The best predictor of smokers who had never attempted cessation was their greater concern over weight control when compared to smokers with a history of smoking cessation attempts. The results are discussed in terms of smoking prevention and intervention efforts.     

Buffering Effect of Parental Monitoring Knowledge and Parent-Adolescent Relationships on Consequences of Adolescent Substance Use

When adolescents begin using substances, negative consequences are not always directly proportional to the amount used; heavy users may have few consequences whereas light users may have numerous consequences. This study examined how parental monitoring knowledge and parent–child relationship quality may serve as buffers against negative consequences when adolescents use substances. Self-report questionnaires were administered to a community sample of 200 healthy adolescents and their parents at two time points, one year apart. Results suggest that both parental monitoring knowledge and parent–child relationship quality serve as buffers against negative consequences of substance use—but only when adolescents report high levels of monitoring knowledge or strong parent–child relationship quality. Results suggests adolescent perceived parental monitoring knowledge and parent–child relationship quality each act independently to buffer adolescents against negative consequences of substance use over a 1-year period.     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts.     

Self-Presentation,Reasoned Action,and Adolescents' Decisions to Smoke Cigarettes1

The effectiveness of a one-shot intervention on the social, medical or medical/social consequences of smoking in deterring adolescent smoking was evaluated. Four hundred twenty adolescents completed surveys which measured attitudes, subjective norms, stereotypes, self-presentational beliefs regarding smoking, intentions to smoke, and smoking status at three points in time. The predictive ability of a Theory of Reasoned Behavior and of Impression Management Theory in determining adolescent smoking decisions was also assessed.     

Intrapersonal and Ecodevelopmental Factors Associated with Smoking in Hispanic Adolescents

We examined how relationships among intrapersonal (i.e., attitudes and beliefs about smoking) and ecodevelopmental (i.e., family, school, and peer) factors influence risk for lifetime smoking in immigrant Hispanic adolescents. Our sample was comprised of 223 immigrant Hispanic adolescents and their families and was drawn from 3 middle schools in a single school district. Data collected is a result of adolescent and parent completed questionnaires as well as county school data (i.e., GPA, teacher reported effort and conduct, absences). Results indicated only poor school functioning, peer smoking, and lack of perceived harm concerning smoking were directly related to adolescent lifetime smoking. Poor school functioning and peer smoking mediated the relationship between family functioning and adolescent smoking. Implications of these results for the design of smoking preventive interventions for immigrant Hispanic adolescents are discussed.     

Perceived self-efficacy and everyday problem solving among young and older adults

This research tested the hypothesis that age differences in both self-efficacy perceptions and problem-solving performance would vary as a function of the ecological relevance of problems to young and older adults. The authors developed novel everyday problem-solving stimuli that were ecologically representative of problems commonly confronted by young adults (young-adult problems), older adults (older adult problems), or both (common problems). Performance on an abstract problem solving task lacking in ecological representativeness (the Tower of Hanoi problem) also was examined. Although young persons had higher self-efficacy beliefs and performance levels on the Tower of Hanoi task problem and the young-adult problems, this pattern reversed in the domain of older adult problems, where the self-efficacy beliefs and performance of older persons exceeded those of the young.     

Historical changes in cigarette smoking and smoking-related beliefs after 2 decades in a midwestern community.

Rates of cigarette smoking and smoking-related beliefs in 1980 and 2001 among 7th-11th graders in a midwestern community were compared. Smoking was less prevalent in 2001 than in 1980, with the greatest declines in experimental smoking and a smaller drop in regular smoking. Beliefs about smoking generally became more negative. Adolescents (particularly nonsmokers) viewed smoking as more addictive and as having more negative social consequences in 2001 than in 1980 and had more negative attitudes toward smoking in 2001. These results were replicated among parent-child pairs in which parents were measured when they were adolescents between 1980 and 1983 and their children were measured in 2001. These beliefs and attitudes partially mediated the effects of time on smoking.     

Why do they do it? Affective motivators in adolescents' decisions to participate in risk behaviours

Affective motivators have been targeted in many theories as playing a critical role in adolescents' decisions to participate in a variety of risky behaviours that may have life-altering consequences. In this study, we examined the role of several of these affective motivators across low and high experience groups to determine their perceived influence on the desire to participate in each of five risky behaviours (drinking alcohol, using drugs, having sex, smoking cigarettes, and skipping school). The affective motivators included those that: (a) promote risky behaviours by enhancing pleasant affective states (sensation seeking, social/emotional), (b) promote risky behaviours by reducing or avoiding negative affective states (negative emotions, tension reduction), and (c) deter risky behaviours by avoiding anticipated regret (e.g. of harming future). Results showed that the perceived motivational strength of the affective goals differed substantially between low and high experience groups and across the different risky behaviours. Adolescents with less experience were much more focused on avoiding the negative affective consequences associated with regretting unfavourable future outcomes. In contrast, adolescents with more experience participating in a risky behaviour held stronger beliefs that participation in the behaviour could both enhance positive and reduce negative affective states. We describe how the perceived importance of these motives varies across the risky behaviours, and offer insights into the likely motivational changes that occur as an adolescent moves from no experience to chronic experience engaging in risky behaviours.     

Belief Importance in Expectancy-Value Models of Attitudes1

In this study, 312 respondents were asked to indicate their attitude toward smoking and their smoking behavior. Attitudes were assessed by a direct attitude measure (4 items) and a series of 15 belief statements about the possible consequences of smoking. Next, respondents were asked to select the 3 consequences they found most important. Attitude scores derived from these important beliefs were more predictive of behavior than those based on all 15 beliefs, and far superior to attitude scores based on the remaining 12 beliefs. Differences between the 2 groups (smokers vs. nonsmokers) were more pronounced when attitude scores were based on important beliefs, and disappeared for scores based on nonselected, less important beliefs. It is argued that incorporating belief importance in expectancy-value models helps to assess the structure of attitudes and could improve our insight in the determinants of behavioral preference.     

Adult social behavioral effects of heavy adolescent marijuana use among African Americans

The authors examined the effects of heavy adolescent marijuana use on employment, marriage, and family formation and tested both dropping out of high school and adult marijuana use as potential mediators of these associations among a community sample of African Americans followed longitudinally from age 6 to age 32-33. They used propensity score matching to reduce selection bias when estimating the effects of heavy adolescent marijuana use. Logistic regression results on the sample matched on sex, and early demographic and behavioral variables showed that adolescent marijuana use has adult social behavioral consequences: Use of marijuana 20 times or more during adolescence was associated with being unemployed and unmarried in young adulthood and having children outside of marriage for both males and females. Dropping out of high school and more frequent adult marijuana use seem to be important parts of the pathway from adolescent marijuana use to negative life outcomes.     

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.     

The Relationship Between the Consequences Adolescents Expect from Smoking and Their Behavior: A Factor Analysis with Panel Data1

The expected consequences of behavior are basic to many modern theories of behavior and to programs designed to influence behavior. In this research, 52 consequences expected from smoking cigarettes were measured in a panel study of 1,406 adolescents. Six factors were identified through factor analysis of these consequences. Multivariate analyses generally indicated that the negative physical/social factor predicted the initiation of smoking and the pleasure factor predicted smoking initiation and increased smoking among those who were smokers at the beginning of study. The other factors-positive peer relationships, negative peer relationships, habit, and health-were either unrelated to subsequent smoking behavior or inconsistently related across the multiple measures of behavior. The research is considered in the context of theory, methods, and programs related to adolescent cigarette smoking.     

Disengagement beliefs in smokers: Do they influence the effects of a tailored persuasive message advocating smoking cessation?

Disengagement beliefs function to reduce cognitive dissonance and a number of predictions with regard to disengagement beliefs have been tested and verified. However, the influence of disengagement beliefs on persuasion has not been studied yet. In a field-experiment, 254 smokers were randomly assigned to a persuasive message condition or a no-information control condition. First, it was assessed to what extent disengagement beliefs influenced persuasion. In smokers with low adherence to disengagement beliefs, quitting activity (attempting to quit) in the control condition was high, but this was not further increased by persuasive information on the negative outcomes of smoking. In contrast, smokers who strongly adhered to disengagement beliefs showed low quitting activity in the control condition, but significantly more quitting activity when they received the persuasive message. Second, it was studied what smokers do when they experience negative affect caused by the persuasive message. The results show that in smokers who strongly adhered to disengagement beliefs, negative affect was associated with less quitting activity. Although these results show that quitting activity as assessed at 2 and 8 months follow-ups was influenced by disengagement beliefs, point prevalence seven-day quitting was not. This study shows that adherence to disengagement beliefs is a relevant individual difference in understanding effects of smoking cessation interventions.     

Psychosocial antecedents of tobacco chipping.

The authors examined adolescent antecedents and adult correlates of tobacco "chipping" compared with heavy smoking, experimental smoking, and nonsmoking in a representative community sample. As adolescents, future "chippers" had some smoking risk factors (attitudes, health beliefs, smoking intentions, and tolerance for deviance) and several protective factors (high values for academic success, internal locus of control, supportive relationships, and little smoking among peers and parents). As adults, risk factors included lessened belief in nicotine's addictiveness, lower conscientiousness, higher extraversion, and lower positive affect and life satisfaction; protective factors included high levels of educational attainment and employment and low levels of negative affect and stress (men only). Thus, chippers experience a complex mixture of risk and protective factors for smoking.     

Understanding adolescent worry: the application of a cognitive model

The relationship between worry and 4 cognitive variables, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance, was examined in an adolescent sample of 528 boys and girls aged 14–18. The participants completed questionnaires assessing worry, somatic anxiety symptoms, and the variables mentioned above. The results show that (a) intolerance of uncertainty, positive beliefs about worry, and negative problem orientation each account for a significant amount of variance in adolescent worry scores in the multiple regression, and (b) the discriminant function derived from the 4 variables is effective in classifying moderate and high worriers into their respective groups (72.8% correct classification). Furthermore, analyses demonstrate that intolerance of uncertainty has the strongest association with worry scores and is the most important variable in discriminating between moderate and high adolescent worriers. These results suggest that intolerance of uncertainty plays a key role in our understanding of adolescent worry.     

The natural history of cigarette smoking: predicting young-adult smoking outcomes from adolescent smoking patterns

Assessed the magnitude of risk that adolescent cigarette smoking carries for adult smoking. Using a longitudinal, prospective design, results indicate that even infrequent experimentation in adolescence significantly raises the risk for adult smoking and that regular (at least monthly) adolescent smoking raises the risk for adult smoking by a factor of 16 compared to nonsmoking adolescents. Relative risk was also increased by an early onset of smoking and by a stable, uninterrupted course from experimentation to regular smoking. Relative risk did not significantly vary by age or sex. The continuity of smoking behavior between adolescence and adulthood supports the importance of primary prevention programs directed at adolescent populations.     

Protective effect of supportive family relationships and the influence of stressful life events on adolescent adjustment

The purpose of this study was to determine the association between the occurrence of stressful life events and internalizing and externalizing problems, and to analyze longitudinally buffering effects of supportive family relationships. To this end, 100 Spanish adolescents were studied twice, when they were in mid-adolescence (15-16 years) and two years later. They completed questionnaires regarding stressful life events, family relationships, and adolescent adjustment. Results showed that high quality parent-adolescent relationships protected boys and girls against the negative consequences of stressful life events on externalizing, but not internalizing, symptoms. The adolescents who enjoyed good relationships with their parents in mid-adolescence did not increase their externalizing problems in late adolescence as consequence of the occurrence of stressful events. However, these stressors did lead to an increase in the number of externalizing problems when the family relationships were of a middle or low quality. These results highlight the important role that supportive family relationships play in the behavioral adjustment of adolescents, protecting them against some negative consequences of stressful life events, and suggest the relevance of supporting parents through resources such as parent education in order to help them to improve their relationships with their adolescents.     

Protective effect of supportive family relationships and the influence of stressful life events on adolescent adjustment

Abstract

The purpose of this study was to determine the association between the occurrence of stressful life events and internalizing and externalizing problems, and to analyze longitudinally buffering effects of supportive family relationships. To this end, 100 Spanish adolescents were studied twice, when they were in mid-adolescence (15–16 years) and two years later. They completed questionnaires regarding stressful life events, family relationships, and adolescent adjustment. Results showed that high quality parent-adolescent relationships protected boys and girls against the negative consequences of stressful life events on externalizing, but not internalizing, symptoms. The adolescents who enjoyed good relationships with their parents in mid-adolescence did not increase their externalizing problems in late adolescence as consequence of the occurrence of stressful events. However, these stressors did lead to an increase in the number of externalizing problems when the family relationships were of a middle or low quality. These results highlight the important role that supportive family relationships play in the behavioral adjustment of adolescents, protecting them against some negative consequences of stressful life events, and suggest the relevance of supporting parents through resources such as parent education in order to help them to improve their relationships with their adolescents.     

Control beliefs as a mediator of the relation between stress and depressive symptoms among inner-city adolescents

Adolescents' control beliefs were examined as a mediator of the relation between stress and depressive symptoms among a diverse sample of 445 inner-city adolescents. Results indicated that control beliefs significantly mediate the relation between stress and depressive symptoms. The specific direct effects of six individual stress domains (peer, family, school, neighborhood, economic, discrimination) on control beliefs and depressive symptoms were also examined. Results showed that (1) economic stress relates to adolescents' control beliefs, (2) family stress relates to adolescent depressive symptoms, and (3) peer stress relates to both control beliefs and depressive symptoms. Secondary analyses revealed that control beliefs significantly mediate the specific relations between peer stress and depressive symptoms. Results were not found to vary across ethnic groups. The implications of these findings for adolescent mental health and preventive interventions targeting depression are discussed.