A Q-methodological study of smoking identities

In contrast to the psychological literature on adolescent smoking, little research has investigated the social identities of adult smokers. This study aimed to identify shared ‘smoking identities’ amongst a sample of 64 British smokers from different socio-economic groups using Q-methodology. Participants were asked to sort 70 items concerning smoking and smokers according to their agreement/disagreement with them. The 64 Q-sorts were then subjected to a by-person factor analysis yielding six factors, with the first four interpretable factors being presented here. Each factor is understood to represent a distinct ‘identity position’. The first two, the ‘addicted’ smoker, and the ‘in control’ smoker, oriented around a biomedical model of smoking as an addictive health risk. The final two, the ‘no big deal’ smoker and the ‘proud’ smoker reflected alternative understandings and values. The identity positions also differed in the extent to which smoking was considered a core part of self-identity. Unpacking the ‘smoking identities’ of current smokers offers the opportunity to devise targeted health promotion.     

Sober social networks: The role of online support groups in recovery from alcohol addiction

In the context of addiction research, positive recovery outcomes are affected by the quality of people's social interactions and perhaps to an even greater extent, by the defining norms of the groups they identify with—that is, using versus recovery groups. Here, we examine the role of online supportive networks in the process of recovery from alcohol addiction. We analyse the relationship between negative and positive aspects of recovery capital (i.e., self‐stigma, and respectively, positive recovery identity and self‐efficacy) as they relate to well‐being outcomes among alcohol users in an online recovery support group. Based on a computerised linguistic analysis of the naturally occurring data extracted from an online recovery support group (i.e., 257 posts made by 237 group members), we found that self‐stigma negatively predicts self‐efficacy and well‐being, and social identification with a recovery identity mediates these relationships. Overall, these findings highlight that positive engagement with supportive recovery networks is central to an effective and sustainable recovery.     

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.     

Social representations of smoking and attitudes towards smoking restrictions in the Norwigian Navy

The present study investigated the relationship bewteen social representations about smokers and smoking, and attitudes towards smoking restrictions. Data were collected by means of questionnaires among a sample of employees ( n =4224)in the Norwegian Navy. Based on the results from first- and second-order principal components analyses, three dimensions of social representations were identified. The dimensions were labeled "negative representations", "positive representations" and "social influence". The three dimensions clearly differentiated between daliy, occasional and non-smokers. Further, structural equation modeling of the relation between social representations and attitudes towards smoking restrictions, indicated that social representations function as intermediating factors of the effect from smoking states upon attitudes towards smoking restrictions.
The findings indicate the need to focus upon social psyshological processes taking place in the ineraction between groups of smokers and non-smokers, as understanding of such processes may be relevant in preventing the development of group conflict.     

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.     

Personality predictors of smoking behavior in a sample of physicians

Abstract

The smoking status of 239 physicians was obtained from a mail survey in 1981. MMPI data, which had been obtained from these men 25 years earlier, was used to prospectively predict smoking status at follow-up. Those who never smoked had scores indicative of social conventionality (low scores on L, Pd, and Schubert scales; high scores on Ego-control). A similar pattern was found among smokers who quit after a relatively short smoking history. Compared to ex-smokers, those who continued to smoke at the time of follow-up were characterized by high scores on the Pd and Ma scales. These results were discussed in terms of a multi-stage conceptualization of the smoking cessation process.     

Obsessive-compulsive symptoms and cigarette smoking: an initial cross-sectional test of mechanisms of co-occurrence

ABSTRACT

Tobacco addiction and obsessive-compulsive symptoms (OCS; intrusive thoughts or impulses that cause distress and rituals) are both mediated by compulsivity and negative reinforcement. Little evidence exists to guide theory, research, treatment, and population-based prevention of this co-occurrence. We propose a conceptual model of OCS-smoking co-occurrence in which smokers with elevated OCS capitalize on smoking to assuage OCS. This secondary analysis examined associations between OCS levels and self-reported smoking motives that are model-concordant: i) negative reinforcement—smoking for relief; ii) sensorimotor—benefits of behaviors and sensations of the tobacco self-administration ritual; and iii) habitual—smoking without conscious control. A community sample of cigarette smokers enrolled in a cessation trial (N = 458; 47.2% female; M _age = 36.9; SD = 13.6) completed pre-quit self-report measures of OCS levels and smoking motives. Regression models adjusted for sociodemographic covariates and non-OCS psychopathologies indicated that OCS level was positively associated with each model-concordant motive. OCS level was also correlated with tobacco dependence severity and greater withdrawal symptom severity experienced during previous quit attempts. Those with higher OCS report greater motivation to smoke for negative reinforcement, sensorimotor behavioral-ritualistic, habit/automaticity, and stimulation reasons. Further examination of the proposed model of OCS-smoking co-occurrence is warranted to guide theory and intervention for this population.     

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.     

Understanding smoking after acute illness: An application of the sentinel event method

The sentinel event theory provides a stepwise approach for building models to understand how negative events can spark health behaviour change. This study tested a preliminary model using the sentinel events method in a sample (N = 300) of smokers who sought care for acute cardiac symptoms. Patients completed measures on: smoking-related causal attribution, perceived severity of the acute illness event, illness-related fear and intentions to quit smoking. Patients were followed up one week after the health event and a seven-day timeline follow back was completed to determine abstinence from tobacco. Structural equation models were performed using average predictor scale scores at baseline, as well as three different time anchors for ratings of illness severity and illness-related fear. Quit intentions, actual illness severity and age were the consistent, positive and independent predictors of seven-day point prevalence abstinence. Additional research on the influences of perceptions and emotional reactions is warranted.     

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.     

Are smokers interested in genetic testing for smoking addiction? A socio-cognitive approach

Genetic advances have made genetically tailored smoking cessation treatments possible. In this study, we examined whether smokers are interested in undergoing a genetic test to identify their genetic susceptibility to nicotine addiction. In addition, we aimed to identify socio-cognitive determinants of smokers’ intention to undergo genetic testing. Following the protection motivation theory (PMT), we assessed the following constructs using an online survey among 587 smokers: threat appraisal (i.e. susceptibility and severity), fear, coping appraisal (i.e. response efficacy and self-efficacy), response costs and intention. In addition, knowledge, social norms and information-seeking behaviour were measured. Mean intention rates were 2.57 on a 5-point scale. Intention was significantly associated with threat appraisal and coping appraisal, as predicted by the PMT. Fear of the outcome was negatively associated with the intention to undergo genetic testing, but response costs, knowledge and social influence were not. Intention to undergo genetic testing in turn was positively related to seeking information about genetic testing and genetically tailored smoking cessation treatments. Smokers seem ambivalent or ‘on the fence’ with regard to undergoing a genetic test for smoking addiction. Socio-cognitive concepts such as susceptibility, severity, response efficacy and self-efficacy may be used to inform or educate smokers about the value of genetically tailored smoking cessation treatments.     

Predicting stage transitions for smoking cessation applying the attitude-social influence-efficacy model

Abstract

Cross-sectional studies integrating motivational stages with expectancy value models have suggested that contemplating smokers perceive more advantages of quitting and social support than precontemplators. Moreover, smokers preparing to quit were found to differ from precontemplators and contemplators by having higher self-efficacy expectations.

Using the ASE model, the present study confirmed the findings of these cross-sectional studies. The longitudinal design of this study, however, facilitated prediction of transitions that smokers made during a 10-month follow-up. Smokers who progressed from precontemplation perceived more advantages of quitting than those who remained in precontemplation. Smokers regressed from contemplation perceived fewer advantages of quitting than those who did not regress. Finally, smokers who progressed from preparation had higher self-efficacy expectations than those who did not progress.

In sum, the present study provided longitudinal support for the ø-pattern, which suggests tailoring of health educational messages to subjects in the various stages of change.     

戒烟社会支持与吸烟者戒烟意向的关系：亲友认同的调节作用和吸烟危害认识的中介作用

研究旨在考察吸烟者的亲友认同和吸烟危害认识在亲友戒烟社会支持与戒烟意向关系中的作用。对340名吸烟者被试进行问卷调查,结果表明：（1）戒烟社会支持显著正向预测戒烟意向;（2）吸烟危害认识对社会支持和戒烟意向的关系起完全中介作用;（3）亲友认同对戒烟社会支持和戒烟意向的关系起显著调节作用。研究拓展了压力缓冲模型,说明了戒烟社会支持的认知功能,且支持了社会认同在社会支持发挥作用过程中的重要性。     

大学生社会行为、成就动机与网络成瘾倾向的关系研究——以武汉市5所高校为例

运用问卷调查法探讨大学生的社会行为、成就动机与网络成瘾倾向的关系。对299位大学生的调查结果表明:(1)追求成功动机、避免失败动机和社交能力对大学生网络成瘾倾向有直接影响;(2)成就动机还通过社交能力间接影响网络成瘾倾向。     

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.     

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.     

The intergenerational transmission of implicit and explicit attitudes toward smoking: Predicting adolescent smoking initiation

This study examined the intergenerational transmission of implicit and explicit attitudes toward smoking, as well as the role of these attitudes in adolescents’ smoking initiation. There was evidence of intergenerational transmission of implicit attitudes. Mothers who had more positive implicit attitudes had children with more positive implicit attitudes. In turn, these positive implicit attitudes of adolescents predicted their smoking initiation 18-months later. Moreover, these effects were obtained above and beyond the effects of explicit attitudes. These findings provide the first evidence that the intergenerational transmission of implicit cognition may play a role in the intergenerational transmission of an addictive behavior.     

A placebo-controlled randomized trial of D-cycloserine augmentation of cue exposure therapy for smoking cessation

Recent studies underscore the importance of studying d-cycloserine (DCS) augmentation under conditions of adequate cue exposure treatment (CET) and protection from reconditioning experiences. In this randomized trial, we evaluated the efficacy of DCS for augmenting CET for smoking cessation under these conditions.

Sixty-two smokers attained at least 18 hours abstinence following 4 weeks of smoking cessation treatment and were randomly assigned to receive a single dose of DCS (n=30) or placebo (n=32) prior to each of two sessions of CET. Mechanistic outcomes were self-reported cravings and physiologic reactivity to smoking cues. The primary clinical outcome was 6-week, biochemically-verified, continuous tobacco abstinence.

DCS, relative to placebo, augmentation of CET resulted in lower self-reported craving to smoking pictorial and in vivo cues (d = 0.8 to 1.21) in a relevant subsample of participants who were reactive to cues and free from smoking-related reconditioning experiences. Select craving outcomes were correlated with smoking abstinence, and DCS augmentation was associated with a trend toward a higher continuous abstinence rate (33% vs. 13% for placebo augmentation).

DCS augmentation of CET can significantly reduce cue-induced craving, supporting the therapeutic potential of DCS augmentation when applied under appropriate conditions for adequate extinction learning.