Successes and failures in resisting cigarettes affect partner support for smoking cessation

Objective: Potential support providers may rely on observable behaviours (e.g. resisting a cigarette vs. smoking) to determine how much and what kind of support to provide. We evaluated the effect of smokers’ salient behaviour on partners’ likelihood of providing positive and negative support.

Design: Partners of smokers (N = 131) were randomly assigned to recall a time when their partner either successfully resisted a cigarette, failed to resist a cigarette or a control condition (no recall). All participants reported the likelihood of providing positive and negative support to their partner. Perceived commitment to quitting smoking was measured as a potential mediator.

Main Outcome Measures: The main outcome was intention to provide support for a quit attempt.

Results: Participants who recalled their partners’ past failures reported more intentions to engage in negative support and smaller ratios of positive to negative intended support than did participants in the success or control condition. These effects were partially mediated by perception of commitment to quitting.

Conclusion: Lapses in a quit attempt may change the nature of the support quitters receive. Interventions to improve communication between partners about the smoker’s commitment to quitting and experienced challenges may result in better support.     

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.     

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.     

The impact of smoking cues in antismoking messages among intermittent and light smokers

Objective: Based on the Limited Capacity Model of Motivated Mediated Message Processing, this study explored the effects of smoking cues in antismoking Public Service Announcements (PSAs) on message processing among intermittent/light smokers and nonsmokers.

Method: A 2 (smoking cues: present vs. absent) × 2 (smoking status: smokers vs. nonsmokers) mixed experimental design was conducted. Self-report measures and two physiological measures including skin conductance and heart rate were examined.

Results: Messages with smoking cues generated higher levels of arousal (F = 4.57, p = .04), attention (F = 2.51, p = .04), positive message evaluation (F = 28.70, p < .001) and less intent to smoke (F = 26.60, p < .001). Intermittent and light smokers had much stronger reactions to messages containing tobacco-related visuals, including arousal (F = 4.10, p = .04), perceived ad effectiveness (F = 9.24, p = .03) and intent to smoke (F = 22.98, p < .001).

Implication: The antismoking arguments may have suppressed cue-induced smoking urges, which dampened negative persuasion outcomes. Limitations included the restricted generalisability and the focus on short-term effect. Future research may use a random sample of PSAs with a general population.     

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.     

Young adult e-cigarette users’ reasons for liking and not liking e-cigarettes: A qualitative study

Objective: To gain an in-depth understanding of what young adult electronic- or e-cigarette users like or dislike about e-cigarettes. We aimed to determine the reasons that may encourage young adults to use e-cigarettes or discourage them from using e-cigarettes.

Design: Twelve focus group discussions were conducted with 62 current daily e-cigarette users (63% men) of mean age = 25.1 years (standard deviation = 5.5). Data were analysed following principles of inductive content analysis.

Results: Results indicated 12 categories of reasons for liking e-cigarettes (e.g. recreation, smoking cessation) and 6 categories of reasons for not liking e-cigarettes (e.g. poor product quality, poor smoking experience).

Conclusions: Young adults’ motives for using or not using e-cigarettes appear to be varied and their relative importance in terms of predicting e-cigarette use initiation, dependence, and cigarette/e-cigarette dual use needs to be carefully studied in population-based, empirical studies. The current findings suggest that e-cigarettes may serve social, recreational, and sensory expectancies that are unique relative to cigarettes and not dependent on nicotine. Further, successful use of e-cigarettes in smoking cessation will likely need higher standards of product quality control, better nicotine delivery efficiency and a counselling component that would teach smokers how to manage e-cigarette devices while trying to quit smoking cigarettes.     

Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults

Objective: To test the effect of exposure to the US Food and Drug Administration’s proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes towards smoking.

Design and methods: A two-session web-based study was conducted with 2192 young adults 18–25-years-old. During session one, demographics, smoking behaviour, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current US Surgeon General’s text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes.

Results: Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p = .004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current US Surgeon General’s text warnings (p = .014), but there was no difference compared to those who viewed text-only warnings.

Conclusion: Graphic health warnings on cigarette packages can influence young adult smokers’ implicit attitudes towards smoking.     

The interplay of received social support and self-regulatory factors in smoking cessation

Objective: In smoking cessation, individual self-regulation and social support have both proven to be useful. However, the roles of self-regulatory processes and social support are mostly examined separately. The present study aims at examining the unique and joint interactive effects of self-regulation as specified in the health action process approach (HAPA) and social support on smoking cessation. The study tested whether social support can compensate for low levels of self-regulation or whether synergistic effects emerge.

Design & Measures: Around a self-set quit date, 99 smokers completed baseline questionnaires on HAPA-variables, smoking-specific received social support and smoking cessation (continuous abstinence and point prevalence), with a follow-up Cpproximately 29?days after the quitdate.

Results: Social support moderated the association between volitional self-efficacy and smoking, as well as coping planning and smoking but not between action planning and smoking. No compensatory effect of social support for lower levels of individual regulation emerged but the combination of high levels of the individual variables and social support was related to successful smoking cessation, indicating a synergistic effect.

Conclusions: The results confirm the importance of examining both self-regulation and social factors in smoking cessation. This should be considered when developing future interventions for smoking cessation.     

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.     

Pilot study of the effects of a workplace smoking ban on indices of smoking,cigarette craving,stress and other health behaviours

Abstract

Worksite smoking bans provide an ideal opportunity to examine the effects of enforced smoking restrictions on not only smoking behaviour, but also other health behaviours. This pilot study examines the short term effects of a such a ban on self-reported smoking behaviour, carbon monoxide and plasma cotinine levels and a number of other appetitive behaviours. The total number of cigarettes smoked on a working day and the number smoked just during working hours both declined following the introduction of a ban. Although the carbon monoxide levels of smokers during working hours demonstrated a similar trend to self-reported smoking, smokers' cotinine levels tended to increase, following an initial decrease following the ban. These data are suggestive of a compensatory process and a change in smoking topography, probably outside working hours. Measures of stress and craving also appeared to be affected by the introduction of smoking restrictions.     

Cigarette graphic warning labels increase both risk perceptions and smoking myth endorsement

Objective: Cigarette graphic warning labels elicit negative emotion, which increases risk perceptions through multiple processes. We examined whether this emotion simultaneously affects motivated cognitions like smoking myth endorsement (e.g. ‘exercise can undo the negative effects of smoking’) and perceptions of cigarette danger versus other products.

Design: 736 adult and 469 teen smokers/vulnerable smokers viewed one of three warning label types (text-only, low emotion graphic or high emotion graphic) four times over two weeks.

Main outcome measures: Emotional reactions to the warnings were reported during the first and fourth exposures. Participants reported how often they considered the warnings, smoking myth endorsement, risk perceptions and perceptions of cigarette danger relative to smokeless tobacco and electronic cigarettes.

Results: In structural equation models, emotional reactions influenced risk perceptions and smoking myth endorsement through two processes. Emotion acted as information about risk, directly increasing smoking risk perceptions and decreasing smoking myth endorsement. Emotion also acted as a spotlight, motivating consideration of the warning information. Warning consideration increased risk perceptions, but also increased smoking myth endorsement. Emotional reactions to warnings decreased perceptions of cigarette danger relative to other products.

Conclusions: Emotional reactions to cigarette warnings increase smoking risk perceptions, but also smoking myth endorsement and misperceptions that cigarettes are less dangerous than potentially harm-reducing tobacco products.     

Age and pre quit-day attrition during smoking cessation treatment

ABSTRACT

The present study aimed to replicate the finding that younger age predicts higher pre quit-day attrition. Our second aim was to explain this relation by examining empirically and theoretically informed age-related risk factors for low smoking cessation treatment engagement. 136 participants (M _age = 44.2 years, SD = 11.3 years; age = 22–64 years) were randomized to 15-weeks of either 1) an exercise intervention (n = 72) or 2) a wellness education control condition (n = 64). First, a logistic regression analysis was employed to test whether younger adults were more likely than older adults to drop prior to quit date. Next, we assessed whether smoking related health concerns, social expectancies, and/or perceived severity of craving affected the strength of the relation between age and attrition, by adding these three variables to the logistic regression along with age. The logistic regression model indicated that younger age and treatment condition were significantly related to the odds of dropping from treatment prior to the scheduled quit date. Further, health concerns, social expectancies, and/or perceived severity of cravings did not account for the effect of age on pre quit-day attrition. These findings highlight the importance of identifying empirically and theoretically informed variables associated with the pre quit-day attrition problem of young smokers.     

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。     

Evaluating the role of anxiety sensitivity in barriers to cessation and reasons for quitting among smokers with asthma

The aim of the present study was to examine the unique predictive ability of anxiety sensitivity (AS) in terms of perceived barriers to cessation and smoking cessation motives among daily smokers with asthma (n = 125, 54% male, M_age = 37.7 years, SD = 12.1). As hypothesized, after controlling for the effects of race, asthma control, negative affect, and smoking rate, AS significantly predicted greater barriers to cessation, and reasons for quitting related to health concerns and self-control. Contrary to hypotheses, AS did not significantly predict external reasons for quitting. These findings suggest that smokers with asthma who are fearful of physiological arousal may be a particularly ‘at-risk’ population for smoking cessation difficulties due, in part, to greater perceived barriers to cessation. Interventions focused on enhancing intrinsic motivation for quitting and reducing AS may be most effective for this population.     

The effectiveness of narrative versus informational smoking education on smoking beliefs,attitudes and intentions of low-educated adolescents

Objective: This study tests the effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents.

Design: A field experiment with three waves of data collection was conducted. Participants (N = 256) were students who attend lower secondary education. At the first and third waves, they completed a questionnaire. At the second wave, 50.8% of the participants read a smoking education booklet in narrative form and 49.2% read a booklet in informational form. After reading, all participants also completed a questionnaire at wave 2.

Main outcome measures: Beliefs about negative consequences of smoking, attitudes towards smoking and intentions to smoke were measured.

Results: Repeated measures analyses with time as a within-subjects factor and condition as a between-subjects factor showed that beliefs about smoking were more negative at Wave 2 compared to Wave 1, irrespective of condition. However, attitudes towards smoking were more positive at Wave 3 compared to Wave 1 when participants had read the narrative version.

Conclusion: These results show that narrative smoking education is not more effective than informational smoking education for low-educated adolescents and can even have an unintended effect for this target group by making attitudes towards smoking more positive.     

Home-based smoking prevention program Smoke-free Kids on smoking-related cognitions: Secondary outcomes from a cluster randomized controlled trial

Objectives: The home-based smoking prevention programme ‘Smoke-free Kids’ did not have an effect on primary outcome smoking initiation. A possible explanation may be that the programme has a delayed effect. The aim of this study was to evaluate the effects on the development of important precursors of smoking: smoking-related cognitions.

Methods: We used a cluster randomised controlled trial in 9- to 11-year-old children and their mothers. The intervention condition received five activity modules, including a communication sheet for mothers, by mail at four-week intervals. The control condition received a fact-based programme. Secondary outcomes were attitudes, self-efficacy and social norms. Latent growth curves analyses were used to calculate the development of cognitions over time. Subsequently, path modelling was used to estimate the programme effects on the initial level and growth of each cognition.

Results: Analyses were performed on 1398 never-smoking children at baseline. Results showed that for children in the intervention condition, perceived maternal norms increased less strongly as compared to the control condition (β = ?.10, p = .03). No effects were found for the other cognitions.

Conclusion: Based on the limited effects, we do not assume that the programme will have a delayed effect on smoking behaviour later during adolescence.     

Initial responses to the first dose of nicotine in novel smokers: The role of exposure to environmental smoking and genetic predisposition

Background: Sensitivity to initial smoking constitutes an early predictor of the risk of dependence. We investigated the role of exposure to smoking (by parents, siblings, and peers) and reward-related candidate gene polymorphisms (OPRM1 A118G, DRD2 TaqlA and DRD4?bp VNTR) in adolescents’ responses to initial smoking.

Methods: We used cross-sectional survey data and saliva samples from 171 Dutch students who had never inhaled on a cigarette (mean age: 13.9?years). The outcome measure was adolescents’ self-reported responses to initial smoking.

Results: Exposure to peer smoking was associated with increased liking (OR?=?1.74, CI?=?1.13–2.70) and more pleasant sensations (β?=?.21, p?=?.01). Exposure to maternal smoking was associated with less unpleasant sensations (β?=??.20, p?=?.01). Adolescents carrying the G-variant of the OPRM1 A118G polymorphism were more likely to report liking (OR?=?2.50, CI?=?1.09–5.73) and adolescents homozygous for the C-variant of the DRD2 TaqlA polymorphism reported less unpleasant sensations (β?=?.18, p?=?.04).

Conclusion: Although preliminary, these findings suggest that exposure to environmental smoking and polymorphisms in the OPRM1 and DRD2 gene may affect initial sensitivity to nicotine, an early phenotype of the risk of dependence. In the future, collaborative efforts to combine data from multiple studies in meta-analyses are needed to improve accuracy of estimated effects in genetic studies.     

A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory

Mounting evidence indicates that pain can motivate cigarette smoking behavior, smokers have reliably endorsed the use of tobacco to cope with pain, and there is reason to suspect that pain may impede smoking cessation. Smoking-related outcome expectancies are among the best predictors of cigarette consumption and relapse, and the goal of this pilot study was to develop a standardized measure of how tobacco smokers perceive their pain and smoking behavior to be interrelated (i.e. pain as a motivator of smoking, expectancies for smoking as a means of coping with pain, and pain as a barrier to quitting). Participants (N = 75) completed an online survey that was designed to assess interrelations between pain and tobacco smoking. The nine-item Pain and Smoking Inventory (PSI) demonstrated excellent internal consistency (α = .95). As expected, PSI scores were higher among smokers with chronic pain (vs. no pain), and were positively associated with established indices of both pain and tobacco smoking dependence. These results corroborate the notion that smokers can effectively communicate perceptions of interrelations between their pain and smoking behavior. Future research is needed to establish reliability and validity of the PSI among larger, more diverse samples of smokers with varying levels of pain. Future work should also examine PSI scores as predictors of smoking cessation outcomes, and whether PSI data may usefully inform the development of tailored interventions for smokers in pain.     

Do smokers devaluate smoking cues after go/no-go training?

Objective: Smoking is one of the leading public health problems worldwide. The inability to quit smoking may be the result of the amplified value of smoking-related cues and inhibitory control deficits. Previous research has shown that pairing substance-related cues with no-go trials in go/no-go training reduces the value of these cues, an effect known as devaluation. The current experiment investigated the devaluation effect of go/no-go training on smoking-related cues, and compared this effect between smokers and nonsmokers.

Design and Main Outcome Measures: 39 smokers and 43 nonsmokers were trained to respond immediately to neutral stimuli, but inhibit their reaction when smoking stimuli were presented. Before and after training, participants evaluated smoking and neutral stimuli, where part of these stimuli were subsequently presented in the training, and the other part was not used in training.

Results: Not responding to smoking stimuli in go/no-go training decreased subsequent evaluations of trained smoking stimuli compared to untrained smoking stimuli, thereby replicating food and alcohol studies and extending the devaluation effect to smoking-related cues. This devaluation effect was found for both smokers and non-smokers.

Conclusion: Smoking-related cues can be devaluated in smokers and non-smokers, thereby showing the potential for Go/No-Go training in smoking cessation interventions.