Worry about health in smoking behaviour change

Many smokers and ex-smokers worry about their health. Given that worry keeps attention focused on the threat, it was expected that worrying about health in smokers would motivate them to quit and in ex-smokers may prevent relapse. Furthermore, worry was expected to influence the process of smoking cessation in interaction with self-efficacy, which is a measure of control over smoking, and with disengagement beliefs, which distorts the threatening meaning of potential motivating information. In the present study 380 smokers and 324 ex-smokers were recruited to join a prospective study with a follow-up of eight months. At T1, smoking/quitting behavior, worry and the other psychological constructs were assessed. At T2 quitting activity in smokers and relapse in ex-smokers were assessed. As expected, smokers who worried about the health effects of smoking reported higher quitting activity at T2. The three-way interactions between worry, self-efficacy and disengagement beliefs in the prospective prediction of quitting activity and relapse were significant: Among smokers with high self-efficacy combined with strong disengagement beliefs, worry led to more quitting activity. Among ex-smokers with low self-efficacy combined with strong disengagement beliefs, worry led to more relapse. The present results suggest new ways of approaching the stimulation of quitting and the prevention of relapse.     

Specifying the determinants of the initiation and maintenance of behavior change: an examination of self-efficacy, satisfaction, and smoking cessation.

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.     

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.     

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.     

The role of prior quitting experience in the prediction of smoking cessation

Aims: In the Transtheoretical Model (TTM), the preparation stage (as applied to smoking cessation) is defined as planning to quit in the next 30 days plus having quit for at least 24 h in the last year. This study examined the value of prior quitting experience as a stage classification criterion by investigating whether prediction of making a quit attempt differed as a function of prior quitting experience. Participants: One thousand and forty-six participants, all planning to quit in the next 30 days, in a randomised trial of the effectiveness of a telephone counselling and computer-generated tailored advice intervention were followed up at 3 months. Findings: A multivariate predictive model had markedly greater capacity to predict making a quit attempt among participants with prior quitting experience (as defined in several different ways), compared to analyses of the overall sample. A previous attempt of 24 h in the previous month was associated with the greatest difference in prediction. A quit attempt in the previous year (the TTM definition) did not discriminate. Conclusions: Recent prior quitting experience moderated the predictive capacity of some variables that influence smoking cessation. The findings provide some support for a stage model of smoking cessation but not its operationalisation by the TTM.     

Effects of Contract Framing,Motivation to Quit,and Self-Efficacy on Smoking Reduction1

Social learning theorists (SLT) have advocated that individual's cognitive beliefs about perceived behavioral ability and outcome expectancies are predictive of behavior change. SLT's also propose that the threat of losing positive rewards may result in greater behavior change than gaining rewards for altering behaviors such as smoking. Specifically, presenting behavioral outcomes in a loss frame context has proven more influential under certain conditions than presenting outcomes in a gain frame context. The present study evaluated the relationship between smoking cessation self-efficacy motivation to quit, and contract framing on smoking reduction. The majority of cognitive and behavioral changes occurred between baseline and 3 months into a 12-month treatment program. An interaction between contract framing and motivation to quit suggested that, for subjects with low motivation, receiving combined (gain plus loss) frame contracts resulted in smoking fewer cigarettes posttreatment than receiving gain frame only contracts. An interaction between framing and self-efficacy also indicated that subjects who received combined frame contracts smoked fewer cigarettes if they had high rather than low self-efficacy beliefs.     

Residual outcome expectations and relapse in ex-smokers.

From a social cognitive theoretical point of view, strong positive outcome expectations of smoking are a cause of relapse in smoking cessation, working in concert with self-efficacy. This study investigated whether and to what extent this could be verified in a sample of ex-smokers. Some (N = 324) ex-smokers were followed for 7 months. At Time 1 (T1) and Time 2 (T2), participants filled in a self-report questionnaire assessing residual outcome expectations (ROEs), self-efficacy, craving for tobacco, and smoking behavior, which was sent and returned by mail. First, prospective analyses showed that ROEs assessed at T1 predicted relapse reported at T2 over and above self-efficacy. Second, the influence of ROEs (and self-efficacy) on relapse was mediated by craving experience. Third, the hypothesized interactions between ROEs and self-efficacy were significant and meaningful.     

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。     

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.     

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.     

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。     

Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation.

Correlates of concern about weight gain following smoking cessation and self-efficacy about controlling weight gain were examined in 940 men and 1,166 women who were surveyed on 2 occasions as part of a randomized trial of work-site interventions for smoking cessation. Weight concerns were positively associated with female sex, body weight, dieting for weight control, nicotine addiction, and social encouragement to quit. Bivariate analyses replicated prior findings that elevated weight concerns are associated with a reduced likelihood of quitting smoking, at least in women. Analyses controlling for demographics, nicotine dependence, and social factors replicated prior findings that weight concerns are not negatively related to smoking cessation and that some measures of concern are positively related to cessation. These analyses suggest that conflicting findings found in this literature are due primarily to how weight concerns are defined and whether covariates like nicotine addiction are used in data analyses.     

The Impact of Social Influences in the Context of Attitude,Self-Efficacy,Intention, and Previous Behavior as Predictors of Smoking Onset1

Three different constructs for measuring social influence were utilized in the present study to explain adolescents' present and future smoking behavior at 6 (T2), 12 (T3), and 18 months (T4) after the first test. Social influence was assessed by measuring the social norms, perceived smoking behavior, and direct pressure. The impact of the social influence constructs was also assessed in the context of broader models, including attitudes and self-efficacy expectations, intention, and previous behavior. The three social influence measures correlated significantly with intention and behavior. Stepwise regression analyses showed that perceived behavior and pressure made significant contributions, after entering social norms, in explaining actual and future adolescent smoking behavior. Adding attitudes and self-efficacy increased the predictive power of the model significantly. In agreement with the theory of Fishbein & Ajzen (1975), intention was the most powerful predictor in explaining present and future smoking behavior. Attitudes, self-efficacy, and the social influences also made small unique contributions improving the explanatory power by approximately 5%. Previous behavior, however, had a substantial unique contribution in predicting future behavior after attitudes, social influences, self-efficacy, and intention were entered in the equations. Since social influences may exert their impact via different routes, it is recommended that smoking prevention programs discuss not only overt pressures such as direct pressure from peers, parents, and media, but also address the more covert social pressures such as modeling and the adolescents' ability to cope with these covert influences. Furthermore, norms on nonsmoking should be made explicit.     

Does change in positive affect mediate and/or moderate the impact of symptom distress on psychological adjustment after cancer diagnosis? A prospective analysis

This study tested the predictive value of the Transtheoretical Model (TTM) for the preparation to action stage transition by conducting a detailed examination of changes in TTM components in the days leading up to, and following, a planned quit attempt. Participants were 193 callers to a Quitline telephone service. Only limited support for the TTM was found. Consistent with the TTM, measures of self-efficacy were related to making an attempt and to achieving 7 + days of abstinence. Contrary to the TTM, the behavioral change processes were unrelated to making quit attempts and to short-term abstinence, with the exception of self-liberation, which is conceptually related to self-efficacy. New non-TTM measures assessing commitment to quitting were predictive of outcomes. The results provide strong support for the preparation to action transition being discontinuous, and thus consistent with a stage model. However, they bring into question many of the other postulates of the TTM. Further critical testing and evaluation of the TTM is required.     

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.     

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.     

Stages of readiness to quit smoking: population prevalence and correlates.

We examined the population prevalence and correlates of stages in smokers' readiness to quit, using data from 1,048 smokers recruited in a self-weighting, multistage, systematic clustered area sample from 0.44% of South Australian dwellings, with an 89% response rate. Smokers in the precontemplation stage comprised 24.1% of the sample, smokers in the contemplation stage comprised 47.2%, and smokers in the preparation stage comprised 28.7%. No sociodemographic variables (i.e., age, sex, marital status, educational level) were found to be significant independent predictors of membership in the different stages. The five significant independent predictors of being in the precontemplation stage (vs. the contemplation stage) were (a) having a higher confidence of quitting, (b) seeing fewer health risks associated with smoking, (c) not having made an attempt to quit, (d) seeing quitting as more difficult, and (e) smoking 25 or more cigarettes a day. The two significant independent predictors of being in the contemplation stage (vs. the preparation stage) were (a) having lower confidence of quitting and (b) not having tried to quit. We discuss implications for the understanding of smoking behavior in populations and also consider how cessation campaigns might address the factors associated with different stages of readiness to quit.     

Can genetic risk information enhance motivation for smoking cessation? An analogue study.

Protection motivation theory and the extended parallel processing model are used to predict the motivational impact of information regarding a genetic susceptibility to heart disease. One hundred ninety-eight smokers read 1 of 3 vignettes: gene positive, gene negative, or standard smoking risk information. Analyses examined whether the impact of type of risk information was moderated by smokers' self-efficacy (SE) levels. Key outcomes were intention to quit and intention to attend an information session about quitting. There were significant main effects of SE and of receiving gene-positive risk information on intentions to quit. There was a significant Risk x SE interaction on intentions to attend an information session. SE was not associated with intentions to attend the information session for smokers in the gene-positive group. Intentions to attend the session were negatively associated with SE for smokers in the lower risk groups. Implications for using genetic risk information to motivate smoking cessation are discussed.     

Psychosocial Predictors of Change in Cigarette Smoking

Over a period of 6 months, factors related to change in cigarette smoking were investigated in a group of 250 adult outpatients, all of whom smoked at the time of enrollment in the study. Among the variables tested were demographic, social, and situational factors, beliefs about the health effects of smoking and difficulty of quitting, and intentions regarding future smoking. Information was gathered at baseline and the first and sixth months by means of telephone interviews. Relative to smoking at 6 months, intention, education, and professional advice made independent contributions to cessation. The processes of quitting were examined in more detail. Attempting to quit was related to intention, professional advice, level of smoking, and social cues to smoke. Among those who tried to stop, difficulty with urges to smoke, and education affected success versus failure. Earlier success related to less anxiety and tension, and to less difficulty in not smoking when in negative situations. The findings suggest that a complex set of social and cognitive factors affect change in smoking behavior, and that somewhat different factors are operative at different stages.