Smokers’ thoughts and worries: A study using ecological momentary assessment.

Objective: The purpose of this study was to investigate smokers’ thoughts and worries about their smoking behavior. Researchers have sometimes asked smokers to make such self-assessments but typically using retrospective summary judgments. Design: Using ecological momentary assessment, community and student smokers reported five times daily during two separate 1-week intervals. Main Outcome Measures: Smokers reported their thoughts about smoking, worries about smoking, and level of contemplation to quit smoking. Results: Smokers reported thinking negatively about their smoking 26.8% of the time they had a cigarette. The most frequent thoughts reported by smokers related to immediate reinforcement of smoking (e.g., “How I smell like cigarettes”). However, smokers reported more intense worry about thoughts related to health concerns (e.g., “Symptoms I'm having because of smoking”). The occurrence of negative thoughts was significantly and positively related to contemplation about quitting, worry about smoking, and risk perceptions. Finally, self-reported worry intensity was more strongly related to contemplation of quitting than negative thought occurrence. Conclusion: Our results show that thoughts about smoking (i.e., cognitions) and feelings about smoking (i.e., worry) are loosely connected and it is feelings rather than cognitions that are most related to contemplation to quit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The instability of health cognitions: Visceral states influence self-efficacy and related health beliefs.

Objective: To determine how visceral impulses, such as hunger and drug craving, influence health beliefs. Design: The authors assessed smokers' self-efficacy and intentions to quit while in a randomly assigned state of cigarette craving or noncraving (Study 1), and assessed dieters weight-loss beliefs while hungry or satiated (Study 2). Main outcome measures: Self-efficacy, smoking cessation, weight-loss goals. Results: The authors found, in both the context of smoking and weight-loss, that participants in a cold (e.g., satiated) state had different health beliefs than participants in a hot state (e.g., hungry). Specifically, in Study 1, the authors found that smokers who experienced cigarette craving had lower self-efficacy than did satiated smokers. Consequently, smokers who craved a cigarette had less intention to quit smoking in the future compared with satiated smokers. In Study 2, the authors found that hungry dieters had less self-efficacy than did satiated dieters. This difference led hungry dieters to form less ambitious future weight-loss goals and view prior weight-loss attempts with more satisfaction. Conclusion: These findings contribute to our understanding of the nature of health beliefs and reveal that health beliefs are more dynamic than previously assumed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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 × 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How self-affirmation reduces defensive processing of threatening health information: Evidence at the implicit level.

Objective: Self-affirmation reduces defensive responses to threatening health information, but little is known about the cognitive processes instigated by self-affirmation. This study tested whether self-affirmation increases responsiveness to threatening health information at the implicit level. Design: In an experimental study (N = 84), the authors presented high- (coffee drinkers) and low-relevance (noncoffee drinkers) participants with threatening health information linking caffeine consumption to health problems. Prior to reading this information, the authors manipulated self-affirmation. Main Outcome Measures: Participants completed an unobtrusive lexical decision task to measure the accessibility of threat-related cognitions and reported their perceptions of message quality and intentions to take precautions. Results: Among high-relevance participants, self-affirmation increased the accessibility of threat-related cognitions, increased perceptions of message quality, and promoted adaptive behavioral intentions. Conclusion: The findings suggest that self-affirmation can increase implicit responsiveness to threatening health information among a target audience, that is, people for whom the health information is highly relevant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regret and rationalization among smokers in Thailand and Malaysia: Findings from the International Tobacco Control Southeast Asia Survey.

Objective: To test whether differences of history and strength in tobacco control policies will influence social norms, which, in turn, will influence quit intentions, by influencing smokers’ regret and rationalization. Design: The data were from the International Tobacco Control (ITC) Policy Evaluation Southeast Asia Survey, a cohort survey of representative samples of adult smokers in Thailand (N = 2,000) and Malaysia (N = 2,006). The survey used a stratified multistage sampling design. Main Outcome Measures: Measures included regret, rationalization, social norms, and quit intention. Results: Thai smokers were more likely to have quit intentions than Malaysian smokers. This difference in quit intentions was, in part, explained by the country differences in social norms, regret, and rationalization. Reflecting Thailand’s history of stronger tobacco control policies, Thai smokers, compared with Malaysian smokers, perceived more negative social norms toward smoking, were more likely to regret, and less likely to rationalize smoking. Mediational analyses revealed that these differences in social norms, accounted, in part, for the country-quit intention relation and that regret and rationalization accounted, in part, for the social norm-quit intention relation. Conclusion: The results suggest that social norms toward smoking, which are shaped by tobacco control policies, and smokers’ regret and rationalization influence quit intentions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized, controlled trial of adding expired carbon monoxide feedback to brief stop smoking advice: Evaluation of cognitive and behavioral effects.

Objective: To determine the effect of adding biomarker feedback (expired air carbon monoxide) to standard quit advice on cognitive antecedents of behavior change and smoking cessation and to identify potential effect moderators and mediators. Design: Smokers (N = 160) were randomized to a control (quit advice plus leaflet) or an intervention condition (as control group plus carbon-monoxide level feedback). Cognitive measures were assessed immediately after the intervention and behavioral measures at 6 months' follow-up. Main Outcome Measures: Primary outcome measures were threat and efficacy appraisal, fear arousal, and intention to stop smoking. Secondary outcome measures were quit attempts within the last 6 months and 7-day point prevalence abstinence. Results: Threat appraisal was significantly enhanced in the intervention compared with the control group, t(158) = 2.29, p = .023, as was intention to stop smoking in the next month, t(151) = 2.9, p = .004. However, this effect on intention to stop smoking was short-lived. Groups did not differ in terms of quit attempts or abstinence at follow-up, but the intervention increased the likelihood of cessation in smokers with higher self-efficacy, χ2(1) = 5.82, p = .016. Conclusions: Carbon-monoxide level feedback enhances the effect of brief quit advice on cognitive antecedents of behavior change and smoking cessation rates but further research is required to confirm the longevity of this effect and its applicability to smokers with low self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Desire and efforts to quit smoking among cigarette smokers in Wisconsin

This research studied the desire and attempts of cigarette smokers in Wisconsin to quit smoking. Data were based on the 1993 Wisconsin Division of Health's Behavioral Risk Factor Surveillance System (BRFSS). Among the 23% of respondents who were current smokers, 79% said they wanted to quit smoking and 60% said they had quit smoking for a day or more in the preceding year. High rates of wanting to quit and having tried to quit were found in all demographic subgroups of smokers studied. Compared to lighter smokers, heavy cigarette smokers (20 or more cigarettes per day) were less likely to have tried quitting in the past year, but were almost as likely to want to quit. These results demonstrate the great demand for smoking cessation services among smokers in Wisconsin and support for efforts to increase the use and effectiveness of these interventions.     

Resisting tempting foods and smoking behavior: Implications from a self-control theory perspective.

Objective: Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking. Design: Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess. Main Outcome Measures: Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable. Results: As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), χ2(1, N = 101) = 3.65 p     

Chorioretinal damage caused by the excision of choroidal neovascularization

BACKGROUND: In recent years many longitudinal studies have examined the predictors of smoking acquisition. However, only a few studies have focused on the precursors of smoking cessation. The current study is one of the first concentrating on longitudinal predictors of young people's smoking cessation. METHODS: Subjects were 215 smokers ages 14-15 years who were reinterviewed 3 years later. These smokers were allocated to four groups based on their motivation to quit and actual quitting behavior at the last wave. Independent variables were smoking-specific cognitions, social influences, and aspects of smoking habits. RESULTS: Univariate comparisons between the four groups showed that those with a positive attitude toward smoking and lower self-efficacy were less likely to be motivated to quit 3 years later. No long-term effects of environmental influences were found. Aspects of smoking habits, such as intensity and frequency of smoking, and the context of cigarette use affected the motivation to quit. Logistic regression analyses were conducted to examine differences in predictors between the groups in more detail. These analyses revealed that differences mainly in attitudes and self-efficacy affected whether subjects were absolutely not motivated to quit or had actually quit 3 years later. Differences in smoking behavior affected the allocation to the more closely related groups (e.g., preparing versus quitting). CONCLUSIONS: Adolescents' motivation to quit is affected by smoking-related cognitions and habitual factors. More research is needed to decide whether the relation between intensity and frequency of smoking and the likelihood to quit later on should be interpreted in terms of differences in smoking initiation or in terms of preparation to quit.     

Changes in employee smoking behavior after implementation of restrictive smoking policies

How do restrictive smoking policies affect the smoking behavior of employees? At two federal hospitals, 2,700 employees completed written surveys after implementation of restrictive smoking policies. At one hospital, smokers reported less smoking at work (down 2.0 cigarettes a day at 6 months, 1.7 at 12) without compensatory smoking. At the other, no significant changes in smoking behavior were reported. However, at both hospitals, some baseline smokers quit smoking. At 6 months, 9% had quit at one hospital and 8% at the other. Analyses were done using these two studies and 17 published studies. In 11 of 11 studies, consumption at work decreased, and in 12 of 14, total daily consumption decreased. Regression analysis indicated that the number of smokers who quit smoking after policy implementation increases over time at rates exceeding those normally expected in the population. Smoking policies appear to effect a reduction in total cigarette consumption and an increase in the number of smokers who quit.     

Impact of expenditures for veterinary services and medical supplies on dairy farm productivity and profitability

OBJECTIVES: This study was undertaken to explore smoking patterns and attitudes that influence smoking cessation and relapse among African Americans. METHODS: Baseline data from eight Community Intervention Trial for Smoking Cessation (COMMIT) sites were analyzed. RESULTS: Compared with Whites, African Americans who smoke less than 25 cigarettes per day were 1.6 times more likely to smoke within 10 minutes of awakening (a behavioral indicator of nicotine dependence), adjusting for education, age, and gender (OR = 1.2 for heavier smokers). African Americans reported a stronger desire to quit smoking and reported serious quit attempts in the past year. African Americans favored tobacco restrictions (they were 1.8 times more likely than Whites to view smoking as a serious community problem, 1.7 times more likely to favor restrictions on cigarette vending machines, and 2.1 times more likely to prohibit smoking in their car). African Americans were lighter/moderate, menthol smokers. CONCLUSIONS: African Americans find smoking socially unacceptable and are strongly motivated to quit, but their "wake-up" smoking may indicate high nicotine dependence, making abstinence difficult even for lighter smokers.     

How useful are the stages of change for targeting interventions? Randomized test of a brief intervention to reduce smoking.

Objective: To see whether the stages of change are useful for targeting a brief intervention to reduce smoking based on implementation intentions. A second objective was to rule out demand characteristics as an alternative explanation for the findings of intervention studies based on the transtheoretical model and implementation intentions. Design: Participants (N = 350) were randomized to a passive control condition (questionnaire only), active control condition (questionnaire plus instruction to plan to quit), or experimental condition (questionnaire, plan to quit, form an implementation intention). Their behavior and psychosocial orientation to quit were measured at baseline and at 2-month follow-up. Main Outcome Measures: Theory of planned behavior variables, nicotine dependence, and quitting. Results: Significantly more people quit smoking in the experimental condition than in the control conditions, and the planning instructions changed intention to quit and perceived control over quitting, but not behavior. Stage of change moderated these effects such that implementation intentions worked best for individuals who were in the preparation stage at baseline. Conclusion: Harnessing both motivational and volitional processes seems to enhance the effectiveness of smoking cessation programs, although further work is required to clarify inconsistencies in the literature using the stages of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships Between Perceived Stress and Health Behaviors in a Sample of Working Adults.

The study examined associations between perceived stress and fat intake, exercise, alcohol consumption, and smoking behaviors. Data were from surveys of 12,110 individuals in 26 worksites participating in the SUCCESS project (D. J. Hennrikus, R. W. Jeffery, & H. A. Lando, 1995), a study of smoking cessation interventions. Linear regression analyses examined cross-sectional associations between stress level and health behaviors. Analyses were stratified by gender and controlled for demographics. High stress for both men and women was associated with a higher fat diet, less frequent exercise, cigarette smoking, recent increases in smoking, less self-efficacy to quit smoking, and less self-efficacy to not smoke when stressed. Stress was not associated with alcohol intake. Findings suggest that the association between stress and disease may be moderated in part by unhealthy behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neural activity during health messaging predicts reductions in smoking above and beyond self-report.

Objective: The current study tested whether neural activity in response to messages designed to help smokers quit could predict smoking reduction, above and beyond self-report. Design: Using neural activity in an a priori region of interest (a subregion of medial prefrontal cortex [MPFC]), in response to ads designed to help smokers quit smoking, we prospectively predicted reductions in smoking in a community sample of smokers (N = 28) who were attempting to quit smoking. Smoking was assessed via expired carbon monoxide (CO; a biological measure of recent smoking) at baseline and 1 month following exposure to professionally developed quitting ads. Results: A positive relationship was observed between activity in the MPFC region of interest and successful quitting (increased activity in MPFC was associated with a greater decrease in expired CO). The addition of neural activity to a model predicting changes in CO from self-reported intentions, self-efficacy, and ability to relate to the messages significantly improved model fit, doubling the variance explained (R2self-report = .15, R2self-report + neural activity = .35, R2change = .20). Conclusion: Neural activity is a useful complement to existing self-report measures. In this investigation, we extend prior work predicting behavior change based on neural activity in response to persuasive media to an important health domain and discuss potential psychological interpretations of the brain–behavior link. Our results support a novel use of neuroimaging technology for understanding the psychology of behavior change and facilitating health promotion. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of culturally specific cessation messages on theoretical antecedents of behavior among low-income african american smokers.

Previous research has highlighted the importance of cultural relevance in health risk communications, including tobacco interventions. However, few studies have examined the active components of smoking cessation messages targeting low-income African American smokers. This study tested the influence of message content and culturally specific framing in a sample of adult smokers. In a 2 × 2 factorial experiment, 243 African American smokers (M = 19 cigarettes/day) recruited from the community (55% women; mean age = 43 years) were randomly assigned to 1 of 4 conditions: culturally specific smoking messages, standard smoking messages, culturally specific exercise/weight messages, or standard exercise/weight messages. The primary outcome measures were theoretical antecedents to behavior change, including risk perceptions (general, personal, and culturally specific), readiness to quit smoking, and smoking-related knowledge. The results showed that the smoking messages produced greater culturally specific risk perceptions, readiness to quit smoking, and smoking-related knowledge. The culturally specific messages produced greater personal risk perceptions and intentions to quit. Culturally specific risk perceptions were most affected by culturally specific smoking messages. Findings support the roles of message content and culturally specific framing in the efficacy of brief written interventions for smoking cessation in this population. Future research is needed to examine the influence of these constructs on behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in self-efficacy resulting from unaided attempts to quit smoking.

Investigated changes in smoking self-efficacy as a result of successful and unsuccessful quit attempts. The sample consisted of 182 smokers (aged 19–70 yrs) who planned to quit smoking without professional assistance. Prior to a self-selected quit date, smoking self-efficacy was assessed. Quit status was determined 1, 6, and 12 mo after the quit date. Self-efficacy was reassessed at the 12-mo follow-up. At 12 mo the sample consisted of 44 quitters, 24 continuous smokers, 102 relapsers, and 12 Ss whose smoking status was uncertain. Self-reports of cessation were corroborated by collateral report and confirmed by saliva cotinine analysis. As predicted, quitters increased their self-efficacy, and continuous smokers decreased their self-efficacy from the prequit baseline to the 12-mo follow-up. Relapsers' self-efficacy also dropped significantly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

Objective: To assess the validity of the stages of change (SOC) algorithm for current smokers. Design: This study was a mail-based, cross-sectional survey study of 242 adult smokers. Main Outcome Measures: The main outcome measures were the SOC algorithm and a variety of alternative questionnaire items measuring motivation to quit smoking. Results and Conclusion: The results revealed that the SOC algorithm systematically underestimated motivation to quit smoking relative to a variety of other measures. Further, the stages of change do not appear to be qualitatively distinct categories. More than half the precontemplators were contemplating cessation, and many precontemplators intended to quit. Most contemplators were not merely contemplating cessation but rather were trying to quit currently. In summary, there is a divergence between the concepts underlying the SOC-precontemplation, contemplation, and preparation-and the operational definitions of these concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How many cigarettes did you smoke? Assessing cigarette consumption by global report, time-line follow-back, and ecological momentary assessment.

Objective: This study evaluated and compared several methods of assessing daily cigarette consumption. Design: Comparison of measures of daily cigarette consumption from several sources, from 232 smokers entering a smoking cessation program. Main Outcome Measures: Global reports of average smoking, Time-Line Follow-Back (TLFB) recall for the week preceding the study (premonitoring TLFB), 2 weeks' cigarette recordings using electronic diaries and ecological momentary assessment (EMA), and TLFB recall of smoking during EMA (monitored TLFB). Results: Global reports and premonitoring TLFB showed severe digit bias: six times as many values as expected were rounded at 10. Monitored TLFB also showed substantial digit bias (four times). EMA data showed none. EMA averaged 2.6 cigarettes lower than monitored TLFB, but exceeded TLFB on 32% of days. Across days, EMA and TLFB only correlated 0.29. Daily variations in TLFB did not correlate with variations in carbon monoxide (CO) measures taken on 3 days, but EMA measures did; among participants whose CO varied, r = .69. CO correlated with EMA cigarettes recorded in the preceding 2 hours, suggesting timely recording of cigarettes. Conclusion: TLFB measures are limited for precise assessment of cigarette consumption. EMA measures appear to be useful for tracking smoking, and likely other health-relevant events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic effects of self-efficacy on smoking lapses and relapse among adolescents.

Objective: The present study examined whether dynamic day-to-day variations in self-efficacy predicted success in quit attempts among daily smoking adolescents. Design: A sample of 149 adolescents recorded their smoking and self-efficacy three times per day during 1 week prior to and 3 weeks after a quit attempt. Main Outcome Measures: The first lapse, second lapse, and relapse after at least 24 hours of abstinence from smoking were the main outcome measures. Results: Self-efficacy was relatively high and moderately variable prior to the first lapse, but decreased and became more variable thereafter. Lower self-efficacy as measured at the lapse assessment significantly increased the risk that a second lapse and relapse would occur. Individual differences in baseline self-efficacy did not predict any of the treatment outcomes. The time-varying analyses, however, showed that lower self-efficacy on a given day predicted the first lapse, the second lapse, and relapse on the succeeding day. Daily concomitant smoking (any smoking on the preceding day) was not significantly related to relapse. Conclusion: The present results emphasize the importance of self-efficacy among adolescents in cessation and highlight the need for dynamic formulations and assessments of adolescents' self-efficacy and relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)