Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial.

Elizabeth L Seaman,Jennifer M Taber,David Crane,Peter R Harris,William M P Klein,Rebecca A Ferrer,Cendrine D Robinson

doi:10.2196/18433

Abstract

BackgroundMost smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats.ObjectiveThis study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation.MethodsAll users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry.ResultsThe study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation.ConclusionsSpontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions.Trial RegistrationISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

Highlights

BackgroundTobacco use remains a leading cause of preventable death and disease globally, contributing to over 7.1 million deaths annually [1]
Spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation
Baseline sadness was associated with a lower likelihood of reporting successful cessation at the 1-month follow-up; optimism was significantly associated with past-week cessation at the 1-month follow-up, and happiness and anger were both significantly associated with past-month cessation at the 1-month follow-up

Summary

Introduction

Tobacco use remains a leading cause of preventable death and disease globally, contributing to over 7.1 million deaths annually [1]. Approximately 343,000 people in the United States die from cancer related to tobacco use [2]. Many adults are motivated to quit smoking cigarettes; most attempts to quit are unsuccessful [3,4]. There are several empirically supported behavioral treatments for smoking cessation [6]. The high rate of unsuccessful quit attempts [7] suggests that there is a need for supplementary and disseminable behavioral interventions. Cigarette cravings may undermine perceived competence to quit and constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats

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