Positive Smoking Outcome Research Articles

Anxiety-related constructs and smoking outcome expectancies among Latinx smokers.

Hispanic/Latinx (hereafter Latinx) smokers in the United States (US) experience unique smoking cessation-related challenges. Smoking outcome expectancies (i.e., positive and negative beliefs about the consequences of smoking behavior) have been linked to the maintenance of smoking and comorbidity with negative emotional states such as anxiety among Latinx smokers. However, past work has not characterized rates of probable anxiety disorder and elevated levels of anxiety sensitivity among English-speaking daily Latinx smokers from the United States or concurrently evaluated the explanatory relevance of anxiety symptoms and anxiety sensitivity for negative and positive smoking outcome expectancies. The present investigation sought to (a) determine the base rate of probable anxiety disorder and elevated anxiety sensitivity and (b) explore the unique roles of anxiety symptoms and anxiety sensitivity in relation to negative and positive smoking outcome expectancies. Participants included 338 English-speaking Latinx adult daily cigarette smokers from the United States (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Findings revealed high rates of probable anxiety disorder (50.9%) and elevated anxiety sensitivity (73.4%) among English-speaking Latinx smokers from the United States. Anxiety sensitivity, but not anxiety symptoms or disorders, was significantly related to negative consequences, negative reinforcement, positive reinforcement, and appetite/weight control smoking outcome expectancies. Overall, anxiety experiences were common among Latinx smokers, and anxiety sensitivity was a relatively more consistent and robust predictor of negative and positive outcome expectancies relative to anxiety symptoms and probable anxiety disorder. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An ecological momentary assessment study of outcome expectancies and smoking lapse in daily life

ObjectiveOutcome expectancies have been identified as key components of behavior change. Expectancies related to affect control are hypothesized to play an important role in smoking cessation, such that smokers may be more likely to lapse if they believe they can control their affect by smoking and less likely if they believe they can control their affect by means other than smoking. However, little is known about whether real-time, real-world changes in affect control expectancies influence smoking lapse during a quit attempt. MethodsA diverse sample (N = 369) of adult smokers completed ecological momentary assessment of smoking expectancies and lapse for 28 days following a quit attempt. Multilevel logistic regression was used to examine whether the difference score of positive smoking outcome expectancies (the belief that smoking would improve mood) minus positive coping outcome expectancies (the belief that something other than smoking would improve mood) was related to smoking lapse in daily life. ResultsThere was a significant within-person association between the expectancies difference score and lapse likelihood. When the difference score was 1 unit above a person’s typical level, odds of lapse increased by 18.65 % (β = 0.174, SE = 0.024, p < .0001, OR = 1.189, 95 % CI [1.135, 1.247]). ConclusionSmokers undergoing a quit attempt were more likely to lapse in moments when the difference in the belief that smoking would improve their mood minus the belief that something other than smoking would improve their mood was larger. This work has relevance for tailoring interventions to both cultivate positive coping outcome expectancies and reduce smoking outcome expectancies, and informs theoretical models about the dynamic nature of outcome expectancies.

Relationship between health literacy in substance use and alcohol consumption and tobacco use among adolescents, Northeast Thailand.

BACKGROUND:Health literacy (HL) is an important role-play in health risk behaviors such as alcohol drinking and smoking. Inadequate HL in substance use (HLSU) is a barrier to reduce the risk of alcohol and tobacco use. This study aims to investigate the association of HLSU with alcohol consumption and tobacco use among Thai adolescents. Hence, the strengthening of HL program intervention may applied to reduce substance abuse among Thai adolescents.MATERIALS AND METHODS:This was a cross-sectional study conducted on 1087 university students studying in three universities located in northeastern area with multistage sampling methods by geographical areas. The data were collected by self-administered questionnaire. Multiple logistic regression was applied to determine the effect of HLSU of alcohol consumption and tobacco use.RESULTS:Most adolescents were drinkers (60.7%) and about 20.7% were smokers. Approximately 40% of them reported as inadequate HLSU. Adolescents with inadequate HLSU and a high level of positive alcohol expectancies and smoking outcome expectancies (SOE) were more likely to drink alcohol and smoke. Conversely, those who had a high level of negative alcohol drinking and SOE were less likely to consume alcohol and tobacco.CONCLUSION:Adolescents’ alcohol consumption and tobacco use were influenced by HL, hence improving adolescents’ HLSU could help prevent or reduce the risk of drinking and smoking behaviors.

Smoking Outcome Expectancy: Pengetahuan, Perilaku, dan Konsekuensi dari Merokok

Penelitian ini bertujuan untuk melihat hubungan antara smoking outcome expectancy dan pengetahuan tentang bahaya merokok pada perokok dengan level kecanduan tinggi, sedang, dan rendah. Smoking outcome expectancy adalah konstruk untuk menjelaskan harapan yang diperoleh seseorang dari perilaku merokok. Penelitian ini melibatkan responden sebanyak 101 perokok dewasa muda. Smoking outcome expectancy diukur dengan menggunakan alat ukur SCQ-A (Smoking Consequences Questionnaire for Adults) yang disusun oleh Copeland, et al. (1995) yang diadaptasi oleh Jeffries, et al. (2004). Pengetahuan tentang bahaya merokok diukur dengan general knowledge of smoking yang disusun oleh Martini dan Sulistyowati (2005). Alat ukur untuk kategorisasi level ketergantungan merokok adalah FTND (Fagerström Test for Nicotine Dependence) yang dikembangkan oleh Fagerstro¨m, et al. (1992). Penelitian ini menggunakan desain penelitian korelasional dengan metode pengolahan statistik pearson correlation. Terdapat dua hasil utama dari penelitian ini. Pertama, terdapat hubungan yang tidak signifikan antara positive smoking outcome expectancy dan pengetahuan tentang bahaya merokok pada perokok dewasa muda. Kedua, terdapat hubungan positif yang signifikan antara negative smoking outcome expectancy dan pengetahuan tentang bahaya merokok pada perokok dewasa muda. Hal ini dimungkinkan pengetahuan tentang bahaya merokok bukan merupakan prediktor utama bagi perilaku merokok dan smoking outcome expectancy. Bagi orang yang merokok dengan level ketergantungan tinggi, pengetahuan sudah tidak mempengaruhi perilakunya. Perilaku merokok diharapkan bisa menjadi coping stress atau mekanisme fisiologis yang dibutuhkan tubuh.

Feasibility of mobile health game “Fume” in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

ObjectiveNew interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10–13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website. MethodsIn total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n = 61), a group with access to the website (n = 47), and a group with no intervention (n = 43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests. ResultsStatistically significant favorable changes during the study period were found for positive (P = 0.002) and negative (P = 0.02) smoking outcome expectations and attitudes towards cigarette smoking (P = 0.01) within the group using Fume. No statistically significant changes were detected within the website or control groups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P < 0.001), number of separate visit days (P < 0.001) and total duration of use (P < 0.001) were larger for the group using Fume than for that using the website. Fume sparked more interest in early adolescents than the website did (P < 0.001). There were no statistically significant differences in opinions about Fume and those regarding the website. ConclusionsThe intervention with embedded game elements, the health game Fume, was found to be more feasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking self-efficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.

Modelling the contribution of negative affect, outcome expectancies and metacognitions to cigarette use and nicotine dependence

BackgroundBoth positive smoking outcome expectancies and metacognitions about smoking have been found to be positively associated with cigarette use and nicotine dependence. The goal of this study was to test a model including nicotine dependence and number of daily cigarettes as dependent variables, anxiety and depression as independent variables, and smoking outcome expectancies and metacognitions about smoking as mediators between the independents and dependents. MethodsThe sample consisted of 524 self-declared smokers who scored 3 or above on the Fagerstrom Test for Nicotine Dependence (FTND: Uysal et al., 2004). ResultsAnxiety was not associated with either cigarette use or nicotine dependence but was positively associated with all mediators with the exception of stimulation state enhancement and social facilitation. Depression, on the other hand, was found to be positively associated with nicotine dependence (and very weakly to cigarette use) but was not associated with either smoking outcome expectancies or metacognitions about smoking. Only one smoking outcome expectancy (negative affect reduction) was found to be positively associated with nicotine dependence but not cigarette use. Furthermore one smoking outcome expectancy (negative social impression) was found to be positively associated with cigarette use (but not to nicotine dependence). All metacognitions about smoking were found to be positively associated with nicotine dependence. Moreover, negative metacognitions about uncontrollability were found to be positively associated with cigarette use. ConclusionsMetacognitions about smoking appear to be a stronger mediator than smoking outcome expectancies in the relationship between negative affect and cigarette use/nicotine dependence. The implications of these findings are discussed.

Posttraumatic Stress Symptoms and Their Association With Smoking Outcome Expectancies Among Homeless Smokers in Boston.

Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston. We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist-Civilian version and considered scores at least 14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression. Eighty-six percent of eligible individuals participated (N = 306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger (P = .001), more likely to report fair/poor health (P = .01), chronic obstructive pulmonary disease (P = .02), and past-month hallucinations (P = .004), and had greater drug (P < .001) and alcohol (P < .001) use severity and cigarette dependence (P = .002). In analyses controlling for these confounders, PTSD screen-positive participants more strongly endorsed smoking to reduce negative affect (P = .01), smoking for social benefits (P = .002), and smoking for weight control (P = .03). Exploratory analyses suggested that these associations were driven by avoidance/numbing and re-experiencing symptoms. Symptoms of posttraumatic stress are common among homeless smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment. In this study of homeless cigarette smokers in Boston, over two-thirds of participants screened positive for PTSD. PTSD screen-positive respondents more strongly endorsed multiple positive smoking outcome expectancies than screen-negative individuals. These findings suggest that the psychological sequelae of trauma may be a pervasive but under-recognized factor impacting the persistence of smoking among homeless people. Tobacco cessation programs for this population should consider screening for PTSD, fostering a trauma-sensitive treatment environment, and incorporating strategies that have shown promise in smokers with PTSD.

Positive smoking outcome expectancies mediate the association between negative affect and smoking urge among women during a quit attempt.

Ecological momentary assessment was used to examine associations between negative affect, positive smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 302 female smokers who enrolled in an individually tailored smoking cessation treatment study. Multilevel mediation analysis was used to examine the temporal relationship among the following: (a) the effects of negative affect and positive smoking outcome expectancies at 1 assessment point (e.g., time j) on smoking urge at the subsequent time point (e.g., time j + 1) in Model 1; and, (b) the effects of negative affect and smoking urge at time j on positive smoking outcome expectancies at time j + 1 in Model 2. The results from Model 1 showed a statistically significant effect of negative affect at time j on smoking urge at time j + 1, and this effect was mediated by positive smoking outcome expectancies at time j, both within- and between-participants. In Model 2, the within-participant indirect effect of negative affect at time j on positive smoking outcome expectancies at time j + 1 through smoking urge at time j was nonsignificant. However, a statistically significant indirect between-participants effect was found in Model 2. The findings support the hypothesis that urge and positive smoking outcome expectancies increase as a function of negative affect, and suggest a stronger effect of expectancies on urge as opposed to the effect of urge on expectancies.

Self-efficacy and acceptance of cravings to smoke underlie the effectiveness of quitline counseling for smoking cessation

BackgroundFew studies have examined why smoking cessation interventions are effective. The aim of this study was to examine the mediating processes underlying the effectiveness of cessation counseling administered by the Dutch national quitline. MethodsData were used of a two-arm randomized controlled trial in which smoking parents, who were recruited through primary schools in The Netherlands, received either quitline cessation counseling (n=256) or a self-help brochure (n=256). The endpoint was 6-months prolonged abstinence at 12-months follow-up, with 86.7% outcome data retention. Putative psychological mediators of treatment effectiveness included smoking-related cognitions (positive smoking outcome expectancies, self-efficacy), emotions (negative affect, perceived stress, depressive symptoms), and smoking cue coping methods (avoidance coping, acceptance coping) assessed at 3-months post-measurement. ResultsQuitline cessation counseling significantly decreased positive smoking outcome expectancies and negative affect and increased self-efficacy to refrain from smoking, avoidance of external cues to smoking, and acceptance of internal cues to smoking compared to self-help material. Increased self-efficacy to refrain from smoking in stressful and tempting situations (p<.001) and increased acceptance of cravings to smoke (p<.001) significantly mediated the effect of quitline cessation counseling on prolonged abstinence at 12-months follow-up (explained variance: 25.1%). ConclusionsSelf-efficacy to refrain from smoking and acceptance of cravings represent an important source of therapeutic change in smoking cessation counseling.

Positive smoking outcome expectancies mediate the relation between alcohol consumption and smoking urge among women during a quit attempt.

Social learning models of addiction hypothesize that situational factors interact with cognitive determinants to influence a person's motivation to use substances. Ecological momentary assessment was used to examine the association between alcohol consumption, smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 113 female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment. Participants carried a palm-top personal computer for 7 days and were instructed to complete 4 random assessments each day and to initiate an assessment when they were tempted to smoke. Multilevel mediational analyses were used to examine (a) the effects of alcohol consumption before time j and positive smoking outcome expectancies at time j on smoking urge at time j + 1 (Model 1) and (b) the effects of alcohol consumption before time j and smoking urge at time j on positive smoking outcome expectancies at time j + 1 (Model 2). Model 1 found a significant effect of alcohol consumption before time j on smoking urge at time j + 1 (p = .04), and this effect was significantly mediated by positive smoking outcome expectancies at time j (p < .0001). Model 2 failed to find a significant effect of alcohol consumption before time j on positive smoking outcome expectancies at time j + 1. The findings suggest that alcohol consumption is significantly associated with increased positive smoking outcome expectancies that, in turn, are associated with increased smoking urge in women seeking to quit smoking.

Examining the relationships between posttraumatic stress disorder symptoms, positive smoking outcome expectancies, and cigarette smoking in people with substance use disorders: A multiple mediator model

Cigarette smoking is highly prevalent in people with substance use disorders (SUDs) and is associated with significant physical health problems. Posttraumatic stress disorder (PTSD) is also highly associated with both SUDs and cigarette smoking and may serve as a barrier to smoking cessation efforts. In addition, people with PTSD are more likely to hold positive smoking outcome expectancies (i.e., beliefs that smoking cigarettes results in positive outcomes); these beliefs may contribute to cigarette smoking in people with SUDs experiencing PTSD symptoms. The present study examined the relationship between PTSD symptoms and typical daily cigarette smoking/cigarette dependence symptoms in a sample of 227 trauma-exposed current smokers with SUDs (59.9% male, 89.4% Caucasian) seeking detoxification treatment services. Additionally, the indirect effects of multiple types of positive smoking outcome expectancies on these relationships were examined. Participants completed questionnaires assessing PTSD symptoms, positive smoking outcome expectancies, cigarette consumption, and cigarette dependence symptoms. Results indicated that PTSD symptoms were not directly related to cigarette consumption or cigarette dependence symptoms. However, negative affect reduction outcome expectancies were shown to have a significant indirect effect between PTSD symptoms and cigarette consumption, while negative affect reduction, boredom reduction, and taste-sensorimotor manipulation outcome expectancies were all found to have significant indirect effects between PTSD symptoms and cigarette dependence symptoms. The indirect effect involving negative affect reduction outcome expectancies was statistically larger than that of taste sensorimotor manipulation outcome expectancies, while negative affect reduction and boredom reduction outcome expectancies were comparable in magnitude. These results suggest that expectancies that smoking can manage negative affective experiences are related to cigarette smoking in people with SUDs experiencing PTSD symptoms and suggest that effective smoking cessation treatments should take into account these expectancies.

HIV Symptom Distress and Smoking Outcome Expectancies Among HIV+ Smokers: A Pilot Test

Smoking occurs at high rates among people with HIV/AIDS, but little attention has been paid to understanding the nature of tobacco use among HIV+ smokers, especially the role that HIV symptoms may play in cognitive smoking processes. Accordingly, the present investigation examined the relation between HIV symptom distress (i.e., the degree to which HIV symptoms are bothersome) and smoking outcome expectancies. Fifty-seven HIV+ adult smokers (82.50% male; M(age)=47.18; 45.6% White, 28.1% Black, 17.5% Hispanic) were recruited from AIDS service organizations and hospital-based clinics. On average, participants reported knowing their HIV+ status for 16 years and the majority of participants reported that they acquired HIV through unprotected sex (66.6%). Participants completed measures pertaining to HIV symptoms, smoking behavior, and smoking outcome expectancies. HIV symptom distress was positively related to negative reinforcement, negative consequences, and positive reinforcement smoking outcome expectancies after accounting for relevant covariates. The present research suggests that HIV symptom distress may play an important role in understanding smoking outcome expectancies for smokers with HIV/AIDS. Clinical implications for HIV+ smokers are discussed, including the importance of developing effective smoking cessation treatments that meet the unique needs of this group of smokers.

Beyond fear appeals: Contradicting positive smoking outcome expectancies to influence smokers' implicit attitudes, perception, and behavior

Smokers often have (implicit or explicit) positive smoking outcome expectancies that motivate them to smoke. For instance, they may feel that smoking is relaxing, that it improves concentration, or that it is seen as cool and attractive by peers. These expectations are, for the most part, illusory. In order to counteract these expectations, we designed cigarette package warning labels that contradicted common positive outcome expectancies. We investigated the effectiveness of our new warning labels in two experiments. We first measured smokers' implicit attitudes toward smoking using an affective priming method and found that our new warning labels changed positive attitudes into ambivalent attitudes. We then tested whether our warning labels changed smokers' self-reported positive outcome expectancies and smoking behavior. Smokers presented with the new warning labels immediately associated positive outcome expectancies less strongly with smoking and reported smoking fewer cigarettes in the 24hours following the experiment. Explicitly taking the reasons for unhealthy behavior into account when trying to change people's habits could offer a valuable contribution to effective health campaigns.

An evaluation of pain-related anxiety among daily cigarette smokers in terms of negative and positive reinforcement smoking outcome expectancies

The present investigation sought to evaluate the unique explanatory relevance of pain-related anxiety in relation to negative and positive reinforcement smoking outcome expectancies among 135 (40.7% female; M age = 26.11, SD = 11.23) adult daily cigarette smokers. As predicted, pain-related anxiety was significantly related to greater expectancies that smoking will decrease negative affect, and lesser expectancies that smoking will result in positive outcomes. The observed effects were evident above and beyond the variance accounted for by gender, current level of non-specific bodily pain, daily cigarette use, relations with non-criterion outcome expectancies, and shared variance with anxiety sensitivity. Results suggest that there may be segments of the smoking population who are at relatively greater risk for certain expectancies for tobacco smoking by virtue of individual differences in pain-related anxiety.

Dynamic Self-Efficacy and Outcome Expectancies: Prediction of Smoking Lapse and Relapse.

According to social learning models of drug relapse, decreases in abstinence self-efficacy (ASE) and increases in positive smoking outcome expectancies (POEs) should foreshadow lapses and relapse. In this study, the authors examined this hypothesis by using ecological momentary assessment data from 305 smokers who achieved initial abstinence from smoking and monitored their smoking and their ASE and POEs by using palmtop computers. Daily ASE and POEs predicted the occurrence of a 1st lapse on the following day. Following a lapse, variations in daily ASE predicted the onset of relapse, even after controlling for concurrent smoking. ASE and POEs generally neither mediated nor moderated each other's effects. These data emphasize the role of dynamic factors in the relapse process.

Development and validation of an adolescent smoking consequences questionnaire

Several researchers have investigated the role of outcome expectancies in the initiation and maintenance of smoking behavior. Empirical studies with adults, using a validated self-report instrument, have shown that smokers identify higher levels of positive smoking expectancies and lower levels of negative smoking expectancies compared with nonsmokers and ex-smokers. Studies examining smoking outcome expectancies among adolescents have yielded similar findings, but many of these studies did not use a self-report expectancy measure validated with teens. Therefore, the present study sought to modify a well-known adult smoking expectancy instrument, the Smoking Consequences Questionnaire (SCQ), and to validate its factor structure with a community sample of adolescent nonsmokers and current smokers (aged 11-19 years). Results of a confirmatory factor analysis provided support for a seven-latent-factor structure modeled after the SCQ-Adult. As expected, smoking behavior and the intent to smoke in the future were associated with the endorsement of positive and negative smoking outcome expectancies. The psychometric data provide early support for the validity and reliability of this modified SCQ, renamed the Adolescent Smoking Consequences Questionnaire, for the assessment of smoking expectancies among smoking inexperienced and experienced teens.