The applicability of the theory of planned behavior to the intention to quit smoking across workplaces in southern Taiwan

Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study

Objective

To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar.

Methods

A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed.

Results

The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months.

Conclusion

The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.

Who Are More Likely to Have Quit Intentions among Malaysian Adult Smokers? Findings from the 2020 ITC Malaysia Survey

Increasing quitting among smokers is essential to reduce the population burden of smoking-related diseases. Smokers' intentions to quit smoking are among the strongest predictors of future quit attempts. It is therefore important to understand factors associated with intentions to quit, and this is particularly important in low- and middle-income countries, where there have been few studies on quit intentions. The present study was conducted to identify factors associated with quit intentions among smokers in Malaysia. Data came from the 2020 International Tobacco Control (ITC) Malaysia Survey, a self-administered online survey of 1047 adult (18+) Malaysian smokers. Smokers who reported that they planned to quit smoking in the next month, within the next six months, or sometime beyond six months were classified as having intentions to quit smoking. Factors associated with quit intentions were examined by using multivariable logistic regression. Most smokers (85.2%) intended to quit smoking. Smokers were more likely to have quit intentions if they were of Malay ethnicity vs. other ethnicities (adjusted odds ratio (AOR) = 1.82, 95% confidence interval (CI) = 1.03-3.20), of moderate (AOR = 2.11, 95% CI = 1.12-3.99) or high level of education vs. low level of education (AOR = 1.97, 95% CI = 1.04-3.75), if they had ever tried to quit smoking vs. no quit attempt (AOR = 8.81, 95% CI = 5.09-15.27), if they received advice to quit from a healthcare provider vs. not receiving any quit advice (AOR = 3.78, 95% CI = 1.62-8.83), and if they reported worrying about future health because of smoking (AOR = 3.11, 95% CI = 1.35-7.15 (a little worried/moderately worried vs. not worried); AOR = 7.35, 95% CI = 2.47-21.83 (very worried vs. not worried)). The factors associated with intentions to quit smoking among Malaysian smokers were consistent with those identified in other countries. A better understanding of the factors influencing intentions to quit can strengthen existing cessation programs and guide the development of more effective smoking-cessation programs in Malaysia.

Gender Differences in the Extended Theory of Planned Behaviour on Smoking Cessation Intention in Young Soldiers

Background: The theory of planned behaviour (TPB) explanation of smoking cessation intentions consists of gender differences. The purpose of this study is to adopt the extended TPB to discuss factors influencing the smoking cessation intentions of young adult volunteer soldiers and to further compare the respective factors for both genders. Methods: This is a cross-sectional study. Data were collected from 139 and 165 male and female volunteer soldiers who smoked, respectively. Research participants completed a self-administered questionnaire that comprised items pertaining to the participants’ demographic characteristics, smoking behaviours, smoking cessation experiences, social environments, and TPB variables. Results: Subjective norms (friends) are a positive key factor for young adult male (β = 0.033, p = 0.012) and female (β = 0.076, p < 0.001) volunteer soldiers’ smoking cessation intentions, and perceived behavioural control is a key factor for male young (β = 0.226, p = 0.040) adult volunteer soldiers’ smoking cessation intention. The extended TPB accounted for 27.9% and 53.2% of the variance in the intention to quit smoking in the male and female volunteer soldiers, respectively. Conclusions: We suggest that smoking cessation strategies can reinforce gender-specific intervention strategies to assist young adult volunteer soldiers in smoking cessation.

A randomized controlled pilot trial of a smoking cessation intervention for US women living with HIV: telephone-based video call vs voice call

Background

People living with HIV smoke at a rate three times that of the general population. This randomized controlled pilot trial tested the feasibility and acceptability of a video-call smoking cessation intervention in women living with HIV and its preliminary efficacy compared with a voice-call smoking cessation intervention. The study focused on women due to a paucity of studies among this population, and women are less likely than men to quit smoking when provided with conventional treatment.

Methods

Participants in both arms received an HIV-tailored smoking cessation intervention comprising eight 30-minute weekly counseling sessions in conjunction with active nicotine patches for 8 weeks. The only difference between the two arms was the delivery mode of the intervention: via either telephone-based video or voice call. Survival analysis and a Cox proportional hazard regression model were performed to identify factors predicting 6-month prolonged abstinence from smoking.

Results

A video-call intervention was almost 30% less feasible than a voice-call intervention because women in their 50s and 60s or poorer women living in some southern states did not have access to video-call equipment. However, those who received the video-call intervention were more likely to complete the study than those who had the voice-call intervention. There was no difference in the acceptability of the two interventions. A survival analysis revealed that those in the video arm were significantly more likely to maintain smoking abstinence over the 6-month follow-up period than those in the voice arm (log rank χ²=4.02, P<0.05).

Conclusion

Although a video-call intervention is less feasible than a voice-call intervention, the former seems to outperform the latter in achieving long-term smoking abstinence for women living with HIV, which may offer an advantage over establishing therapeutic alliance and visually monitoring their adherence to nicotine patches.

Clinical trial registration

ClinicalTrials.gov NCT02898597.

Tobacco cessation interventions for young people

BACKGROUND

Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.

OBJECTIVES

To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO.

SELECTION CRITERIA

We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up.

MAIN RESULTS

Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias.

AUTHORS' CONCLUSIONS

There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

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 use of planned behavior theory in predicting cigarette smoking among Waterpipe smokers

Background

Waterpipe and cigarette smoking have been found to be associated with each other as cigarette smokers were more likely to be waterpipe users than non-cigarette smokers. Also, waterpipe smokers were likely to be former daily cigarette users. The aim of this study is to examine the likelihood of waterpipe use leading to cigarette use among current waterpipe users using theory of planned behavior.

Methods

Four hundred six current waterpipe smokers who initially had started tobacco use with the waterpipe were recruited from 15 waterpipe lounges in 2015. From a total of 70 waterpipe lounges in Riyadh, the 15 waterpipe lounges were selected randomly and participants were also selected randomly inside each waterpipe lounge based on the table or section number. The survey was developed using the Qualtrics Online Survey Software and participants completed a survey using iPad tablets.

Results

Cigarette smoking and intention to smoke cigarettes were predicted by attitude and perceived behavioral control. There was no direct effect of subjective norm on the cigarette use behavior, yet subjective norm had a statistically significant indirect effect on intentions through attitude and perceived behavioral control.

Conclusions

The findings of this study could be useful in prevention/intervention programs aimed at reducing tobacco smoking behaviors among waterpipe users. Intervention programs might be directed at the attitude and perceived behavioral control by targeting underlying behavioral and control beliefs. The theory of planned behavior provided solid explanations of intention to use cigarettes among waterpipe smokers.

Determinants of intentions to quit smoking among adult smokers in Bangladesh: findings from the International Tobacco Control (ITC) Bangladesh wave 2 survey

Background

With about 22 million adult smokers, Bangladesh needs strong measures that would promote smoking cessation. Using data from Wave 2 of the International Tobacco Control (ITC) Survey, this study examined the factors associated with intention to quit smoking among Bangladeshi smokers.

Methods

Data from Wave 2 of the International Tobacco Control (ITC) Survey in Bangladesh, a face to face survey of adult smokers, were analysed. In the ITC survey, households were sampled using a stratified multistage design and interviewed using a structured questionnaire.

Results

Of the respondents (N = 2982), most were male (96 %), married (80 %), and Muslim (83 %); 33 % were illiterate and 54 % were aged below 40. Almost two-thirds were from areas outside Dhaka, 78 % smoked cigarettes exclusively; and 36 % had an intention to quit smoking in the future. This study identified several predictors, comparable to other international studies, of intention to quit smoking: area of residence, number of cigarettes smoked daily, previous quit attempt, visiting a doctor in the past, having child aged 5 or below at home, perceived benefit from quitting, being worried about own health, knowledge of SHS, not enjoying smoking and workplace smoking policy.

Conclusions

These findings suggest that the prevalence of intention to quit smoking is lower among Bangladeshi smokers than those among smokers in developed countries. However, the factors relating to quit intentions among Bangladeshi smokers are comparable to those found in Western countries. Population based tobacco control programs and policies should consider these predictors in the design of interventions to increase quitting among smokers in Bangladesh.

Predictors of Intention to Seek Medical Help by Peruvian Mothers for Children Who Have Signs of Pneumonia

The Theory of Planned Behavior was used to assess predictors of Peruvian mothers seeking medical help when they believed their child had signs of pneumonia. Open-ended interviews to identify beliefs were followed by a questionnaire administered to 500 mothers from low-income settlements in Lima in June and July 2000. Subjective norm (what important referents want) was the best predictor of intention, followed by mothers' feelings about how easy it would be to take the child to the clinic. Attitude toward taking the child to a clinic was not a significant predictor of intention. This study indicates a stronger role for subjective norm than attitudes and perceived control in similar studies done with this model in other settings. It, of course, only predicts intention to act and not behavior, important here given social-economic barriers, e.g., cost, to access to care among this study group.

Intention to quit water pipe smoking among Arab Americans: Application of the theory of planned behavior

In this study, we examined the effect of theory of planned behavior (TPB) constructs on the intention to quit water pipe smoking by using an observational, survey-based, cross-sectional study design with a convenient sample of Arab American adults in Houston, Texas. Multivariate logistic regression models were used to determine predictors of intention to quit water pipe smoking in the next year. A total of 340 participants completed the survey. Behavioral evaluation, normative beliefs, and motivation to comply were significant predictors of an intention to quit water pipe smoking adjusting for age, gender, income, marital status, and education. Interventions and strategies that include these constructs will assist water pipe smokers in quitting.

Quitting Without Reporting Having Tried: Findings From a National Survey

Background: It is assumed that smokers rarely quit without ‘attempting’ to do so but the assumption does not appear to have been adequately tested. This study assessed the prevalence of reporting having stopped without reporting a quit attempt and the reasons given for this discrepancy.

Methods: Data were collected from ex-smokers who said they had quit within the last 12 months during nationally representative household surveys conducted monthly between 2006–12.

Results: Of the 1,892 ex-smokers who said that they had quit within the last 12 months, 13.9% (95%CI = 12.4%–15.5%) reported having made no serious quit attempts in that period. In a sub-group of 24 smokers who were asked why they had reported stopping without also reporting an attempt, nine cited inconsistency over timing; three reported stopping without attempting to do so; four did not consider it an ‘attempt’ because they had succeeded; and six had not ruled out the occasional cigarette in the future.

Conclusions: A substantial minority of people who report having stopped in the past year may fail to report a corresponding quit attempt. However, quitting smoking without considering that one has tried appears to be rare. Instead, the most common reason for the discrepancy is inconsistent reporting of the timing of quit attempts.

Systematic searching for theory to inform systematic reviews: is it feasible? Is it desirable?

BACKGROUND

In recognising the potential value of theory in understanding how interventions work comes a challenge - how to make identification of theory less haphazard?

OBJECTIVES

To explore the feasibility of systematic identification of theory.

METHOD

We searched PubMed for published reviews (1998-2012) that had explicitly sought to identify theory. Systematic searching may be characterised by a structured question, methodological filters and an itemised search procedure. We constructed a template (BeHEMoTh - Behaviour of interest; Health context; Exclusions; Models or Theories) for use when systematically identifying theory. The authors tested the template within two systematic reviews.

RESULTS

Of 34 systematic reviews, only 12 reviews (35%) reported a method for identifying theory. Nineteen did not specify how they identified studies containing theory. Data were unavailable for three reviews. Candidate terms include concept(s)/conceptual, framework(s), model(s), and theory/theories/theoretical. Information professionals must overcome inadequate reporting and the use of theory out of context. The review team faces an additional concern in lack of 'theory fidelity'.

CONCLUSIONS

Based on experience with two systematic reviews, the BeHEMoTh template and procedure offers a feasible and useful approach for identification of theory. Applications include realist synthesis, framework synthesis or review of complex interventions. The procedure requires rigorous evaluation.

How to reduce the latent social risk of disease: the determinants of vaccination against rabies in Taiwan

To control the latent social risk of disease, the government usually spreads accurate information and attempts to improve the public’s attitude toward adopting prevention. However, these methods with the Knowledge, Attitudes, and Practices (KAP) model do not always work. Therefore, we used the theory of planned behavior (TPB) to understand dog owners’ behavior and distinguished the knowledge effect as objective knowledge (OK) and subjective knowledge (SK). A total of 310 dog owners completed a questionnaire based on our model. We employed structural equation modeling to verify the structural relationships and found three main results. First, our model was fit, and each path was significant. People with better attitudes, stronger subjective norms, and more perceptive behavioral control have stronger behavioral intention. Second, perceived behavioral control, not attitude, was the best predictive index in this model. Finally, on perceived behavioral control, subjective knowledge showed more influence than objective knowledge. We successfully extended TPB to explain the behavioral intention of dog owners and presented more workable recommendations. To reduce the latent social risk of disease, the government should not only address dog owners’ attitudes, but also their subjective norms and perceptive behavioral control. Indeed, perceptive behavioral control and SK showed the most influence in this model. It is implied that the self-efficacy of dog owners is the most important factor in such a behavior. Therefore, the government should focus on enhancing dog owners’ self-efficacy first while devoted to prevention activities.

A qualitative evidence synthesis of employees' views of workplace smoking reduction or cessation interventions

BACKGROUND

The need to reduce smoking rates is a recognised public health policy issue in many countries. The workplace offers a potential context for offering smokers' programmes and interventions to assist smoking cessation or reduction. A qualitative evidence synthesis of employees' views about such programmes might explain why some interventions appear effective and others not, and can be used to develop evidence-based interventions for this population and setting.

METHODS

A qualitative evidence synthesis of primary research exploring employees' views about workplace interventions to encourage smoking cessation, including both voluntary programmes and passive interventions, such as restrictions or bans. The method used was theory-based "best fit" framework synthesis.

RESULTS

Five relevant theories on workplace smoking cessation were identified and used as the basis for an a priori framework. A comprehensive literature search, including interrogation of eight databases, retrieved 747 unique citations for the review. Fifteen primary research studies of qualitative evidence were found to satisfy the inclusion criteria. The synthesis produced an evidence-based conceptual model explaining employees' experiences of, and preferences regarding, workplace smoking interventions.

CONCLUSION

The synthesis suggests that workplace interventions should employ a range of different elements if they are to prove effective in reducing smoking among employees. This is because an employee who feels ready and able to change their behaviour has different needs and preferences from an employee who is not at that stage. Only a multi-faceted intervention can satisfy the requirements of all employees.

Tobacco cessation interventions for young people

BACKGROUND

Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the second update of a Cochrane review first published in 2006.

OBJECTIVES

To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialized Register in February 2013. This includes reports for trials identified in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsyclNFO.

SELECTION CRITERIA

We included randomized controlled trials, cluster-randomized controlled trials and other controlled trials recruiting young people, aged less than 20, who were regular tobacco smokers. We included any interventions; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months follow-up among those who smoked at baseline.

DATA COLLECTION AND ANALYSIS

Both authors independently assessed the eligibility of candidate trials and extracted data. Included studies were evaluated for risk of bias using standard Cochrane methodology. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at longest follow-up.

MAIN RESULTS

Twenty-eight trials involving approximately 6000 young people met our inclusion criteria (12 cluster-randomized controlled trials, 14 randomized controlled trials and 2 controlled trials). The majority of studies were judged to be at high or unclear risk of bias in at least one domain. Many studies combined components from various theoretical backgrounds to form complex interventions.The majority used some form of motivational enhancement combined with psychological support such as cognitive behavioural therapy (CBT) and some were tailored to stage of change using the transtheoretical model (TTM). Three trials based mainly on TTM interventions achieved moderate long-term success, with a pooled risk ratio (RR) of 1.56 at one year (95% confidence interval (CI) 1.21 to 2.01). The 12 trials that included some form of motivational enhancement gave an estimated RR of 1.60 (95% CI 1.28 to 2.01). None of the 13 individual trials of complex interventions that included cognitive behavioural therapy achieved statistically significant results, and results were not pooled due to clinical heterogeneity. There was a marginally significant effect of pooling six studies of the Not on Tobacco programme (RR of 1.31, 95% CI 1.01 to 1.71), although three of the trials used abstinence for as little as 24 hours at six months as the cessation outcome. A small trial testing nicotine replacement therapy did not detect a statistically significant effect. Two trials of bupropion, one testing two doses and one testing it as an adjunct to NRT, did not detect significant effects. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions.

AUTHORS' CONCLUSIONS

Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence or continuous abstinence at six months), especially those incorporating elements sensitive to stage of change and using motivational enhancement and CBT. Given the episodic nature of adolescent smoking, more data is needed on sustained quitting. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. There is not yet sufficient evidence to recommend widespread implementation of any one model. There continues to be a need for well-designed adequately powered randomized controlled trials of interventions for this population of smokers.

"Best fit" framework synthesis: refining the method

BACKGROUND

Following publication of the first worked example of the "best fit" method of evidence synthesis for the systematic review of qualitative evidence in this journal, the originators of the method identified a need to specify more fully some aspects of this particular derivative of framework synthesis.

METHODS AND RESULTS

We therefore present a second such worked example in which all techniques are defined and explained, and their appropriateness is assessed. Specified features of the method include the development of new techniques to identify theories in a systematic manner; the creation of an a priori framework for the synthesis; and the "testing" of the synthesis. An innovative combination of existing methods of quality assessment, analysis and synthesis is used to complete the process. This second worked example was a qualitative evidence synthesis of employees' views of workplace smoking cessation interventions, in which the "best fit" method was found to be practical and fit for purpose.

CONCLUSIONS

The method is suited to producing context-specific conceptual models for describing or explaining the decision-making and health behaviours of patients and other groups. It offers a pragmatic means of conducting rapid qualitative evidence synthesis and generating programme theories relating to intervention effectiveness, which might be of relevance both to researchers and policy-makers.

Social influences on the motivation to quit smoking: main and moderating effects of social norms

The present study extends the previous research on the social influences on quitting by investigating inconsistencies between different types of social norms and their main and moderating effects on quitting intentions. The theory of planned behaviour (TPB) served as the theoretical framework. Social influences were operationalised by subjective quitting norm (significant others' expectations that one should quit), descriptive quitting norm (significant others' quitting behaviour), and descriptive smoking norm (partner's smoking). Because gender differences had previously been reported, norm effects were also analysed with respect to gender. A total of 168 smokers who had a partner (47% men, mean age M=34, SD=16) completed measures of TPB variables (including subjective quitting norm), descriptive quitting norm, descriptive smoking norm, and smoking behaviour. Subjective and descriptive quitting norms were more inconsistent in women than in men. The descriptive quitting norm enhanced the TPB prediction of intention by 5%. A three-way interaction accounted for an additional 3% of the variance and revealed both that subjective and descriptive quitting norms interacted in their prediction and that gender moderated this effect: the subjective quitting norm correlated positively to quitting intention only in women with a strong descriptive quitting norm. All analyses were controlled for number of cigarettes per day. These findings confirmed that it is important to distinguish subjective and descriptive norms and that differences exist in how these norms motivate women and men to quit smoking. Consistent quitting norms such as quitting of significant others in combination with their expectations that one should quit appear to be less common but more important in women to form a corresponding intention.

Alcohol-Related Social Gatherings with Coworkers: Intentions to Behave and Intentions to Not Behave

Two studies are reported using the theory of planned behaviour (TPB) to examine Koreans' intentions and self-reported behaviour of joining and not joining alcohol-related social gatherings with work colleagues after work hours. Study 1 showed that group-related attitudes and perceived behavioural control of the TPB components regarding joining were significantly associated with intentions to join. Study 2 examined TPB components regarding not joining and intentions to not join. Study 2 found that although none of the TPB components was directly related to intentions, subjective norms from work colleagues moderated the effect of group-related attitudes on intentions to not join. The TPB components and intentions were not significantly related to self-reported behaviour of joining. The findings indicate that the relationships between the TPB components and intentions can be different for engaging and not engaging in a behaviour.

Role of anticipated regret, intentions and intention stability in adolescent smoking initiation

OBJECTIVES

To examine the impact of anticipated regret within the theory of planned behaviour (TPB) on intentions of adolescents to initiate smoking. To examine the moderating role of anticipated regret and intention stability on the relationship between intentions and smoking initiation in adolescents.

METHODS

We conducted two studies measuring anticipated regret within the TPB applied to adolescent smoking initiation. In the first study, 347 non-smoking adolescents (between 11 and 12 years of age) completed the TPB and anticipated regret measures about smoking initiation. In the second study, 675 non-smoking adolescents (between 11 and 12 years of age) completed the TPB, anticipated regret, and intention stability measures in relation to smoking initiation. Smoking was assessed objectively by carbon monoxide breath monitor 9 months later.

RESULTS

In Studies 1 and 2, regret significantly added to predictions of intentions over and above components of the TPB (p < .001). In Study 2, smoking behaviour was predicted by intentions and the relationship of intentions to behaviour was moderated by regret and intention stability.

CONCLUSIONS

Regret and intention stability were shown to be important variables within the TPB in understanding intentions and behaviour of smoking initiation in adolescents.

Failure to report attempts to quit smoking

INTRODUCTION

Accurately assessing quit attempt history is important to develop population estimates of cessation and to increase our understanding of smoking trajectories. Thus, the current study investigated failure to report quit attempts as a function of length of quit attempt by time since quit attempt over the past year.

METHODS

The present study used data from the Smoking Toolkit Study, a series of population-based surveys of smokers and recent ex-smokers in England aged 16 years and older. Among the 11,772 smokers identified at baseline (24.4% of the total sample), this study focused on the 4234 participants (36.0% of current smokers) who reported between one and three quit attempts in the past year.

RESULTS

There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported.

CONCLUSION

A large proportion of unsuccessful quit attempts fail to be reported, particularly if they only last a short time or occurred longer ago. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates. Future research is needed to establish whether there is differential reporting of quit attempts as a function of features of attempts such as use of cessation aids.

Gender differences in smoking: A longitudinal study of beliefs predicting smoking in 11-15 year olds

This longitudinal study investigated differences in beliefs and perceived behavioural control between smokers and non-smokers in a large sample of adolescents. Positive and negative instrumental beliefs, normative beliefs, perceived behavioural control (PBC) and smoking status were assessed in the same participants at 11, 13 and 15 years of age. Prospective analyses among non-smokers revealed that for boys, negative instrumental beliefs in non-smokers at age 11 predicted smoking at age 15 years. For girls, normative beliefs and PBC in non-smokers at age 11 predicted smoking status at age 13; normative beliefs at age 11 predicted smoking at age 15; and positive instrumental beliefs and normative beliefs at age 13 predicted smoking status at age 15. Cross-sectional data revealed that smokers were significantly more likely than non-smokers to endorse positive instrumental beliefs, less likely to agree with negative instrumental belief items, more likely than non-smokers to perceive social pressure to smoke, and less likely to report control over smoking, and that female smokers reported less control over smoking and fewer negative instrumental beliefs than all other groups including male smokers at age 13. The need for belief-based preventative interventions that are age- and gender-relevant is discussed.

Intention to quit smoking among lesbian, gay, bisexual, and transgender smokers

INTRODUCTION

Smoking is highly prevalent among lesbian, gay men, bisexual, and transgender (LGBT) persons and contributes to health disparities. Guided by the theory of planned behavior (TPB), we identified beliefs related to attitudes, perceived behavioral control, and subjective norms, as well as LGBT-specific variables, to explain variance in intention to quit smoking in the next 6 months in LGBT smokers.

METHODS

Individual interviews (n = 19) identified beliefs about quitting smoking and LGBT-salient variables and aided in survey development. Surveys were sent to a random sample from an LGBT community center's mailing list and center attendees, with a 25.4% response rate. Bivariate and multivariate analyses were conducted with the final sample of 101 smokers.

RESULTS

No sociodemographic or LGBT-specific variables beyond the TPB constructs were related to intention to quit smoking. A multivariate TPB model explained 33.9% of the variance in quitting intention. More positive attitudes and specific beliefs that cessation would make smokers feel more like their ideal selves and improve health and longevity were related to greater intention to quit (p values < .05). Subjective norm and perceived behavioral control were marginally significant, with perceived approval of partners and others and beliefs that life goal achievement would make it easier to quit positively related to intention. Depression and stress levels were high.

DISCUSSION

This is among the first studies to examine theoretically grounded variables related to intention to quit smoking in LGBT smokers. We identified specific behavioral, normative, and control beliefs that can serve as intervention targets to reduce smoking in the LGBT community.

Cross-cultural validation of a smoking abstinence self-efficacy scale in Korean American men

The main purpose of the study was to examine the psychometric properties of a Smoking Abstinence Self-Efficacy Scale with Korean men in the US. The scale was modified to reflect the Korean cultural practice of smoking behavior and was cross-culturally validated with a panel of 10 professionals. An 11-item Korean version of the scale was administered twice over a one-month period. Data were analyzed for internal consistency reliability, stability, and construct validity. After the deletion of one item, an exploratory factor analysis yielded two factors, which explained 62% of the variance. Internal consistency was satisfactory for the total scale (.89), Factor I (.88), and Factor II (.80) but intraclass correlation coefficient for the total scale (.57) was low. Nicotine dependence and nicotine withdrawal showed modest but statistically significant correlations with the scale.

Predictors of short-term smoking cessation among Korean American men

OBJECTIVES

The purpose of this study was to examine which demographic, smoking behavior, and theoretical variables of theory of planned behavior would predict smoking cessation attempts among Korean American men.

DESIGN

This is a longitudinal study and data collection was conducted at baseline and 1-month follow-up.

SAMPLE

At baseline, 118 Korean adult male smokers were recruited into the study and of these, 93 participated at follow-up.

MEASURES

Study questionnaires consisted of demographic data, smoking behavior, and theoretical variables.

ANALYSIS

A multiple regression analysis was performed to identify correlates of behavioral intentions to quit smoking at baseline and binary logistic regression analysis for predictors of actual quitting behavior at follow-up.

RESULTS

Among smoking behavior variables, past-year quit attempts and average number of cigarettes smoked per day explained 15% of the variance in behavioral intentions to quit smoking ( p<.0001). Two theoretical variables attitudes and perceived family social norms increased the explanatory power by 22% ( p<.0001) with an overall of 37%. Religion and perceived family social norms had about 32% predictive power over actual quitting behavior ( p<.0001).

CONCLUSIONS

Any smoking cessation programs planned for Korean American men consider encouraging family members to affirm antismoking messages to this ethnic subgroup.

The influence of message framing, intention to quit smoking, and nicotine dependence on the persuasiveness of smoking cessation messages

This study explores the combined effect of message framing, intention to quit smoking, and nicotine dependence on the persuasiveness of smoking cessation messages. Pre- and post-message measures of quit intention, attitude toward smoking cessation, and perceived behavioral control were taken in two separate waves from current cigarette smokers with varying levels of nicotine dependence (N=151). In the second wave, participants were randomly assigned to one of two groups. In the first group, participants read a smoking cessation message which emphasized the benefits of quitting (positive frame). In the second group participants read a message which emphasized the costs of not quitting (negative frame). Results show that smokers' intentions to quit smoking and their level of nicotine dependence jointly influence the persuasiveness of positive and negative message frames. When nicotine dependence and quitting intention are both high, a negative frame works best. Conversely, a positive frame is preferable when nicotine dependence or quitting intention is low. Smokers' level of processing is proposed as the underlying mechanism explaining the different effects of message frames.

Differences in Smoking Attitudes of Adolescents and Young Adults

This study employed the Theory of Planned Behavior to examine the differences between adolescent ( n = 182) and young adults ( n = 209) in their intention to smoke and examined possible differences. Analysis showed that young adults had more positive self-reported attitudes toward smoking than adolescents, had higher intentions to smoke, lower perceived behavioral control over smoking and perceived they were more informed about smoking. The Theory of Planned Behavior provided good prediction of intention for both young adults ( R2 = .70, attitudes, information, and past behavior significant) and adolescents ( R2 = .68, attitudes, past behavior significant). For both samples attitudes were the strongest predictor of intentions to smoke. Implications for understanding intention toward smoking between adolescents and young adults are discussed.

Cognitions about smoking and not smoking in adolescence

The theory of planned behavior identifies important proximal determinants of behavior, including attitude toward the behavior, perception of subjective norms exerted by significant others, and perception of perceived control over performance of the behavior. Because research in the planned behavior tradition has focused on desirable target behaviors, it is not clear how these determinants can best be conceptualized to account for adolescents' acquisition of health risk behaviors such as smoking. This cross-sectional study compared the explanatory power of planned behavior constructs assessed in relation to "smoking" and "not smoking" in a sample of 248 Dutch secondary students (aged 12 to 17 years; 56% girls). The results indicated that four variables--attitude toward smoking, perceived subjective norm, and perceived behavioral control over both smoking and not smoking--best explained the adolescents' smoking intentions and smoking behavior. Methodological and practical implications for smoking interventions are discussed.

Readiness to change smoking behavior in adolescents with psychiatric disorders

There has been recent increased interest in utilizing motivational interviewing (MI) to increase adolescent readiness to quit smoking, but attempts to impact quit rates have thus far been discouraging. A better understanding of factors associated with adolescent readiness to quit smoking prior to receiving any intervention may provide guidance when tailoring future MI interventions in order to increase their effectiveness with this population. Adolescent smokers (N=191) who had been admitted to a psychiatric hospital and enrolled in a clinical trial evaluating MI completed questionnaires that assessed smoking behavior and variables thought to be related to smoking. Confidence to quit smoking and negative beliefs about smoking were significant predictors of adolescents' baseline readiness to quit smoking. The failure to demonstrate relationships between health consequences and readiness suggest that caution may be warranted in the use of feedback, a common component of MI-based interventions. Such feedback tends to focus on health consequences, which was unrelated to adolescent baseline readiness to change smoking behavior in the current study. Parallels between current results and the Theory of Planned Behavior are discussed in consideration of developing more effective MI-based interventions for adolescent smokers.

Utility of the theory of reasoned action and theory of planned behavior for predicting Chinese adolescent smoking

One third of smokers worldwide live in China. Identifying predictors of smoking is important for prevention program development. This study explored whether the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) predict adolescent smoking in China. Data were obtained from 14,434 middle and high school students (48.6% boys, 51.4% girls) in seven geographically varied cities in China. TRA and TPB were tested by multilevel mediation modeling, and compared by multilevel analyses and likelihood ratio tests. Perceived behavioral control was tested as a main effect in TPB and a moderation effect in TRA. The mediation effects of smoking intention were supported in both models (p<0.001). TPB accounted for significantly more variance than TRA (p<0.001). Perceived behavioral control significantly interacted with attitudes and social norms in TRA (p<0.001). Therefore, TRA and TPB are applicable to China to predict adolescent smoking. TPB is superior to TRA for the prediction and TRA can better predict smoking among students with lower than higher perceived behavioral control.

Overseas Development Workers: ‘Big Five’ Personality Scores

To test hypotheses formulated by Ones and Viswesvaran (1997), a cohort of 47 selected volunteer overseas development workers from New Zealand completed the NEO PI-R ‘Big Five’ personality inventory. In line with hypotheses, these workers were significantly higher than population norms on openness and its six subfacets, and on agreeableness and the subfacet of tender-mindedness, but contrary to hypotheses, they were not significantly different on either neuroticism or conscientiousness. The article argues for further research in this field.

Predicting the intention to quit smoking and quitting behaviour: extending the theory of planned behaviour

OBJECTIVES

The present study examined the ability of the TPB to predict the intention to quit smoking and quitting behaviour. In addition, the predictive power of future orientation, number of cigarettes smoked, planning, past behaviour and the interactions between intention and other predictors was examined.

MATERIAL AND METHODS

The data were derived from a longitudinal survey among 103 daily smoking students at the University of Oslo (mean age 24.6 years, mean number of years of smoking = 8 years). These data were collected by means of self-administered questionnaires at T1 (October 2003) and at T2 (February 2004) in terms of recording actual quitting.

RESULTS

The TPB components accounted for 30% of the variance in quitting intentions, and affective attitude and descriptive norm emerged as the strongest predictors of quitting intention. Ordinal regression analysis showed that intention was a borderline significant predictor of subsequent quitting behaviour, while the impact of PBC was non-significant (model 1). The inclusion of the additional variables improved the fit of the model, with number of cigarettes and planning appearing as significant predictors of behaviour (model 2). As predicted, there was a significant interaction between perceived control and intentions on quitting (model 3). Nagelkerke R(2) increased from .07 in model 1 to .54 in model 2, and finally to .58 in model 3.

CONCLUSIONS

The results indicate that affective attitude and descriptive norm play a more crucial role than the other TPB predictors in motivating smokers to quit. The results also indicate that self-regulatory strategies are important in relation to addictive behaviours.

Tobacco cessation interventions for young people

BACKGROUND

Teenage smoking prevalence is around 15% in developing countries (with wide variation from country to country), and around 26% in the UK and USA. Although most tobacco control programmes for adolescents are based around prevention of uptake, there are also a number of initiatives to help those who want to quit. Since those who do not smoke before the age of 20 are significantly less likely to start as adults, there is a strong case for programmes for young people that address both prevention and treatment.

OBJECTIVES

To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Tobacco Addiction Group's Specialized Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, and the bibliographies of identified trials. We also searched the 'grey' literature (unpublished materials), and contacted authors and experts in the field where necessary.

SELECTION CRITERIA

Types of studies: Randomized controlled trials, cluster-randomized controlled trials and controlled trials.

TYPES OF PARTICIPANTS

Young people, aged less than 20, who are regular tobacco smokers. Types of interventions: The interventions ranged from simple ones such as pharmacotherapy, targeting individual young people, through complex programmes targeting people or organizations associated with young people (for example, their families or schools), or the community in which young people live. We included cessation programmes but excluded programmes primarily aimed at prevention of uptake. Types of outcome measures: The primary outcome was smoking status at six months follow up, among those who smoked at baseline. We report the definition of cessation used in each trial (e.g seven- or thirty-day point prevalence abstinence, or sustained or prolonged abstinence), and we preferred biochemically verified cessation when that measure was available.

DATA COLLECTION AND ANALYSIS

Both authors independently assessed the eligibility of candidate trials identified by the searches, and extracted data from them. We categorized included trials as being at low, medium or high risk of bias, based on concealment of allocation, blinding (where applicable) and the handling of attrition and losses to follow up. We conducted limited meta-analyses of some of the trials, provided that it was appropriate to group them and provided that there was minimal heterogeneity between them. We estimated pooled odds ratios using the Mantel-Haenszel method, based on the quit rates at longest follow up for trials with at least six months follow up from the start of the intervention.

MAIN RESULTS

We found 15 trials, covering 3605 young people, which met our inclusion criteria (seven cluster-randomized controlled trials, six randomized controlled trials and two controlled trials). Three trials used or tested the transtheoretical model (stages of change) approach, two tested pharmacological aids to quitting (nicotine replacement and bupropion), and the remaining trials used various psycho-social interventions, such as motivational enhancement or behavioural management. The trials evaluating TTM interventions achieved moderate long-term success, with a pooled odds ratio (OR) at one year of 1.70 ( 95% confidence interval (CI) 1.25 to 2.33) persisting at two-year follow up with an OR of 1.38 (95% CI 0.99 to 1.92). Neither of the pharmacological intervention trials achieved statistically significant results (data not pooled), but both were small-scale, with low power to detect an effect. The three interventions (5 trials) which used cognitive behavioural therapy interventions did not individually achieve statistically significant results, although when the three Not on Tobacco trials were pooled the OR 1.87; (95% CI 1.00 to 3.50) suggested some measure of effectiveness. Although the three trials that incorporated motivational interviewing as a component of the intervention achieved a pooled OR of 2.05 (95% CI 1.10 to 3.80), the impossibility of isolating the effect of the motivational interviewing in these trials meant that we could not draw meaningful inferences from that analysis.

AUTHORS' CONCLUSIONS

Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence at six months), especially those incorporating elements sensitive to stage of change. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. Psycho-social interventions have not so far demonstrated effectiveness, although pooled results for the Not on Tobacco trials suggest that that this approach may yet prove to be effective; however, their definition of cessation (one or more smoke-free days) may not adequately account for the episodic nature of much adolescent smoking. There is a need for well-designed adequately powered randomized controlled trials for this population of smokers, with a minimum of six months follow up and rigorous definitions of cessation (sustained and biochemically verified). Attrition and losses to follow up are particularly problematic in trials for young smokers, and need to be kept to a minimum, so that management and interpretation of missing data need not compromise the findings.

Understanding smoking cessation: the role of smokers' quit history

Many studies have found smokers' quit history to correlate with quitting smoking, but little is known about the psychological processes explaining this relationship. This study uses the integrative model of behavioral prediction to examine how quit history affects quit intention. Data from 3,428 Dutch smokers demonstrate that quit history affects (a) beliefs about quitting and (b) the degree to which self-efficacy predicts quit intention. It seems that a relatively unsuccessful history of prior quit attempts reduces self-efficacy over quitting and strengthens the relationship of self-efficacy with the intention to quit. The results are used to call for more process-oriented research in order to advance our understanding of the relationship between quit history and quit intention.

Nurses' intention to report child abuse in Taiwan: a test of the theory of planned behavior

The purposes of this study were to identify factors associated with nurses' intention to report suspected child abuse in Taiwan, and to determine the empirical adequacy of the extended theory of planned behavior (TPB) to explain nurses' intention to report child abuse. A stratified quota sampling technique was used to select registered nurses in emergency rooms, psychiatric units, and pediatric units in Taiwan. A total of 1,362 questionnaires from 1,617 nurses were used for the analyses. Structural equation modeling demonstrated that nurses' attitudes toward reporting child abuse, perceived behavioral control, subjective norms, and knowledge of the child abuse and reporting law explained 85% to 91% of the variance in nurses' intention to report child abuse for the less severe and severe child abuse cases in vignettes, respectively. The findings support the use of the extended TPB in identifying factors associated with nurses' intention to report child abuse in Taiwan.

Social influences on smoking cessation: a comparison of the effect of six social influence variables

BACKGROUND

This study brings together the fragmentary knowledge on social influence factors related to smoking cessation. An inventory of social influence variables shows six social influence factors. With the exception of descriptive norm, most of these are rarely studied in the context of smoking cessation.

METHODS

Regression analysis on the data of 2895 smokers was used to estimate the relative importance of social influence variables as predictors of intention. The moderating effect of quit history was studied by adding interaction terms to the regression analysis.

RESULTS

The regression analysis shows that subjective norm and injunctive norm, that is, the social norms on what ought to be done, are more important than descriptive norms, that is, the perceived smoking and smoking cessation behavior of others. This holds especially for smokers whose past cessation attempts quickly failed. Most smokers think that it is acceptable to smoke in most social situations, but simultaneously think that other people approve it if they quit smoking.

CONCLUSIONS

Results suggest that health campaigns should incite social interaction to increase smokers' awareness of social norms on the proper behavior. Also, studies into smoking cessation should take account of the various social influence factors outlined in this study.

Intention to quit smoking, attempts to quit, and successful quitting among Hong Kong Chinese smokers: population prevalence and predictors

PURPOSE

To assess the prevalence of each step in the smoking-cessation process (intention to quit, attempts to quit, and successful quitting) and to examine the factors associated with them among Chinese smokers.

DESIGN

A cross-sectional survey of subjects from randomly selected households.

SETTING

Four thousand one hundred forty-two households in Hong Kong.

SUBJECTS

A total of 11,779 persons, aged 15 years or older, were enumerated (response rate = 74.0%).

MEASURES

A validated structured questionnaire was used for data collection. The questionnaire sought information on the subject's sociodemographic background, smoking habits, and workplace attitude to smoking. The predictors for successful quitting, past quitting attempts, and intention to quit were assessed by chi2 tests and multiple logistic regression.

RESULTS

Of the respondents, 14.4% were current smokers, 7.5% were ex-smokers, and 78.1% were nonsmokers. Of the daily smokers, 52% intended to quit. The factors associated with quitting were being married, being in the student/retired/others category, being older, having received higher education, not smoking to kill time, and smoking because of curiosity. Being married and not smoking to kill time were associated with past quitting attempts. Being male, married, and not smoking to kill time were associated with the intention to quit smoking.

CONCLUSION

The findings of this study indicate that differing predictors may contribute to the different transitional stages of smoking cessation. Population-based smoking-cessation programs should take these predictors into consideration in the design of interventions.

Too late to Quit? Effect of Smoking and Smoking Cessation on Morbidity and Mortality Among the Elderly in a Longitudinal Study

This prospective study of the elderly population estimated the risks of smoking for morbidity and mortality and identified whether cessation of smoking reduced the risk of disease. Data came from face-to-face interviews that used a population-based probability sample of those aged 60 years or over in Taiwan, provided by the Population and Health Research Center, Bureau of Health Promotion. In total, 4,049 subjects were included at the baseline year of 1989 and followed up in 1993 and 1996. Smoking-related variables included current smoking status, smoking history, daily consumption, and years since the cessation of smoking. Cox regression models were used to analyze the relative risks for morbidity and mortality, controlling for demographics, physical function, and comorbidities. The sample was made up of 50.2% nonsmokers, 15.2% ex-smokers, and 34.6% current smokers in the baseline year. Current smokers were more likely to have lower respiratory tract diseases throughout the study. Current smokers had a higher risk of stroke from 1989 to 1993. No dose-response relationship for smoking exposure or impact of years since smoking cessation was found. Whether cessation of smoking is protective should be investigated for middle-aged adults followed to old age. An effective strategy for smoking cessation in the elderly is suggested, and people should be encouraged to quit smoking at any time.