Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile
Monday, March 22, 2021
Posted by: Natalia Gromov
Seaman
EL, Robinson CD, Crane D, Taber JM, Ferrer RA, Harris PR, Klein WMP.
Association of Spontaneous
and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App:
Randomized Controlled Trial.
J Med Internet Res. 2021 Mar 5;23(3):e18433. doi: 10.2196/18433. PMID:
33666561.
Background.
Most smokers attempt to stop using cigarettes numerous times before
successfully quitting. Cigarette cravings may undermine perceived competence to
quit and thus constitute psychological threats to the individual's
self-concept. Self-affirmation may promote smoking cessation by offsetting
these threats.
Objective.
This study examines whether self-affirmation is associated with smoking
cessation in the context of a cessation app. Two types of self-affirmation are
examined: tendency to spontaneously self-affirm, and self-affirmation
inductions added to a publicly available smoking cessation app (Smoke-Free Quit
Smoking Now). In addition, this study explores whether optimism and emotional
states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking
cessation.
Methods. All
users who met the inclusion criteria, provided consent to participate, and
completed a baseline assessment, including all individual difference measures,
were randomized to 1 of 4 conditions. Half of the participants were randomly
assigned to complete a self-affirmation induction upon study entry.
Orthogonally, half of the participants were randomly assigned to receive
self-affirming text notifications during their quit attempt or to receive
conventional notifications. The induction and the text notifications were fully
automated, and all data were collected through self-assessments in the app.
Self-reported smoking cessation was assessed 1 month and 3 months following
study entry.
Results.
The study enrolled 7899 participants; 647 completed the 1-month follow-up.
Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of
participants self-reported not smoking in the previous week and 6.4% (503/7899)
self-reported not smoking in the previous month. Greater tendency to
spontaneously self-affirm predicted a greater likelihood of cessation
(P<.001) at 1 month after controlling for smoking-related variables. Neither
self-affirmation induction influenced cessation. In addition, spontaneous
self-affirmation did not moderate the relationship between self-affirmation
inductions and cessation. Greater baseline sadness was associated with a lower
likelihood of reporting successful cessation. Optimism predicted past-week
cessation at the 1-month follow-up, and both happiness and anger predicted
past-month cessation at the 1-month follow-up; however, none of these potential
predictors moderated the relationship between self-affirmation conditions and
successful cessation.
Conclusions.
Spontaneous self-affirmation may be an important psychological resource for
managing threats to self-concept during the smoking cessation process. Sadness
may hinder quit attempts. Future research can explicate how spontaneous versus
induced self-affirmation can promote smoking cessation and examine boundary
conditions for the effectiveness of disseminated self-affirmation
interventions.
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