This study evaluated factors related to internal and external self-efficacy to quit smoking in a large, diverse sample of community smokers. The results could be used to design behavioral interventions to promote self-efficacy to quit smoking, a critical predictor of success among smokers trying to quit. The findings indicate that behavioral approaches to enhancing smoking cessation self-efficacy may be effective if techniques are included to help smokers develop a sense of perceived control over abstinence-induced symptoms and help smokers to manage cravings stimulated by positive affect/social situation smoking cues. In addition, techniques to enhance smoking cessation self-efficacy need to be targeted, in particular, to Hispanic smokers.
Participants who reported higher levels of perceived control over symptoms that arise following abstinence (i.e., withdrawal, irritability, depressed mood) reported higher internal and external self-efficacy. This finding suggests that participants with low perceived control over withdrawal symptoms may benefit from an initial counseling session that focuses on ways to enhance control over, and mitigate the effects of, withdrawal symptoms. This result converges well with the Theory of Planned Behavior (Ajzen, 1991
), which emphasizes the role played by a greater sense of personal control in determining adherence to health behaviors including achieving abstinence from tobacco use (Taylor, 2002
Likewise, participants who reported lower reactivity to positive affect/social situation smoking cues also exhibited higher levels of smoking cessation self-efficacy, although this relationship was confined to external self-efficacy. This certainly makes sense given that the cues indicated on the positive affect/social cue subscale are generally external situations related to smoking and the items from the external self-efficacy subscale concern confidence to resist smoking in environmental situations. There was some indication of the converse of this relationship; that is, the relationship between the internal self-efficacy subscale and reactivity to negative affect cues approached significance (p
= .07; ). Thus, the link between cue reactivity and smoking cessation self-efficacy may be segmented into domains based on internal states vs. external events or situations. Consistent with studies that emphasize the role of cue reactivity in the treatment of nicotine dependence and other drug addictions (Carter & Tiffany, 1999
), interventions to promote smoking cessation self-efficacy should address cue reactivity as well but in a manner that focuses on developing competency and confidence in dealing with both internal and external smoking-related states and situations.
Lastly, the results indicated that Hispanic/Latino American smokers have significantly lower levels of internal smoking cessation self-efficacy vs. smokers in other ethnic/racial groups. This converges with data showing that Hispanic/Latino smokers show a poorer response to pharmacotherapies for nicotine dependence (Covey, et al., 2008
). Significantly lower levels of smoking cessation self-efficacy among Hispanic/Latino smokers may increase their vulnerability to smoking relapse while attempting to quit smoking using treatments for nicotine dependence. Thus, this sub-group of smokers may need targeted counseling to promote smoking cessation self-efficacy to enhance their chances for successful smoking cessation. This may require the development of tailored smoking cessation counseling content in Spanish and the development of culturally-specific counseling that would help Hispanic-Americans develop smoking cessation self-confidence, particularly with regard to internal stimuli related to smoking behavior.
This study is limited by the cross-sectional nature of the data. Additionally, a small number of correlates of self-efficacy was examined. Further, all measures were self-report and subject to biases. Lastly, participants were treatment-seeking smokers. Nevertheless, this study used a large and demographically diverse sample to address an under-studied construct predictive of smoking behavior and response to treatments for nicotine dependence. This study also focused on internal and external smoking cessation self-efficacy. Thus, these findings may be relatively more generalizable to the population of US treatment-seeking smokers and provide useful data for the development of behavioral treatments for nicotine dependence that focus on enhancing smoker self-efficacy to quit smoking. The development and evaluation of future behavioral treatments to enhance self-efficacy to quit smoking may contribute to the ongoing decrease in smoking prevalence rates in the US.