This is the first study to examine self-efficacy among rural smokers. As in previous research with other populations, we found that higher self-efficacy is related to older age (Schnoll et al., 2005
), length of longest abstinence (DiClemente, Prochaska, & Gibertini, 1985
), and greater nicotine dependence (DiClemente, Prochaska, & Gibertini, 1985
). Although number of cigarettes per day also was related to self-efficacy (DiClemente, Prochaska, & Gibertini, 1985
; Willemsen et al., 1996
), nicotine dependence was a better predictor of self-efficacy than number of cigarettes smoked per day in the present study. Furthermore, consistent with present findings, previous research (Etter, Prokhorov, & Perneger, 2002
) reported that women had lower confidence in their ability to quit smoking but smoked fewer cigarettes per day (Females: M
= 21.9, SD
= 10.1; Males: M
= 26.2, SD
= 10.5; p
< .0001). Our findings also support previous research showing that those closer to initiating a quit attempt report greater self-efficacy (Prochaska & DiClemente, 1984
; Prochaska et al., 1991
) and that those with depressive symptoms have lower self-efficacy (Haukkala et al., 2000
). Given the increased prevalence of depression among smokers (Breslau, Kilbey, & Andreski, 1993
) and the more numerous barriers to mental health care in rural areas, health care providers must be aware of the relationship between depression and low self-efficacy in order to gear their smoking cessation intervention strategies toward both treating depressive symptoms and increasing self-efficacy.
The current findings indicated that increased encouragement to quit smoking from family and friends was related to higher self-efficacy. Furthermore, this study found that having other smokers in the home and having more friends that smoke was related to less self-efficacy. Taken together, these findings highlight the positive impact of social support and the negative impact of the presence of other smokers on overall self-efficacy among rural smokers. Thus, health care providers may be able to impact self-efficacy of smokers by intervening on their potential support systems (e.g., encouraging smokers trying to quit to identify support systems, recommending home smoking restrictions).
The present study is the first we are aware of to find a relationship between self-efficacy and autonomous motivation (i.e., being motivated by choice and willingness to engage in a behavior). The ability to call upon personal reasons for refraining from smoking (e.g., “I feel I want to take responsibility for my own health,” “I have carefully thought about it and believe it is very important for many aspects of my life”) may be an important strategy to increase self-efficacy among rural smokers. The ability to call upon controlled, external, or compliance-based reasons (i.e., “others would be upset with me”, “I’d feel guilty or ashamed”) appears to be significantly less important. Likewise, peer pressure, guilt, and other negative reinforcers may not be effective motivators in this population. Thus, health care providers may increase the self-efficacy of smokers by helping patients focus on positive reinforcers, such as their personal reasons and the positive aspects of their social environment. Moreover, helping patients to reframe their thinking about the perceived negative reinforcers to cessation and to identify personal reasons related to extrinsic motivators may be effective strategies for increasing self-efficacy.
The current study showed that the modal response to the items on the SEQ-12 was “Not very sure” or “More or less sure” of one’s ability to resist smoking in various situations. This held true for both the intrinsic and extrinsic subscales. Given that readiness to quit is highly related to self-efficacy, the fact that this study included smokers at all stages of readiness to quit may explain the relatively low level of self-efficacy in this sample.
The present study has important limitations. First, we did not assess for potential interactions influencing self-efficacy. These issues should be addressed in future studies after developing specific a priori hypotheses that might reduce the potential for identifying spurious relationships. Also, this sample of smokers seen in rural clinics may not be representative of all smokers in rural communities. This sample was predominantly white and may not represent rural smokers of other racial and ethnic groups. These participants also had access to regular medical care. Nevertheless, studies on this population can inform rural health care providers who have the opportunity to promote self-efficacy during regular clinic visits or during the diagnosis of a smoking-related illness. Health care providers also may assess for predictors of self-efficacy among their patients, such as level of nicotine dependence and the presence of social support, in order to better understand the patient’s health risk profile and the effectiveness of efforts to enhance self-efficacy.
Overall, self-efficacy is an important construct because of its relationship to successful smoking cessation. Because smoking is more prevalent and smoking cessation efforts face more challenges in rural areas, it is important to understand characteristics related to self-efficacy among rural smokers. By identifying patients at risk for low self-efficacy (e.g., heavy smokers, females) and by capitalizing on characteristics associated with high self-efficacy (e.g., autonomous motivation, social support), rural health care providers may be able to better enhance self-efficacy in their efforts to help smokers quit.