JMIR Publications

ABSTRACT

Background:

Most smokers attempt cessation numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the self-concept. Self-affirmation may promote smoking cessation by offsetting these threats.

Objective:

This study examined whether self-affirmation was associated with smoking cessation in the context of a cessation app. Two types of self-affirmation were examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly-available smoking cessation application (Smoke Free - Quit Smoking Now). Additionally, this study explored whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predicted smoking cessation.

Methods:

All users who met inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to one of four conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half 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 application. Self-reported smoking cessation was assessed 1 month and 3 months following study entry.

Results:

The study enrolled 7,899 participants; 647 completed the 1-month follow up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% of participants (569/7,899) self-reported not smoking in the previous week and 6.4% (503/7,899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted greater likelihood of cessation (p<0.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. Additionally, spontaneous self-affirmation did not moderate the relationship between the self-affirmation inductions and cessation. Greater baseline sadness was associated with lower likelihood of reporting successful cessation; neither optimism nor any of the other mood states were associated with 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-affirmations. Clinical Trial: This study was intended to replicate our team’s earlier study (Taber et al., 2016) in a different setting.