Implicit Attitudes and Smoking Behavior in a Smoking Cessation Induction Trial.
BACKGROUND
Although studies have suggested that implicit attitudes may predict smoking-related decisions, evidence that changes in implicit attitudes toward smoking are related to changes in smoking behavior is lacking. Using data from a trial comparing interventions to induce quit attempts among unmotivated smokers, this study examined whether changes in implicit attitudes were associated with quit attempts and cessation after controlling for explicit motivation.


METHODS
Daily smokers recruited from the community completed measures of implicit attitudes (Implicit Association Test) and explicit measure of motivation to smoke at baseline, mid-intervention (week 12 [W12]) and follow-up (week 26 [W26]). Quit attempts and cessation were assessed at follow-up, and cessation was biochemically verified.


RESULTS
As hypothesized, Implicit Association Test scores became more negative from baseline to W12, a change that was sustained at follow-up. Logistic regression analyses in which implicit attitudes were used to predict smoking outcomes revealed that negative changes in implicit attitudes from baseline to W12 and from baseline to W26 were significantly related to quit attempts (OR = 0.71, 95% CI [0.52, 0.97], p < .05 for both) independent of explicit motivation. Negative changes in implicit attitudes from baseline to W26 were significantly related to cessation (OR = 0.50, 95% CI [0.25, 1.00], p < .05).


CONCLUSIONS
Negative changes in implicit attitudes were associated with positive changes in smoking behavior independent of explicit motivation. This result indicates that smoking cessation interventions may be enhanced by incorporating strategies to change implicit attitudes, and that changes in implicit attitudes are also potentially important intervention outcomes.


CONCLUSIONS
Smoking cessation interventions may be improved by going beyond the current focus on explicit psychological constructs and targeting automatic cognitive processes such as implicit attitudes. The results are encouragement to examine how best to manipulate smokers' implicit attitudes as well as to determine the effect on their smoking behavior.
School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, WA.
Hyoung S
HS
Lee
Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
Merideth
M
Addicott
Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
Laura E
LE
Martin
School of Public and Community Health Sciences, the University of Montana, Missoula, MT.
Kari J
KJ
Harris
Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO.
Kathy
K
Goggin
Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
Kimber P
KP
Richter
Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN.
Christi A
CA
Patten
Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
F Joseph
FJ
McClernon
Institute for Life Span Studies, University of Kansas, Lawrence, KS.
Kandace
K
Fleming
Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospitals and Clinics and Department of Psychology, University of Missouri-Kansas City, Kansas City, MO.
Delwyn
D
Catley
D001294:Attitude to Health; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*
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