Seaman, Elizabeth L, Robinson, Cendrine D, Crane, David, Taber, Jennifer M, Ferrer, Rebecca A, Harris, Peter R and Klein, William M P (2021) Association of spontaneous and induced self-affirmation with smoking cessation in users of a mobile app: randomized controlled trial. Journal of Medical Internet Research (JMIR), 23 (3). a18433. ISSN 1438-8871

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Abstract

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.

Trial Registration:
ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

Item Type:	Article
Keywords:	smoking cessation, smartphone, mHealth, sadness, self-affirmation, spontaneous self-affirmation, apps, mobile phone
Schools and Departments:	School of Psychology > Psychology
SWORD Depositor:	Mx Elements Account
Depositing User:	Mx Elements Account
Date Deposited:	19 Nov 2020 09:59
Last Modified:	25 Mar 2021 10:45
URI:	http://sro.sussex.ac.uk/id/eprint/95160

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