Eline Meijer

Quitting smoking: The importance of non-smoker identity in predicting smoking behaviour and responses to a smoking ban

Objective: We examined how ‘smoker’ and ‘non-smoker’ self- and group-identities and socio-economic status (SES) may predict smoking behaviour and responses to antismoking measures (i.e. the Dutch smoking ban in hospitality venues). We validated a measure of responses to the smoking ban. Design: Longitudinal online survey study with one-year follow-up (N = 623 at T1 in 2011; N = 188 at T2 in 2012) among daily smokers. Main outcome measures: Intention to quit, quit attempts and ‘rejecting’, ‘victimizing’, ‘socially conscious smoking’ and ‘active quitting’ responses to the smoking ban. Results: Non-smoker identities are more important than smoker identities in predicting intention to quit, quit attempts and responses to the smoking ban, even when controlling for other important predictors such as nicotine dependence. Smokers with stronger non-smoker identities had stronger intentions to quit, were more likely to attempt to quit between measurements, and showed less negative and more positive responses to the smoking ban. The association between non-smoker self-identity and intention to quit was stronger among smokers with lower than higher SES. Conclusion: Antismoking measures might be more effective if they would focus also on the identity of smokers, and help smokers to increase identification with non-smoking and non-smokers.

Socio-economic status in relation to smoking: The role of (expected and desired) social support and quitter identity

RATIONALE Smoking behavior differs substantially between lower and higher socioeconomic status (SES) groups. Previous research shows that social support for quitting may be more available to higher-SES smokers, and higher-SES smokers may have stronger nonsmoker self-identities (i.e., can see themselves more as nonsmokers). OBJECTIVE To investigate how SES influences smoking behavior, taking the role of identity processes and social support into account. METHOD A cross-sectional online survey study was conducted among 387 daily smokers from lower, middle and higher-SES groups in the Netherlands in 2014. Educational level was used as an indicator of SES. Expected and desired social support for quitting smoking, expected exclusion from the social network when quitting, identity factors and intention to quit were measured. RESULTS Smokers from all SES backgrounds desired to receive positive social support if they would quit smoking. Lower-SES smokers expected to receive more negative and practical support than middle or higher-SES smokers. There were no significant differences between SES groups for almost all identity measures, nor on intention to quit. Above and beyond other important influences such as nicotine-dependence, results showed that smokers regardless of SES who expected to receive more positive support tended to have stronger intentions to quit. Moreover, smokers who could see themselves more as being quitters (quitter self-identity) and perceived themselves less as smokers (smoker self-identity), as well as smokers who felt more positive about nonsmokers (nonsmoker group-identity) had stronger intentions to quit. No significant interactions with SES were found. CONCLUSION The results suggest that developing ways to stimulate the social environment to provide adequate support for smokers who intend to quit, and developing ways to strengthen identification with quitting in smokers may help smokers to quit successfully. Findings further suggest that the possible-self as a quitter is more important than the current-self as a smoker.

Identity Change Among Smokers and Ex-Smokers : Findings From the ITC Netherlands Survey

Successful smoking cessation appears to be facilitated by identity change, that is, when quitting or nonsmoking becomes part of smokers’ and ex-smokers’ self-concepts. The current longitudinal study is the first to examine how identity changes over time among smokers and ex-smokers and whether this can be predicted by socioeconomic status (SES) and psychosocial factors (i.e., attitude, perceived health damage, social norms, stigma, acceptance, self-evaluative emotions, health worries, expected social support). We examined identification with smoking (i.e., smoker self-identity) and quitting (i.e., quitter self-identity) among a large sample of smokers (n = 742) and ex-smokers (n = 201) in a cohort study with yearly measurements between 2009 and 2014. Latent growth curve modeling was used as an advanced statistical technique. As hypothesized, smokers perceived themselves more as smokers and less as quitters than do ex-smokers, and identification with smoking increased over time among smokers and decreased among ex-smokers. Furthermore, psychosocial factors predicted baseline identity and identity development. Socioeconomic status (SES) was particularly important. Specifically, lower SES smokers and lower SES ex-smokers identified more strongly with smoking, and smoker and quitter identities were more resistant to change among lower SES groups. Moreover, stronger proquitting social norms were associated with increasing quitter identities over time among smokers and ex-smokers and with decreasing smoker identities among ex-smokers. Predictors of identity differed between smokers and ex-smokers. Results suggest that SES and proquitting social norms should be taken into account when developing ways to facilitate identity change and, thereby, successful smoking cessation.

A longitudinal study into the reciprocal effects of identities and smoking behaviour: Findings from the ITC Netherlands Survey

OBJECTIVE Although it has been found that identity constructs related to smoking are associated with changes in smoking behaviour, the direction of causal associations is as yet unclear. This study aims to clarify the nature and direction of these associations. METHODS In this longitudinal study we examined the reciprocal relations between identity constructs (i.e., smoker self-identity, quitter self-identity and smoker group-identity), intention to quit and smoking and quitting behaviour among a sample of 1036 smokers and ex-smokers, using cross-lagged structural equation modelling. Moreover, we tested whether these relations differed by socio-economic status (SES). RESULTS Identity and smoking behaviour were reciprocally related in that in intention to quit and smoking behaviour consistently predicted identity change, and identity predicted (changes in) intentions to quit and smoking behaviour. Behaviour appears more important for identity change than identity for behaviour change. Furthermore, quitter self-identity appears more important than smoker self- and group-identity. Relationships did not differ significantly between SES-groups. The findings were replicated using a cross-validation sample. CONCLUSION Results imply that changing smoking behaviour may be a vehicle to change smoking-related identity. Moreover, strengthening identification with quitting is more crucial for quit success than decreasing smoker identities. The finding that behaviour may be more important for identity than vice versa, if replicated, may call for additions to identity theories.

Strengthening quitter self-identity: An experimental study

Objectives: Smoking-related self-identity processes are important for smoking cessation. We examined whether quitter self-identity (i.e. identification with quitting smoking) could be strengthened through a writing exercise, and whether expected social support for quitting, manipulated through vignettes, could facilitate identification with quitting. Design: Participants (N = 339 daily smokers) were randomly assigned to a 2 (identity: strengthened quitter self-identity vs. control) × 3 (social support: present vs. absent vs. neutral control) between-participants design. Main Outcome Measures: The main outcome was post-test quitter self-identity. Results: Post-test quitter self-identity was not strengthened successfully. Only a small and marginally significant intervention effect was found on quitter self-identity, which did not generalise to positively influence quit-intention or behaviour. The social support manipulation did not facilitate quitter self-identity. Secondary content analyses showed that quitter self-identity was strengthened among participants who linked quitting smoking to their lifestyle, wanted to become quitters for health reasons, and whose reasons for becoming quitters included approach of positive aspects of quitting, but not among participants who linked quitter self-identity to their self-perceptions. Conclusions: Results provide insight into the content of smokers’ self-conceptualizations as quitters. Writing exercises should be improved and tested to eventually successfully strengthen quitter identities.