Socioeconomic status and smokers' number of smoking friends: findings from the International Tobacco Control (ITC) Four Country Survey.

BACKGROUND: Smoking rates are higher among low socioeconomic (SES) groups, and there is evidence that inequalities in smoking are widening over time in many countries. Low SES smokers may be more likely to smoke and less likely to quit because smoking is heavily concentrated in their social contexts. This study investigated whether low SES smokers (1) have more smoking friends, and (2) are more likely to gain and less likely to lose smoking friends over time. Correlates of having more smoking friends and gaining or losing smoking friends were also considered. METHOD: Respondents included 6321 adult current smokers (at recruitment) from Wave 1 (2002) and Wave 2 (2003) of the International Tobacco Control Project (ITC) Four Country Survey, a nationally representative longitudinal cohort survey of smokers in Australia, Canada, UK, and US. RESULTS: Low SES smokers reported more smoking friends than moderate and high SES smokers. Low SES smokers were also more likely to gain smoking friends over time compared with high SES smokers. Smokers who were male, younger, and lived with other smokers reported more smoking friends, and were also more likely to gain and less likely to lose smoking friends. Smoking behaviours, such as higher nicotine dependence were related to reporting more smoking friends, but not to losing or gain smoking friends. CONCLUSIONS: Smoking is highly concentrated in the social networks of lower SES smokers and this concentration may be increasing over time. Cessation interventions should consider how the structure of low SES smokers' social networks affects quitting.

The relation between number of smoking friends, and quit intentions, attempts, and success: findings from the International Tobacco Control (ITC) Four Country Survey.

Smokers who inhabit social contexts with a greater number of smokers may be exposed to more positive norms toward smoking and more cues to smoke. This study examines the relation between number of smoking friends and changes in number of smoking friends, and smoking cessation outcomes. Data were drawn from Wave 1 (2002) and Wave 2 (2003) of the International Tobacco Control (ITC) Project Four Country Survey, a longitudinal cohort survey of nationally representative samples of adult smokers in Australia, Canada, United Kingdom, and United States (N = 6,321). Smokers with fewer smoking friends at Wave 1 were more likely to intend to quit at Wave 1 and were more likely to succeed in their attempts to quit at Wave 2. Compared with smokers who experienced no change in their number of smoking friends, smokers who lost smoking friends were more likely to intend to quit at Wave 2, attempt to quit between Wave 1 and Wave 2, and succeed in their quit attempts at Wave 2. Smokers who inhabit social contexts with a greater number of smokers may be less likely to successfully quit. Quitting may be particularly unlikely among smokers who do not experience a loss in the number of smokers in their social context.

Patterns of cognitive dissonance-reducing beliefs among smokers: a longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey.

OBJECTIVE: The purpose of this paper is to assess whether smokers adjust their beliefs in a pattern that is consistent with Cognitive Dissonance Theory. This is accomplished by examining the longitudinal pattern of belief change among smokers as their smoking behaviours change. METHODS: A telephone survey was conducted of nationally representative samples of adult smokers from Canada, the USA, the UK and Australia from the International Tobacco Control Four Country Survey. Smokers were followed across three waves (October 2002 to December 2004), during which they were asked to report on their smoking-related beliefs and their quitting behaviour. FINDINGS: Smokers with no history of quitting across the three waves exhibited the highest levels of rationalisations for smoking. When smokers quit smoking, they reported having fewer rationalisations for smoking compared with when they had previously been smoking. However, among those who attempted to quit but then relapsed, there was once again a renewed tendency to rationalise their smoking. This rebound in the use of rationalisations was higher for functional beliefs than for risk-minimising beliefs, as predicted by social psychological theory. CONCLUSIONS: Smokers are motivated to rationalise their behaviour through the endorsement of more positive beliefs about smoking, and these beliefs change systematically with changes in smoking status. More work is needed to determine if this cognitive dissonance-reducing function has an inhibiting effect on any subsequent intentions to quit.

Perceived risk and quitting behaviors: results from the ITC 4-country survey.

OBJECTIVE: To rigorously test the relation between perceived risk (i.e., belief about the likelihood of harm) and quitting smoking. METHODS: Data from a longitudinal study with a nonrestrictive sample of smokers (N = 4307) from the United States, Canada, the United Kingdom, and Australia were examined to predict quitting behaviors at 8-12 months. RESULTS: Perceived risk predicted plans to quit, quit attempts, and, to some extent, sustained quitting. The relation was stronger for relatively simple (e.g., plans to quit) than for complex behaviors (e.g., sustained quitting). CONCLUSION: Perceived risk plays a significant role in predicting quitting smoking, more so for relatively simple behaviors.

Rewriting the self-fulfilling prophecy of social rejection: self-affirmation improves relational security and social behavior up to 2 months later.

Chronically insecure individuals often behave in ways that result in the very social rejection that they most fear. We predicted that this typical self-fulfilling prophecy is not immutable. Self-affirmation may improve insecure individuals' relational security, and this improvement may allow them to express more welcoming social behavior. In a longitudinal experiment, a 15-min self-affirmation improved both the relational security and experimenter-rated social behavior of insecure participants up to 4 weeks after the initial intervention. Moreover, the extent to which self-affirmation improved insecure participants' relational security at 4 weeks predicted additional improvements in social behavior another 4 weeks after that. Our finding that insecure participants continued to reap the social benefits of self-affirmation up to 8 weeks after the initial intervention demonstrates that it is indeed possible to rewrite the self-fulfilling prophecy of social rejection.

The merit of meritocracy.

We argue that the preference for the merit principle is a separate construct from hierarchy-legitimizing ideologies (i.e., system justification beliefs, prejudice, social dominance orientation), including descriptive beliefs that meritocracy currently exists in society. Moreover, we hypothesized that prescriptive beliefs about merit should have a stronger influence on reactions to the status quo when hierarchy-legitimizing ideologies are weak (vs. strong). In 4 studies, participants' preference for the merit principle and hierarchy-legitimizing ideologies were assessed; later, the participants evaluated organizational selection practices that support or challenge the status quo. Participants' prescriptive and descriptive beliefs about merit were separate constructs; only the latter predicted other hierarchy-legitimizing ideologies. In addition, as hypothesized, among participants who weakly endorsed hierarchy-legitimizing ideologies, the stronger their preference for the merit principle, the more they opposed selection practices that were perceived to be merit violating but the more they supported practices that were perceived to be merit restoring. In contrast, those who strongly endorsed hierarchy-legitimizing ideologies were always motivated to support the status quo, regardless of their preference for the merit principle.

Support and correlates of support for banning smoking in cars with children: findings from the ITC Four Country Survey.

BACKGROUND: Since 2006, banning smoking in cars with children has become a rapidly growing tobacco control policy. However, to date, there have been few studies examining support and correlates of support for car smoking bans, and none of the existing studies have been international in nature. We conducted such a study among smokers in four countries. METHODS: 6716 adult current smokers from the 2007 Wave of the International Tobacco Control Four Country Survey, a nationally representative, longitudinal cohort telephone survey of smokers in the USA, Canada, UK and Australia. Controlling for demographics, heaviness of smoking, smoking health knowledge/beliefs and quit intentions, we compared support and correlates of support for banning smoking in cars with children across the four countries. RESULTS: The majority of smokers supported banning smoking in cars with children. Support was highest in Australia (83%), followed by the UK (75%) and Canada (74%); support was lower-but still high-in the USA (60%). Support was highest among smokers who: had stronger quit intentions, were lighter smokers, had lower education, had no children in the home, believed that cigarette smoke is dangerous to non-smokers and could cause asthma in children, and were concerned about modelling smoking to children. CONCLUSIONS: These findings indicate that a majority of smokers in the four countries support banning smoking in cars with children, and lend support to banning smoking in cars with children. Additionally, they suggest that support may be increased by educating smokers about the dangers of cigarette smoke exposure.

Predictors of smoking cessation among adult smokers in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia Survey.

INTRODUCTION: Limited longitudinal studies on smoking cessation have been reported in Asia, and it remains unclear whether determinants of quitting are similar to those found in Western countries. This study examined prospective predictors of smoking cessation among adult smokers in Thailand and Malaysia. METHODS: Four thousand and four smokers were surveyed in Malaysia and Thailand in 2005. Of these, 2,426 smokers were followed up in 2006 (61% retention). Baseline measures of sociodemographics, dependence, and interest in quitting were used to predict both making quit attempts and point prevalence maintenance of cessation. RESULTS: More Thai than Malaysian smokers reported having made quit attempts between waves, but among those who tried, the rates of staying quit were not considerably different between Malaysians and Thais. Multivariate analyses showed that smoking fewer cigarettes per day, higher levels of self-efficacy, and more immediate quitting intentions were predictive of both making a quit attempt and staying quit in both countries. Previous shorter quit attempts and higher health concerns about smoking were only predictive of making an attempt, whereas prior abstinence for 6 months or more and older age were associated with maintenance. DISCUSSION: In Malaysia and Thailand, predictors of quitting activity appear to be similar. However, as in the West, predictors of making quit attempts are not all the same as those who predict maintenance. The actual predictors differ in potentially important ways from those found in the West. We need to determine the relative contributions of cultural factors and the shorter history of efforts to encourage quitting in Asia.

Motivational factors predict quit attempts but not maintenance of smoking cessation: findings from the International Tobacco Control Four country project.

AIM: To explore whether measures of motivation to quit smoking have different predictive relationships with making quit attempts and the maintenance of those attempts. METHODS: Data are from three wave-to-wave transitions of the International Tobacco Control Four (ITC-4) country project. Smokers' responses at one wave were used to predict the likelihood of making an attempt and among those trying the likelihood of maintaining an attempt for at least a month at the next wave. For both outcomes, hierarchical logistic regressions were used to explore the predictive capacity of seven measures of motivation to quit smoking, controlling for a range of other known or possible predictors. RESULTS: Bivariate analyses indicate that measures of motivation to quit are predictive of making quit attempts, but they predict relapse among those making attempts. Multivariate analyses identified wanting to quit and frequency of prematurely butting out cigarettes as the main positive predictors of making attempts, but this was reduced by intention and recency of last attempt. For maintenance, premature butting out was the main motivation variable predicting relapse and was essentially unaffected by other measures. DISCUSSION: The findings show that it is wrong to suggest that all one needs to quit is to be motivated to do so. The reality is that one needs to be motivated to prompt action to stop smoking, but this is not sufficient in and of itself to ensure that cessation is maintained. These findings call attention to the importance of understanding the differential roles that prequit and postquit experiences play in smoking cessation and of providing help to smokers to stay off cigarettes.

Inequality, discrimination, and the power of the status quo: Direct evidence for a motivation to see the way things are as the way they should be.

How powerful is the status quo in determining people's social ideals? The authors propose (a) that people engage in injunctification, that is, a motivated tendency to construe the current status quo as the most desirable and reasonable state of affairs (i.e., as the most representative of how things should be); (b) that this tendency is driven, at least in part, by people's desire to justify their sociopolitical systems; and (c) that injunctification has profound implications for the maintenance of inequality and societal change. Four studies, across a variety of domains, provided supportive evidence. When the motivation to justify the sociopolitical system was experimentally heightened, participants injunctified extant (a) political power (Study 1), (b) public funding policies (Study 2), and (c) unequal gender demographics in the political and business spheres (Studies 3 and 4, respectively). It was also demonstrated that this motivated phenomenon increased derogation of those who act counter to the status quo (Study 4). Theoretical implications for system justification theory, stereotype formation, affirmative action, and the maintenance of inequality are discussed.

Regret and rationalization among smokers in Thailand and Malaysia: findings from the International Tobacco Control Southeast Asia Survey.

OBJECTIVE: To test whether differences of history and strength in tobacco control policies will influence social norms, which, in turn, will influence quit intentions, by influencing smokers' regret and rationalization. DESIGN: The data were from the International Tobacco Control (ITC) Policy Evaluation Southeast Asia Survey, a cohort survey of representative samples of adult smokers in Thailand (N = 2,000) and Malaysia (N = 2,006). The survey used a stratified multistage sampling design. MAIN OUTCOME MEASURES: Measures included regret, rationalization, social norms, and quit intention. RESULTS: Thai smokers were more likely to have quit intentions than Malaysian smokers. This difference in quit intentions was, in part, explained by the country differences in social norms, regret, and rationalization. Reflecting Thailand's history of stronger tobacco control policies, Thai smokers, compared with Malaysian smokers, perceived more negative social norms toward smoking, were more likely to regret, and less likely to rationalize smoking. Mediational analyses revealed that these differences in social norms, accounted, in part, for the country-quit intention relation and that regret and rationalization accounted, in part, for the social norm-quit intention relation. CONCLUSION: The results suggest that social norms toward smoking, which are shaped by tobacco control policies, and smokers' regret and rationalization influence quit intentions.

Do risk-minimizing beliefs about smoking inhibit quitting? Findings from the International Tobacco Control (ITC) Four-Country Survey.

OBJECTIVE: To replicate findings that risk-minimizing and self-exempting beliefs lower quit intentions, and to extend this by testing their capacity to prospectively predict smoking cessation. METHOD: 13,324 adult (> or =18 years) cigarette smokers from the USA, Canada, UK, and Australia from one of the first three waves (2002-2004) of the International Tobacco Control 4-Country survey were employed for the predictive analysis where beliefs measured in one wave (1-3) of a cohort were used to predict cessation outcomes in the next wave (2-4). RESULTS: Both types of belief were negatively associated with both intention to quit in the same wave and making a quit attempt at the next wave. When taken together and controlling for demographic factors, the risk-minimizing beliefs continued to be predictive, but the self-exempting belief was not. Some of the effects of risk-minimizing beliefs on quit attempts seem to be independent of intentions, but not consistently independent of other known predictors. There were no consistent predictive effects on sustained cessation among those who made attempts to quit for either measure. CONCLUSIONS: Countering risk-minimizing beliefs may facilitate increased quitting, but this may not be so important for self-exempting beliefs.

A two-dimensional model that employs explicit and implicit attitudes to characterize prejudice.

In the authors' 2-dimensional model of prejudice, explicit and implicit attitudes are used to create 4 profiles: truly low prejudiced (TLP: double lows), aversive racists (AR: low explicit modern racism/high implicit prejudice), principled conservatives (PC: high explicit modern racism/low implicit prejudice), and modern racists (MR: double highs). Students completed an Asian Modern Racism Scale and an Asian/White Implicit Association Test. The authors compared the 4 groups' prejudice-related ideologies (i.e., egalitarianism/humanism and social conservatism) and economic/political conservatism (Study 1, N=132). The authors also tested whether MR but not PC (Study 2, N=65) and AR but not TLP (Study 3, N=143) are more likely to negatively evaluate an Asian target when attributional ambiguity is high (vs. low). In support of the model, TLP did not hold prejudice-related ideologies and did not discriminate; AR were low in conservatism and demonstrated the attributional-ambiguity effect; PC did not strongly endorse prejudice-related ideologies and did not discriminate; MR strongly endorsed prejudice-related ideologies, were conservative, and demonstrated the attributional-ambiguity effect. The authors discuss implications for operationalizing and understanding the nature of prejudice.

The cost of lower self-esteem: testing a self- and social-bonds model of health.

The authors draw upon social, personality, and health psychology to propose and test a self-and-social-bonds model of health. The model contends that lower self-esteem predicts health problems and that poor-quality social bonds explain this association. In Study 1, lower self-esteem prospectively predicted reports of health problems 2 months later, and this association was explained by subjective reports of poor social bonds. Study 2 replicated the results of Study 1 but used a longitudinal design with 6 waves of data collection, assessed self-reports of concrete health-related behaviors (i.e., number of visits to the doctor and classes missed due to illness), and measured both subjective and objective indicators of quality of social bonds (i.e., interpersonal stress and number of friends). In addition, Study 2 showed that poor-quality social bonds predicted acute drops in self-esteem over time, which in turn predicted acute decreases in quality of social bonds and, consequently, acute increases in health problems. In both studies, alternative explanations to the model were tested.

Victoria's dirty secret: how sociocultural norms influence adolescent girls and women.

The present studies tested whether the salience of sociocultural norms for ideal appearance leads women to base their self-worth more strongly on appearance, which in turn leads them to feel more concerned with others' perceptions and less satisfied with their bodies. Study 1 tested this model by manipulating the salience of the sociocultural norm among female university students. The model was supported. In Study 2 an intervention challenging the legitimacy of the sociocultural norm was delivered to female and male adolescents. Compared to controls, females who received this intervention were less accepting of the sociocultural norms for appearance, based their self-worth less strongly on appearance, and in turn were less concerned with others' perceptions and were more satisfied with their bodies. The implications for women are discussed.

Don't take another bite: how sociocultural norms for appearance affect women's eating behavior.

Four studies tested the impact of exposure to thin images on women's eating behavior. In Study 1, women who were exposed to commercials containing thin models ate less in a taste test than women exposed to neutral commercials. The next two studies revealed that the impact of the thin images could be reduced by challenging the sociocultural norms for appearance. In Study 2, including images of relatively heavier women who have been successful in life (an indirect challenge to the norm) attenuated the impact of the thin images on women's eating behavior. Study 3 demonstrated that convincing women that their peers do not endorse the sociocultural norms also reduced the impact of the thin images. In Study 4, we found that exposure to thin images led to activation of an association between heaviness and rejection and that the more this association was activated, the less participants ate.

Smoking in movies, implicit associations of smoking with the self, and intentions to smoke.

We examined whether identifying with a film character who smokes increases implicit associations of the self with smoking. Undergraduate men were randomly assigned to view film clips in which the male protagonist either smoked or did not smoke. We measured subsequent levels of self-smoking associations using a reaction time task, as well as self-reported beliefs about smoking and smokers. Greater identification with the smoking protagonist predicted stronger implicit associations between the self and smoking (for both smokers and nonsmokers) and increased intention to smoke (among the smokers). Stronger implicit self-smoking associations uniquely predicted increases in smokers' intentions to smoke, over and above the effects of explicit beliefs about smoking. The results provide evidence that exposure to smoking in movies is causally related to changes in smoking-related thoughts, that identification with protagonists is an important feature of narrative influence, and that implicit measures may be useful in predicting deliberative behavior.

Authoritarian dynamics and unethical decision making: high social dominance orientation leaders and high right-wing authoritarianism followers.

When dilemmas require trade-offs between profits and ethics, do leaders high in social dominance orientation (SDO) and followers high in right-wing authoritarianism (RWA) make decisions that are more unethical than those made by others? This issue was explored in 4 studies with female participants performing managerial role-playing tasks. First, dyads comprising a person who was either low or high in SDO and a person who was either low or high in RWA negotiated for a leadership position. People high in SDO were more likely to obtain leader positions than to obtain follower positions. No other effects were significant. Second, leaders high in SDO partnered with an agreeable (confederate) follower made decisions that were more unethical than those of leaders low in SDO. Third, followers high in RWA were more acquiescent to and supportive of an unethical (confederate) leader than were followers low in RWA. Fourth, high SDO leader-high RWA follower dyads made decisions that were more unethical than those made in role-reversed dyads because leaders had more influence. Implications of these results for conceptualizing SDO, RWA, and authoritarian dynamics are discussed.

Tobacco denormalization and industry beliefs among smokers from four countries.

BACKGROUND: Tobacco denormalization is an important concept for understanding smoking behavior. The present study sought to assess beliefs about the tobacco industry and the social acceptability of smoking among nationally representative samples of adult smokers from four countries, and to assess the relationship of these measures to cessation behavior and tobacco-control policy. DESIGN: A longitudinal survey of 9058 adult smokers from Canada (n = 2214), the United States (n = 2138), the United Kingdom (n = 2401), and Australia (n = 2305), was conducted in October-December 2002 and again in June and August 2003 (75% follow-up rate). The analyses were conducted in 2005. RESULTS: The findings indicate that few smokers perceive approval for their smoking, and most hold relatively antagonistic beliefs toward the tobacco industry. For example, 80% of smokers reported that society disapproves of smoking, and more than three quarters reported that tobacco companies cannot be trusted to tell the truth. Social and industry denormalization were independently associated with intentions to quit smoking. Baseline levels of social denormalization were associated with abstinence at the 8-month follow-up, as were changes in industry denormalization beliefs between baseline and follow-up. Anti-industry beliefs at baseline did not predict abstinence at follow-up. A similar pattern of findings was observed across all four countries. In addition, social denormalization and anti-industry beliefs were significantly associated with tobacco-control policies, such as noticing health warnings on packages and greater workplace smoking restrictions. CONCLUSIONS: Tobacco denormalization constructs were independently linked to cessation-related outcomes among adults from four countries. Tobacco-industry denormalization themes in mass media campaigns may help to reduce tobacco use above and beyond more traditional communications that target social norms.

Remembering the message: the use of a reminder cue to increase condom use following a safer sex intervention.

Condom use interventions may be more powerful if they provide cues to recall safe-sex messages when sexual activity occurs. The authors tested this notion by assigning sexually active introductory psychology students (N = 196) to a standard safe-sex intervention, a safe-sex with reminder intervention, or a control (drinking and driving) intervention. Participants assigned to the reminder intervention were given a "friendship bracelet" to wear and were instructed to have the bracelet remind them of the intervention. In a follow-up session (5-7 weeks later), they were asked questions pertaining to condom use. Of the 125 participants who had engaged in sexual intercourse, condom use at last intercourse was higher in the bracelet condition (55%) than in the standard (27%) or control (36%) conditions. The authors also found that the bracelet remained effective, even when participants were under the influence of alcohol. These findings therefore imply that health intervention programs may be more efficacious if they include strategies such as reminder cues to increase the salience of health information in the appropriate contexts.