Revealing the complexity of quitting smoking: a qualitative grounded theory study of the natural history of quitting in Australian ex-smokers.

OBJECTIVE: To explore the quitting histories of Australian ex-smokers in order to develop an understanding of the varied contribution of smoking cessation assistance (either pharmacotherapy or professionally mediated behavioural support) to the process of quitting. DESIGN: Qualitative grounded theory study; in-depth interviews. PARTICIPANTS: 37 Australian adult ex-smokers (24-68 years; 15 men, 22 women) who quit in the past 6-24 months. RESULTS: Although participants' individual quitting histories and their overall experiences of quitting were unique, when the 37 quitting histories were compared it was clear two experiences were common to almost all participants: almost no one quit at their first quit attempt and almost everyone started out quitting unassisted. Furthermore, distinct patterns existed in the timing and use of assistance, in particular the age at which assistance was first used, how some participants were resolutely uninterested in assistance, and how assistance might have contributed to the process of successful quitting even if not used on the final quit attempt. Importantly, three patterns in use of assistance were identified: (1) only ever tried to quit unassisted (n=13); (2) started unassisted, tried assistance but reverted back to unassisted (n=13); (3) started unassisted, tried assistance and quit with assistance (n=11). For most participants, insight into what quitting would require was only gained through prior quitting experiences with and without assistance. For a number of participants, interest in assistance was at its lowest when the participant was most ready to quit. CONCLUSION: Quitting should be viewed as a process drawing on elements of assisted and unassisted quitting rather than a stand-alone event that can be labelled as strictly assisted or unassisted.

Measured, opportunistic, unexpected and naïve quitting: a qualitative grounded theory study of the process of quitting from the ex-smokers' perspective.

BACKGROUND: To better understand the process of quitting from the ex-smokers' perspective, and to explore the role spontaneity and planning play in quitting. METHODS: Qualitative grounded theory study using in-depth interviews with 37 Australian adult ex-smokers (24-68 years; 15 males, 22 females) who quit smoking in the past 6-24 months (26 quit unassisted; 11 used assistance). RESULTS: Based on participants' accounts of quitting, we propose a typology of quitting experiences: measured, opportunistic, unexpected and naïve. Two key features integral to participants' accounts of their quitting experiences were used as the basis of the typology: (1) the apparent onset of quitting (gradual through to sudden); and (2) the degree to which the smoker appeared to have prepared for quitting (no evidence through to clear evidence of preparation). The resulting 2 × 2 matrix of quitting experiences took into consideration three additional characteristics: (1) the presence or absence of a clearly identifiable trigger; (2) the amount of effort (cognitive and practical) involved in quitting; and (3) the type of cognitive process that characterised the quitting experience (reflective; impulsive; reflective and impulsive). CONCLUSIONS: Quitting typically included elements of spontaneity (impulsive behaviour) and preparation (reflective behaviour), and, importantly, the investment of time and cognitive effort by participants prior to quitting. Remarkably few participants quit completely out-of-the-blue with little or no preparation. Findings are discussed in relation to stages-of-change theory, catastrophe theory, and dual process theories, focusing on how dual process theories may provide a way of conceptualising how quitting can include elements of both spontaneity and preparation.

The views and experiences of smokers who quit smoking unassisted. A systematic review of the qualitative evidence.

BACKGROUND: Unassisted cessation - quitting without pharmacological or professional support - is an enduring phenomenon. Unassisted cessation persists even in nations advanced in tobacco control where cessation assistance such as nicotine replacement therapy, the stop-smoking medications bupropion and varenicline, and behavioural assistance are readily available. We review the qualitative literature on the views and experiences of smokers who quit unassisted. METHOD: We systematically searched for peer-reviewed qualitative studies reporting on smokers who quit unassisted. We identified 11 studies and used a technique based on Thomas and Harden's method of thematic synthesis to discern key themes relating to unassisted cessation, and to then group related themes into overarching concepts. FINDINGS: The three concepts identified as important to smokers who quit unassisted were: motivation, willpower and commitment. Motivation, although widely reported, had only one clear meaning, that is 'the reason for quitting'. Willpower was perceived to be a method of quitting, a strategy to counteract cravings or urges, or a personal quality or trait fundamental to quitting success. Commitment was equated to seriousness or resoluteness, was perceived as key to successful quitting, and was often used to distinguish earlier failed quit attempts from the final successful quit attempt. Commitment had different dimensions. It appeared that commitment could be tentative or provisional, and also cumulative, that is, commitment could be built upon as the quit attempt progressed. CONCLUSION: A better understanding of what motivation, willpower and commitment mean from the smoker's perspective may provide new insights and direction for smoking cessation research and practice.

Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers.

OBJECTIVE: When tobacco smokers quit, between half and two-thirds quit unassisted: that is, they do not consult their general practitioner (GP), use pharmacotherapy (nicotine-replacement therapy, bupropion or varenicline), or phone a quitline. We sought to understand why smokers quit unassisted. DESIGN: Qualitative grounded theory study (in-depth interviews, theoretical sampling, concurrent data collection and data analysis). PARTICIPANTS: 21 Australian adult ex-smokers (aged 28-68 years; 9 males and 12 females) who quit unassisted within the past 6 months to 2 years. 12 participants had previous experience of using assistance to quit; 9 had never previously used assistance. SETTING: Community, Australia. RESULTS: Along with previously identified barriers to use of cessation assistance (cost, access, lack of awareness or knowledge of assistance, including misperceptions about effectiveness or safety), our study produced new explanations of why smokers quit unassisted: (1) they prioritise lay knowledge gained directly from personal experiences and indirectly from others over professional or theoretical knowledge; (2) their evaluation of the costs and benefits of quitting unassisted versus those of using assistance favours quitting unassisted; (3) they believe quitting is their personal responsibility; and (4) they perceive quitting unassisted to be the 'right' or 'better' choice in terms of how this relates to their own self-identity or self-image. Deep-rooted personal and societal values such as independence, strength, autonomy and self-control appear to be influencing smokers' beliefs and decisions about quitting. CONCLUSIONS: The reasons for smokers' rejection of the conventional medical model for smoking cessation are complex and go beyond modifiable or correctable problems relating to misperceptions or treatment barriers. These findings suggest that GPs could recognise and respect smokers' reasons for rejecting assistance, validate and approve their choices, and modify brief interventions to support their preference for quitting unassisted, where preferred. Further research and translation may assist in developing such strategies for use in practice.

Exposure to the 'Dark Side of Tanning' skin cancer prevention mass media campaign and its association with tanning attitudes in New South Wales, Australia.

Melanoma is the most common cancer among 15- to 29-year-olds in Australia, with rates increasing with age. The 'Dark Side of Tanning' (DSOT) mass media campaign was developed in 2007 to influence attitudes related to tanning. This study aimed to assess recall and impact of the DSOT campaign. Data were collected using online surveys of 13- to 44-year-olds living in New South Wales in the summer months of 2007-2010 (n = 7490). Regression models were used to determine predictors of recall of DSOT and to investigate associations between exposure to the campaign and tanning attitudes. The campaign achieved consistently high recall (unprompted recall 42-53% during campaign periods; prompted recall 76-84%). Those who recalled DSOT advertisements had a higher likelihood of reporting negative tanning attitudes compared with those who reported no recall, after adjusting for other factors (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01-1.27 for unprompted recall; OR 1.19, 95% CI 1.03-1.36 for prompted recall). Being interviewed in later campaign years was also a significant predictor of negative tanning attitudes (e.g. fourth year of campaign versus first year: OR 1.24, 95% CI 1.01-1.53). These results suggest that mass media campaigns have potential to influence tanning-related attitudes and could play an important role in skin cancer prevention.

What do we know about unassisted smoking cessation in Australia? A systematic review, 2005-2012.

CONTEXT: A significant proportion of smokers who quit do so on their own without formal help (ie, without professionally or pharmacologically mediated assistance), yet research into how smokers quit focuses primarily on assisted methods of cessation. OBJECTIVE: The aim of the present work was to systematically review recent smoking cessation research in Australia, a nation advanced in tobacco control, to determine what is known about smokers who quit unassisted in order to (1) inform a research agenda to develop greater understanding of the many smokers who quit unassisted and (2) elucidate possible lessons for policy and mass communication about cessation. METHODS: In January 2013, four e-databases and the grey literature were searched for articles published between 2005 and 2012 on smoking cessation in Australia. Articles focusing solely on interventions designed to stimulate cessation were excluded, as were articles focusing solely on assisted cessation, leaving articles reporting on smokers who quit unassisted. Data from articles reporting on unassisted cessation were extracted and grouped into related categories. RESULTS: A total of 248 articles reported on smoking cessation, of which 63 focused solely on interventions designed to stimulate cessation, leaving 185 reporting on the method of cessation ('how' a smoker quits). Of these, 166 focused solely on assisted cessation, leaving 19 reporting, either directly or indirectly, on smokers who quit unassisted. Data from these studies indicated 54% to 69% of ex-smokers quit unassisted and 41% to 58% of current smokers had attempted to quit unassisted. CONCLUSIONS: The majority of Australian smokers quit or attempt to quit unassisted, yet little research has been dedicated to understanding this process. Almost all research that reported unassisted cessation referenced it as a comparator to the focal point of assisted cessation. Public health may benefit from insights gained from greater research into the cessation method used by most smokers. Suggestions and a rationale for such research are provided.

Impact of Australia's introduction of tobacco plain packs on adult smokers' pack-related perceptions and responses: results from a continuous tracking survey.

OBJECTIVES: To investigate the impact of Australia's plain tobacco packaging policy on two stated purposes of the legislation--increasing the impact of health warnings and decreasing the promotional appeal of packaging--among adult smokers. DESIGN: Serial cross-sectional study with weekly telephone surveys (April 2006-May 2013). Interrupted time-series analyses using ARIMA modelling and linear regression models were used to investigate intervention effects. PARTICIPANTS: 15,745 adult smokers (aged 18 years and above) in New South Wales (NSW), Australia. Random selection of participants involved recruiting households using random digit dialling and selecting the nth oldest smoker for interview. INTERVENTION: The introduction of the legislation on 1 October 2012. OUTCOMES: Salience of tobacco pack health warnings, cognitive and emotional responses to warnings, avoidance of warnings, perceptions regarding one's cigarette pack. RESULTS: Adjusting for background trends, seasonality, antismoking advertising activity and cigarette costliness, results from ARIMA modelling showed that, 2-3 months after the introduction of the new packs, there was a significant increase in the absolute proportion of smokers having strong cognitive (9.8% increase, p=0.005), emotional (8.6% increase, p=0.01) and avoidant (9.8% increase, p=0.0005) responses to on-pack health warnings. Similarly, there was a significant increase in the proportion of smokers strongly disagreeing that the look of their cigarette pack is attractive (57.5% increase, p<0.0001), says something good about them (54.5% increase, p<0.0001), influences the brand they buy (40.6% increase, p<0.0001), makes their pack stand out (55.6% increase, p<0.0001), is fashionable (44.7% increase, p<0.0001) and matches their style (48.1% increase, p<0.0001). Changes in these outcomes were maintained 6 months postintervention. CONCLUSIONS: The introductory effects of the plain packaging legislation among adult smokers are consistent with the specific objectives of the legislation in regard to reducing promotional appeal and increasing effectiveness of health warnings.

The natural history of antismoking advertising recall: the influence of broadcasting parameters, emotional intensity and executional features.

BACKGROUND: The necessary first steps for televised media campaign effects are population exposure and recall. To maximise the impact of campaign funding, it is critical to identify modifiable factors that increase the efficiency of an advertisement reaching the target audience and of their recalling that advertisement. METHODS: Data come from a serial cross-sectional telephone survey with weekly interviews of adult smokers and recent quitters from the state of New South Wales, Australia, collected between April 2005 and December 2010 (total n=13 301). Survey data were merged with commercial TV ratings data (Gross Rating Points (GRPs)) to estimate individuals' exposure to antismoking campaigns. RESULTS: Multivariable logistic regression analyses indicated that GRPs and broadcasting recency were positively associated with advertisement recall, such that advertisements broadcast more at higher levels or in more recent weeks were more likely to be recalled. Advertisements were more likely to be recalled in their launch phase than in following periods. Controlling for broadcasting parameters, advertisements higher in emotional intensity were more likely to be recalled than those low in emotion; and emotionally intense advertisements required fewer GRPs to achieve high levels of recall than lower emotion advertisements. There was some evidence for a diminishing effect of increased GRPs on recall. CONCLUSIONS: In order to achieve sufficient levels of population recall of antismoking campaigns, advertisements need to be broadcast at adequate levels in relatively frequent cycles. Advertisements with highly emotional content may offer the most efficient means by which to increase population recall.

When your smoking is not just about you: antismoking advertising, interpersonal pressure, and quitting outcomes.

The authors investigated the potential for antismoking advertising to generate interpersonal pressure on smokers to quit using the Cancer Institute NSW's Tobacco Tracking Survey, a telephone tracking survey of adult smokers conducted throughout the year with approximately 50 interviews per week (N = 5,448). The survey includes questions relating to recently broadcast antismoking advertisements, including whether smokers have received pressure from family and friends as a result of their seeing the advertisements. The authors conducted multivariate logistic regression analyses to predict: (a) receiving ad-stimulated interpersonal pressure; and (b) quitting outcomes. All analyses controlled for smoker characteristics and potential exposure to the advertisements. Compared with ads coded as having a low level of emotion (by independent coders), ads coded as highly emotional were more likely to have generated interpersonal pressure. Ad-stimulated interpersonal pressure was associated with an increased likelihood of recent quit attempts and with salient quitting thoughts, with a greater effect on quitting thoughts for interpersonal pressure generated by highly and moderately emotional ads. These results support previous research suggesting that highly emotional antismoking ads with personal stories or graphic imagery are effective in promoting smoking cessation, and these results help to identify communication processes that contribute to the ads' success.

Student drug testing in the context of positive and negative school climates: results from a national survey.

Positive school climates and student drug testing have been separately proposed as strategies to reduce student substance use in high schools. However, the effects of drug testing programs may depend on the favorability of school climates. This study examined the association between school drug testing programs and student substance use in schools with different climates. The analysis was based on a nationally representative sample of 943 high school students (48% female) ranging from 14 to 19 years of age (62% identifying as white, 18% Hispanic, 13% African American, and 7% in other categories). Results showed that both male and female students in schools with positive climates reported lower levels of personal substance use. Drug testing was associated with lower levels of personal substance use in positive school climates, but only for female students. There was no relationship between drug testing and male students' substance use. The results are discussed in terms of the importance of considering school climates before implementing drug-testing programs in high schools.

Tobacco in the news: associations between news coverage, news recall and smoking-related outcomes in a sample of Australian smokers and recent quitters.

This paper aims to track smokers' and recent quitters' recall of tobacco news, compare patterns of recall with patterns of news coverage and assess associations between news recall and smoking-related cognitions and behaviours, by using a quantitative analysis. The Cancer Institute New South Wales (NSW)'s Tobacco Tracking Survey, a continuous tracking telephone survey of adult smokers and recent quitters, was used to monitor recall of tobacco news and smoking-related cognitions and behaviours from January to September 2010 (approximately 50 interviews per week; n = 1952). Thirty per cent of respondents reported semi-prompted recall of tobacco news with patterns of recall closely following peaks in news coverage. Television was the most frequently cited source of tobacco news. Multivariate logistic regression analyses indicated that, controlling for individual characteristics, smokers with high levels of tobacco news recall were significantly more likely to have strong beliefs about harms from smoking [odds ratio (OR) = 1.38] and frequent thoughts about quitting (OR = 1.32). The results show that the news media are an important source of information for smokers, with the potential to influence beliefs and to put or keep quitting on the smokers' agenda. Media advocacy remains an important component of tobacco control.

Impact of the 2010 tobacco tax increase in Australia on short-term smoking cessation: a continuous tracking survey.

OBJECTIVE: To use population-level data to monitor the impact on smoking cessation activity of the April 2010 Australian tobacco tax increase. DESIGN AND SETTING: The Cancer Institute NSW [New South Wales] Tobacco Tracking Survey (CITTS) is a continuous tracking telephone survey conducting about 50 interviews per week. Data from February to September in 2009 and 2010 were analysed (ie, data on people who quit smoking in the 3 months before and 5 months after the tax increase in 2010 were compared, and quitting activity over the same period in 2009 was also analysed). PARTICIPANTS: Adult smokers and smokers who had stopped smoking in the previous 12 months; 2009 (n = 1604); 2010 (n = 1699). MAIN OUTCOME MEASURE: Recent quitting (defined as stopping smoking or trying to quit within a 1-month period). RESULTS: 22% of the sample reported that they had quit smoking in May 2010, compared with 13% in April 2010 and 12% in May 2009. Respondents interviewed in the 3 months after the tax increase (May-July) were significantly more likely to report quitting than those interviewed in the 3 months before the tax increase (odds ratio, 1.84; 95% CI, 1.26-2.69; P < 0.01). This increase in quitting activity was not sustained in the subsequent months (August-September). CONCLUSIONS: The tobacco tax increase was associated with a short-term increase in the rate of smoking cessation among NSW adult smokers and recent quitters, suggesting that regular increases in tobacco tax may further encourage quitting activity.

Use and perceived helpfulness of smoking cessation methods: results from a population survey of recent quitters.

BACKGROUND: Increasing rates of smoking cessation is one of the most effective measures available to improve population health. To advance the goal of increasing successful cessation at the population level, it is imperative that we understand more about smokers' use of cessation methods, as well as the helpfulness of those methods in real-world experiences of quitting. In this survey of recent quitters, we simultaneously examined rates of use and perceived helpfulness of various cessation methods. METHODS: Recent quitters (within 12 months; n = 1097) completed a telephone survey including questions relating to 13 cessation methods. Indices of use and perceived helpfulness for each method were plotted in a quadrant analysis. Socio-demographic differences were explored using bivariate and multivariate analyses. RESULTS: From the quadrant analysis, cold turkey, NRT and gradual reduction before quitting had high use and helpfulness; GP advice had high use and lower helpfulness. Prescribed medication and online programs had low use but high helpfulness. Remaining methods had low use and helpfulness. Younger quitters were more likely to use unassisted methods such as cold turkey; older or less educated quitters were more likely to use assisted methods such as prescribed medication or advice from a general practitioner. CONCLUSIONS: The majority of recent quitters quit cold turkey or cut down before quitting, and reported that these methods were helpful. Efforts to influence population smoking prevalence should attempt to provide support and motivation for smokers choosing these methods, in addition to assessing the effectiveness and accessibility of other methods for smokers who need or choose them.

Where do youth learn about suicides on the Internet, and what influence does this have on suicidal ideation?

BACKGROUND: Young people are susceptible to suicidal behavior as a result of learning about the suicidal behavior of others. This study was designed to determine whether Internet sites, such as online news and social networking websites, expose young people to suicide stories that might increase suicide ideation. METHOD: We reinterviewed 719 young people ages 14 to 24 who had participated in a prior nationally representative survey. Respondents reported knowledge of persons they knew who had committed or attempted suicide as well as personal experiences of hopelessness and suicidal ideation on both occasions. On the second occasion one year later, they also reported use of various Internet platforms and how often they had been exposed to suicide stories on those sites, as well as from personal sources. Changes in ideation as a function of exposure to different sources of suicide stories were analyzed holding constant prior hopelessness and ideation. RESULTS: While traditional sources of information about suicide were most often cited (79% were from friends and family or newspapers), online sources were also quite common (59%). Social networking sites were frequently cited as sources, but these reports were not linked to increases in ideation. However, online discussion forums were both cited as sources and associated with increases in ideation. CONCLUSIONS: The Internet and especially social networking sites are important sources of suicide stories. However, discussion forums appear to be particularly associated with increases in suicidal ideation. Greater efforts should be undertaken to promote Internet sites directed to young people that enhance effective coping with hopelessness and suicidal ideation.

Australian smokers' and recent quitters' responses to the increasing price of cigarettes in the context of a tobacco tax increase.

AIMS: To track smokers' responses to the increasing price of cigarettes after a tax increase, and assess socio-demographic differences in responses. DESIGN: The Cancer Institute NSW's Tobacco Tracking Survey (CITTS) is a continuous tracking telephone survey. Weekly data were collected between May and September 2010. SETTINGS: New South Wales, Australia. PARTICIPANTS: A total of 834 smokers and 163 recent quitters (quit in last 12 months). MEASUREMENTS: Responses to the price increase included smoking-related changes (tried to quit, cut down) and product-related changes (changed to lower priced brands, started using loose tobacco, bought in bulk). Recent quitters were asked how much the increasing price of cigarettes influenced them to quit. FINDINGS: Overall, 47.5% of smokers made smoking-related changes and 11.4% made product-related changes without making smoking-related changes. Multinomial logistic regressions showed that younger smokers (versus older) were more likely to make product-related changes and smoking-related changes in comparison to no changes. Low- or moderate-income smokers (versus high-income) were more likely to make smoking-related changes compared to no changes. Highly addicted smokers (versus low addicted) were more likely to make product-related changes and less likely to make smoking-related changes. The proportion of smokers making only product-related changes decreased with time, while smoking-related changes increased. Recent quitters who quit after the tax increase (versus before) were more likely to report that price influenced them. CONCLUSIONS: The effect of increasing cigarette prices on smoking does not appear to be mitigated by using cheaper cigarette products or sources. These results support the use of higher cigarette prices to encourage smoking cessation.

Talking "truth": predictors and consequences of conversations about a youth antismoking campaign for smokers and nonsmokers.

Using data from the Legacy Media Tracking Survey II, this study investigated relations among youth's evaluations of the "truth" antismoking campaign, campaign-related interpersonal discussion, and campaign-relevant outcomes (n = 8,000). Regression analyses showed that smokers were less likely to have discussed the campaign than nonsmokers, and this effect was mediated by negative campaign evaluation. However, smokers with a negative evaluation of the campaign were more likely to talk about it than were nonsmokers reporting negative evaluation. Nonsmokers who talked about the campaign had beliefs, attitudes, and intentions in greater agreement with campaign messages than those who did not talk about the campaign. For smokers, talking about the campaign was associated with beliefs, attitudes, and intentions in greater agreement with campaign messages, but only if associated with positive campaign evaluation. For smokers with a negative campaign evaluation, talking about the campaign was associated with beliefs and attitudes counter to the campaign messages.

Associations between adolescent seatbelt non-use, normative perceptions and screen media exposure: results from a national US survey.

BACKGROUND: Failure to use seatbelts in motor vehicles is a major source of youth injuries, and previous research has noted the widespread non-use of seatbelts in popular media. OBJECTIVES: To explore whether increased exposure to entertainment screen media was associated with inflated normative perceptions regarding seatbelt non-use, and to determine any associations between normative perceptions and seatbelt non-use. METHODS: A nationally representative telephone survey of school-aged American adolescents (14-17 years, n=915) measuring: screen media exposure; normative perceptions with reference to friends' disapproval of non-use, and prevalence of non-use among friends, school peers and peers; and self-reported seatbelt non-use. RESULTS: Using structural equation modelling, analyses indicate that, after demographic and individual characteristics relevant to screen media exposure and seatbelt non-use had been controlled for, frequent exposure to entertainment media was associated with positive normative perceptions about seatbelt non-use for boys, but not for girls. Normative perceptions related to friends' and school peers' seatbelt use were associated with seatbelt non-use for both boys and girls. CONCLUSIONS: Attempts to increase adolescent seatbelt use could include public communication campaigns to alter normative perceptions. Broadcasting these campaigns in conjunction with the media that under-represent seatbelt use may be a successful strategy for reducing the influence of such media on male adolescents.

Relation between newspaper coverage of 'light' cigarette litigation and beliefs about 'lights' among American adolescents and young adults: the impact on risk perceptions and quitting intentions.

AIM: To investigate the impact of newspaper use in a year of increased coverage of litigation against the tobacco industry on youths' beliefs about the health risks of 'light' cigarettes, and examine relations between inaccurate beliefs about 'lights', perceptions of risk and intentions to quit smoking. PARTICIPANTS: The data come from the 2004 National Annenberg Survey of Youth, a representative random digit dial telephone survey of youths aged 14-22 years in the USA (n=1501; current smokers, n=305; 'lights' smokers, n=112). DESIGN: All youths were asked about newspaper use and beliefs regarding 'light' cigarettes (riskiness, addictiveness, ease of quitting). Smokers reported on risk perceptions and quitting intentions. We also examined changes in newspaper coverage related to 'lights' from January 2001 to April 2004. RESULTS: Newspaper coverage related to 'lights' increased in the first months of 2003, and continued into 2004. Logistic regression analyses suggest that 'lights' smokers with lower levels of newspaper use were most likely to hold inaccurate beliefs about 'lights' (OR=5.93, 95% CI 1.48 to 23.77). Smokers of 'lights' with inaccurate beliefs were less likely to perceive their smoking as risky (OR=0.29, 95% CI 0.11 to 0.87), and smokers with inaccurate beliefs were less likely to have strong quitting intentions (OR=0.52, 95% CI 0.28 to 0.96). CONCLUSIONS: Inaccurate beliefs about the risks of 'lights' were negatively related to youth smokers' perceptions of risk and intentions to quit smoking. News coverage surrounding the tobacco industry's failure to disclose these risks might help reduce these inaccurate, and potentially dangerous, beliefs.

Adolescent and young adult crash risk: sensation seeking, substance use propensity and substance use behaviors.

In a national youth sample, the propensity to use substances was more strongly related to motor vehicle crashes than use of any specific substance studied (cigarette, alcohol, marijuana). Substance use propensity was associated with sensation seeking, suggesting that increased crash risk for these youth is likely a result of general risk-taking tendencies.

The contribution of antismoking advertising to quitting: intra- and interpersonal processes.

This study explored the roles of transportability-the tendency to become absorbed in a narrative-and interpersonal discussion in the use of televised antismoking advertising in attempts to quit smoking. We used data from a representative population survey of adults (n = 2,999), examining responses from current smokers (n = 594) and former smokers who had quit in the last 5 years (n = 167). Logistic regression analysis revealed that current and former smokers higher in transportability were more likely to recall an antismoking ad (OR = 1.08, p < .001), and to perceive they had been helped by antismoking advertising in their attempts to quit smoking (OR = 1.05, p < .01). Transportability also was related to the recall of narrative antismoking advertisements (OR = 1.06, p < .05). Among current smokers, those who engaged in interpersonal discussion about any antismoking advertising were more likely to have made a quit attempt (OR = 2.76, p < .001). Finally, individuals were most likely to discuss advertising containing information about the negative health consequences of smoking using graphic images or simulations of bodily processes. These results suggest that the effectiveness of antismoking advertising is dependent upon both intra- and interpersonal processes that are triggered by the advertisements.