Justice beliefs for self and others: Associations with positive and negative affectivity in African Americans and White Americans.

Prior research has shown that a belief in personal justice (i.e., justice for self) is associated with better health and well-being, whereas a belief in justice more generally (i.e., justice for others) is unrelated. However, an emerging perspective is that racial differences may overlay the relationships between multidimensional beliefs about justice and indices of well-being. This includes that well-being among African Americans may be additionally supported by rejecting rather than endorsing some forms of believing in justice. In the present study, we consider racial similarities and differences in the links between beliefs about justice for self and others and emotional well-being. African Americans (N = 117) and White Americans (N = 188) completed measures of beliefs about justice for self and others, and also measures of dispositional tendencies towards experiencing positive and negative emotion (i.e., positive and negative affectivity). In both groups, beliefs about justice for the self were associated with greater positive affect and reduced negative affect. However, beliefs about justice for others were additionally associated with greater negative affect only among African Americans. The link between justice for others and negative affect among African Americans was not attributable to measurement or mean differences in justice beliefs across racial groups, or to socioeconomic differences. Results align with an emerging perspective that simultaneously endorsing and rejecting justice beliefs may be vital to preserving well-being for some racial minorities.

A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools.

Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.

Exploring motivation to quit and risk appraisals of hookah tobacco smoking for self and partner among a member of single and dual smoker couples.

Negative health effects of waterpipe tobacco smoking (WTS) are likely more pronounced in dual rather than single smoker couples. Data on how smokers' perceived harms for self and partner differ between couple types and how these perceptions are associated with motivation to quit are needed. We examined these associations by surveying one member of dual smoker (i.e., both partners smoke) and single smoker (i.e., one partner smokes) couples who engages in WTS. We enrolled online adults ages 18-32 who engaged in WTS during the last month and were in a committed relationship of at least six months. Participants rated their harm to self and, when relevant, to partner, how much they were harming their partner due to their WTS, and partner's smoke exposure. Participants reported their motivation to quit. Of the 323 participants, 215 (67%) were in dual smoker couples. Participants in dual smoker couples reported lower own perceived risk, which correlated highly with perceived partner risk, than participants in single smoker couples; they also reported harming their partners more even though they downplayed how frequency of smoke exposure was harming the partner. Motivation to quit did not differ by couple type. Across couple types, motivation to quit increased with greater perceived harms. Smokers in dual compared to single smoker couples downplay their risks and perceived harms their smoking causes their partner. Interventions focused on harms to self and partner may be effective to increase motivation to quit and cessation in both couple types.

Effects of Educational Materials About Harms of Waterpipe Tobacco Charcoal use on Adult Smokers' Risk Perceptions.

A prospective online study, consisting of 203 participants ages 18 and older who smoked waterpipe (hookah) within the last 30 days, examined how brief messaging about harms of burning charcoal to heat waterpipe tobacco (shisha) influenced knowledge of toxicants released by using charcoal and perceived harms of using charcoal. Participants were randomized to either a control or to an educational arm that reviewed toxicants released by burning charcoal and the health consequences. Participants in the educational relative to the control arm perceived charcoal as more harmful, were more knowledgeable of toxicants released by burning charcoal, and expressed a stronger desire to quit. Effects were sustained a week later. Brief messages about the harms of burning charcoal were effective and may be used to educate the public about the harms of waterpipe tobacco smoking.

Perceptions of physical activity and sedentary behaviour guidelines among end-users and stakeholders: a systematic review.

BACKGROUND: Many of the world's population, across all age groups and abilities, are not meeting or even aware of internationally recommended physical activity (PA) and sedentary behaviour (SB) guidelines. In order to enhance awareness and uptake, guidelines should be perceived positively by targeted users. The purpose of this study was to review the literature on end-user and stakeholder perceptions of PA and SB guidelines. METHODS: The electronic databases APA PsycInfo, CINAHL, MEDLINE, and SPORTDiscus, using EBSCOhost Research Platform, and Web of Science were searched from inception to June, 2021 with keyword synonyms for "perceptions", "PA guidelines", and "SB guidelines". Studies of any design that collected stakeholder and/or end-user responses to a PA and/or SB guideline were included and assessed for risk of bias. The PA and/or SB guideline could be any type of official form (e.g., national documents, organizational guidelines, expert consensus statements, etc.) from any country, that targets individuals at the regional, provincial/statewide, national, or international level, and includes all types of guidelines (e.g., strength, aerobic, clinical, nonclinical, screen-time, sitting, etc.). Data were extracted and analyzed using thematic synthesis. RESULTS: After screening 1399 abstracts and applying citation screening, 304 full-texts were retrieved. A total of 31 articles met the inclusion criteria. End-users and stakeholders for PA guidelines across all age groups expressed the need for simplified language with more definitions, relatable examples and imagery, and quantification of PA behaviours. There was concern for the early years and child PA guidelines leading to guilt amongst parents and the SB guidelines, particularly the recommendations to limit screen-time, being unrealistic. General age group PA guidelines were not perceived as usable to populations with differing abilities, clinical conditions, and socioeconomic status. Guidelines that targeted clinical populations, such as persons with multiple sclerosis and persons with spinal cord injury, were well received. CONCLUSIONS: There is a clear need to balance the evidence base with the pragmatic needs of translation and uptake so that the guidelines are not ignored or act as a barrier to actual engagement.

Effects of mental simulation of future waterpipe tobacco smoking on attitudes, perceived harms and intended use among young adults.

The desire to engage in waterpipe tobacco smoking (WTS) may occur when smokers and nonsmokers conjure positive mental simulations of WTS. However, effects of these simulations on desire to smoke waterpipe tobacco and potential mediators are unexplored. This research addressed these effects among young adult waterpipe tobacco smokers and nonsmokers. Two online studies were conducted with adults ages 18-30. In Study 1, 200 smokers, 190 susceptible nonsmokers, and 182 nonsusceptible nonsmokers were randomized to mentally simulate or not WTS in the future. In Study 2, 234 smokers and 241 susceptible nonsmokers were randomized to four arms: no simulation or simulations that varied valence of experience (positive, negative or no valence provided). Main outcomes were immediate desire to smoke waterpipe tobacco, cognitive and affective attitudes, and perceived harms. In Study 1, mental simulations increased the desire to smoke waterpipe tobacco among smokers. In Study 2, asking participants to simulate WTS positively or with no valence instruction increased desire to smoke relative to negative valence instruction or no simulation. Negative simulations reduced perceived probability of smoking within a month compared to positive simulations. Effects on desire to engage in WTS were mediated by cognitive and affective attitudes among susceptible nonsmokers and by cognitive attitudes among smokers. These findings suggest that exploring when and how often mental simulations about WTS are evoked and their potency for promoting prevention and cessation of WTS merit further attention.

Influencing Perceptions of Harm of Waterpipe Tobacco Smoking Among One Member of Couples Who Use Waterpipe.

INTRODUCTION: Waterpipe tobacco smoking (WTS) often occurs socially, increasing health risks for the smoker and others through secondhand smoke effects. While messages on WTS harms enhance perceived risks for self, whether these messages elevate perceived risks for others, such as one's romantic partner who engages in WTS, is unclear. We tested this idea by surveying one member of dual-smoking couples who engages in WTS. AIMS AND METHODS: As part of an online study, we enrolled adults ages 18-30 who engaged in WTS and were in a committed relationship of at least 6 months whose partner engaged in WTS. Participants were randomized to a control arm or to one of two arms consisting of watching a brief video on health harms or overcoming myths about WTS, respectively. Outcomes were perceived harms and measures of desire and probability of quitting for self and partner. RESULTS: Participants (N = 238) who watched either video, compared with participants who did not watch a video, reported greater perceived health risks for self and partner and that their own WTS harmed their partner. Participants who watched either video reported a greater desire to quit for themselves, perceived that their partner had a greater desire to quit, and reported a higher likelihood of quitting together in the next 6 months. CONCLUSIONS: Brief videos containing risk-based messaging increase young adult waterpipe tobacco smokers' perceived harms and desire to quit for self and partner. This can be a useful strategy to motivate cessation in couples who engage in WTS. IMPLICATIONS: This study shows for the first time that at least among one member of dual-smoking couples who engages in WTS, brief videos on harms of WTS influences perceived harms and motivation to quit for the self and one's partner. This can be a useful strategy to promote cessation.

Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial.

Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.

Assessing multiple features of partner support for smoking cessation in dual-smoker couples.

The purpose of this study was to evaluate a new scale to measure multiple aspects of partner support for quitting smoking relevant to dual-smoker couples, called the Partner Support for Quitting Scale. The best model fit (N = 238 individuals in 119 couples) considers the frequency of, confidence in, and perceived usefulness of partner support behaviors. Path analysis revealed that the Partner Support for Quitting Scale factors were uniquely predicted by relationship commitment and nicotine dependence and, in turn, predicted self-efficacy for smoking cessation and desire to quit. Preliminary support was found for the Partner Support for Quitting Scales' value as an assessment tool for measuring partner support for smoking cessation among dual-smoker couples.

You won't regret it (or love it) as much as you think: impact biases for everyday health behavior outcomes.

When predicting the future, people tend to overestimate the intensity of their emotions, a phenomenon known as the impact bias. Design: In two studies, we examined the impact bias for health outcomes. In Study 1, participants were randomized to think about a negative health outcome in the future or one in the past. In Study 2, participants came to the laboratory and were asked to predict and report their emotions surrounding an actual health outcome (consuming an unhealthy food). Results: In both studies, an impact bias emerged. In Study 1, participants thinking about an outcome in the future estimated more negative emotion than those thinking about an outcome in the past. In Study 2, when facing an actual health outcome, participants anticipated more negative and positive emotion than they experienced. Impact biases were also associated with behavioral motivation - desire to change the outcome (Study 1) and increased preventive intentions (Study 2). Additional analyses revealed that regret was a particularly important emotion. Conclusion: Although research has highlighted an impact bias for severe health outcomes like disease, these studies provide evidence of an impact bias for health outcomes generally. They also suggest that the bias may have implications for behavior intentions.

Initial development of the Hookah Smoker Scale: Assessing young adults' mental schemas about hookah "smokers".

Many young adult hookah tobacco users do not consider themselves hookah "smokers," but data on this topic are limited. There are no existing measures of young adults' mental schemas of hookah "smokers." We examined the factor structure and reliability of the Hookah Smoker Scale and examined associations with perceived harm and addictiveness and attitudes toward hookah. Two hundred and forty-six young adult (ages 18-30) hookah smokers participated in a cross-sectional online study. Participants completed items assessing schemas characterizing hookah smokers and valid measures of perceived harm and addictiveness of hookah smoking, risk appraisals, and attitudes toward hookah. Exploratory factor analysis using principal axis factoring with oblique rotation extracted a 12-item scale with three dimensions (Regular Use, Social-Enabled Use, and Self-Enabled Use). The scale explained 69.7% of the variance (eigenvalue = 9.2). Cronbach's α for the scale was .89, with Cronbach's α ≥ .80 for four-item subscales. Higher subscale scores indicate stronger beliefs that the dimension characterizes a hookah smoker. Higher Regular Use scores (score variance = 46.9%; eigenvalue = 5.6) were associated with greater perceived harm and addictiveness (ß = 0.21, p = .01), greater risk appraisals (ß = 0.20, p = .02), and more negative attitudes toward hookah (ß = -0.18, p = .03). The Hookah Smoker Scale is a promising measure that can be used to identify targets for preventing and reducing young adults' hookah tobacco use. Findings also suggest young adults associate health risks of hookah with daily smoking, but not with intermittent social smoking patterns.

Perceived Harms of Waterpipe Tobacco Heating Sources Among Young Adult Waterpipe Tobacco Smokers.

Background. Waterpipe tobacco smoking is associated with many negative health outcomes due to toxicants produced by heating the tobacco using charcoal or electrical heaters. Little is known about how young adult waterpipe tobacco smokers perceive harms of these heating sources. Aims. To examine young adult waterpipe tobacco smokers' perceived harms of electrical heaters and charcoal to heat waterpipe tobacco. Method. This online cross-sectional study enrolled 18- to 32-year-olds who smoked waterpipe tobacco within the past 30 days. Participants completed measures assessing, for each heating source, amount and knowledge of toxicants released (e.g., carbon monoxide, cancer-causing chemicals), perceived safety, worry about inhaling toxicants, perceived health risk, desire to quit, and intention to smoke in the next month. Question order for knowledge of and perceived harms was counterbalanced for each heating source. Results. Analyses were based on responses from 199 participants. Perceived harms for both heating sources were average to low. Despite some question order effects, participants viewed charcoal as more harmful than electrical heaters. Participants knew more about chemicals released from charcoal than electrical heaters. Greater knowledge of chemicals released by both heating sources correlated positively with perceived harms. Perceived harms were associated with a stronger desire to quit, yet unrelated with likelihood of smoking waterpipe during the next month. Discussion. Many young adult waterpipe tobacco smokers view charcoal as more harmful than electrical heaters, although knowledge about harms for each heating source is poor. Conclusion. Interventions are needed to inform the public about harms of waterpipe heating sources in order to curb use.

Illness uncertainty, partner support, and quality of life: A dyadic longitudinal investigation of couples facing prostate cancer.

OBJECTIVE: Prostate cancer (PC) and its treatment often result in chronic, negative side-effects that affect both patients and their romantic partners. Illness uncertainty is a chronic stressor that impacts PC patients and their partners and, if left unmanaged, predicts decreased interpersonal functioning and quality of life (QOL) after treatment is complete. This study explored associations among psychosocial constructs, measured from both partners during the first year following a PC diagnosis, to better understand both partners' experiences and identify potential intervention targets for improving QOL. METHODS: Couples (N = 165) in which one partner was undergoing treatment for PC were recruited from the Duke University Medical Center of Urology. Patients and their partners were surveyed at four time points: diagnosis and 1-, 6-, and 12-months post treatment. An Actor-Partner Interdependence Model (APIM) framework was used to examine associations among perceived partner support, nonsupportive behaviors, illness uncertainty, relationship satisfaction, and physical and mental QOL. RESULTS: Partners feeling more supported at diagnosis was related to patients feeling more supported at 6 months. When patients' illness uncertainty decreased between diagnosis and 1 month, partners reported feeling more supported and engaging in fewer nonsupportive behaviors at 6-months post-treatment. Finally, partners' reports of support at 6 months predicted patients' 12-month ratings of physical and mental QOL and relationship satisfaction. CONCLUSIONS: Findings highlight psychological interdependence between PC patients and their partners. Future interventions to improve long-term QOL in couples facing PC may benefit by targeting both partner support and illness uncertainty.

Do Couple-Focused Cessation Messages Increase Motivation to Quit Among Dual-Smoker Couples?

INTRODUCTION: Dual-smoker couples are a highly prevalent group who report low motivation to quit smoking. AIMS: This study tested the effect of a messaging intervention (couples- vs. individual-focused smoking outcomes) on motivation to quit among dual-smoker couples and examined the moderating effect of perceived support. METHODS: A total of 202 individuals in 101 dual-smoker couples were randomized by dyad using a 2 (frame: gain/loss) by 2 (outcome focus: individual/couple) factorial design. Participants reviewed scenarios of either positive or negative outcomes of quitting versus not quitting as they applied to either the individual or the couple. Participants then reported their own motivation to quit and motivation for their partner to quit. The main outcome was motivation to quit smoking. RESULTS: No main effects of framing or message focus emerged. Significant interactions between message focus and negative support predicted motivation for self and partner to quit. Individuals who reported lower negative support reported greater motivation for self to quit and less motivation for partner to quit after reviewing couple- (vs. individual-) focused messages. CONCLUSIONS: Individuals in dual-smoker couples typically report low motivation to quit smoking. Couple-focused messages may increase motivation to quit among individuals who are not receiving negative support from their partners.

Predicting Colorectal Cancer Screening among Adults Who Have Never Been Screened: Testing the Interaction between Message Framing and Tailored Risk Feedback.

Providing adults tailored risk estimates of getting colorectal cancer (CRC) can increase screening. A concern is that receipt of lower risk estimates will demotivate screening; this effect may be curbed by matching level of risk with message framing. Theoretically, pairing lower risk estimates with gain-frame messages, and higher risk estimates with loss-frame messages, should increase screening and screening intentions more than pairing lower risk estimates with loss-frame messages/higher risk estimates with gain-frame messages. These effects may be mediated by how screening is construed (e.g., to find health problems vs. to reaffirm one is healthy). These predictions were tested experimentally among 560 men and women ages 50-75 who have never screened. Participants at baseline received online a tailored comparative risk estimate with gain- or loss-frame information on screening. Screening was assessed six months later. Among the 400 reached at six months, 9.5% reported screening. There were no main effects or interactions between risk feedback and framing predicting construals, screening intentions, or screening. Worry about getting CRC and screening intentions predicted screening. While hypothesized interactions were not found, future research should explore further mechanisms through which online interventions utilizing risk feedback and framing motivate screening among adults who have never screened.

Comparing harm beliefs and risk perceptions among young adult waterpipe tobacco smokers and nonsmokers: Implications for cessation and prevention.

INTRODUCTION: Very little is known about how waterpipe tobacco smokers and nonsmokers compare on harm beliefs about waterpipe tobacco smoking (WTS) and how these beliefs are related to risk appraisals and intentions to engage in WTS. We investigated these issues among young adult waterpipe tobacco smokers, susceptible nonsmokers, and non-susceptible nonsmokers. METHODS: Young adults ages 18 to 30 who smoked waterpipe tobacco during the last 30 days or never used waterpipe tobacco were recruited online through Turkprime. Nonsmokers were grouped as susceptible or not. Participants completed measures of harm beliefs, risk appraisals (i.e., perceived risks and worry), and desire to quit among smokers or willingness/curiosity to try waterpipe among nonsmokers. RESULTS: Analyses were based on 247 smokers and 418 nonsmokers. Smokers endorsed most strongly harm beliefs that portrayed WTS as safe, followed by susceptible and then non-susceptible nonsmokers. Most harm beliefs were significantly related to risk appraisals, yet weakly associated with desire to quit or willingness/curiosity to try waterpipe tobacco, except among susceptible nonsmokers. CONCLUSIONS: Greater efforts are needed to correct maladaptive beliefs about WTS harms, especially among smokers. Among susceptible nonsmokers, harm beliefs may be more influential in predicting willingness to try WTS than risk appraisals.

Reactions to online colorectal cancer risk estimates among a nationally representative sample of adults who have never been screened.

Data on the public's reactions to online tailored colorectal cancer (CRC) risk estimates are sparse. We assessed among 560 men and women aged 50-75 with no CRC screening history reactions to online tailored CRC estimated comparative risk (i.e., self vs. other their age and sex). Assessed were reactions to estimate (i.e., repeating back estimate, match between perceived comparative risk and estimate, accuracy and usefulness of estimate, emotional reactions), risk appraisals and screening intentions. 73% of the sample accurately repeated back their estimate; the match between perceived comparative risk and the estimate was lowest among those informed of being at higher risk. Higher estimates were viewed as less useful and evoked more negative emotions. Viewing the estimate as more useful and experiencing more negative emotions were related with higher risk appraisals and, in turn, screening intentions. These data indicate that adults at higher comparative risk resist accepting a higher risk status.

Developing a scale to assess health regulatory focus.

RATIONALE: Regulatory focus (i.e., focus on motivation to achieve gains or avoid losses and non-gains) is used to tailor health behavior change interventions, improving efficacy, but is currently assessed by scales that are not health-specific and may capture a version of the construct that is not ideally matched to the rationale for tailoring. OBJECTIVE: We developed and validated a Health Regulatory Focus Scale (HRFS), which assesses tendencies to avoid negative health consequences (prevention focus) or achieve positive health outcomes (promotion focus). METHODS: Across four studies (and a scale development study in supplementary online materials), we established convergent, discriminant, and predictive validity for the HRFS. In studies examining predictive validity, main outcome measures were health behavior intentions, including intentions to reduce alcohol use, quit smoking, eat a healthy diet, exercise, be screened for cancer, and engage in general cancer preventive behaviors. RESULTS: The promotion and prevention sub-scales performed well in confirmatory factor analyses. Single-factor models had significantly poorer fit than models delineating promotion and prevention. The sub-scales were differentially (and only modestly) correlated with related constructs (anxiety, optimism, information avoidance, ambiguity/fatalism). Higher HRFS-Promotion focus generally corresponded with greater health behavior intentions. Conversely, higher HRFS-Prevention focus corresponded with lower health behavior intentions. Associations were largely maintained even when controlling for established regulatory focus measures, supporting the assertion that the HRFS would predict unique variance in health behavior intentions. CONCLUSION: The HRFS has the potential to improve the precision with which framed health messages change behavior, as it may assess a version of regulatory focus that is more ideally matched to rationale for tailoring interventions.

Patient's lung cancer diagnosis as a cue for relatives' smoking cessation: evaluating the constructs of the teachable moment.

BACKGROUND: To understand whether patient-reported experiences with lung cancer may create teachable moments (TM) for their relatives as evidenced by shifts in their risk perceptions, affective response, and self-image and in turn, motivation to quit smoking. METHODS: Patients at a comprehensive cancer center (n = 152) completed a survey within 6 months of lung cancer diagnosis to assess their cancer-related symptoms and openness and enumerated relatives who were smokers. Relative smokers (n = 218) then completed a survey assessing their risk perceptions, affective response, and self-image as a smoker related to the patient's diagnosis (TM mechanisms), and their motivation to quit smoking. Cross-sectional mediation and moderation analyses were conducted to explore the links between patient-reported experiences, and relatives' TM mechanisms, and motivation to quit smoking. RESULTS: Relative-reported affect was a significant mediator of the association between patient-reported symptoms and relative smoker's desire to quit. Relatives' self-image was a significant moderator of the association between patient-reported symptoms and relative smoker's desire to quit, such that patients' reported symptoms were associated with relatives' desire to quit only when the relative smoker reported a generally positive self-image as a smoker. No evidence was found for moderated mediation. However, the link between symptoms and negative affect was moderated by perceptions of risk. CONCLUSION: Whether smokers experience a family member's lung cancer as a TM is influenced by multiple interrelated cognitive and affective factors that warrant further exploration. Clearer understanding of these factors could inform how to re-invigorate and sustain this motivation to promote concrete actions toward smoking cessation. Copyright © 2015 John Wiley & Sons, Ltd.