Adolescents' rationalizations to continue smoking: The role of disengagement beliefs and nicotine dependence in smoking cessation
Introduction
Despite increasing smoking prevention efforts and the well-known harmful health effects of smoking, a significant proportion of adolescents still initiate a smoking habit and, subsequently, continue to smoke. The high prevalence of smoking among adolescents, together with the risk of onset of dependence and the negative health consequences of smoking, underscore the need to develop and implement smoking cessation programs for adolescents.
With regard to smoking cessation, adolescent smokers form a particularly difficult group. For instance, compared to adult smokers, adolescents are generally less motivated to quit smoking and show relatively low rates of ‘spontaneous’ quit attempts (Mermelstein, 2003, Pallonen, 1998). The relatively low motivation to quit among adolescents may be present because they do not seem to consider quitting as urgent (Balch, 1998). Adolescents plans for quitting are often relatively vague and far in the future (Mermelstein, 2003). Thus, compared to adults, adolescent smokers seem to be less interested in quitting and more resistant and unwilling to change their smoking behaviour.
For adult smokers, it has been proposed that those who are highly resistant to quit, and continue to smoke despite their knowledge of the hazardous effects of smoking, experience forms of cognitive dissonance reduction (Chapman et al., 1993, McMaster and Lee, 1991). Cognitive dissonance is usually experienced when an individual has two or more cognitions that are dissonant in relation to one another resulting in motivational tension (Festinger, 1957, Wicklund and Brehm, 1976). In adult smokers dissonance reduction was found to appear in the form of rationalizations or justifications for continuing smoking. These rationalizations or justifications for continuing smoking are referred to as disengagement beliefs (also known as self-exempting beliefs or permission giving beliefs). For example, to lower cognitive dissonance, a smoker might adhere to beliefs such as “I know heavy smokers that lived long”, thereby ignoring the fact that smoking and age of death are negatively related (Dijkstra, in Press, Solomon and Manson, 1997). Having these beliefs may make it easier for smokers to disengage from the idea that it would be better to quit their smoking habit (Oakes, Chapman, Borland, Balmford, & Trotter, 2004). In adult samples, disengagement beliefs were found to have a significant negative effect on several aspects of smoking cessation, such as the motivation to quit, the likelihood of undertaking a quit attempt and actual smoking cessation (Bandura, 1986, Bandura et al., 1996, Dijkstra et al., 1999, Dijkstra and Brosschot, 2003, Johnson, 1968, Kleinjan et al., 2006, Oakes et al., 2004, Olshavsky and Summers, 1974).
Even though endorsement of disengagement beliefs seems to be an important predictor of a lack of motivation to quit and unsuccessful quit attempts in adult smokers, it has not been studied to what extent adolescents adhere to disengagement beliefs and whether having disengagement beliefs is important in explaining adolescents' motivation to quit and actual smoking cessation. Since adolescents generally do not consider smoking cessation as urgent and continue to smoke even when aware of the negative consequences (Tewolde, Ferguson, & Benson, 2006), it is likely that disengagement beliefs indeed play a role. However, since adult smokers may be more likely to have an established smoking pattern and to have developed more stable dissonance reduction mechanisms for effectively withstanding antismoking messages, disengagement beliefs among adults may be stronger and play a more profound role in smoking cessation as compared to adolescents. The first goal of the present study is, therefore, to establish whether adolescents adhere to disengagement beliefs and, if so, to what extent they engage in these beliefs in comparison to adults.
Among adolescents, levels of nicotine dependence are negatively associated with motivation to quit smoking (Fagan et al., 2007, Kleinjan et al., 2008a, Prokhorov et al., 2001), and to actual cessation (Kleinjan et al., 2008b, Horn et al., 2003). Thus, smoking continuation among adolescents can, at least in part, be explained by the magnitude of nicotine dependence. In addition, studies among adults found that heavier and more dependent smokers displayed more cognitive dissonance in the form of minimizing, denying, or avoiding information about the dangers of smoking (Halpern, 1994). Since adolescents are reported to be well informed about the relation between smoking and health problems (Tewolde et al., 2006), it seems plausible that, besides experiencing physical and psychological dependence symptoms, adolescent smokers experience a fairly constant threat, knowing that smoking makes them susceptible to possible health damage and other negative consequences. Subsequently, the threat of negative health consequences may be perceived as less worrisome when disengagement beliefs are used to deny or distort this knowledge. Therefore, it is expected that among adolescents, disengagement beliefs are associated with nicotine dependence levels and that, besides levels of nicotine dependence, disengagement beliefs play an important role in the continuation of smoking behaviour. To test these hypotheses, the second goal of our study is two-fold. First, to assess whether the adherence to disengagement beliefs is associated with nicotine dependence, motivation to quit and smoking cessation one year later. In line with adult studies, it is expected that higher levels of dependence will be associated with a greater adherence to disengagement beliefs (Dawley et al., 1985, Halpern, 1994), and that both nicotine dependence and disengagement beliefs are negatively related to the outcome variables (e.g., Dijkstra and Brosschot, 2003, Fagan et al., 2007, Horn et al., 2003, Kleinjan et al., 2006, Kleinjan et al., 2008b). Second, the interplay between nicotine dependence and disengagement beliefs in explaining motivation to quit and smoking cessation will be explored. Based on the assumption that both nicotine dependence and disengagement beliefs will be negatively related to the outcome variables, it is hypothesized that the combination of being highly dependent and adhering strongly to disengagement beliefs will be more negatively related to the smoking cessation cognitions and practices as compared to being either highly dependent or adhering strongly to disengagement beliefs.
Section snippets
Procedure and sample
The present study uses data from the fourth and fifth wave of a larger longitudinal study that started in January 2003, focusing on psychological and environmental processes in relation to tobacco use among Dutch adolescents. Schools in four regions of the Netherlands were randomly selected and approached to take part. The main reason given for refusal to join this study was participation in other studies. The Medical Ethical committee (CMO Arnhem-Nijmegen) approved this study.
A total of
Smoking-specific demographics
For smoking specific demographics of adolescent smokers and adult smokers, see Table 1. Among adolescent smokers, a total of 23.4% (N = 85) were categorized as having quit at T2.
Adherence to disengagement beliefs
As shown in Table 2, adolescent smokers’ adherence to disengagement beliefs is comparable to that of adult smokers. It can be seen that the mean score on disengagement beliefs is higher among adolescents than among adults (M = 41.06 and M = 38.54, respectively); this difference was significant [t (728) = 3.67; p < 0.001]. Only
Discussion
Similar to adult smokers, adolescent smokers adhere to rationalizations and justifications to continue smoking. By making the consequences of smoking less severe or by perceiving themselves to be less vulnerable to adverse health effects, adolescents appear to reduce cognitive dissonance and ‘permit’ themselves to continue to smoke despite the harmful health effects. Remarkably, adolescent smokers’ adherence to disengagement beliefs appears to be even stronger than that of adults.
As expected,
Acknowledgements
This study was partly financed by the Dutch Asthma Foundation and STIVORO for a Smoke-Free Future.
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