Development and Validation of a Smoking Expectancies Measure for Adolescents Seeking to Quit Smoking

ABSTRACT

Background: A more comprehensive understanding of factors that affect smoking cessation outcomes among adolescents may help enhance treatment interventions. One promising but underexplored factor that may influence cessation success is teens’ specific expectancies or beliefs about smoking outcomes. The present study evaluated the validity and reliability of a new measure of expectancies and its association with cessation outcomes among 762 adolescent smokers participating in studies of the American Lung Association's Not On Tobacco cessation program. Methods: Self-report questionnaires were collected prior to and following participation in a smoking cessation program. Self-reported cigarette use was verified with expired-air carbon monoxide. A multistep exploratory and confirmatory factor analysis and reliability and validity analyses were performed. Results: Four theoretically related yet empirically independent factors were identified by the Smoking Expectancies Questionnaire (SEQ): (1) Positive Reinforcement, (2) Negative Reinforcement—Emotional Regulation, (3) Negative Reinforcement—Addiction and Withdrawal, and (4) Negative Outcomes/Risk. These factors could be subsumed by a single SEQ factor that reflected an overall concept of smoking expectancies relevant for adolescent smoking cessation. An overall SEQ Function score reflecting the balance between positive and negative expectancies predicted both preintervention cigarettes per day and cessation outcomes. Conclusions: A single, overall SEQ Function score may prove useful for understanding the associations among individual, social, and contextual factors in predicting treatment outcomes. Additionally, study findings may assist with modifying smoking expectancies among cessation program participants, thereby enhancing treatment outcomes with diverse youth smoking populations.

Keywords:

• Adolescent smoking
• beliefs
• cessation
• expectancies

FUNDING

Funding for Dr. Branstetter was provided in part by NIH grant R03CA136013. The funding agency was not directly involved in the preparation of the manuscript.

AUTHOR CONTRIBUTIONS

Steven A. Branstetter was the lead and coordinating author for this article. He was responsible for writing the majority of the sections of the article and conducting the majority of the data analyses. He worked with all coauthors on conceptual and data interpretation issues and managed revisions and edits of the article. Melissa Mercincavage worked closely with the lead author on writing and revising the introduction and conclusion sections of the article. She assisted in data analyses, data interpretation, preparation of tables and figures, revisions of the article, organizing references, and formatting the article. She was involved in editing and providing feedback on all sections of the article. Geri Dino and Kimberly Horn were co-principal investigators on the original Not On Tobacco (N-O-T) studies from which the data for the present article were taken. Geri Dino assisted in the original selection of the questionnaires used in the present article. Additionally, she was involved in conceptualization and revisions of the current Smoking Expectancies Measure and data analytic planning and interpretation. She provided editorial feedback and overall guidance on the development of the article. Kimberly Horn was involved in the conceptualization and revisions of the current Smoking Expectancies Measure. She assisted the lead author on writing major sections of the article and contributed to data interpretation and overall conceptualization of the article. She provided editorial feedback, assisted in developing responses to reviewer comment, and in all phases of preparation and submission.