Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial

Abstract

Background Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. Objective This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation. Methods All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry. Results The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation. Conclusions Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions. Trial Registration ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

Smartphone Apps for Smoking Cessation: Systematic Framework for App Review and Analysis

“…Furthermore, another central challenge we identified is very few apps from the app store have published studies supporting their functionality or efficacy to help people quit smoking; for example, only 12 apps in 2021 and 11 apps in 2022 [11,16,[39][40][41][42][43][44]. Other reviews have similarly noted that most apps have not been tested in clinical studies [8,17].…”

Investigating the Potential of Inoculation Messages and Self-Affirmation in Reducing the Effects of Health Misinformation

“…In addition to experimentally induced self-affirmation, individuals can also spontaneously self-affirm when feeling threatened. Spontaneous self-affirmation is considered to be a stable individual difference and appears to protect against reactance (Emanuel et al, 2018;Ferrer et al, 2015;Persoskie et al, 2015;Pietersma & Dijkstra, 2012;Taber et al, 2016Taber et al, , 2017, even when experimentally induced self-affirmation does not (Seaman et al, 2020). To thoroughly investigate the role of self-affirmation in protecting against misinformation, then, this study will consider both experimentally induced general values/health affirmations and measured spontaneous self-affirmation.…”

Internal and external self-affirmation resources: validation and assessment of psychometric properties of the spontaneous self-affirmation measure using structural equation modeling

“…The CSAI, like the SSAM, is designed to assess individual differences in self-affirmation. In the current study, we decided to focus on the SSAM for the following reasons: first, the SSAM is specifically designed to assess spontaneous self-affirmation in the face of self-esteem threats, second it assesses different self-affirmation strategies (e.g., focusing on one’s personal strengths, values or social relations), and third, it is also the most widely used questionnaire to assess spontaneous self-affirmation (e.g., Webb et al, 2020 ; Seaman et al, 2021 ; Harris et al, 2023 ). Since self-affirmation is a powerful resilience source, the valid measurement of the construct holds significant importance.…”