Assessment of Self-Efficacy As a Predictor of Smoking Reduction and Abstinence Rates in a Group of Mental Health Patients Enrolled in a Telephone Smoking Cessation Program

Background:

Smoking reduction (SR) as a means of reducing the health risks of continued tobacco use has been shown to be a promising step towards smoking abstinence (SA) for people interested in quitting smoking. Self-efficacy of the smoker plays an important role in making a quit attempt, but little evidence exists about the use of self-efficacy measures to predict rates of smoking reduction and abstinence, especially in a mental health population.

Methods

This study measures self-efficacy in 606 participants with various mental health diagnoses, enrolled in a VA-based telephone counseling program for smoking cessation. Consenting participants received self-help materials, smoking cessation medications, and multi-call cessation counseling. Self-efficacy was measured at baseline using three variables: (1) readiness to quit, (2) motivation to quit, and (3) confidence in one’s ability to stop smoking permanently. These variables were assessed as potential predictors of rates of smoking abstinence and reduction (defined as greater than 50% decrease in cigarettes per day) at 2 and 6 month follow up.

Results:

Motivation scores did not have a significant relationship to rates of SA at 2 months or 6 months. The motivation measure was also not a predictor of SR at 2 months, but was able to significantly predict SR at 6 months (OR 2.27, 95% CI 1.11 to 4.61). Readiness and confidence were not significant predictors of SR at 2 months or 6 months. However, readiness and confidence measures were shown to be significant predictors of abstinence at 2 months (OR 2.54, 95% CI 1.38 to 4.68 and OR 3.43, 95% CI 1.71 to 6.84 for readiness and confidence, respectively) and also at 6 months (OR 1.74, 95% CI 1.03 to 2.92 and OR 3.12, 95% CI 1.68 to 5.85 for readiness and confidence, respectively).

Conclusion:

This study uses readiness, motivation, and confidence measures to examine self-efficacy as a predictor of smoking behavior and change. The difference in the ability of motivation versus readiness and confidence to predict success at smoking cessation or reduction implies that careful assessment of patients at baseline may be informative. Based on the patient’s readiness, motivation, and confidence, a provider may choose to promote smoking cessation or to start with a smoking reduction plan. From a research standpoint, further investigation is warranted in the context of self-efficacy in order to establish more effective assessment and treatment protocols for smoking cessation within the mental health population.