%0 Journal Article
%@ 1438-8871
%I JMIR Publications
%V 23
%N 3
%P e18433
%T Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial
%A Seaman,Elizabeth L
%A Robinson,Cendrine D
%A Crane,David
%A Taber,Jennifer M
%A Ferrer,Rebecca A
%A Harris,Peter R
%A Klein,William M P
%+ CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308, United States, 1 4438524139, eseaman@cdcfoundation.org
%K smoking cessation
%K smartphone
%K mHealth
%K sadness
%K self-affirmation
%K spontaneous self-affirmation
%K apps
%K mobile phone
%D 2021
%7 5.3.2021
%9 Original Paper
%J J Med Internet Res
%G English
%X 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 
%M 33666561
%R 10.2196/18433
%U https://www.jmir.org/2021/3/e18433
%U https://doi.org/10.2196/18433
%U http://www.ncbi.nlm.nih.gov/pubmed/33666561