Predictors of adherence to smoking cessation: Self-efficacy, self-esteem, perspective transformation and nicotine therapy




Kowalski, Susan

Journal Title

Journal ISSN

Volume Title



The purpose of this study was to investigate predictors of smoking cessation adherence at three months among smoking cessation program participants in the state of Texas. Predictors included: perspective transformation, self-efficacy, self-esteem, transdermal nicotine therapy, and demographics.

Using purposive sampling, and a longitudinal design with treatment partitioning, subjects (N = 75) attending ten different smoking cessation programs in Texas were measured at three points in time: the beginning and end of their program, and at three months. A demographic profile, Brod and Hall's Adapted Self-Efficacy Scale (Stanton et al., 1992), and Rosenburg's Self-Esteem Scale (1979) were completed by subjects at their initial program session. The Adapted Revised Marsh Revelation Scale (Van Nostrand, 1992), and a progress report were mailed to subjects at the end of their program. Subjects were interviewed via telephone at the three-month follow-up. Seventy-five subjects completed responses at the beginning of their program and at the three month follow-up, but a 46% mortality rate (34 subjects) was realized in the return of mailed instruments at the end of their program.

Thirty-three percent (25) of the subjects were adherent to smoking cessation at three months. Fifty-six percent (42) of the subjects reported using the nicotine patch. Findings of discriminant function analysis indicated that self-efficacy and self-esteem significantly predicted smoking abstinence at three months (N = 75, p =.0025). Perspective transformation, however, decreased ability to predict smoking or non-smoking groups at three months (N = 41, p =.2969). Thus, perspective transformation was an insignificant predictor of smoking cessation adherence.

Multiple regression analysis indicated that self-efficacy and self-esteem (N = 41) did not predict perspective transformation (R\sp2 =.11, F = 5.029, p =.100). The results of the Chi-Square test (N = 75) indicated that use of the nicotine patch was not related to smoking outcome (χ\sp2 =.2435, p =.6216). Demographics, analyzed by logistic regression (N = 75), were insignificant in predicting success in smoking cessation adherence (67.16% overall predictive ability).

Conclusions from this study identified self-efficacy and self-esteem as significant predictors of smoking cessation adherence at the three month follow-up period. Perspective transformation, the transdermal nicotine system, and demographics were not significant in predicting smoking cessation adherence. An implication from this study is that the internal attributes of participants in smoking cessation programs may influence outcome more than physical addiction or demographic barriers.



Nursing, Behavioral sciences, Psychotherapy, Smoking cessation, Nicotine, Therapy