Developing and testing strategies to effectively reach and involve resistant hard-core smokers in tobacco control

This project will focus on methods to constructively reach and involve hardcore smokers of low and high socioeconomic status (SES) to (re)evaluate their smoking cognitions and behaviours. Recent decreases in smoking prevalence in the Netherlands may not be sustainable as a group of hardcore smokers is expected to make up a larger proportion of the remaining smokers. Most hardcore smokers have a lower SES and have developed stable and solid mechanisms to effectively withstand the antismoking campaign. They form a challenging group to reach by conventional public health campaigns. Most interventions in the Netherlands focus on smokers already motivated to quit. However, regardless of their motivation, if given a choice, the majority of smokers indicate that they would rather be a non-smoker. Since current intervention strategies have not succeeded in engaging hardcore smokers, new approaches are warranted. The aim of this project is to design a website on which hardcore smokers will evaluate their smoking behaviour in a non-coercive way. Several studies will be performed in order to develop this online intervention. First, much effort will be invested into studying how hardcore smokers can be reached and involved in a website on smoking behaviour. Therefore, focus group interviews with hardcore smokers and former hardcore smokers will be conducted. The second goal of these interviews is to gather information about the ambivalence hardcore smokers have toward their own smoking behaviour. This information will be of use in the final part of the project in which Motivational Interviewing (MI) techniques will be applied. The information about their ambivalence will be validated in a subsequent online survey (Study 2). The data of the survey will allow us to identify subgroups of hardcore smokers based on the type of outcome expectancies that are relevant to them. Identification of these subgroups is needed to design a web system that is tailored to people’s unique outcome expectancies. A laboratory study (Study 3) will be conducted to test several conditions for effectively influencing dysfunctional cognitions among our target group. We expect that exposure to fear appeals combined with self-efficacy enhancing information will increase the motivation of hardcore smokers to quit smoking. Based on the outcomes of the focus groups, the online survey and experiment, a pro-active internet system will be developed and tested in an online randomized controlled experiment (Study 4). This system will contain the most optimal fear appeal manipulation. In addition, it will provide participants with individualized feedback on their perceived pro’s and con’s of smoking, a form of MI. Several combinations of these interventions will be tested on their effectiveness in changing smoking behaviour, the motivation to continue smoking, adherence to disengagement beliefs, perceived advantages of smoking, and self-efficacy not to smoke in difficult situations. The internet-system can easily be converted to be used in practice. Given the damaging health effects of smoking together with the vastness of the target population and the massive recruitment capacity through the internet, this intervention has the potential to have a significant effect on public health.