Smoking Behavior In Different Smoking Stages Psychology Essay

Published Date: 23 Mar 2015

This research used the Extended Model of Goal Directed Behaviour to examine how social and personal factors affect the difference between the desire to smoke and smoking behavior of young adults during the stages of development of smoking behavior. This study explores the effect of the exogenous constructs positive and negative anticipated emotions, subjective norm, behavioral control on the endogenous construct behavioral desires. This study examines the predictions that these exogenous constructs have different effect on the endogenous construct for the different smoking stages. Based on a sample of 129 participants the analyses demonstrate that positive anticipated emotions only have effect on behavioral desires for regular smoking young adults and that negative anticipated emotions have no effect for any smoking stage. Subjective norm, however, has a larger effect for experimenters than for regular smoking young adults, whereas perceived behavioral control only has effect for the latter group. The findings and implications are discussed to increase the effectiveness of existing prevention programs for young adults to quit smoking.

Summary

The young adulthood period characterizes with a decrease in the oversight of parents and other adults. Young adults take more responsibility for actions that will affect their current and future health status, e.g. cigarette smoking. There are several theories and models that explain the smoking behavior of young adults. The Extended Model of Goal-Directed Behavior (EMGB) is one of these models which seeks to explain behaviors when the behavioral act in itself is not an end i.e. conduct of a given behavior is part of an overarching goal. The key construct introduced by the EMGB is behavioral desire. Behavioral desires represent the motivational state of mind wherein appraisals and reasons to act are transformed into a motivation to do so. This motivation or desire is hypothesized as the most proximal determinant of intentions in the EMGB. Behavioral desires therefore have an integrative function of exogenous constructs: goal desires, positive and negative anticipated emotions, subjective norms, perceived behavioral control and past behavior.

Researches in this thesis show that social and personal factors influence the smoking behavior of young adults. Every day young adults are affected by different persons who smoke, in particular those who are close to this age group. Moreover, each young adult has an unique combination of personal characteristics which largely determine who he or she is and how he or she behaves, e.g. personality traits such as emotions and behavioral control. However, these theoretical insights only partly explain or predict the likelihood of this influence. Smoking behavior is complex behavior that evolves through different stages. These five smoking stages have been summarized as never smoker, experimentation, intermittent, regular and ex-smoker. It is therefore difficult to indicate which of these factors are most important in which stage, since the influence of these factors depends on the degree to which a young adult has already started experimenting with cigarettes.

The proposed conceptual model of motivated behavior and predictions are deducted based on the stages and EMGB. Since the problem statement assessed in this thesis especially focuses on social and personal factors, it is more relevant to focus on anticipated emotions, subjective norm and perceived behavioral control in the EMGB to understand how these constructs affect the difference between goal desires and volitions in young adults' experimentation and intermittent/regular smoking behavior.

Given the results of the correlations and path coefficients of each construct, my application of the EMGB provides insights about how social and personal factors affect the difference between the desire to smoke and smoking behavior of young adults during the stages of development of smoking behavior to increase the effectiveness of existing prevention campaigns.

Regular smoking young adults will have great desire to use a tool as an aid to quit smoking if thesis young adults perceive high levels of positive emotions associated with the anticipated success to quit smoking. Therefore, prevention programs should communicate to regular smoking young adults that smoking cessation is associated with positive anticipated emotions like excitement, delightful, happiness, satisfaction, proud and self-assurance.

However, prevention campaigns should not use negative anticipated emotions such as angriness, frustration, guilt, sadness, disappointment, depression, worrisome, discommode and fear in the communication to young adults to quit smoking, because young adults who perceive higher levels of negative emotions associated with the anticipated success to quit smoking will have no desire to use a tool as an aid to quit smoking.

Furthermore, experimenters and regular smoking young adults who perceive great normative pressures to use a tool as an aid to quit smoking will have the great desire to do so. Therefore, people (e.g. parents and peers) who are important to these adults should be encouraged to participate in prevention programs to address the smoking behavior of these young adults. These programs should make parents of these adults aware that they play an important role in their child's smoking development and should give advice and information to parents on how they can prevent their children from smoking. Moreover, peers should also be included in prevention programs. These programs should teach experimenters and regular smoking young adults to resist peer pressure to smoke.

My findings also show that behavioral control does contribute to the behavior of regular smoking young adults. These adults have great desire to use a tool as an aid to quit smoking, if these young adults perceive a great level of control and fewer barriers. It is important that prevention programs help these young adults in stopping smoking by convincing them that they have the ability to quit smoking.

Furthermore, positive and negative anticipated emotions are positively correlated for all groups and the effect of subjective norms on behavioral desires might be affected by positive anticipated emotions. According to social scientists, young adults are born with certain personal characteristics but the social environment may mediate or moderate these characteristics to a certain extent. In order to determine that this statement is true, further deeper research is necessary.

The results should be interpreted with care due to the limitations of this research. The first limitation is the consideration of actual behaviors. The construct actual behaviors should also be implemented in the EMGB in future research. The second limitation is the small sample size due to the limited time for this research. The third limitation is the validity of the participants´ reports about the prevalence of cigarette smoking, because smokers are likely to underestimate the amount smoked or to deny smoking at all.

Contents

Introduction

A young adult is generally a person aging from 18 to 29. Young adults differ from adolescents or older adults through a typical phase of major changes. It is a generation that postpones the traditional family pattern. Instead, they live with friends, follow trends in clothing, carefully follow decorations or music, alternate between studies, jobs and sexual partners. Young adults learn to take initiative, obtain legal, emotional and financial independence, marry and get children (Arnett, 2000; Furstenberg et al., 2004). Any financial or other support services previously are decreased or terminated. As oversight of parents and other adults decreases, young adults take responsibility for actions that will affect their current and future health status, e.g. cigarette smoking.

Trends in cigarette smoking among adults have changed little over the past decade despite of public and school education campaigns showing the consequences of smoking. In 2011 34.3% of the young adults in the Netherlands, including 13.8% heavy smokers, smoked each on average 8.5 cigarettes per day (CBS, 2012). Cigarette smoking is addictive and harmful (e.g. De Vries, Engels, Kremers, Wetzels & Mudde, 2003) and is linked with an increased risk of heart diseases, stroke, lung and other types of cancer, and chronic lung diseases (U.S. Department of Health and Human Services, 2004). Furthermore, smoking during pregnancy contributes to an increased risk of miscarriage, premature delivery, and having a low birth weight infant (Mathews, 2001).

There are several theories and models that explain the smoking behavior of young adults. Fishbein and Ajzen's Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA) reasoned that the fundamental factors attitude, subjective norm, perceived personal control and intent related to the behavior influence a young adult's behavior (Montano & Kaspryzk, 2008). Theoretically, a young adult is most likely to take over a behavior if he or she perceives the behavior as normally accepted (i.e., family members, peers, and the media claim that the everyday activity may be normal), has a positive attitude toward the behavior and control over whether or not he or she takes part in the behavior and if it is his or her intention to take over this behavior in the future. Another model that is part of these general behavior models is the Extended Model of Goal-Directed Behavior (EMGB; Perugini & Conner, 2000). The EMGB is a decision making model which seeks to explain behaviors when the behavioral act in itself is not an end i.e. conduct of a given behavior is part of an overarching goal. The key construct in the EMGB is behavioral desire (Bagozzi, 1992; Gollwitzer, 1999), which is influenced by social and personal factors.

These social and personal factors play an important role in the explanation of smoking behavior of young adults (Pieterse & Willemsen, 2005). Every day young adults are affected by different persons who smoke. Famous people like movie stars who smoke on TV, at home where the parents smoke and by classmates or by groups of friends. The social environment plays an important role in the development of smoking behavior among young adults, in particular those who are close to this age group. Moreover, each young adult has an unique combination of personal characteristics which largely determine who he or she is and how he or she behaves (e.g., Robins, John, Caspi, Mofitt, & Stouthamer-Loeber, 1996). Personal factors are for example socio-demographics (gender, age, and income level), self-esteem, risky, rebellious and deviant behavior, emotions, have a tendency to take risks, be sensitive to the influence of peers, the personality traits and skills such as behavioral control.

However, smoking behavior of young adults is complex, because it evolves through different stages (Leventhal and Cleary, 1980). These smoking stages have been summarized as never smoker, experimentation, intermittent, regular and ex-smoker (Flay, 1993; Flay, Ockene, & Tager, 1992). Since the influence of social and personal factors depends on the degree to which young adults have already started experimenting with cigarettes, it is difficult to predict to what extent which of these factors affect the smoking behavior of young adults in each smoking stage (Pieterse & Willemsen, 2005).

Problem Statement and Research Questions

The problem statement assessed in this thesis is therefore as follows:

How do social and personal factors affect the difference between the desire to smoke and smoking behavior of young adults during the stages of development of smoking behavior?

The formulated and investigated research questions are using data from other studies and surveys. The four main questions examined in this thesis are as follows:

Which stages of the development of smoking behavior can be distinguished?

Which cognitive behavior models can be distinguished?

Which social and personal factors play a role in smoking behavior?

How do the stages of development affect the influence of social and personal factors in smoking behavior?

Academic Relevance

As previously discussed, there are fundamental factors that influence a young adult's smoking behavior, like social and personal factors (Montano & Kaspryzk, 2008). In 2005 researchers studied whether young adults' transition from trying smoking to daily smoking could be predicted by family smoking behaviors (Bricker et al., 2005). What they found was that young adults, who were initiating or trying smoking the first time, were influenced by family smoking behaviors. These young adults transitioned from trying to monthly smoking and from monthly to daily smoking. Other researchers found that subjective norm and perceived availability were strongly correlated and there were strong inverse correlations between perceived parental sanctions and smoking (Ma et al., 2003). Other research supports that smoking behavior is influenced by subjective norm (Seo et al., 2005; Larsen et al., 2009; Rosendahl et al., 2005; Book et al., 2005).

Researchers studied positive and negative attitudes toward smoking to determine if attitudes predicted smoking behaviors (Larsen & Cohen, 2009). They found that there were more negative feelings about smoking than positive feelings. How much a young adult smoked in the past was predicted by a positive attitude toward smoking. However, past or current smoking behavior wasn't predicted by a negative attitude. Furthermore, they also studied to determine if intent and future behaviors could be predicted by positivity and negativity. The results of this study supported the first that ambivalence may be a strong predictor of smoking behavior over time. They also found that individual's active smoking behavior in the past and in the future were predicted by a positive attitude. Other researchers also found that smoking behavior and attitudes were strongly correlated (Ma et al., 2003). Examining the Bagozzi and Lee (2000) study on body weight regulation positive emotion alone was found to have a significant effect. Furthermore, in a test of studying effort (Leone, et al. 1999) negative anticipated emotion alone have a significant effect.

Above researches showed that social and personal factors influence the smoking behavior of young adults. However, these theoretical insights only partly explain or predict the likelihood of this influence. Smoking behavior is complex behavior that evolves through different stages. Therefore it is difficult to indicate which of these factors are most important in which stage, since the influence of these factors depends on the degree to which a young adult has already started experimenting with cigarettes (Pieterse & Willemsen, 2005; Leventhal & Cleary 1980; Mayhew, Flay, & Mott, 2000; Colby et al., 2000; Flay, 1993; Flay, Ockene, & Tager, 1992).

In conclusion, empirical evidence shows that social and personal factors play a role in explaining young adults' smoking behavior. However, their smoking behavior arises step by step and in each stage other factors have a different influence on their smoking behavior. Furthermore, new attempts are still needed to address their smoking behavior besides existing actions and prevention programs. Therefore, the contribution of this paper is to provide insights about how social and personal factors affect the difference between the desire to smoke and smoking behavior of young adults during the stages of development of smoking behavior to increase the effectiveness of existing prevention programs.

Structure of the Thesis

This current study sought to examine smoking behavior among young adults in the Netherlands, with four specific objectives. The first objective is to distinguish stages of smoking behavior. The second objective is to distinguish cognitive behavior models such as The Extended Model of Goal-Directed Behavior. The third objective is to determine which social and personal factors play a role in smoking behavior. These first three objectives are discussed in the theoretical framework. The fourth objective is to determine how the stages of development affect the influence of social and personal factors in smoking behavior. This objective is discussed in the remaining of the thesis.

Theoretical Background

Stages in the Development of Smoking Behavior

Smoking is described as a complex behavior which develops through five different stages (Leventhal & Cleary, 1980). Smoking in adolescence is commonly conceptualized as progressing through a sequence of developmental stages characterized by different stages of smoking frequency and intensity (Mayhew, Flay, & Mott, 2000), often leading to dependence of nicotine (Colby et al., 2000). These five smoking stages have been summarized as never smoker, experimentation, intermittent, regular and ex-smoker (Flay, 1993; Flay, Ockene, & Tager, 1992). Experimenter endorses trying cigarettes, although denied smoking within the past 30 days or ever smoking regularly (i.e., daily smoking). Intermittent smokes between 1 and 29 out of the past 30 days and regular refers to smoking which emerges on a daily basis and is driven by high dependency of nicotine and experience of withdrawal symptoms (Colby et al., 2000). Ex-smoker stopped smoking, endorsed regular smoking and denied smoking within the past 30 days.

Behavioral Change Models

Behavioral change theories and models try to explain the motives behind changes in behavioral patterns of individuals. According to these theories and models, environmental, personal, and behavioral characteristics are the major factors in behavioral determination. Each behavioral change theory or model emphasizes on different factors trying to explain behavioral change. The most prevalent are the Social Cognitive Theory, Theories of Reasoned Action and Planned Behavior and Extended Model of Direct-Goal Behavior. Research has also been conducted regarding specific elements of these theories, especially elements like self-efficacy that are common to several of the theories (Ajzen, 1985).

Social Cognitive Theory (Bandura, 1989) suggests that behavioral change is determined by environmental, personal, and behavioral elements. Each element affects each of the others. According to this theory the main requirement for the behavioral change is the conception of the self-efficacy of a person or the belief that one is able to successfully lead the behavior to the desired result or outcome. E.g. when a young adult feels vulnerable to a disease and he expects a positive change if he changes his behavior and perceives encouragements of his social environment to change, then his efforts may not succeed if he does not believe that he can actually change. Substantial empirical evidence suggests that beliefs about self-efficacy (and the related concept of 'optimism') are reliable predictors of behavior and that they have an indirect effect on behavioral intervention (e.g., Bandura et al., 1989; Ewart, 1995; Kaplan et al., 1994). Despite the fact that a lot of research supports the use of Cognitive Social Learning Theory, this theory has the limitation that some behavior is the result of emotion responses (e.g. jealousy can drive a young adult to behave in a way that is not consistent with his normal behavior) (Stephen Pinker, 2007).

The Theory of Reasoned Action predicts an individual's intention to perform a behavior at a specific time and place (Fishbein, 1967). The theory was intended to explain all behavior about which people have the ability to display self-control. Factors that influence behavior choices are joined together through the variable behavioral intention. To maximize the predictive value of intention to a specific behavior it is crucial that measures of intention are very similar to the measurement of behavior as regards the terms of action, target, context and time. The behavioral intentions are a function of attitude and subjective standards (indicate what relevant people in the environment find good or bad behavior).

Fishbein and Ajzen's Theory of Planned Behavior is one of the most widespread theories of human behavior. The theory was first described in 1988 and is a continuation of the Fishbein's TRA. Many years and studies later Fishbein and Ajzen realized that there was something missing in the TRA model. The TRA model only worked in situations where surveyed people also reported to have full control over the situation. Where this is not the case, or less, the model was found not to work. This led to the development of the TPB. The big difference between TRA and TPB is the addition of the determinant perceived behavioral control. The TPB suggests that intention again is the best predictor of behavior. Intention depends on three underlying determinants: attitude towards behavior, subjective norms and perceived behavioral control. Attitude towards behavior is a composite of beliefs about the behavior (perceived outcomes of the behavior and an evaluation of that outcome), the subjective norm is a composition of normative beliefs (the perceived approval or disapproval of significant others and motivation to comply), and perceived control behavior is a composite of beliefs about control (evaluations of the presence or absence of factors that enable and factors that stand in the way and the strength of their influence). Background variables, such as demographic factors, are supposed to influence behavior only through the three determinants and behavior.

However, the TPB is mute concerning the role of goals (Eagly and Chaiken, 1993; Perugini & Conner, 2000). They are implicitly viewed simply as a distal predictor that may influence behavior in a way such that its effects are subsumed by more proximal determinants such as one's attitudes (e.g. their beliefs about whether their smoking is good or bad), subjective norms (e.g. whether the individual feels that important others want them to stop smoking) and perceived behavioral control (e.g. their perceptions regarding the ease at which they can stop smoking or their ability to quit). These three influences, in turn, jointly affect one's behavioral intention that is seen as the direct precursor to behavior. In other words, the underlying assumption is that regardless of the goals (e.g., being healthy) for which behaviors (e.g., stop smoking) may be pursued, the analysis of the determinants of this latter level is sufficient to predict specific actions.

Moreover, goal theory rejects this notion that perceived behavioral control provides the motivational impetus to form a behavioral intention. Goal theory posits that those antecedents alone do in fact provide insufficient impetus to fully understand and explain one's volitions (Armitage & Conner, 2001). This view of a single-level processing of information from goals to behavioral intentions is also at odds with more recent models of goal-directed behavior including the Extended Model of Goal-Directed Behavior (EMGB; Perugini & Conner, 2000). The Extended Model of Goal Directed Behavior is a decision making model which seeks to explain behaviors when the behavioral act in itself is not an end, i.e., conduct of a given behavior is part of an overarching goal. Within the EMGB the interplay between goal and behavioral levels is brought into the forefront by considering behaviors in terms of the goals for which they are functional. The EMGB in respect to the TPB uses a broader class of volition, as suggested by recent contributions (Bagozzi, 1992; Bagozzi & Edwards, 1998; Conner & Sparks, 1996), rather than the narrower construct of intention. The EMGB taps additional areas such as behavioral desire, anticipated emotions, past behavior, goal desirability and perceived goal feasibility.

The key construct introduced by the EMGB is behavioral desire (Bagozzi, 1992; Gollwitzer, 1999). Behavioral desires represent the motivational state of mind wherein appraisals and reasons to act are transformed into a motivation to do so. This motivation or desire is hypothesized as the most proximal determinant of intentions in the EMGB. Behavioral desires therefore have an integrative function of the antecedents, including subjective norms, and perceived behavioral control, and provide impetus for intention formation. This form of desires (Davis, 1984; Perugini & Bagozzi, in press) is further qualified in the EMGB as an extrinsic desire, that is ` ...a desire for something for its believed conduciveness to something else that one desires' (Mele, 1995, p. 391).

Anticipated emotions represent a specific form of counterfactuals [1] , called prefactuals (Gleicher, Boninger, Strathman, Armor, Hetts, & Ahn, 1995), which are hypothesized to influence the desire to perform a given action. Anticipated emotions of goal achievement or failure have a motivational role in goal setting and initiation of behavior-related processes. The process behind the functioning of anticipated emotions are posited to be dynamic, contingent on one's mental appraisal of goal achievement and goal failure, and entailing self-regulatory processes (Bagozzi, 1992; Carver & Scheier, 1990, 1998).

Past behavior is a proxy of habit (Triandis, 1977) and is hypothesized to have a direct impact on behavior. Goal desirability, or goal desires, and goal perceived feasibility are added to the variables specified in the Model of Goal-directed behavior (MGB) and the model is called Extended Model of Goal-directed behavior (EMGB) for expository purposes. Goal desirability has been repeatedly proposed by several authors as key construct (Atkinson, 1964; Dholakia & Bagozzi, 2002; Liberman & Trope, 1998; Gollwitzer, 1990). A widely accepted definition in the social psychological literature for this concept would define goal desirability as ` ... the valence of an action's end state. Goal perceived feasibility refers to the ease or difficulty of reaching the end state' (Liberman & Trope, 1998, p. 7). This definition emphasizes the personal value which is attached to a certain goal outcome. However, it also de-emphasizes the key feature of the personal motivation to achieve that goal outcome, which is central in philosophical analyses (Davis, 1984; Mele, 1995). From the perspective of the agent who is appraising the goal outcome, the desire to achieve that outcome is the key motivational construct. In fact, the desirability of an end state implies by definition that the agent has a desire to achieve that end state. As argued by Perugini and Bagozzi (2001) (the distinction between desires and volitions), this form of desire has a central role in goal-directed behaviors, in particular at the stage of goal setting, and it should be distinguished from the desire to perform a given behavior.

Conceptual Framework and Predictions

The Proposed Conceptual Model

Accepting that the smoking stages and EMGB are valid in this context, the development of a two-step model of motivated behavior (figure 6.1) and predictions are deducted based on past research (Flay, 1993; Perugini and Conner 2000; Perugini and Bagozzi 2001; Shui et al., 2008). The model is represented in a square-and-arrow figure in which causation is indicated by single-headed arrows. In the model the stages in the development of smoking behavior affect the EMGB. The first step is in consistent with previous literature the smoking stages were defined on the basis of smoking frequency and recency. The second step contains the EMGB-constructs goal desires, anticipated emotions, subjective norms, perceived behavioral control and past behavior, which are proximal determinants of behavioral desires. Perceived behavioral control is influenced by goal perceived feasibility and behavioral volitions are influenced by past behavior and behavioral desires. These endogenous constructs are also influenced by factors outside the conceptual model (including measurement error). The effects of such factors are represented by the error terms (e). These terms are much more than random fluctuations in the endogenous constructs due to measurement error.

Figure 6.1 The Proposed Conceptual Model

Every path in the proposed conceptual model represents a prediction.

P1 Smokers with a greater desire to quit smoking will have a greater desire to use a tool as an aid to quit smoking.

P2 Smokers who perceive higher levels of positive anticipated emotions associated with the success to quit smoking will have greater desire to use a tool as an aid to quit smoking.

P3 Smokers who perceive higher levels of negative anticipated emotions associated with the success to quit smoking will have less desire to use a tool as an aid to quit smoking.

P4 Smokers who perceive greater normative pressure to use a tool as an aid to quit smoking will have a greater desire to do so.

P5 Smokers who have a stronger belief in their ability to quit smoking will perceive a greater level of control and fewer barriers in the use of a tool to aid to quit smoking.

P6 Smokers who perceive a greater level of control and fewer barriers in the use a tool as an aid to quit smoking will have a greater desire to do so.

P7 Smokers with a greater desire to use a tool as an aid to quit smoking will have a stronger volition to do so.

P8 Smokers who have used a tool as an aid to quit smoking in the past will have a stronger volition to do so again.

Predictions

Given the results of past research, the exogenous constructs impact behavioral desires which in turn make a contribution to the endogenous construct of volitions (Shui et al., 2008). However, I do not know how the exogenous constructs play a role on behavioral desires in young adults' experimentation and intermittent/regular smoking behavior. Moreover, the problem statement assessed in this thesis especially focuses on social and personal factors. Therefore it is more relevant to focus on subjective norm (P2), anticipated emotions (P3 and P4) and perceived behavioral control (P6). The predictions of these constructs on behavioral desires in the context of young adults' experimentation and intermittent/regular smoking behavior are implemented as refinements (a) of the predictions of past research.

Each young adult has an unique combination of personal characteristics which largely determine who he or she is and how he or she behaves (Robins, John, Caspi, Mofitt, & Stouthamer-Loeber, 1996). Behavioral genetic studies showed that personal characteristics such as individual's emotions and behavioral control also affect the individual's smoking behavior (Hiroi & Agatsuma, 2005; Terracciano & Costa, 2004; Boomsma et al., 1994; Madden et al., 2004). Furthermore, most of these characteristics have been shown to be generalizable across cultures (McCrae, 2001b; McCrae & Costa, 1997; Paunonen et al., 2000; Terraciano, 2003). Although the literature remains unanswered about the effect of positive and negative anticipated emotions on behavioral desires of the three groups my predictions are:

P2a Regular smoking young adults who perceive higher levels of positive anticipated emotions associated with the success to quit smoking will have greater desire to use a tool as an aid to quit smoking than experimenters and intermittent smoking young adults.

P3a Regular smoking young adults who perceive higher levels of negative anticipated emotions associated with the success to quit smoking will have less desire to use a tool as an aid to quit smoking than experimenters and intermittent smoking young adults.

Perceived behavioral control refers to young adults' perceptions of their ability to perform a given behavior: quit smoking. However, I predict that experimenters are more convinced that they can quit smoking than intermittent and regular smoking young adults. Experimenters have the intentions to quit smoking, but they also believe that they simply can quit smoking, because these young adults are less driven by higher dependency of nicotine and experience of withdrawal symptoms than intermittent and regular smoking young adults. Therefore my prediction is:

P6a Experimenters who perceive a greater level of control and fewer barriers in the use a tool as an aid to quit smoking will have a greater desire to do so than intermittent and regular smoking young adults.

Parents play a major role during the life of their children and spend much time with their children during childhood, although mentioned in the introduction a shift can be seen in the transition to young adulthood (Arnett, 2000; Furstenberg et al., 2004). During this period young adults increase the time and energy spent in peer relationship in comparison with a decrease in time spent with parents and family (Larson et al., 1996). However, this decrease does not mean that parents are no longer important in the life of the young adults. Young adults still value maintaining a good relationship with their family and parents and remain important in the social lives of young adults (Dekovic & Meeuw, 1997; Parke & Ladd, 1992). Thus, both peers and family are an important source of influence on the development of the young adults and play a role in young adults' experimentation and intermittent/regular smoking behavior (Avenevoli & Merikangas, 2003; Darling & Steinberg, 1993; Kobus, 2003). However, experimenters will have a greater desire to use a tool as an aid to quit smoking if they perceive greater normative pressure than intermittent and regular smoking young adults, because latter groups are more driven by higher dependency of nicotine and experience of withdrawal symptoms and therefore less sensitive to what peers and family think (Colby et al., 2000). My prediction is:

P4a Experimenters who perceive greater normative pressure to use a tool as an aid to quit smoking will have a greater desire to do so than intermittent and regular smoking young adults.

Method

Participants and Procedure

In this survey quantitative information about individuals is collected with the focus on smoking behavior. The purpose of the survey is to make statistical inferences about the young adults using the sample. The sample includes 331 participants: 188 males and 143 females. They were contacted on forums and social media and requested to complete the questionnaire. The questionnaire was adopted from Perugini and Conner (2000). The data of the questionnaire was collected with Thesis Tools. In the questionnaire the EMGB-constructs were related to the goal to quit smoking in the next 4 weeks. Perugini and Conner (2000) asked their participants to choose their own preferred instrumental behaviors to achieve a goal. However, to avoid unbiased statistics the participants have randomly been assigned a tool to quit smoking halfway through the questionnaire. The tools were Cold Turkey (quit smoking at once without any tool), nicotine-containing patches and nicotine-containing chewing gum. Every tool represented two figures on a dice. By throwing the dice every tool had an equal chance of being selected.

Measures

After the introduction of the questionnaire the participants were asked to answer questions about demographic characteristics (gender, age and income and educational level), the stages in the development of smoking behavior (Appendix 1: Stage Definitions and Associated Measures) and EMGB-constructs (Appendix 2: Construct Definitions and Associated Measures). All the constructs were measured on a 7-point scale to a different amount of items (Appendix 3: Items of the Questionnaire).

Stage Categorization and Corresponding Sample Sizes

On the basis of defined stages of smoking behavior, figure 7.3 presents a branch diagram of stage categorization and the corresponding sample sizes.

Figure 7.3 Branch Diagram Smoking Stage Categorization and Corresponding Sample Sizes

As can be seen from the figure, 97.9% of the population of interest can be classified into one of five smoking stages (never smokers, experimental smokers, intermittent smokers, regular smokers and ex-smokers) that are ordered by degree of smoking and presumed to reflect an underlying dimension of nicotine dependence. To investigate the relationship between experimental smoking experience and continuation of smoking among young adults and given the small sample size of ex-smokers (N = 19), I chose not to further analyze never smokers and ex-smokers within this study.

Results

In this chapter, the sets of analyses were performed by structural equation modeling (SEM) via Amos 20.0 and SPSS 17.

Sample Characteristics

Table 8.1 shows the sample distributions for the pooled, experimental, intermittent and regular smoking young adults (N = 129) in order to understand the stage distributions in view of gender, age, income and education. The mean age of participants was 23.4 years and ranged from 18 to 29 years. The sample included more males than females (54.3% male and 45.7% female). More than 40% of the young adults have a gross income between € 10.000 and € 30.000 per year and more than 60% has a higher education level.

Table 8.1 Percentage of Demographic and Key Variable Characteristics per Stage

Reliability of each Construct

This set of analyses was performed to investigate whether the factor analysis may be performed. First of all zeros (respondents who have not completed the questionnaire or filled in 'no' to the question 'Did you quit smoking past year?') were recoded to system missing in SPSS. Subsequently, all EMGB-constructs were tested for their reliabilities. Question 9 "My desire to quit smoking in the next 4 weeks can be described as" and question 10 "I desire to quit smoking in the next 4 weeks" of the goal desire construct scored a low reliability. Therefore, question 9 was recoded to (1=7), (2=6), (3=5), (4=4), (5=3), (6=2) and (7=1). However, the alpha didn't improve. Eventually only question 10 was used, because this variable hasn't an ordinal measurement level. Furthermore, Question 39 "My desire to quit smoking with the aid of nicotine-containing chewing gum in the next 4 weeks can be described as…" is omitted because the question has another scale.

Table 8.2 Reliabilities for Confirmatory Factor Analysis Model

As can been seen from table 8.2 the reliabilities of all the other EMGB-constructs in the smoking stages experimenter, intermittent and regular were very high (all Kaiser-Meyer-Olkin's values were sufficiently high, i.e. greater than .6, and Bartlett's tests of sphericity were all significant). Finally, the dummy scores of the categorical variables (the above stages of smoking behavior) were calculated for the factor analysis.

Means and Standard Deviations of each Construct

This set of analyses was performed to investigate the means and standard deviations of each construct of the pooled sample and stages. These means and standard deviations are given in table 8.3.

Table 8.3 Means and Standard Deviations of each Construct

This table shows that most young adults have never attempted to quit smoking with a tool in the past and normative pressures to use a tool as an aid to quit smoking are mixed. Stronger positive anticipated emotions were shown than negative anticipated emotions. The desire to quit smoking was stronger for regular smoking young adults than for the pooled sample, experimenters and intermittent smoking young adults. However, the perceived feasibility of achieving the goal to quit smoking was much stronger for experimenters than for the pooled sample and intermittent and regular smoking young adults. This finding is in line with the perceived behavior control that shows that experimenters have no concerns about the difficulties in the use of a tool to quit smoking. This is in contrast to regular smoking young adults who have more concerns. Finally, most young adults have slightly mixed desire for the use of a tool to quit smoking with a slightly lower level of volitions.

Correlations of each Construct

Correlation is the (linear) relation between two constructs in each group and is equal to the contribution of pathway through which two constructs is linked. The degree of correlation between two constructs is expressed as the correlation coefficient. The value can range between -1 and +1. 0 means no linear relationship, 1 a perfect positive linear relationship and -1 a perfect negative linear relationship. The further the correlation coefficient is removed from 0, the stronger the correlation and the more accurate the value of one construct can be predicted on the basis of the value of the other construct. If it is known that such constructs are correlated, one construct may be used to predict the other. In this analysis the Pearson Correlation Coefficient (r) is used [2] . This correlation is sensitive only to a linear relationship between two variables (which may exist even if one is a nonlinear function of the other).

Table 8.4 Correlations and P-Values of the Proposed Paths

Based on the analyzed correlations and p-values of the young adults' experimentation and intermittent/regular smoking behavior in table 8.4, I can say whether the predictions are supported or not.

P1 Goal Desires ƒ  Behavioral Desires

Goal desires are weakly correlated with behavioral desires for the pooled sample (-.279). However, smokers with a greater desire to quit smoking will have less desire to use a tool as an aid to quit smoking, because the correlation is negative. Therefore I can say that prediction 1 is not supported. Furthermore, the effect of goal desires on behavioral desires is larger for intermittent smoking young adults (-.321) than for the pooled sample, but the effect was stronger for latter group (.002>.028). Moreover, goal desires have no effect on behavioral desires for experimenters and regular smoking young adults.

P2(a) Positive Anticipated Emotions ƒ  Behavioral Desires

Positive anticipated emotions are positively and moderately/weakly correlated with behavioral desires for the pooled sample (.351). Therefore I can say that prediction 2 is supported. Furthermore, the effect of these emotions on behavioral desires is larger for experimenters (.424) than for the pooled sample, intermittent (.333) and regular smoking young adults (.412), but experimenters have the weakest effect of all groups. In conclusion, prediction 2a is not supported.

P3(a) Negative Anticipated Emotions ƒ  Behavioral Desires

Negative anticipated emotions are also positively correlated with behavioral desires, but only the correlations of the pooled sample (.222) is significant. Therefore I can say that prediction 3 is supported. Since these emotions have no effect on behavioral desires for the other groups, prediction 3a is not supported.

P4(a) Subjective Norm ƒ  Behavioral Desires

Subjective norm is positively and moderately correlated with behavioral desires for the pooled sample (.415). Therefore I can say that prediction 4 is supported. Furthermore, the effect of subjective norm on behavioral desires is larger for experimenters (.480) than for the pooled sample, intermittent (.372) and regular smoking young adults (.458), but experimenters have the weakest effect of all groups. In conclusion, prediction 4a is also supported.

P5 Goal Perceived Feasibility ƒ  Perceived Behavioral Control

The correlation between goal perceived feasibility and perceived behavioral control is positive and moderate for the pooled sample (.497). Therefore I can say prediction 5 is supported. The effect of goal perceived feasilibility on perceived behavioral control is larger and stronger for intermittent smoking young adults (.653) than for the pooled sample, experimenters (.445) and regular smoking young adults (.42).

P6(a) Perceived Behavioral Control ƒ  Behavioral Desires

Perceived behavioral control is positively correlated with behavioral desires for the pooled sample (.068). However, the correlation is very weak to negligible and insignificant. Perceived behavioral control has no effect on behavioral desires and therefore I can say that prediction 6 is not supported. This also applies for the correlations for the other groups (experimenters = .128, intermittent = -.197 and regular = .026), because these correlations are insignificant. Prediction 6a is also not supported.

P7 Behavioral Desires ƒ  Volitions

The correlation between behavioral desires and volitions is positive and strong for all groups (> 0.7). However, the effect of behavioral desires on volitions is larger and stronger for intermittent smoking young adults (.789) than for the pooled sample, experimenters and regular smoking young adults, respectively .754, .710 and .719. These strong, high correlation may occur, because behavioral desires is the only independent construct which has an effect on volitions. In conclusion, prediction 7 is supported.

P8 Past Behavior ƒ  Behavioral Desires

The correlation between past behavior and behavioral desires is positive and weak for the pooled sample (.25). Therefore I can say prediction 8 is supported. The effect of past behavior on behavioral desires is larger and stronger for intermittent smoking young adults (.446) than for the pooled sample. However, there is no effect of past behavior on behavioral desires for experimenters and regular smoking young adults, because the correlations are insignificant.

Predictions and Paths

Path analysis is based on multiple regressions, but the conceptualization of the predictor (independent constructs) here is more complex. The main purpose of path analysis is to examine relationships between the independent constructs as predictors of the dependent construct. There are numerous linkages between the predictive constructs. The relationships between constructs in path analysis are given by path coefficients. These are essentially based on the correlation coefficients, which are beta weights that have been calculated in the multiple regressions. Furthermore, when the critical ratio (C.R.) is larger than 1.64 for a regression weight, that path is significant at the .1 level or better. In the β-value columns, one asterisk (*) indicate significance smaller than .1. The critical ratio is equal to the estimate divided by the standard error.

Table 8.5 Path Coefficients and Critical Values of the Proposed Paths

Based on the analyzed path coefficients and critical values are illustrated in table 8.5, I can say whether the predictions are supported or not. Furthermore, I can compare the results of the correlations with the results of the paths. In such comparison suppression effect may occur: when the presence of another construct causes multivariate path coefficient to strongly differ from bivariate correlation. The path coefficient for an exogenous construct to an endogenous construct is very different from correlation. This is the result from overwhelming influence of another exogenous construct.

P1 Goal Desires ƒ  Behavioral Desires

The path coefficient for goal desires of the pooled sample is -.221. The negative coefficient means that smokers with a greater desire to quit smoking will have less desire to use a tool as an aid to quit smoking. But the coefficient is insignifant and therefore goal desires has no effect on behavioral desires. So prediction 1 is not supported. Moreover, the path coefficients for goal desires of intermittent (-.256) and regular smoking young adults (-.269) are significant, which means that goal desires have an effect on behavioral desires for these groups. The effect was stronger for latter group (-2.483>-2.829). However, the correlation between goal desires and behavioral desires for regular smoking young adults is insignificant. So it might be possible that the path coefficient of these adults are influenced by another exogenous construct. Furthermore, goal desires have no effect on behavioral desires for experimenters (-.056).

P2(a) Positive Anticipated Emotions ƒ  Behavioral Desires

Regular smoking young adults (.493) will have the greatest desire to use a tool as an aid to quit smoking if these young adults perceive high levels of positive anticipated emotions associated with the success to quit smoking. The effect of positive anticipated emotions on behavioral desires is larger and stronger for this group than for the pooled sample (.345), experimenters (.267) and intermittent smoking young adults (.144). Since the path coefficients of the pooled sample and regular smoking young adults are only significant, predictions 2 and 2a are supported. In contrary to these results, the correlations of all the groups are significant. Therefore, it might be possible that another exogenous construct influence the path coefficients of experimenters and intermittent smoking young adults.

P3(a) Negative Anticipated Emotions ƒ  Behavioral Desires

Besides positive anticipated emotions, the path coefficients for negative anticipated emotions of all groups are insignificant. Therefore, negative anticipated emotions have no effect on behavioral desires at all. This also applies for the results of the correlations. However, all the correlations between these constructs are positive and the path coefficients for these emotions are negative. In conclusion predictions 3 and 3a are not supported.

P4(a) Subjective Norm ƒ  Behavioral Desires

Experimenters (.429) who perceive great normative pressures to use a tool as an aid to quit smoking will have the greatest desire to do so than the pooled sample (.299) and intermittent (.194) and regular smoking young adults (.384). The effect of subjective norm on behavioral desires is just like the results of the correlations weaker for experimenters than for the pooled sample, intermittent and regular smoking young adults. However, subjective norm has no effect on behavioral desires for intermittent smoking young adults. Based on these results, predictions 4 and 4a are supported. Moreover, the correlation between subjective norm and behavioral desires is significant and the path coefficient is insignificant. Therefore, it might possible that the path coefficient of intermittent smoking young adults is influenced by another exogenous constructs.

P5 Goal Perceived Feasibility ƒ  Perceived Behavioral Control

Experimenters (.816) who have a strong belief in their ability to quit smoking will perceive the greatest level of control and fewer barriers in the use of a tool as an aid to quit smoking than the pooled sample (.499) and intermittent (.457) and regular smoking young adults (.329). Furthermore, all path coefficients are significant. However, the effect of goal perceived feasibility on perceived behavioral control is stronger for the pooled sample than for experimenters (9.174>2.313). In conclusion, prediction 5 is supported.

P6(a) Perceived Behavioral Control ƒ  Behavioral Desires

Regular smoking young adults (.260) will have the greatest and strongest desire than the pooled sample (.169), experimenters (.15) and intermittent smoking young adults (-.061) to use a tool as an aid to quit smoking, if these young adults perceive a great level of control and fewer barriers. This is not the case for intermittent smoking young adults. These young adults will have a less desire to do so, because the path coefficient is negative. However, perceived behavioral control has no effect on behavioral desires for intermittent smoking young adults but also for experimenters due to insignificant path coefficients. Therefore prediction 6 is supported and 6a not. In contrary to these results, the correlations of all the groups are insignificant. Therefore, it might be possible that another exogenous construct influence the path coefficients of intermittent smoking young adults.

P7 Behavioral Desires ƒ  Volitions

Intermittent smoking young adults (.820) with a great desire to use a tool as an aid to quit smoking will have a strongest volition to do so than the pooled sample (.748), experimenters (.656) and regular smoking young adults (.691). Furthermore, all path coefficients are significant. However, the effect of behavioral desires on volitions is stronger for the pooled sample than for intermittent smoking young adults (12.269>8.704). In conclusion, prediction 7 is supported.

P8 Past Behavior ƒ  Behavioral Desires

Finally, experimenters (1.088) who have used a tool as an aid to quit smoking in the past will have the greatest volition to do so again than the pooled sample (.461) and intermittent (.650) and regular smoking young adults (.016). All path coefficients are significant, except for regular smoking young adults just like the correlation between these constructs. However, the path coefficient of experimenters is significant in contrary to the correlation. Therefore, it might possible that the path coefficient of experimenters is influenced by another exogenous constructs. In conclusion, prediction 8 is supported.

Discussion

This study sought to examine smoking behavior among young adults in the Netherlands. In order to assess the problem statement the research questions are answered below. Furthermore, the limitations, future research and implications of this research are also noticed.

9.1 Outcomes

RQ 1: Which stages of the development of smoking behavior can be distinguished?

The first outcome is the distinction of the stages of the development of smoking behavior. The smoking behavior of young adults is described as a complex behavior which develops through five different stages. The first stage is described as young adults who have never smoked before. The second stage is characterized by experimentation. The experimenter endorses trying cigarettes, although denied smoking within the past 30 days or ever smoking regularly (i.e., daily smoking). In the third stage young adults are intermittent smokers and smokes between 1 and 29 out of the past 30 days. The fourth stage refers to regular smoking young adults whose smoking behavior is on a daily basis and is driven by high dependency of nicotine and experience of withdrawal symptoms. The last stage is characterized by ex-smokers who stopped smoking, endorsed regular smoking and denied smoking within the past 30 days.

RQ 2: Which cognitive behavior models can be distinguished?

The second outcome is the distinction of behavioral change theories and models, which try to explain the motives behind changes in behavioral patterns of young adults. The most prevalent are the Social Cognitive Theory, Theories of Reasoned Action (TRA) and Planned Behavior (TPB) and Extended Model of Direct-Goal Behavior (EGMB). According to Social Cognitive Theory the main requirement for the behavioral change is the conception of the self-efficacy of a person or the belief that one is able to successfully lead the behavior to the desired result or outcome. However, this theory has the limitation that some behavior is the result of emotion responses.

The TRA predicts an individual's intention to perform a behavior at a specific time and place (Fishbein, 1967). But many years later the researchers found out that TRA model only worked in situations where surveyed people also reported to have full control over the situation. This led to the development of the TPB, which added perceived behavioral control as determinant. However, the TPB is mute concerning the role of goals. They are implicitly viewed simply as a distal predictor that may influence behavior in a way such that its effects are subsumed by more proximal determinants (e.g. subjective norms and perceived behavioral control).

Moreover, goal theory rejects this notion that perceived behavioral control provides the motivational impetus to form a behavioral intention. Goal theory posits that those determinants alone do in fact provide insufficient impetus to fully understand and explain one's volitions. The Extended Model of Goal-Directed Behavior (EMGB) includes this view of a single-level processing of information from goals to behavioral intentions. The EMGB is a decision making model which seeks to explain behaviors when the behavioral act in itself is not an end. The EMGB taps additional areas such as behavioral desire, anticipated emotions, past behavior, goal desirability and perceived goal feasibility.

RQ 3: Which social and personal factors play a role in smoking behavior?

The third outcome is which social and personal factors play an important role in the explanation of smoking behavior of young adults. Every day young adults are affected by different persons who smoke e.g. parents. The social environment plays an important role in the development of smoking behavior among young adults, in particular those who are close to this age group. Moreover, each young adult has an unique combination of personal characteristics which largely determine who he or she is and how he or she behaves. Personal factors are for example socio-demographics (gender, age, and income level), self-esteem, risky, rebellious and deviant behavior, emotions, have a tendency to take risks, be sensitive to the influence of peers, the personality traits and skills such as behavioral control.

The proposed conceptual model of motivated behavior and predictions are deducted based on the stages and EMGB. Since the problem statement assessed in this thesis especially focuses on social and personal factors, it is more relevant to focus on anticipated emotions, subjective norm and perceived behavioral control in the EMGB to understand how these constructs affect the difference between goal desires and volitions in young adults' experimentation and intermittent/regular smoking behavior.

RQ 4: How do the stages of development affect the influence of social and personal factors in smoking behavior?

The last outcome is how the stages of development affect the influence of social and personal factors in smoking behavior. Positive anticipated emotions have only effect on behavioral desires for regular smoking young adults. These adults will have great desire to use a tool as an aid to quit smoking if these young adults perceive high levels of positive anticipated emotions associated with the success to quit smoking. This doesn't apply for negative anticipated emotions, because none of the stages who perceive higher levels of negative anticipated emotions associated with the success to quit smoking will have a desire to use a tool as an aid to quit smoking than experimenters and intermittent smoking young adults.

Experimenters who perceive great normative pressures to use a tool as an aid to quit smoking will have greater desire to do so than regular smoking young adults. However, subjective norm has no effect on behavioral desires for intermittent smoking young adults. Regular smoking young adults will have the greatest and strongest desire than experimenters and intermittent smoking young adults, if these young adults perceive a great level of control and fewer barriers. This is not the case for intermittent smoking young adults. These young adults will have a less desire to do so, because the path coefficient is negative. However, perceived behavioral control has no effect on behavioral desires for intermittent smoking young adults but also for experimenters due to insignificant path coefficients.

Limitations

The limitations of this research should be noticed. The first limitation is the consideration of actual behaviors. I have focused on volitions, but it is not clear that volitions mediate all the other constructs' effects on actual behavior, because the effects of constructs like goal desires and (positive and negative) anticipated emotions might have a direct impact on actual behavior. Therefore the construct actual behaviors should also be implemented in the EMGB in future research.

The second limitation is the small sample size. There are many rules of thumbs about how large the sample size should be. The larger the sample size, the more sure the results truly reflect a representative population. This indicates that for a given confidence level, the larger the sample size, the smaller the confidence interval. According to Tanaka (1987) the ratio of sample size to the number of free parameters should be at least 20 to 1 and to Bentler and Chou (1987) 5 to 1. Furthermore, sample size of 200 is seen as a goal for SEM research. The sample size was small due to the limited time for this research.

The third limitation is the validity of the participants´ reports about the prevalence of cigarette smoking, because smokers are likely to underestimate the amount smoked or to deny smoking at all; this may be due to persons not precisely remembering the amount they smoke, or because they want to give socially desirable answers (Patrick, Cheadle, Thompson, Diehr, Koepsell & Kinne, 1994). In sum, the results should be interpreted with care due to the limitations.

Future Research

As can been seen from the correlations of each construct (Appendix 4: Correlations of each Construct), both positive and negative anticipated emotions are positively correlated for all groups. Since these anticipated emotions are independent variables of behavioral desires and these anticipated emotions are correlated, the effect of positive anticipated emotions on behavioral desires might be affected by negative anticipated emotions. The correlation between positive on negative anticipated emotions is stronger for experimenters (.6) than for the pooled sample, intermittent and regular smoking young adults, respectively .502, .541 and .429.

Moreover, the effect of subjective norms on behavioral desires might be affected by positive anticipated emotions for the same argument as above. Social scientists have come to realize that for most human behavior and characteristics, genetic and environmental influences are more complementary than competitive (Legrand, McGue & Iacono, 1999). Smoking may develop when inherited vulnerabilities combine additively with environmental risk to 'push' an individual over a putative smoking threshold (Legrand et al., 1999). Thus, this implies that young adults are born with certain personal characteristics but the social environment may mediate or moderate these characteristics to a certain extent. This might be an explanation why subjective norm and anticipated emotions are correlated. However, in order to determine that this statement is true, further deeper research is necessary.

Implications

Given the limitations discussed above, the contextual results reported in this paper must be taken with caution. However, my application of the EMGB provides insights about how social and personal factors affect the difference between the desire to smoke and smoking behavior of young adults during the stages of development of smoking behavior to increase the effectiveness of existing prevention campaigns. In my opinion, these existing programs should not concentrate on young adults but also on social (environment) and personal (individual characteristics) factors per stage to address young adults' smoking behavior.

Regular smoking young adults will have great desire to use a tool as an aid to quit smoking if thesis young adults perceive high levels of positive emotions associated with the anticipated success to quit smoking. Therefore, prevention programs should communicate to these young adults that smoking cessation is associated with feelings like excitement, delightful, happiness, satisfaction, proud and self-assurance.

This does not apply to anticipat