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Guo, "Cognitive attributions for smoking and their roles on subsequent smoking progression and regression," 2009

USC Dissertation in Public Health.
August 3, 2009

Qian Guo, Ph.D.

Abstract (Summary)
Cigarette smoking poses a major public health problem worldwide. Researchers have discovered numerous smoking determinants by linking people's personal and environmental factors with actual smoking behaviors. However, few studies have explored how smokers themselves explain the causes of their smoking behaviors. According to attribution theory, causal attributions are critical, because they provide the basis for a person's future actions. Studies have been undertaken to ask people directly why they smoke. However, most of them focused on identifying cognitive attributions for smoking. Few of them have investigated whether cognitive attributions were associated with actual smoking and influential to subsequent smoking. To fill in the gaps, the present research was conducted.

Subjects were 14,434 students randomly drawn from middle and high schools in China seven cities. Self-administration surveys were conducted twice with one year apart. Demographic characteristics, smoking status, and cognitive attributions for smoking were assessed. Exploratory factor analysis was employed to categorize cognitive attributions into themes. The relative importance of each cognitive attribution was ranked by smoking status and gender. The roles of cognitive attributions on subsequent smoking development were examined by multilevel analyses. Susceptibility to smoking's mediation effects were examined by Baron and Kenny criteria, Sobel test, and program Prodclin. Polychotomous logistic regression was applied to examine how each cognitive attribution played its roles in smoking trajectory.

Eight factors were generated representing eight themes of cognitive attributions for smoking. They were curiosity, coping, social image, social belonging, engagement, autonomy, mental enhancement, and weight control. Seven of them were associated with current smoking. Six of them were associated with subsequent smoking progression. Most associations were partially mediated by susceptibility to smoking. Eventually, this research found how each cognitive attribution influenced smoking at certain points in smoking trajectory and in particular ways.

An essential recommendation from findings of this research is that anti-smoking programs should be unique and evidence-based. To prevent adolescents from smoking in long run, it is necessary to develop and implement comprehensive anti-smoking programs incorporating primary and secondary smoking prevention components and smoking cessation components.

Advisor: Johnson, Carl Anderson
Committee members: Unger, Jennifer B.,  Azen, Stanley P.,  MacKinnon, David P.,  Chi, Iris