Implicit and explicit attitudes predict smoking cessation: Moderating effects of perceived control and plans to quit

Background: Tobacco control programs often include messages designed to change attitudes toward smoking to influence adults to attempt smoking cessation. In this study we tested (1) whether implicit attitudes toward smoking would prospectively predict cessation over a long time interval among a community sample of smokers and (2) whether plans to quit and perceived control over smoking would moderate the effects of implicit and explicit attitudes on prospectively predicting cessation. Methods: Participants were 453 adult smokers who were recruited to a longitudinal web-based study with two sessions, 18 months apart. Models predicted cessation at 18-month follow-up from baseline covariates (educational attainment and amount smoked per day), baseline predictors (plans to quit, perceived control over smoking, and implicit and explicit attitudes toward smoking), and interactions among the predictors. Results: The effects of attitudes on smoking cessation significantly varied with levels of perceived control over smoking and plans to quit. Explicit attitudes significantly predicted cessation among those with high (but not low or medium) levels of perceived control over smoking. Conversely, however, implicit attitudes significantly predicted cessation among those with low levels of perceived control over smoking and among those with high perceived control, but only if they did not have a plan to quit. Conclusions: Implicit and explicit attitudes were differentially important in the prediction of smoking cessation depending on participants' perceived control over smoking. Because smoking cessation involves both controlled and automatic processes, interventions may need to consider attitude change strategies that focus on both implicit and explicit attitudes.