How effective are physical appearance interventions in changing smoking

perceptions, attitudes and behaviours? A systematic review

Keira Flett, David Clark-Carter, Sarah Grogan

Staffordshire University, Stoke on Trent, UK

Rachel Davey

University of Canberra, Australia

Word Count: 2,846

Address correspondence to:

Keira Flett 

Psychology Department

Staffordshire University

Stoke on Trent

STAFFORDSHIRE

ST4 2DE

Phone: 07837633710

E-mail: K.Flett@staffs.ac.uk

Key Words: Smoking Cessation, Physical Appearance, Intervention, Behaviour.

1

ABSTRACT

Objective

A systematic review was conducted in order to identify physical appearance

interventions related to smoking cessation, and to evaluate their effectiveness in order

to inform smoking cessation practice.

Data Sources

Articles were only included if they focused on an appearance intervention related to

changing smoking attitudes, intentions or behaviour. Seventeen online databases were

searched using date restrictions (1980 to 2011) revealing 4356 articles. After

screening 11 articles were identified that met the review criteria. Seven articles

investigated the impacts of facial age-progression software on smoking cessation.

Three articles focused on reducing weight concerns in order to improve smoking

abstinence rates. One oral health article was identified which focused on physical

appearance in order to prevent or reduce smoking.

Data Synthesis

Few studies have focused on physical appearance interventions in smoking cessation

however the identified studies report positive impacts on smoking related cognitions

and cessation behaviours. Two different methods of quality analysis were conducted

for quantitative and qualitative papers. The consensus was that the quality of the

articles was generally weak. Of the 10 quantitative articles, nine were rated weak and

one was rated moderate. The one qualitative study provided clear, in-depth

information.

Conclusions

Questions still remain as to whether physical appearance interventions have an impact

on smoking attitudes, intentions or behaviours, particularly in British samples. To

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inform practice, additional, well-designed, studies are needed. They should include

control groups, use robust randomised allocation to conditions, measures with

established reliability and validity and take measures pre and post intervention.

Key Words: Smoking Cessation, Physical Appearance, Intervention, Behaviour.

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What this paper adds: This is the first review to investigate physical appearance interventions and

smoking. The review found that physical appearance interventions impacted positively

on smoking outcomes. Study quality analyses illustrated that evidence needs to be interpreted with

caution. Future well-designed studies are needed to understand fully factors

influencing the effectiveness of physical appearance interventions.

INTRODUCTION

One of the biggest challenges for smoking cessation practices includes engaging

young people with smoking cessation services. The health problems associated with

smoking are well known[1] and have been highlighted in various smoking cessation

campaigns however success has been debatable. One promising motivational factor

which may impact on smoking behaviours is concern about physical appearance.

Physical appearance in Western societies is valued highly, as illustrated in beauty-

related expenditure on procedures such as cosmetic surgery[2]. Research has

suggested that reducing cessation related weight concerns[3], emphasising facial

wrinkling[4] and making people aware of the oral health impacts of smoking[5] may

be effective ways to enable people to quit smoking, but it is unclear how effective

these interventions are. One study found that smokers said that they would quit if skin

ageing and other negative effects on appearance became evident[4]. It has also been

suggested that reducing weight gain concerns in contrast to managing weight may

prove to be an effective smoking cessation intervention[6-11]. In addition the impact

of teeth discolouration on physical appearance may act as an effective technique to

combat smoking[12- 14].

In order to determine what is known about the effectiveness of physical appearance

interventions on smoking cessation for individual smokers, a systematic review of

available published literature was conducted. The research question for this

systematic review is:

What is the current evidence on the effectiveness of physical appearance

interventions in changing smoking perceptions, attitudes and behaviours?

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METHOD

A systematic search was conducted in December 2011 in order to identify smoking

and appearance intervention research. Methods included searching 17 online

databases including PsychARTICLES, CINAHL, Cochrane Database, Web of

Knowledge, Ingenta Connect, PsycINFO, Science Direct, Swetwise, Wiley

Interscience, Sage Journals, Springer Link, PubMED, PubCentral, British Medical

Journal (BMJ), BBNet, Australasian Medical Journal (AMJ) and Narcis. The

University library and smoking-related text books were further searched. In addition,

manual searches were conducted using search engines and reference lists of relevant

articles were reviewed.

The search keywords were chosen in order to cover terms for smoking, physical

appearance and intervention. The following key words were used to search for

relevant articles: '(smok* OR cigarette* OR nicotine OR tobacco) AND (intervention

OR cessation OR program OR quit*) AND (appearance OR beauty OR looks OR

attractive OR skin OR ageing OR wrinkl* OR fac*) OR (weight OR thin* OR 

exercise OR physical activity) OR (yellow* OR stain* OR discolour* OR teeth OR

oral OR dental OR dentist) OR (morph* OR ag* OR software OR computer OR

electronic OR technology) OR (hair OR eye*). Main terms were searched using

‘AND’ and similar terms were searched using ‘OR’. Existing reviews were searched

with ‘review’ in the heading. Manual searches included viewing the titles within

selected journal volumes. If there were a large number of studies identified then

advanced search was used including selecting the limit: ‘search in article titles’. In

advanced search articles were requested from 1980 to 2011 and the population group

was specified. Exclusion of articles before 1980 was based on the rationale that body

image research was developing from 1980’s onwards[2].

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Inclusion and exclusion criteria were applied to all the articles. Articles were included

if they aimed to investigate an appearance intervention related to changing smoking

attitudes, intentions or behaviour. 

Articles were excluded if they:

Involved a sample consisting of a specific clinical subgroup (such as

individuals with depression or psychosomatic disorders).

Were dated before 1980. 

Involved a meta-analysis or literature review (in contrast to an intervention

design). 

Were not written in English.

The combined search revealed 4356 articles. Each article title was reviewed in

relation to the topic relevance, producing a list of 251 articles. The 251 abstracts were

then reviewed. Full text content was accessed for 158 of the 251 articles resulting in

11 articles found to fulfil the inclusion criteria. If abstracts did not contain sufficient

detail to judge their relevance then the full text content was reviewed. Articles were

excluded if they did not fit the inclusion criteria. Eleven articles were found to fulfil

the criteria. A quality rating and summary of the identified articles was conducted

using the McMaster, and Walsh and Downe quality assessments[15, 16].

The stages of the retrieval process are shown in Figure 1[17].

The McMaster quality assessment was conducted on 10 of the quantitative research

articles identified[15]. The assessment involved six quality ratings: selection bias,

study design, blinding, data collection methods, withdrawals and drop-outs. The

process of quality assessment involved selecting appropriate codes including either:

strong (3), moderate (2) or weak (1). Three of the authors independently determined

the quality ratings. Researchers reached a 100% rating agreement for eight of the

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studies[18-25]. On With the two studies where opinions differed[26, 27], consensus

was reached through discussion.

The Walsh and Downe[16] quality assessment was conducted on one qualitative

article identified[28]. The quality assessment was conducted by three of the authors

(reaching 100% agreement) involving commenting on the following eight areas:

Scope and Purpose, Design, Sampling Strategy, Analysis, Interpretation, Reflexivity,

Ethical Dimensions and Relevance/Transferability.

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RESULTS

A total of 11 research articles were identified that met the inclusion criteria. (See Table 1 below for the key features of each study). Study

strengths and limitations are discussed in the following section.

Table 1: Brief Study Checklist. Study Design Participants n Outcome Measures Results

[18]Semer et al. (2005)

Cohort analytic Female / male smokers & non-smokers 64 Smoking behaviours, intentions Individuals reported that the intervention was effective. No statistical significant results.

[19]Pirie et al. (1992)

Cohort analytic Female smokers 417 Weight, carbon monoxide ratings, smoking behaviours

Results are unclear due to various intervention components possibly having an impact. Statistical significant group differences.

[20]Weiss et al. (2010)

Cohort Female students; non-smokers, ex-smokers & occasional smokers

845 Smoking behaviours, intentions, beauty perceptions

Increased motivations to quit smoking, however lack of engagement in smoking cessation course. Significant differences on stages of change variables.

[21]Grogan et al. (2011)

Randomised control trial

Female smokers 70 Carbon monoxide, smoking behaviours, theory of planned behaviour constructs, dependence

Increased intentions to quit smoking. Significant differences on theory of planned behaviour and nicotine dependence variables.

[22]Burford et al. (2009)

Randomised control trial

Female / male smokers 50 Dependence, smoking behaviours Pilot study providing limited information regarding the outcomes measured. No statistical significant results.

[23]Hysert et al. (2008)

Cohort Female / male smokers & non-smokers 792 Attitudes, smoking behaviour, diet, physical activity

Maintenance reported as individuals remembered the intervention, smoking

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behaviour differences. Statistically significant differences for progression to smoking.

[24]Hysert et al. (2003)

Cohort Female / male smokers, non-smokers & ex-smokers

445 Self image, intentions, perceptions Statistically significant results including increased intentions to quit and positive attitudes.

[25]Perkins et al. (2001)

Cohort analytic Female smokers 219 Carbon monoxide, depression, mood weight, dependence

Statistically significant differences between groups for increased smoking cessation rates.

[26]Copeland et al. (2006)

Cohort analytic Female smokers 79 Carbon monoxide, weight, dependence, body concerns, situational factors

Support for tailored appearance interventions due to cessation rates, statistically significant differences between the two groups at a three-month follow up.

[27]Kentala et al. (1999)

Cohort analytic Female / male smokers & non-smokers 2, 586 Smoking abstinence Higher smoking cessation rates in control group, however not statistically significant.

[28]Grogan et al. (2010)

Qualitative Female smokers 47 Semi-structured interviews & one focus group

Demonstrated effectiveness including increasing intentions to quit linked to personal susceptibility. No statistical outcomes as the study included only qualitative investigations.

Quality assessment results for each study are included in Tables 2 and 3.

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Table 2: Quantitative Study Analysis[15].Authors Selection

biasDesign Confound

ersBlinding Data

Collection Methods

Withdrawals & Dropouts

GLOBAL RATING

[18]Semer et al. (2005) Weak (3) Weak (3) Weak (3) Weak (3) Weak (3) Weak (3) Weak (3)

[19]Pirie et al. (1992) Weak (3) Moderate (2) Strong (1) Weak (3) Moderate (2) Strong (1) Weak (3)

[20]Weiss et al. (2010) Weak (3) Moderate (2) Weak (3) Weak (3) Strong (1) Weak (3) Weak (3)

[21]Grogan et al. (2011) Moderate (2) Strong (1) Moderate (2) Moderate (2) Strong (1) Strong (1) Moderate (2)

[22]Burford et al. (2009) Weak (3) Weak (3) Moderate (2) Weak (3) Moderate (2) Weak (3) Weak (3)

[23]Hysert et al. (2008) Weak (3) Weak (3) Weak (3) Weak (3) Weak (3) Weak (3) Weak (3)

[24]Hysert et al. (2003) Weak (3) Moderate (2) Weak (3) Weak (3) Weak (3) Weak (3) Weak (3)

[25]Perkins et al. (2001) Weak (3) Moderate (2) Strong (1) Moderate (2) Weak (3) Weak (3) Weak (3)

[26]Copeland et al. (2006) Weak (3) Moderate (2) Strong (1) Weak (3) Strong (1) Strong (1) Weak (3)

[27]Kentala et al. (1999) Weak (3) Moderate (2) Weak (3) Weak (3) Weak (3) Moderate (2) Weak (3)

Table 3: Qualitative Study Analysis[16].

Authors

Scope & Purpose

Design Sampling Strategy Analysis Interpretation Reflexivity Ethical dimensions

Relevance/ transferability

[28]Grogan et al. (2010)

Clear rationale provided.

Method described in regards to the importance of using grounded theory. Data collection strategies explained.

Description provided. Sample restricted to one geographical area.

Described in detail.

Clear descriptions.

Described in the limitations section.

Basic study procedures explained (e.g. debrief).

Future directions provided and results linked to previous research findings.

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Weiss et al.[20] evaluated the effectiveness of age-progression technology involving

ageing photographs to demonstrate facial wrinkling with female smokers. The

software used to conduct the age-progressions included APRIL Age Progression

Software, Version 2.3. APRIL age-progression software produces ageing algorithms

which are based on a cohort of 2000 individuals and published data of specific effects

of smoking on skin. The software provides images of how an individual will age as a

non-smoker compared to a 1-pack-a-day smoker. Strengths of the research involve a

large sample size, trained professionals implementing the intervention and reliable

measures were administered. Weaknesses of the study included no control group and

no nicotine replacement therapy (NRT) access, and no individuals from the study

attended the smoking cessation group that was available.

Grogan et al.[21] conducted a randomised control trial (RCT) in order to assess the

effectiveness of an age-progression intervention with women smokers. APRIL Age

Progression Software version 2.5 was used in the study. The study strengths included

the study design and reliable outcome measures. Limitations included a lack of

information regarding who had access to nicotine replacement therapies (NRT) at the

start of the study.

Grogan et al.[28] carried out a qualitative study with women smokers who

participated in an age-progression intervention (APRIL Age Progression Software,

version 2.5). Strengths of the study included the in-depth information gained from the

interviews and focus group research. Potential limitations have been identified by the

authors including participants possibly feeling social pressure to report that the

intervention was effective.

Burford et al.[22] conducted a pilot investigation involving assessing the

effectiveness of an age-progression facial-wrinkling intervention (APRIL software)

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with male and female smokers. Strengths included a control group comparison and a

male sample: due to previous studies predominantly assessing female outcomes).

Limitations include the lack of information regarding the study design (as allocation

to groups was not explicit), nicotine replacement therapy access, and the rate of drop-

outs.

Hysert et al.[23] evaluated an age-progression intervention with male and females

using APRIL age-progression software. Strengths involve investigating an age-

progression intervention as a potential preventative method in schools. The main

limitation was the fact that there was no control group as a comparison (alternative

intervention) group was used instead, so it was not possible to identify effects of an

intervention compared with no intervention due to internal validity issues.

Semer et al.[18] assessed the impacts of smoking on facial appearance using

computer ageing technology developed by a technology faculty. A particular strength

included investigating male and female viewpoints. In terms of limitations the study

lacks internal validity due to study design (no control group) and data collection

methods as no outcome differences were reported for the individuals who attended a

motivational event (involving the age-progression software).

Hysert et al.[24] aimed to examineexamined computer ageing technology (APRIL

software) with males and females. Strengths include investigating a limited research

area. Each participant’s photograph was aged by an average of 30 years. Clearly a

decision was made to only age the images by 30 years however the results are not

comparable to other studies that have utilised the full software ageing possibilities (as

APRIL software can age an image to 72 years). In addition, design wise the study did

not include a control group comparison. N.B. Some additional detail on the study by

Hysert et al.[24] has been derived from Mirand, Hysert and Donohue[29].

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Perkins et al.[25] aimed to identify the most effective approach to addressing weight

gain concerns in women quitting smoking. Women were randomised to one of three

treatments. Strengths of the study include evaluating a psychological method to

promote smoking cessation (reducing weight concerns). However a particular

limitation includes monitoring of weight gain among participants which may have led

to increased body image concerns.

Copeland et al.[26] researched a multidisciplinary treatment involving general

psychological, dietary and exercise components with female participants. Participants

were randomly assigned to one of two conditions including an individually tailored

and a non tailored group. Strengths included examining whether or not smoking-

cessation information should be personally tailored or not. No post-treatment

measures were administered to investigate body image differences; therefore

conclusions have to be treated with caution. Further limitations include no control

group and weight monitoring which may have led to body image concerns.

Pirie et al.[19] assessed the effectiveness of two weight reduction strategies including

nicotine gum and a behavioural weight control program. Female participants were

allocated randomly to four groups. Strengths included investigating a nicotine

replacement therapy in conjunction with a psychological intervention. A study

limitation also illustrated in Copeland et al.[26], included the incorporation of

exercise, dietary and weight gain concern reduction components. Concern exists in

terms of reducing weight concerns in contrast to proactively reducing actual weight.

As with Copeland et al.[26] and Perkins et al.[25] the study involved continuous

monitoring of weight gain which may have increased body image concerns.

Kentala et al.[27] conducted a RCT to evaluate a dental health intervention with

adolescent males and females. A particular strength included investigating a limited

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area as this study was the only one identified using oral appearance as a potential

motivator for smoking cessation. A limitation involves dental status not being

reported at each stage of the study. For instance if individuals possess discolouration

already they may be more likely to not initiate smoking or alternatively abstinence

may be encouraged.

DISCUSSION

This review aimed to evaluate the existing research base relating to smoking and

physical appearance interventions in order to inform stop-smoking services. The main

findings suggest some positive impacts on smoking outcomes but there is a lack of

consensus between studies; therefore evidence needs to be dealt with in a cautiously

optimistic way. Of the seven facial wrinkling studies, Grogan et al.[21] and Burford et

al.[22] provided the most convincing claims due to a more robust study design

including a control group comparison. The paper by Perkins et al.[25] provided the

most convincing findings of the weight gain concern articles due to conducting pre

and post measures to assess weight concern. The oral health study findings cannot be

compared to similar research due to limited studies focusing on physical

appearance[27]. Overall, the quality of the articles was generally weak. The facial-

wrinkling studies seemed most promising compared to the oral and weight studies.

This may be due to facial-wrinkling interventions having a personalised impact on

individuals.

Limitations in study design and subsequent reporting were identified. Some of the

studies did not include randomised controlled methods illustrating potential sample

bias and hence limitations of investigating intervention effectiveness. A lack of

measure information such as examples of administered questions or source references

were not provided for some of the studies; therefore the reliability and validity of the

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findings are questioned. We were unable to combine statistical information from the

studies due to variation in outcome measures used in different studies. It is difficult to

recommend principles, specific methods and metrics for future studies due to various

reasons including a) different research objectives, b) different means of investigation

(qualitative/ quantitative) and c) financial reasons (time; sample size recruitment,

access of reliable measures). However, we suggest that future studies attempt to use

similar means of investigation (e.g. reliable measures) and report statistical

information (e.g. effect sizes) in order for future meta-analyses to be conducted.

Lack of consistency in the study environment may have affected the results of many

of the studies, particularly in relation to demand characteristics as it is uncertain

whether participants completed interventions and administered measures alone or in a

group setting. Drop-out rates illustrate an additional generalised limitation among the

studies. A particular problem in smoking research is the assumption that drop-outs are

individuals who have relapsed, whereas they may be effective quitters who have

simply stopped attending and this also suggests problems with Intention to Treat

(ITT) analyses often employed. A further general problem reflected in each study is

the lack of baseline measurement of satisfaction with, and importance of, physical

appearance. Certain individuals may be more susceptible to physical appearance

interventions compared to others who are more satisfied with, or less interested in,

their appearance.

There are a number of questions remaining that can be focused on in future research.

For instance there has not yet been any published qualitative research evaluating how

males experience appearance interventions. Also the majority of studies have not

assessed maintenance tools e.g. taking facial-wrinkling images home or attending

relapse sessions. Although some of the studies investigated nicotine replacement

15

therapies (NRT) we suggest that further studies need to determine whether or not

having NRT available has an impact on effectiveness of these kinds of interventions.

Future studies need to incorporate follow-up time points for the following reasons a)

to investigate whether or not appearance interventions motivate smokers to join a

smoking-cessation service, and b) to examine any short term and long term impacts.

Furthermore future research with other groups (adolescents, non-smokers, older

smokers) may provide informative recommendations in the future. Health orientated

services could provide funding for future research. Also collaboration between people

with complementary expertise is recommended to ensure studies are of high quality

e.g. health orientated services working with academic institutions. There is potential

for linking this work with mass media smoking cessation campaigns. For instance,

launching a shopping centre initiative where large numbers of individuals can be

accessed. Further ideas include having physical appearance information on internet

quit websites. Other ways of disseminating information could include using telephone

and text messaging methods. However a particular limitation of mass media

dissemination (e.g. television advertisements) is lack of personalised impact (the

potential reason why appearance interventions may work); mass media campaigns

need to find ways of personalising their promotion strategies to maximise impact.

In terms of future directions, practitioners will benefit from more high quality,

controlled studies with consistent outcome measures and rigorous methodologies.

Qualitative studies would also be useful. Interviews or focus groups would provide in-

depth information about intervention design and effectiveness. Taking into

consideration the reviewed studies’ designs, future appearance studies need to recruit

large sample sizes. In order to recruit large sample sizes research could be conducted

in collaboration with smoking-cessation services or educational institutes.

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To inform stop-smoking services, studies that address physical appearance related

concerns are long overdue. This review therefore provides a guide to future research

in this area. Additional well-designed studies are required to determine the

effectiveness of physical appearance interventions in terms of smoking attitudes,

intentions and behaviours.               

       

17

* Funding Statement: This research received no specific grant from any funding

agency in the public, commercial or not-for-profit sectors.

* Competing Interests Statement: I declare that I have read and understood the

declaration of interest policies. Regarding this review there was no declaration of

interests among the authors.

*Contributorship Statement: Keira Flett conducted the primary data collection and

first draft preparation. Professor Clark Carter provided statistical expertise. Professor

Grogan developed the review design and conception. Professor Davey assisted with

the analysis of studies. All authors contributed to the draft paper and helped devise the

final manuscript.

18

REFERENCES

1. American Lung Association. General smoking facts. 2010. Available from:

http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/general-

smoking-facts.html.. http://www.webcitation.org/5xmv493qS. [accessed 14

July 2010]. (Archived by Webcite at

http://www.webcitation.org/5xmvEQS51).

2. Grogan S. Body Image: Understanding Body Dissatisfaction in Men, Women

and Children (second edition). New York: Routledge. 2008:1-249.

3. Schneider KL, Spring B, Pagoto SL. Affective Benefits of Exercise While

Quitting Smoking: Influence of Smoking-Specific Weight Concern.

Psychology of Addictive Behaviours. 2007; 21: 255-260. DOI: 10.1037/0893-

164X.21.2.255.

4. Grogan S, Fry G, Gough B, Conner M. Smoking to Stay Thin or Giving up to

Save Face. Young Men and Women Talk about Appearance Concerns and

Smoking. British Journal of Health Psychology. 2009; 14: 175-186. DOI:

10.1348/135910708X327617.

5. Carr A, Ebbert J. Interventions for Tobacco Cessation in the Dental Setting.

Cochrane Database of Systematic Reviews. 2006; 1: 1-18. DOI:

10.1002/14651858.CD005084.pub2. 

6. Perkins KA, Levine MD, Marcus MD, Shiffman S. Addressing Women’s

Concerns about Weight Gain due to Smoking Cessation. Journal of Substance

Abuse Treatment. 1997; 14: 173-182. DOI: 10.1016/S0740-5472(96)00158-4.

7. Potter BK, Pederson LL, Chan SSH, Aubut JL, Koval JJ. Does a Relationship

exist between Body Weight, Concerns about Weight, and Smoking among

Adolescents? An Integration of the Literature with an Emphasis on Gender.

19

Nicotine and Tobacco Research. 2004; 6: 397-425. DOI:

10.1080/14622200410001696529.  

8. Aubin H, Berlin I, Smadja E & West R. Factors Associated with Higher Body

Mass Index, Weight Concern, and Weight Gain in a Multinational Cohort

Study of Smokers Intending to Quit. International Journal of Environmental

Research and Public Health. 2009; 6: 943-957. DOI: 10.3390/ijerph6030943.

9. Jonsdottir D, Jonsdottir H. Does Physical Exercise in Addition to a

Multicomponent Smoking Cessation Program Increase Abstinence Rate and

Suppress Weight Gain? An Intervention Study. Scandinavian Journal of

Caring Sciences. 2001; 15: 275-282. DOI: 10.1046/j.1471-6712.2001.00039.x.

10. French SA, Jeffrey RW. Weight Concerns and Smoking: A Literature Review.

Annals of Behavioral Medicine. 1995; 17: 234-244. DOI:

10.1007/BF02903918.

11. Levine MD, Marcus MD, Perkins KA. Concerns about Weight Gain

Following Smoking Cessation. Cognitive and Behavioural Practice. 2003; 10:

105-111. DOI: 10.1016/S107729(03)80018-4.

12. Gordon JS, Andrews JA, Lichtenstein E, Severson HH, Akers L.

Disseminating a Smokeless Tobacco Cessation Intervention Model to Dental

Hygienists: A Randomized Comparison of Personalized Instruction and Self-

Study Methods. Health Psychology. 2005; 24: 447-455. DOI: 10.1037/0278-

6133.24.5.447.

13. Alkhatib MN, Holt RD, Bedi, R. Smoking and Tooth Discolouration: Findings

from a National Cross-Sectional Study. BioMed Central Public Health. 2005;

5: 1-4. DOI: 10.1186/1471-2458-5-27.

20

14. Afifah RM, Schwartz E. Patient Demand for Smoking Cessation Advice in

Dentist Offices after Introduction of Graphic Health Warnings in Australia.

Australian Dental Journal. 2008; 53: 208-216. DOI: 10.1111/j.1834-

7819.2008.00051.x.

15. Thomas BH, Ciliska D, Dobbins M, Micucci S. A Process for Systematically

Reviewing the Literature: Providing the Research Evidence for Public Health

Nursing Interventions. Worldviews on Evidence-Based Nursing. 2004; 1: 176-

184. DOI: 10.1111/j.1524-475X.2004.04006.x.

16. Walsh D, Downe S. Appraising the Quality of Qualitative Research.

Midwifery. 2006; 22: 108-19. DOI: 10.1016/j.midw.2005.004.

17. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred

Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA

Statement. PLoS Med. 2009; 6: e1000097.

DOI:10.1371/journal.pmed1000097.

18. Semer N, Ellison J, Mansell C, Hoika L, MacDougal W, Gansky S, Walsh M.

Development and Evaluation of a Tobacco Cessation Motivational Program

for Adolescents based on Physical Attractiveness and Oral Health. Journal of

Dental Hygiene. 2005; 79: 9.

http://findarticles.com/p/articles/mi_hb6368/is_4_79/ai_n29239239/

19. Pirie PL, McBride CM, Hellerstedt W, Jeffrey RW, Hatsukami D, Allen S,

Lando H. Smoking Cessation in Women Concerned about Weight. American

Journal of Public Health. 1992; 82: 1238-1244. DOI:

10.2105/AJPH.82.9.1238.

20. Weiss C, Hanebuth D, Coda P, Dravta J, Heintz M, Stutz EZ. Aging Images as

a Motivational Trigger for Smoking Cessation in Young Women. International

21

Journal of Environmental Research and Public Health. 2001; 7: 3499-3512.

DOI: 10.3390/ijerph7093499. DOI: 10.3390/ijerph7093499.

21. Grogan S, Flett K, Clark-Carter D, Conner M. Brief Report: A Randomised

Controlled Trial of an Appearance-Related Smoking Intervention. Health

Psychology. 2011; In Press. DOI: 10.1037/a0024745.

22. Burford O, Smith M, Carter O. Photoageing Intervention (PAINT): A

Proposal for a Randomised Controlled Trial in Australian Primary Care.

Australasian Medical Journal. 2009; 7: 8-12. DOI: 10.4066/AMJ.2009.108.

23. Hysert P, Rivard C, Hyland A. At Face Value: A Survey of Self Image and

Health Behaviour. 2008: Summary Data.

24. Hysert PE, Mirand AL, Giovino GA, Cummings KM, Kuo CL. “At Face

Value”: Age Progression Software provides Personalised Demonstration of the

Effects of Smoking on Appearance (Letter). Tobacco Control. 2003; 12:

238. DOI: 10.1136/tc.12.2.238.

25. Perkins KA, Marcus MD, Levine MD, D'Amico D, Miller A, Broge M,

Ashcom J. Cognitive Behavioural Therapy to Reduce Weight Concerns

Improves Smoking Cessation Outcome in Weight-Concerned Women. Journal

of Consulting and Clinical Psychology. 2001; 69: 604-613. DOI:

10.1037/0022-006X.69.4.604.  

26. Copeland AL, Martin PD, Geiselman PJ, Rash CJ, Kendzor DE. Smoking

Cessation for Weight-Concerned Women: Group vs. Individually Tailored,

Dietary, and Weight-Control Follow-Up Sessions. Addictive Behaviors. 2006;

31: 115-127. DOI: 10.1016/j.addbeh.2005.04.020.

22

27. Kentala J, Utriainen P, Pahkala K, Mattila K. Can Brief Intervention through

Dental Care have an Effect on Adolescent Smoking? Preventive Medicine.

1999; 29: 107-111. DOI: 10.1006/pmed.1999.0512.

28. Grogan S, Flett K, Clark-Carter D, Gough B, Davey R, Richardson D,

Rajaratnam G. Women Smokers’ Experiences of an Age-Appearance Anti-

Smoking Intervention: A Qualitative Study. British Journal of Health

Psychology. 2010; 14: 175-186. DOI:10.1348/2044-8287.002006.

29. Mirand A, Hysert PE, Donohue K. Statistical Summary of Hysert’s 2003

Study March 1 2004. 2004; Summary Data.

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