Self-motivation for smoking cessation among teenagers: Preliminary development of a scale for...

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Personality and Individual Differences 39 (2005) 895–902

Self-motivation for smoking cessation among teenagers:Preliminary development of a scale for assessment of

controlled and autonomous regulation

Stephen Joseph a,*, Gill Grimshaw b, Naumana Amjad b, Alan Stanton c

a Department of Psychology, University of Warwick, Coventry CV4 7AL, UKb Warwick Medical School, Medical Teaching Centre, University of Warwick, Coventry CV4 7AL, UK

c Solihull PCT, Solihull, B91 3EF, UK

Received 14 April 2004; received in revised form 1 February 2005; accepted 22 February 2005

Available online 4 June 2005

Abstract

Two studies are reported in which the aim was to develop a short self-report scale to assess Motivation

for Smoking Cessation in Teenagers (MSCT). An initial pool of 29 items was developed from previous

work and through interviews with 50 teenagers in an attempt to assess the constructs of autonomousand controlled regulation. Using responses from a further 198 teenagers, Principal Component Analysis

provided evidence for a two component structure, reflecting autonomous and controlled regulation. On

the basis of these results, 12 items were selected on the basis of their component loadings in order to com-

pose the final revised scale.

� 2005 Elsevier Ltd. All rights reserved.

Keywords: Smoking cessation; Intrinsic motivation; Self-determination; Autonomous regulation

0191-8869/$ - see front matter � 2005 Elsevier Ltd. All rights reserved.

doi:10.1016/j.paid.2005.02.027

* Corresponding author. Tel.: +44 2476 522590; fax: +44 2476 524225.

E-mail address: [email protected] (S. Joseph).

mailto:[email protected]

896 S. Joseph et al. / Personality and Individual Differences 39 (2005) 895–902

1. Introduction

Adolescent and teenage smoking is an important area of concern because smokers at this ageare likely to become adults with long term smoking behaviours resistant to attempts at cessation(e.g., Chassin, Presson, Pitts, & Sherman, 2000; Janson, 1999; Khudar, Dayal, & Mutgi, 1999).Consequently, targeting adolescents and teenagers for smoking cessation programs before theybecome habitual smokers is important (Rose, Chassin, Presson, & Sherman, 1996; Williamset al., 2002). Cessation programs among youth have, however, reported only limited success withlow participation and high drop out rates (e.g., Burt & Peterson, 1998; Stanton, Lowe, & Gilles-pie, 1996).Evidence suggests that interventions for smoking cessation are most effective when harnessing

intrinsic rather than extrinsic motivations (Curry, Grothaus, & McBride, 1997; Curry, Wagner, &Grothaus, 1990, 1991). The role of intrinsic motivation in various health behaviours has beeninvestigated in the context of Self-Determination Theory (SDT; Deci & Ryan, 1985, 1996).SDT suggests that intrinsically motivated and autonomous behaviours are inherently fulfillingand rewarding for a person and therefore increase the likelihood of behaviour change (Deci,Eghrari, Patrick, & Leone, 1994; Vallerand & Bissonette, 1992).Despite the evidence for the role of autonomous motivation, studies have not specifically

focused on adolescent and teenage motivations. The adolescent and teenage years are character-ized by the developing need for personal freedom and autonomy. Smoking may be experienced asrepresenting a sense of freedom and autonomy.In other studies motivation/autonomous regulation has been assessed with the Treatment Self-

Regulation Questionnaire (TSRQ) which is based on the work of (Ryan & Connell, 1989). As thegeneral constructs of autonomous versus controlled motivation are applicable in many contexts,the specific phrasing, number of items, question stems and format of TSRQ has been revisedby researchers according to the nature of investigation and context of behaviour studied.Only one study, however, reports using the TSRQ with adolescents (Williams, Cox, Kouides,& Deci, 1999). The aim of this study was to develop a version suitable for adolescents andteenagers.

2. Study 1: Development of the initial item pool

The aim of this study was to pilot items with adolescents and teenagers in the UK. A qualitativestudy was carried out to generate a pool of items grounded in the language and conceptual worldof teenage smokers. The purpose was to establish accessibility and comprehension of items for thisage group. At the time of the study Solihull Primary Care Trust was expressing concern about thenumber of young smokers.

2.1. Method

Fifty teenagers (20 girls, 30 boys) participated. They were all students from two colleges (25from each college) in Solihull, England, between the age range of 16–19 (M = 17.48,SD = 1.18). Consent to undertake a pilot survey was obtained from College authorities and the

S. Joseph et al. / Personality and Individual Differences 39 (2005) 895–902 897

students were recruited through the student services at one college and through a youth worker ofthe college at the other college. Interviews were carried out on college premises on two differentoccasions. Participation was voluntary and consent from individual participants was obtainedprior to data collection. Participants were asked to confirm their smoking status, initiation age,and duration of smoking. All the participants stated that they had been smoking for two yearsand smoked a minimum of five cigarettes a day.The original Treatment Self-Regulation Questionnaire has 15 items and three sub-scales. It pre-

sents the question in the form of a statement ‘‘The reasons I would not smoke is because. . .’’ andthen asks the respondents to rate each reason on a seven point scale from not at all true (1) to verytrue (7). Autonomous regulation is measured through 6 items, controlled regulation is measuredthrough 6 items and amotivation is measured through 3 items. Not all studies have used amoti-vation items and the three-factor structure of this 15 items scale has not always been demon-strated. Examples of autonomous regulation items are, ‘‘It is a really important choice I wantto make on my own’’, and ‘‘I want to take responsibility for my health’’. Examples of controlledregulation items are, ‘‘I feel pressure from others not to smoke’’, and, ‘‘I feel guilty or ashamed ofmyself when I smoke’’. Examples of amotivation items are, ‘‘It is easier to do what I am told thanthink about it’’, and, ‘‘I really don�t know why’’. For the purpose of the present study the anchorstatement to the items was changed because the study aimed to test young smokers regardless oftheir intention to quit. The statement was replaced with ‘‘The reason I might consider stoppingsmoking is because. . .’’. All of the students were asked to complete the original treatmentSelf-Regulation Questionnaire and then asked to give feedback about any items they foundunclear.To generate new items, interviews as well as group discussions with young persons were con-

ducted with 20, randomly selected, participants. Twelve (7 boys, 5 girls) of these were interviewedindividually and six (4 boys, 2 girls) participated in a group discussion on the health day at thecollege. The questions that followed were: Do you ever consider stopping smoking? What makesyou think about stopping smoking? Further probing was carried out to access the autonomousand controlled dimensions of reasons the participants cited.

2.2. Results

The preliminary analysis of responses to the questionnaire revealed difficulty or ambiguityabout one item. Item 16 (i.e., smoking is not consistent with my life goals) was left blank by 6respondents and had a question mark on 4 returned questionnaires. In feedback, those respon-dents expressed that they were not sure what this item meant. Thus item 16 was deleted from fur-ther scale development.

2.3. Item generation

Responses from the qualitative component of the study were used to phrase new items. Theitems were grouped according to themes guided by theory. The dimension of some reasons/moti-vations was not clear but they were included within the extended questionnaire to test whetherthey formed part of any one component on Principal Components Analysis in Study 2. In total29 items composed the extended questionnaire (see Table 1).

Table 1

Varimax rotated component loadings

Smoking motivation item Component 1 Component 2

The reason I might consider stopping smoking is because. . .(1) It is an important choice I want to make on my own .62 �.14(2) I once decided to start smoking, now I decide to quit .61 .00

(3) I feel pressure from others not to smoke �.15 .50

(4) My best mate has stopped smoking .11 .21

(5) It will improve my stamina in sports .49 .00

(6) I have thought about it carefully and believe it is very

important for many aspects of my life

.77 .00

(7) . . . actually I really do not think about it �.48 .33

(8) Everyone is going on about how bad it is .00 .58

(9) I feel guilty or ashamed of myself when I smoke .13 .64

(10) I do not like the way it has become a habit and I have no control .64 .00

(11) I am expected to give it a try .00 .70

(12) I want to take responsibility for my health .75 .00

(13) I feel bad about myself when I smoke .59 .28

(14) It is easier to do what I am told than to think about it �.26 .74

(15) I want others to approve of me .00 .72

(16) I saw some program on what smoking does to lungs .52 .00

(17) . . . actually, I do not really know why �.45 .38

(18) I want others to see I can do it .18 .65

(19) Others can sometimes be upset with me because I smoke .12 .68

(20) I feel it is very important for my health .79 .00

(21) I want to prove to myself that I can do it .74 .00

(22) It would save money .30 .31

(23) It is not what I want for myself .66 .13

(24) It will make my parents happy .26 .58

(25) I do not want to carry on with it as a habit .81 .00

(26) It matters to me what others think of me .00 .64

(28) I personally believe giving up smoking will be the best for my health .80 .00

(29) It will be good to know I can give it up .80 .00

(30) I want to give it try although I am not sure why �.16 .56

Note: Item 27 was excluded as it was the same as item 16 repeated for checking attention to wordings.


3. Study 2: Psychometric properties of the scale

Having established our initial pool of 29 items through the qualitative component of Study 1 weproceeded to administer the extended questionnaire to a larger sample for psychometric analysis.The scale for the second study contained a total of 30 items because one item (i.e., item 16) wasrepeated (i.e., item 27) to provide us with a reliability test.

3.1. Method

The respondents were 198 teenagers (100 male and 98 females) in the age range from 16 to 19(M = 17.57, SD = 0.91) from two sixth form colleges. In terms of ethnic background, the ratio is


60% White, 25% Asian and 15% AfroCarribean, for the first college, and 45% Asian, 25% Afro-Carribean, and 30% White for the second college.The students were given the questionnaires in various settings to ensure that a range of social

groupings was selected. All completed the 30 item extended questionnaire developed in Study 1.

3.2. Results

The repeated item 16 and 27 correlated highly (r = .89) indicating that questions were answeredreliably. The repeat item was therefore excluded from further analysis.The principal component analysis was carried out on all remaining 29 items. Seven components

had eigenvalues above 1.00 (eigenvalues = 7.61, 5.04, 1.79, 1.43, 1.25, 1.13, 1.06) and together theyaccounted for 69% of variance. From the scree plot it was evident that there was a clear divide attwo factors, and so a two component forced solution was carried out (see Fig. 1). The items andtheir component loadings are shown in Table 1.Examination of the two components suggested to us that these are tapping internal regulation

on component 1 and external regulation on component 2. At this point we were concerned to re-duce the number of items to develop the final version of the scale. We wanted the scale to be asshort as possible and made the choice to select the highest loading six items on each component.Finally, in order to test that the two component structure was not affected by our selection ofitems we conducted a final Principal Components Analysis on these 12 items. The two componentstructure was clearly evident when the 12 items were subject to Principal components Analysis (seeTable 2).The resultant Cronbach�s alpha values are .91 for the 6-item autonomous regulation subscale

and .84 for the 6-item controlled regulation subscale.

Scree Plot

Component Number2927252321191715131197531

Eige

nval

ue

10

8

6

4

2

0

Fig. 1. Scree plot showing the principal components analysis of the 29 items.

Table 2

Component loadings >.50 for revised 12-item self-motivation scale

Component 1 Component 2

Autonomous regulation

(25) I do not want to carry on with it as a habit .81

(29) It will be good to know I can give it up .80

(28) I personally believe giving up smoking will be the best for my health .80

(20) I feel it is very important for my health .79

(6) I have thought carefully and believe it is very important

for many aspects of my life

.77

(12) I want to take responsibility for my health .75

Controlled regulation

(14) It is easier to do what I�m told than to think about it .74

(15) I want others to approve of me .72

(11) I am expected to give it a try .70

(19) Others can sometimes be upset with me because I smoke .68

(18) I want others to see I can do it .65

(9) I feel guilty or ashamed of myself when I smoke .64

Eigenvalues 7.61 5.04

Total variance explained = 43%


4. Conclusion

In conclusion, this study was carried out to develop a motivation for smoking cessation scalefor teenagers. The study provides further evidence for the constructs of autonomous versus con-trolled reasons for quitting smoking suggested by Self-Determination Theory. Further psycho-metric research is now required to validate the scale and to test whether it is able to predictsuccessful quitting.

Appendix A. Motivation for smoking cessation in teenagers (MSCT)

Below are some statements about your views on smoking. The purpose is to understand the rea-sons why you may consider stopping smoking. Your cooperation will be greatly appreciated.Each statement gives a choice from one to seven. You can show your degree of agreement by

circling numbers in between 1 and 7, where:

7 ¼ Agree completely6 ¼ Agree a lot5 ¼ Agree a little4 ¼ Neither disagree or agree3 ¼ Disagree a little2 ¼ Disagree a lot1 ¼ Disagree completely


I think about stopping smoking because. . .. . .

(1) I do not want to carry onwith it as a habit

1
2 3 4 5 6 7
(2) It will be good to know I can give it up
1 2 3 4 5 6 7 (3) I personally believe giving up smokingwill be the best for my health
1
2 3 4 5 6 7
(4) I feel it is very important for my health
1 2 3 4 5 6 7 (5) I have thought carefully and believe it isvery important for many aspects of my life
1
2 3 4 5 6 7
(6) I want to take responsibility for my health
1 2 3 4 5 6 7 (7) It is easier to do what I am toldthan to think about it
1
2 3 4 5 6 7
(8) I want others to approve of me
1 2 3 4 5 6 7 (9) I am expected to give it a try 1 2 3 4 5 6 7 (10) Others can sometimes be upset with me
because I smoke
1 2 3 4 5 6 7
(11) I want others to see I can do it
1 2 3 4 5 6 7 (12) I feel guilty or ashamed of
myself when I smoke
1 2 3 4 5 6 7
References

Burt, R. D., & Peterson, A. V. (1998). Smoking cessation among high school seniors. Preventive Medicine, 27, 319–327.

Chassin, L., Presson, C. C., Pitts, S. C., & Sherman, S. J. (2000). The natural history of cigarette smoking from

adolescence to adulthood in a midwestern community sample: multiple trajectories and their psychosocial correlates.

Health Psychology, 19, 223–231.

Curry, S., Grothaus, L. C., & McBride, C. (1997). Reasons for quitting smoking; Intrinsic and extrinsic motivation for

smoking cessation in a population-based sample of smokers. Addictive Behaviours, 22, 727–739.

Curry, S., Wagner, E. H., & Grothaus, L. C. (1990). Intrinsic and extrinsic motivation for smoking cessation. Journal of

Consulting and Clinical Psychology, 58, 310–316.

Curry, S., Wagner, E. H., & Grothaus, L. C. (1991). Evaluation of intrinsic and extrinsic motivation intervention with a

self-help smoking cessation program. Journal of Consulting Psychology, 59, 318–324.

Deci, E. L., Eghrari, H., Patrick, B. C., & Leone, D. R. (1994). Facilitating internalization: the self-determination

theory perspective. Journal of Personality, 62, 119–142.

Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum.

Deci, E. L., & Ryan, R. M. (1996). Promoting healthy behaviour. In Why we do what we do: Understanding self

motivation. New York: Penguin Books.

Janson, H. (1999). Longitudinal patterns of tobacco smoking from childhood to middle age. Addictive Behaviours, 24,

239–249.

Khudar, S. A., Dayal, H. H., & Mutgi, A. B. (1999). Age at smoking onset and its effect on smoking cessation. Addictive

Behaviours, 24, 673–677.

Rose, J. S., Chassin, L., Presson, C. C., & Sherman, S. J. (1996). Prospective predictors of quit attempts and smoking

cessation in young adults. Health Psychology, 15, 261–268.

Ryan, R. M., & Connell, J. P. (1989). Perceived locus of causality and internalisation: examining reasons for acting in

two domains. Journal of Personality and Social Psychology, 57, 749–761.


Stanton, W. R., Lowe, J. B., & Gillespie, A. M. (1996). Adolescents� experiences of smoking cessation. Drug dependenceand Alcohol dependence, 43, 63–70.

Vallerand, R. J., & Bissonette, R. (1992). Intrinsic, extrinsic and amotivational styles as predictors of behaviour: a

prospective study. Journal of Personality, 60, 601–620.

Williams, G. C., Cox, E. M., Kouides, R., & Deci, E. L. (1999). Presenting the facts about smoking to adolescents: the

effects of an autonomy-supportive style. Archives of Paediatrics and Adolescent Medicine, 153, 859–964.

Williams, G. C., Minicucci, D. S., Kouides, R. W., Levesque, C. S., Chirkov, V. I., Ryan, R. M., et al. (2002). Self-

determination, smoking, diet and health. Health Education Research, 17, 512–521.

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