Using self-affirmation to increase the effects of emotive health warnings on smoking: A randomised exploratory trial

Aims: This study tests whether enhancing a currently used emotive graphic smoking health warning with a self-affirmation component reduces cigarette consumption, and whether potential effects are stronger in heavier smokers, as suggested by previous research.

Methods: Participants (n = 265) were randomly allocated to a self-affirmation (reflecting on personal values and positive traits using a questionnaire) or matched control condition before viewing an emotive graphic health message from a current Australian government public health campaign. The primary outcome (cigarettes per day [CPD]) was assessed both before, and a week following, the intervention.

Results: No main effect of self-affirmation on smoking, but as hypothesised, a significant interaction between baseline smoking and self-affirmation was found that showed that heavier smokers (> 21 CPD) who self-affirmed significantly reduced CPD compared to non-affirmed smokers.

Conclusions: These findings support the use of self-affirmation to enhance smoking awareness campaigns in heavier smokers.

Implications: This study shows that enhancing emotive graphic smoking health messages with self-affirmation (the act of reflecting on positive aspects of oneself), increases their effectiveness in heavier smokers. This suggests that self-affirmation might be a particularly useful tool for health promotion targeting heavier smokers. This study adds to previous research in that it is the first to test the add-on effects of self-affirmation to current graphic health messages on smoking rather than smoking-related cognitions.