Exploring the association of number of cigarettes smoked and confidence to quit smoking in Korean American emerging adults: a multilevel modeling approach

Social cognitive theory and the behavioral theory have been used to explain the relationship between self-efficacy for abstaining from smoking and smoking behavior change. Social cognitive theory suggests increased perceived self-efficacy for abstaining from smoking leads to smoking reduction; in contrast, the behavioral theory suggests it is the decrease in smoking behavior that leads to an increase in perceived self-efficacy. The purpose of this study was to test these two competing theories in Korean American emerging adults (KAEA) (18 through 25 years of age) smokers. Data were obtained from a 7 day mobile Ecological Momentary Assessment (EMA) of situational and social contexts associated with smoking behaviors of KAEA smokers through electronic surveys on their own smartphones. Daily measures were collected for 7 days from 78 participants for a total of 546 observations. Two multilevel models were conducted to assess the bidirectional association between self-confidence to quit and number of cigarettes smoked per day. The first model was used to evaluate whether daily number of cigarettes was a predictor of the level of confidence to quit smoking the next day. The second model was used to evaluate whether daily confidence to quit was a predictor of next day’s number of cigarettes smoked. The main predictors, self-confidence to quit and number of cigarettes smoked, were disaggregated into within person effects and between person effects. Results from the first model demonstrated that smoking more than one’s usual self that day (within-person) was associated with lower levels of confidence to quit cigarettes, but this relationship was not statistically significant (est=−0.04, p=0.18). However, being a heavier smoker than average (between-person) was significantly associated with lower levels of confidence to quit smoking (est=−.03, p=0.02). Results from the second model showed having higher confidence to quit smoking than one’s usual confidence level (within-person) was not significantly associated with next day’s number of cigarettes smoked (p=0.95), but being a smoker with higher confidence to quit than the average (between-person) was significantly related to lower numbers of number of cigarettes smoked the next day (est=−0.19, p=0.04). These findings are helpful in understanding the KAEA smoking behavior, but more work needs to be done to understand how one’s self confidence to quit smoking and smoking frequency affect the behavior of KAEA smokers.