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EFFECT OF EVALUATIVE CONDITIONING ON ATTITUDES OF SMOKERS TOWARDS SMOKING BEHAVIOUR: THE MODERATING ROLE OF SELF-EFFICACY

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CHAPTER ONE

Introduction

Any behaviour that affects human health directly or indirectly attracts the attention of people, government, and even the society at large. Among these behaviours is cigarette smoking behaviour. Smoking behaviour is a practice of taking tobacco substance which is absorbed into the blood stream and harm virtually all parts of the body. This substance is inform of dried leaves of the tobacco plant which have been rolled into a small square of rice paper to create a small round cylinder called a cigarette. Medical dictionary defined smoking as the inhalation of the smoke of burning tobacco encased in cigarettes, pipes, and cigars. Historically, smoking has been as old as 5000 BC when it was practiced in ancient civilization cities such as the Babylonians, Indians and Chinese, where it was burnt as incense during Shamans rituals and was later adopted for pleasure (Robicsek, 1978).  In shamanistic rituals, smoking of tobacco or other various hallucinogenic drugs were used to trances and to come into contact with the spirit world. This burning of incense is still in practice in Catholic and Orthodox Christian churches.

However, there are serious changes in smoking behaviour prevalence since the mid-1990s. For instance, smokers worldwide have increased from 721 million in 1980 to 967 in 2012 and the number of cigarettes consumed have also increased from 4.96trillion to 6.25 trillion (Marie, 2014). Moreover, the prevalence of cigarette smoking among Nigerians is unstable. For instance, Odey, Okokon, Ogbeche, Godwin, and Emmanuel (2012) reported a prevalence rate of 6.4% among adolescents in Calabar, Southeastern Nigeria and 5.7% in Ilorin, North Central Nigeria. Smoking prevalence rates ranging 4.7% in Ibadan (Southwest Nigeria) to 16.7% in Kano (Northeast Nigeria) among respondents aged between 13 to 15 years was reported (Ekanem, 2008). Salawu, Damburam, Desalu, Olokoba, Agbo, and Midala (2009) reported a prevalence rate of 33.9% in Northeast Nigeria, and Obot (1990) reported a prevalence rate of 22.6% in a sample of 1,271 Nigerians. In 2012, smoking prevalence among men was higher than for women in all countries except Sweden, but prevalence for women was above 25% in Austria, Chile, and France and higher than 30% in Greece, among the highest percentages in the world (Global smoking prevalence, 2012). Smoking prevalence among males and females in Nigeria was 10% between 2012 and 2014, and this percentage is compared to be lower in other West African countries like Burkina Faso at 22% (Gats, 2012).

On perception of smokers in Nigeria, a recent survey conducted by the United State for Disease Control (2001), Cross River in Nigeria found that 28% of young people surveyed think that girls who smoke have more friends; while 45% of them have it that the boys who smoke have more friends. Also, 17% think that boys who smoke and 16% think that girls who smoke look more attractive. In the same vein, Odigwe (2003) observed that in Nigeria, cigarette smoking is seen by young people as something exciting and desirable.

Despite the warnings printed on each pack of cigarette, many people still smoke. A 2007 report by Robert and Shiffman have it that each year, 4.9 million people worldwide die as a result of smoking. About 435000 deaths annually in the United State are related to smoking (Mokdad, Marks, Stoup, & Gerberding, 2004). Cigarette smoking behaviour harms every organ of the body; reduces the health of smokers; and can cause cancer almost anywhere in the body like in: bladder, cervix, colon, and rectum, esophagus, kidney and ureter, larynx, liver, oropharynx, pancrease, stomach, trachea, bronchus and even lungs (U.S. Department of health and human services, 2014, 2010). More women die from lung cancer each year than from breast cancer (U.S. Department of health and human services, 2014). About 80% of all deaths from chronic obstructive pulmonary disease (COPD) are caused by smoking and smokers are more likely than non-smokers to develop heart disease, stroke, and blood vessels-cardiovascular disease (U.S. Department of health and human services, 2014, 2010). Smoking behaviour affects the health of teeth and gums and can cause tooth loss; increases the risk for cataracts and a type of diabetes-mellitus, making it harder to control and decreases immune function (U.S. Department of health and human services, 2014). It hampers woman conception, affects her baby’s health before and after birth and also increases risk for early delivery stillbirth, orofacial clefts in infants, low birth weight, sudden infant death syndrome, ectopic pregnancy, and low birth weight (U.S. Department of health and human services, 2001, 2010, 2014). It affects men’s sperm, which can reduce fertility and also increase risk for birth defects and miscarriage (U.S. Department of health and human services, 2014). On the other hand, the negative implication on secondhand smokers may be more powerful than many nonsmokers. Thus, spending just one hour in a smoky environment is the equivalent of actually smoking four sticks cigarette (Roizen, 2004).

Several agencies and government have put some outstanding measures towards curbing smoking behaviour among Nigerians. Thus, the national tobacco control bill was presented in 2009 at Abuja National Assembly. This bill regulates all forms of cigarette manufacturing, advertizing, distribution, consumption of tobacco products and smoking in public places in Nigeria such as restaurants, public transports, schools, hospitals and other social gatherings. This bill also prohibits the sale of cigarette to persons under 18. Also, smoking in public places is punishable by a fine of not less than N200 and not exceeding N1000 or to imprisonment to a term of not less than one month and not exceeding two years or both a fine and imprisonment (Smoking in Nigeria, 2008). The anti-tobacco communities are at the forefront of ensuring smoke-free public places.

Moreover, smoking behaviour is an attitude. People acquire smoking behaviour the same way they learn other attitudes. Thus, according to  Allport (1935), attitude is an expression of favour or disfavour toward a person, place, thing, or event. It is disposition of behaviour in a certain way. The vital issue behind attitude concept is the notion that attitudes in some way guide, influence, direct, shape, or predict actual behaviour (Ajzen & Fishbein, 1974; Kraus, 1995). Theories of classical conditioning, instrumental conditioning and social learning contributed a lot in the process of attitude formation. According to Fazio and Olso (2003), attitudes are formed through three components: affect, cognition and behaviour.

Cognitive component: The cognitive components of attitudes refer to the beliefs, thoughts, and attributes that we would associate with an object. People’s mental processes towards smoking determine whether they are going to smoke.

Affective component: The affective components of attitudes refer to person’s feelings or emotions linked to an attitude object. This implies that the way one feels towards the smokers and even smoking will help the person to develop an attitude towards smoking.

Behavioural component: The behavioural components of attitudes refer to past behaviours or experiences regarding an attitude object. Smoking behaviour can also be initiated as a result of past experience.

Smoking is a behaviour we acquired just like other attitudes. This implies that we learn the Attitude Towards Smoking Behaviour (ATSB) the same way we learn other behaviours. Social learning theory of Bandura (1977) has it that we learn by simply imitating a model. Many smokers acquired their attitude either from peers or guardian. Proximity of cigarettes and having a sibling who smokes are vital factors that increase the probability of children developing into regular smoking behaviour (Snell, 2005). Attitude influences unhealthy behaviours, like smoking (Ajzen, 2001). Studies using self-report measures revealed that smokers’ general attitude toward smoking is negative rather than positive (Chassin, Presson, Sherman, & Edward, 1991; Swanson, Rudman & Greenwald, 2001). This suggests that factors other than general attitudes are also behind smoking behaviour. It could be that smokers are in fact characterized by a positive attitude toward smoking, but are unwilling to reveal this. Swanson, Rudman, and Greenwald (2001) also found implicit attitude of smokers toward smoking to be more positive than to nonsmokers. Attitude toward smoking differ with socio-demographic characteristics as smokers are more tolerant than nonsmokers (Ross & Perez, 1998). Environment also influences people’s attitude towards any behaviour (Dols, Van den Hout, Kindt, & Willems, 2002). As such, it has been shown that participants who were deprived of nicotine and exposed to smoking cue generated more positive characteristics of smoking than smokers (Sayette & Hufford, 1997).

Attitude Towards Behaviour Change (ATBC) deals with the relationship between attitude and behaviour change. Attitude change is a necessary instrument for behaviour change (Bettinghaus, 1986; Ajzen & Fishbein, 1980). Perhaps, it is possible that behaviour change like stopping or starting smoking has an influence on attitude (McBroom & Reed, 1992). Attitude-behaviour relationship researches have been carried out within the framework of the theory of reasoned action (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975). In their findings, Krosnick, Judd, and Wittenbrink (2005) posited that the pivot issue that occupies a central position in the study of behaviour change is the concept of attitude. Petty, Wegener, and Fabrigar (1997) reported that a numerous material was produced concerning attitude structure, attitude change, and the consequences of holding attitude. According to this researcher however, positive attitudes exposes us to happiness and joy than negative attitudes. Since our attitudes are the driving forces in our lives, it can be either push us up or pull us down. Thus, moving from positive attitude to negative one like smoking will pull us down and expose us to dangerous health conditions like cancer and cardiovascular diseases.

Self-identity Towards Behaviour Change (STBC) has been shown to be an important factor in changing behaviour, like smoking. Self-identity is the interpretation of a person about self. People think of themselves in terms of social roles, example, parent, employee, and self -identity reflects the values and behaviours that are associated with these roles which are more self-defining than others (Stets, 2006). Thus, the more central a certain role is to someone’s self-identity, the more likely that the behaviours associated with this role will be performed. Similarly, Hogg (2006) social identity theory describes self-identity in terms of the social groups that someone belongs to. Charng, Piliavin, and Callero (1988) posit that the more often people perform a certain behaviour, the more this behaviour becomes part of their self-identity. Few studies have found direct effects of self-dentity on behaviour change (Hamilton & White, 2008; Jackson, Smith, & Conner, 2003). In contrary to this, most researchers have not found direct effects on behaviour (Charng, Piliavi, & Callero, 1988; Smith, Terry, Manstead, Louis, Kotterman, & Wolfs, 2007).

Changing smoking behaviour also depends on one’s Perceived Control Over Behaviour (PCOB). PCOB denotes an individual’s perceived ease or difficulty in performing a particular behaviour (Ajzen, 1991). Perceived behavioural control is determined by the total set of accessible control belief about the presence of factors that may facilitate or hamper performance of the behaviour (Ajzen, 2001). Perceived behavioural control is conceptually related to self-efficacy. Perhaps, the component of perceived behavioural control in the theory of planned behaviour reflects a person’s self-confidence in the ability to conduct the behaviour (Ajzen, 1991). If a person has enough knowledge, she or he will have higher confidence in the ability to carry on the consumption behaviour and his or her attitude toward the act already shows this confidence which implies that the person has volitional control over his or her behaviour. To back it up, Fishbein and Ajzen (1975) opined that the behaviour under consideration must be under volitional control. This connotes that behaviour may be said to be completely under a person’s control if the person can decide at will to perform it or not. However, the extent to which a smoker believes he can control his smoking behaviour is known as perceived control over smoking behaviour.

Intention Towards Behaviour Change (ITBC) is also important to changing behaviour especially smoking behaviour. It is an indication of an individual’s readiness to perform a given behaviour which is an antecedent of such behaviour (Ajzen, 2002). Behaviour is an individual’s response in a given situation. According to Ajzen and Fishbein (1980), intention to perform a particular behaviour is the highest determinant of that behaviour and intention in turn, depends on both an individual’s attitude toward the behaviour. In the case of smoking however, people will have strong intentions to smoke if they view smoking favourably and believe that others who are important to them think that they should smoke. As such, attitude depends upon the intention, population and the individual in question (Sutton, 1989). Ajzen (1985) gave credit to the fact that the formation of intentions to act may also be influenced by aspects that are not under a person’s volitional control.  Considering that intention to perform a particular behaviour is the single best determinant of that behaviour, anybody that engages his self into smoking must have conceived the intention to do so. Nevertheless, because attitudes can influence behaviour (Ajzen, 1991), attitude change may encourage healthy choices of behaviour through vital mechanisms like evaluative conditioning.

Evaluative Conditioning (EC) is a process of attitude formation of like or dislike by pairing condition stimulus with unconditioned stimulus (De Houwer, 2007). This denotes that EC is obtained when a stimulus (conditioned stimulus-CS) acquires the valence of a valenced stimulus (unconditioned stimulus-US) after being paired with it. Thus, evaluative conditioning involves transfer of the valence associated with the unconditioned stimulus (US) to the conditioned stimulus (CS). It is likely achieved through a single pairing order than several pairing in classical condition. EC is of interest to practitioners concerned with modifying attitudes in the social (Walther, Nagengast & Trasselli, 2005), political (Razran, 1954), consumer (Stuart, Shimp, & Engle, 1987), and clinical domains (Eifert, Crail, Carey, & O’ Connor, 1988). Theoretically, EC is often regarded as an automatic affective learning process (Walther, 2002).

Furthermore, basic procedures for demonstrating Evaluative conditioning are:

  1. The neutral stimulus (CS) is paired with an affective stimulus (US). This means presenting the CS first and then the US, with the CS continuing to be present until the US occurs. The interval between the CS and US is called CS-US interval. CS-US interval works best on the order of 5 to 10 seconds.
  2. Changes in the valence of the neutral stimulus are measured. This could be done using some statistical tools.

However, Evaluative conditioning is similar, but not identical to classical or Pavlovian conditioning. It is worthy to note that what distinguishes EC procedure from classical conditioning procedures is that changes of evaluative reaction are examined (Olson & Fazio, 2001). In classical conditioning of Pavlov, the sound of a bell (conditioned stimulus) might often precede the presentation of food (unconditioned stimulus) that elicits salivation (conditioned response). Presenting the bell alone after sometime will elicit the same response. But in EC, the evaluation of attitudes towards the sound of a bell will likely remain unchanged.

Evaluative conditioning has two major characteristics.

Firstly, there is contingency awareness between conditioned stimulus and unconditioned stimulus pairing. This is the extent to which individuals are aware of the conditioned stimulus and unconditioned stimulus pairing and whether such awareness is necessary for EC to occur (De Houwer, Thomas & Baeyens, 2001; Field, 2002). Supporting this issue, researchers posited that EC does not occur without awareness (Pleyers, Corneille, Luminent, & Yzerbyt, 2007; Pleyers, Corneille, Yzerbyt, & Luminent, 2009). In contrary, some researchers also posit that EC is obtained without participants’ awareness of the CS-US contingencies (Baeyens, Eelen, & Van den Bergh, 1990; Olson & Fazio, 2002), and also that contingency awareness is unrelated to the extent to which EC is observed (Baeyens, Eelen, & Van den Bergh, 1990; Baeyens, Hermans, & Eelen, 1993).

Secondly, EC can be resistant to extinction compared with Pavlovian Conditioning (PC). In PC, CS extinguishes if the CS repeatedly presents without the US which decreases the signal value of the CS. But in EC, CS does not depend on signal value instead, on positive or negative values previously associated with US.  This is the reason why EC has a serious resistance to extinction.

In several studies, Evaluative conditioning has been associated with the development of food likes and dislikes. Humans develop a dislike for foods that are followed by negative consequences such as nausea, rashes, diarrhea, and breathing problems (Pelchat & Rozin, 1982). Also, taste aversions are derived from various situations, such as food poisoning, allergic reaction, over consumption and some medical treatments using EC (Batsell & Brown, 1998). Change in food likes has been shown with flavour-flavour pairings in EC. That is by pairing of a neutral flavour (condition stimulus) with a liked or disliked flavour (unconditioned stimulus) that can result in a change in liking of the CS flavour. Flavour-flavour conditioning appears to be an effective tool for increasing liking for isolated tastes and specific foods (Eertmans, Baeyens, & Van den Bergh, 2001).

Nevertheless, the same way evaluative conditioning influences attitude, some other mechanisms like people’s self-efficacy will also have impact on it. Thus, self-efficacy is the belief in one’s ability to complete a given tasks (Ormrod, 2006).  As an example, one’s self-efficacy will determine whether he or she will smoke in the next two hour. Ormrod posits that high or low self-efficacy determines whether or not someone will choose to take on a challenging task. Self-efficacy affects every area of human endeavour. Bandura (1977) identifies four factors affecting self-efficacy which include: Experience, modeling, social persuasion and physiological factors like stressful situations. Self-efficacy has significant effect on human behaviour. For instance, people generally avoid tasks when their self-efficacy is low, but undertake tasks where self-efficacy is high. Self-efficacy has several effects on thought patterns and responses. Low self-efficacy can lead people to think of a task to be harder than they actually are (Bandura, 1977). It also motivates  human behaviour in both positive and negative ways. Thus, the higher the person’s self-efficacy, the more active his efforts becomes. But those with low self-efficacy sometimes experience incentive to learn more about an unfamiliar subject. When self-efficacy exceeds one’s ability, extra ability is required to complete tasks. But when self-efficacy is lower than one’s ability, it hampers skill development (Bandura, 1977). Research shows that when the optimum level of self-efficacy is slightly above ability, people are encouraged to tackle challenging tasks and gain experience (Csikszentmihalyi, 1997). Health related choices, such as smoking, visiting of hospital, physical exercise, dieting, condom use, dental hygiene, seat belt uses, and breast self-examination are dependent on self-efficacy (Conner & Norman, 2005). This implies that our self-efficacy beliefs are cognitions that determine whether health behaviour change will be initiated.

Self-efficacy predicts behavioural intentions and can help prevent relapse to unhealthy behaviours (Schwarzer, 2008).  In line with this, it will likely moderate the relationship between EC and smoking behaviour, which is an unhealthy behaviour.

Statement of the Problem

Smoking remains a significant public health problem, and without mapping out adequate preventive measures, death will continue to increase (Lenhard, 1996). Smoking has therefore been studied more extensively than any other form of consumption. It is generally five times higher among men than women (Guindon & Boisclair, 2003). Nonetheless, smoking has some outstanding consequences to both the active and non-active smokers. Thus, cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. Smoking is the leading preventable cause of death globally (U.S. Department of health and human services, 2010, 2014). It causes several illnesses ranging from; stroke, cancer, orofacial cleft, chronic obstructive pulmonary diseases, cardiovascular diseases, stillbirth, and even lower sperm count in men among others. Considering these ugly menaces of smoking behaviour, the problems this study specifically intended to address include:

  1. Would EC affect attitude towards smoking behaviour after controlling for baseline scores, with those in the EC group having a more negative attitude toward smoking than the control condition?
  2. Would EC affect attitude towards behaviour change after controlling for baseline scores, with those in the EC group having a more positive attitude toward behaviour change than the control?
  • Would EC affect self-identity towards behaviour change after controlling for baseline scores, with those in the EC group having a more positive self-identity towards behaviour change than the control?
  1. Would EC affect perceived control over behaviour after controlling for baseline scores, with those in the EC group having a more positive perceived control over behaviour than the control?
  2. Would EC affect intention towards behaviour change after controlling for baseline score, with those in the EC group having a more positive intention towards behaviour change than the control?
  3. Would participants in the EC group will choose not to smoke than those in the control condition?
  • Would self-efficacy will moderate the relationship between EC and smoking behaviour?

Purpose of the Study

The major aim of this study is to investigate the effect of Evaluative Conditioning (EC) and self-efficacy on attitudes of smokers. Prevalence of cigarette smoking and its tremendous health consequences triggered the researcher to embark on this study. The specific purposes of this study are outlined as follows:

  1. To investigate whether EC will affect attitude towards smoking behaviour after controlling for baseline scores, with those in the EC group having a more negative attitude toward smoking than the control condition.
  2. To investigate whether EC will affect attitude towards behaviour change after controlling for baseline scores, with those in the EC group having a more positive attitude toward behaviour change than the control.
  • To observer whether EC will affect self-identity towards behaviour change after controlling for baseline scores, with those in the EC group having a more positive self-identity towards behaviour change than the control.
  1. To investigate whether EC will affect perceived control over behaviour after controlling for baseline scores, with those in the EC group having a more positive perceived control over behaviour than the control.
  2. To investigate whether EC will affect intention towards behaviour change after controlling for baseline scores, with those in the EC group having a more positive intention towards behaviour change than the control.
  3. To ascertain whether participants in the EC group will choose not to smoke than those in the control condition.
  • To observe whether Self-efficacy will moderate the relationship between EC and smoking behaviour.

Operational Definition of Terms

Smoking Behaviour

Smoking behaviour refers to the practice of inhaling tobacco substance which absorbed into the blood stream and harm virtually all parts of the body. It is also choosing to smoke and not choosing to.

Attitude

Attitude is defined as disposition of behaviour in a particular behaviour.

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