This chapter focuses on implicit attitudes toward smoking and provides the first systematic review of research in this domain. Implicit attitudes are suggested to guide automatic behavior, thereby playing a pivotal role for automatic processes inherent in addictive behaviors. This chapter further explores the extent to which implicit attitudes are context-sensitive. More specifically, it reviews studies that have focused on the differential effects of external cues such as warning labels and internal cues (e.g., deprivation). Results of 32 studies show that although smokers generally have more positive implicit attitudes than non-smokers, the valence of implicit attitudes varies as a result of the applied method or stimuli. Studies reveal that implicit attitudes toward smoking partly depend on external cues, especially outcome expectancies. Similarly, internal cues affect implicit attitudes whereby the level of nicotine deprivation seems vital. Implications for intervention and future research are indicated in the discussion.
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Smoking is one of the leading causes of preventable death (World Health Organization, 2011), whereby tobacco is responsible for about 10% adult deaths worldwide (OECD, 2012a). Smoking rates vary across countries, with at least 20% of the adult population smoking daily in 20 of the 27 EU member states (OECD, 2012a) and over 40% in Asian regions (OECD, 2012b). Smoking rates in the Pacific regions and the USA are slightly lower than in Europe with less than 20% of the adult population smoking daily (Centers for Disease Control and Prevention, 2012; OECD, 2012b).
Given the detrimental health effects of smoking as well as the continuously high prevalence rates, several studies have aimed to determine factors that influence substance use and addictive behaviors. Studies have indicated that the maintenance of smoking may partly be due to the fact that smokers do not know how to quit (Wiers & de Jong, 2006). Other studies have linked the maintenance of smoking with motivational factors related to positive outcome expectancies such as stress reduction or the reduction of withdrawal symptoms (Baker, Brandon, & Chassin, 2004), or suggested a causal effect of implicit attitudes (De Houwer, Custers, & De Clercq, 2006).
Over the last 15 years, implicit cognitions have received more and more attention in order to gain a deeper understanding of substance use and misuse (Wiers & Stacy, 2006). Implicit cognitions entail implicit attitudes, attentional bias, implicit arousal, and memory associations (Rooke, Hine, & Thorsteinsson, 2008). To this extent, Rooke and colleagues (2008) reported in their meta-analysis consistent findings of moderate associations between implicit cognitions and substance use. Implicit attitudes refer to immediate automatic affective reactions to stimuli (Fazio, 1990; Strack & Deutsch, 2004). They are defined as automatic evaluations of an attitude object (Gawronski & Bodenhausen, 2006) that are activated by the mere presence of the object (Fazio, 2007; Olson & Fazio, 2009). Implicit attitudes have been found to influence automatic behavior (Fazio, 2001) and therefore may play a pivotal role for the automatic components inherent in addictive behaviors (Tiffany, 1990; Wiers & de Jong, 2006). Implicit attitudes can be theoretically distinguished from explicit attitudes, which are defined as conscious evaluations resulting from propositional reasoning (Gawronski & Bodenhausen, 2006; Strack & Deutsch, 2004). The question then arises what kind of attitudes are related to behavior, under what conditions, and by what processes. The MODE model (Fazio, 1990) identifies the associations between attitude objects and their evaluations and focuses on the strength of such associations to predict behavioral responses. From the MODE model it follows that the relative ease in which object-evaluation activation takes place determines the extent to which implicit attitudes will control a person’s behavior, i.e. induces a spontaneous reaction to the perceived situation and offsets alternative behavior choices that require more deliberate effort (Schuette & Fazio, 1995). In other words, the extent to which an attitude is strong enough to be automatically activated by an object determines the extent to which the behavior occurs spontaneously from the attitude or can be influenced by more conscious and controlled processing (Olson & Fazio, 2009). Applied to smoking, one could argue that for smokers the –positive– implicit attitudes toward smoking are so strong that they would automatically lead to smoking behavior and offset conscious efforts to quit smoking (De Houwer et al., 2006).