Associations of outcome expectancies with smoking: A meta-analysis

Expected positive and negative outcomes of smoking have been suggested to predict nicotine involvement. The present meta-analysis integrated research on the associations between smoking outcome expectancies and smoking.

A systematic search in the electronic databases PsycInfo, Medline, Psyndex, Google Scholar, and Web of Science identified 215 studies, which were included in a multi-level meta-analysis.

Positive smoking outcome expectancies were associated with higher smoking levels, with expectancies that smoking reduces negative affect showing the strongest correlation (r = .29) and expectancies that smoking helps with appetite/weight reduction showing the weakest correlation with smoking (r = .14). Associations of expected negative outcomes of smoking tended to be weaker than associations with positive outcome expectancies and were, in part, inconsistent. There were moderating effects of child age, percentage of individuals who smoke, sampling (clinical versus nonclinical), outcome measure (quantity of smoking versus nicotine dependence; use of conventional cigarettes versus e-cigarettes), publication status, and validity of the outcome expectancy measure.

Expectancies about the reduction of negative affect via smoking are a particularly relevant target for prevention and intervention. Our results indicate that decreasing positive expectancies may be more promising than increasing negative expectancies. Tobacco control advocates should draw attention to perceived consequences of smoking in designing measures aimed at preventing smoking initiation and reducing smoking involvement.