Smokers’ Expectancies for Abstinence:
Preliminary Results From Focus Groups
Peter S. Hendricks, Sabrina B. Wood, and Sharon M. Hall
University of California, San Francisco
Smokers’ expectancies regarding the effects of cigarette use are powerful predictors of smoking
motivation and behavior. However, studies have not investigated the consequences that smokers expect
when they attempt to quit smoking: abstinence-related expectancies. The primary goal of this qualitative
study was to gain initial insight into smokers’ expectancies for abstinence. Eight focus groups were
conducted with 30 smokers diverse with respect to age, gender, and ethnoracial background. Content
analyses indicated that smokers anticipate a variety of outcomes from abstinence. The most frequently
reported expectancies included pharmacologic withdrawal symptoms, behavioral withdrawal symptoms,
decreased monetary expense, and immediate improvement of certain aspects of physical functioning and
health. Additional expectancies concerned weight gain, improved attractiveness, enhanced social
functioning/self-esteem, long-term health outcomes, and loss of relationships. Finally, a number of
relatively unheralded expectancies were revealed. These involved nicotine replacement therapy effec-
tiveness, alcohol and other drug use, cue reactivity, cessation-related social support, aversion to smoking,
and “political process” implications. This study provides a preliminary step in understanding smokers’
expectancies for abstinence from cigarettes.
Keywords: tobacco, smoking, abstinence, cessation, expectancies
Smoking-related outcome expectancies remain among the most
widely examined constructs in studies of tobacco use (e.g., Hen-
dricks & Brandon, 2008; Kirchner & Sayette, 2007). They predict
the onset and trajectory of smoking (e.g., Cohen, McCarthy,
Brown, & Myers, 2002; Wetter et al., 2004), are associated with
current smoking behavior (e.g., Cepeda-Benito & Ferrer, 2000;
Jeffries et al., 2004), predict the magnitude of smoking withdrawal
symptoms (Wetter et al., 1994), and predict both short- and long-
term treatment outcome (e.g., Gwaltney, Shiffman, Balabanis, &
Paty, 2005; Wahl, Turner, Mermelstein, & Flay, 2005). They have
primarily been measured by self-report instruments, such as the
Smoking Consequences Questionnaire (SCQ; Brandon & Baker,
1991) and the Smoking Consequences Questionnaire-Adult
(SCQ-A; Copeland, Brandon, & Quinn, 1995).
Despite the research focus on smoking-related outcome expect-
ancies, to our knowledge, no prior study has directly examined
smokers’ expectancies for abstinence. That is, no previous inves-
tigations have directly explored the effects that smokers anticipate
when they attempt to cease cigarette use. Several studies have
appraised smokers’ reasons for quitting. The most commonly
offered motives for cessation comprise concerns about the effects
of smoking on physical functioning and health, including the
effects of secondhand tobacco smoke on others; the financial
disincentive of cigarette use; pressure to quit from family, friends,
and society at large; and the desire to improve one’s appearance
and self-esteem (e.g., Hyland et al., 2004; Myers & MacPherson,
2008; West, McEwen, Bolling, & Owen, 2001). Additional re-
search has assessed smokers’ perceived barriers to successful
cessation. Frequently noted barriers include pharmacologic and
behavioral withdrawal symptoms, including weight gain and urge/
craving to smoke; the notion that quitting represents the loss of a
key enjoyable activity; social pressure to return to smoking; and
among alcohol-dependent smokers, concerns that quitting will
compromise sobriety (e.g., Macnee & Talsma, 1995; Martin,
Rohsenow, Mackinnon, Abrams, & Monti, 2006; West et al.,
2001). The Perceived Risk and Benefit Questionnaire (PBRQ;
McKee, O’Malley, Salovey, Krishnan-Sarin, & Mazure, 2005)
assesses many of the abovementioned positive and negative out-
comes associated with cessation. Finally, some studies have ex-
amined cessation-related cognitions (e.g., “perceptions,” “beliefs”)
among special populations of smokers (e.g., Schmitt, Tsoh, Dowl-
ing, & Hall, 2005; Thompson, Thompson, Thompson, Fredickson,
& Bishop, 2003). The results of these investigations are largely
consistent with research on reasons for quitting and perceived
barriers to care.
While these findings are relevant to smokers’ expectancies for
abstinence, they do not capture the specific if-then contingencies
embodied by the expectancy construct. Indeed, abstinence-related
expectancies have not been fully mapped. This is noteworthy
because these expectancies represent areas of smokers’ cognition
that can be directly addressed by public health campaigns and
Peter S. Hendricks, Sabrina B. Wood, and Sharon M. Hall, Department
of Psychiatry, University of California, San Francisco.
This study was supported by the NIDA grants F32 DA024482, R01
DA02538, K05 DA016752, and P50 DA09253, as well as the State of
California Tobacco-Related Disease Research Program grant 16FT-0049.
The authors thank Tara Brisco and Simone Heron-Carmignani for their
work on the project.
Correspondence concerning this article should be addressed to Peter S.
Hendricks, 401 Parnassus Avenue, TRC, Box 0984, San Francisco, CA
94143. E-mail: firstname.lastname@example.org
Psychology of Addictive Behaviors
2009, Vol. 23, No. 2, 380–385
© 2009 American Psychological Association
individual treatments, thereby enhancing the efficacy of these
In the present study we explored abstinence-related expectan-
cies among tobacco smokers. A central objective of this investi-
gation was to inform an abstinence-related expectancy measure
now in the early stages of development: the Smoking Abstinence
Questionnaire (SAQ). However, the current investigation has sig-
nificance for other reasons. It will be the first to address a gap in
the empirical literature, advancing a more comprehensive under-
standing of a key smoking-related construct. Furthermore, it may
have meaningful implications for the development of smoking
interventions. Finally, it can direct the development of other
abstinence-related expectancy instruments and augment existing
measures that have conceptual overlap with the SAQ (e.g., the
PBRQ). Because scant research exists on smokers’ expectancies
for abstinence, we felt that a qualitative approach was most ap-
propriate at this stage of investigation. Indeed, qualitative research
can provide a wealth of information for unattended areas of study
(e.g., Nichter, Nichter, Thompson, Shiffman, & Moscicki, 2002).
Data were collected through a series of open-ended focus group
interviews with current cigarette smokers. This qualitative method
allowed participants to generate their own responses across the
range of abstinence-related expectancies. Although we had no
specific hypotheses, we expected participants to articulate a wide
spectrum of expectancies for abstinence covering multiple topic
A sample of 30 smokers was recruited from the San Francisco
Bay area through flyers and Internet advertisements to participate
in eight focus groups consisting of three to five individuals each.
Data were collected in somewhat smaller groups than typical
practice to provide members the opportunity to fully express their
expectancies for abstinence. Participants were required to speak
English, be at least 18 years of age, have a smoking rate of at least
15 cigarettes per day, and have a breath carbon monoxide (CO) of
at least 10 ppm at intake. While participants were not formally
stratified with regard to demographic and smoking-related vari-
ables (e.g., gender, age, number of quit attempts, tobacco depen-
dence), recruitment efforts were closely monitored and modified as
necessary to ensure adequate representation among participants
across the range of such variables.
Demographic and smoking history questionnaires.
mographic questionnaire, participants self-reported a number of
demographic variables such as age, gender, ethnicity, and educa-
tion. On the smoking history questionnaire, participants provided
self-report on several smoking variables such as cigarettes smoked
per day, years smoked, and number of quit attempts. This instru-
ment included the Fagerstro ¨m Test of Nicotine Dependence
(FTND; Heatherton, Kozlowski, Frecker, & Fagerstro ¨m, 1991).
Standardized interview questions
were designed to facilitate discussion and elicit contributions from
each participant. Questions provided participants the freedom to
On the de-
formulate their own responses (i.e., they were open-ended), and all
responses were explored to ensure that each participant had the
opportunity to fully express his or her expectancies for abstinence.
Interviews were preceded by an explanation of the expectancy
concept, smoking-related outcome expectancies, and the lack of
existing information on abstinence-related expectancies among
Questions were framed to assess the spectrum of consequences
anticipated from smoking cessation. Example queries include the
following: What kind of things would you expect if you were to
stop smoking and attempt to give up cigarettes for good? What
kind of things would you expect in the short-term? What kind of
things would you expect in the long-term?
Participants who met the screening criteria during a telephone
interview were provided with an overview of the study and sched-
uled for a one-hour focus group session to be held in a conference
room at the University of California, San Francisco. Over a re-
cruitment period of six weeks, 40 smokers met inclusion criteria
and were scheduled for a focus group session; of these, 30 (75%)
attended the focus group meeting.
Before the initiation of the focus group session, participants
completed an informed consent form, provided a CO sample, and
completed the demographic and smoking information question-
naires. The semi-structured interview was then administered by the
principal investigator, who is a clinical psychologist with training
in facilitating group discussion. Research assistants accompanied
the principal investigator and helped administer assessment tools
and document sessions via audiorecording and note-taking. Each
participant engaged in group discussion, yielding a response rate of
100%. Upon completion of the focus group session, participants
were debriefed and paid $20 for their participation.
Analysis of Qualitative Data
Focus group sessions were audiorecorded with a digital voice
recorder and transcribed verbatim to an electronic word processing
file. These data were analyzed using the five-stage framework
approach to deductive content analysis, which has been described
in detail elsewhere (e.g., Pope, Ziebland, & Mays, 2000; Ritchie &
Spencer, 1993). First, transcripts were compared with audiorecord-
ings to ensure accurate and complete documentation of focus
group interviews. Transcripts were then reviewed to provide for a
familiarization with the manner in which participants expressed
expectancies for abstinence, as well as with the range of expect-
ancies conveyed. Second, all key expectancy concepts were iden-
tified, and a comprehensive collection of expectancy concept cat-
egories was developed by which all responses could be coded. This
stage of the analysis resulted in the identification of 16 distinct
expectancy concepts. Third, two independent raters coded partic-
ipant responses from each of the eight focus groups according to
the 16 expectancy categories with the use of a coding manual.
Interrater agreement for this task was high (? ? .98), with dis-
agreements being resolved by discussion. Fourth, data from each
of the eight focus groups was converged so that each of the 16
expectancy concepts contained the coded responses for all partic-
ipants. Fifth, and finally, expectancy concepts were defined and
SMOKERS’ EXPECTANCIES FOR ABSTINENCE
clarified with the goal of providing concise and comprehensible
results. Data were also analyzed by counting the number of par-
ticipants who generated verbal responses that corresponded to each
of the expectancy concepts (e.g., counting analysis; Krueger,
1998). The purpose of this portion of the analysis was to gain
insight regarding the degree to which certain outcomes may be
associated with abstinence from smoking.
Table 1 describes demographic and smoking history character-
istics of the sample. Table 2 contains the results from the counting
Expectancy Concept 1: Pharmacologic Withdrawal
The premise of this expectancy concept was that quitting would
result in the characteristic smoking withdrawal syndrome. For
example, one participant said, “I’d have some mood swings.”
Another participant stated, “I’d be anxious, very anxious.”
Expectancy Concept 2: Behavioral Withdrawal
This concept was marked by the expectancy that abstinence
would result in the loss of an important tool to cope with negative
affect (see Baker, Japuntich, Hogle, McCarthy, & Curtin, 2006).
One participant said, “I would be completely lost without ciga-
rettes. It’s a home for me, a familiar, comforting friend.” Another
participant said, “I’m scared to death of life without cigarettes. I
call them security sticks.”
Expectancy Concept 3: Decreased Monetary Expense
The theme of this expectancy concept was that quitting would
result in decreased financial burden. For example, one participant
noted, “I’d save a couple thousand dollars a year.”
Expectancy Concept 4: Immediate Physical Functioning
The common theme of this expectancy concept was that absti-
nence would result in conspicuous improvements in physical func-
tioning and health shortly after the last cigarette. For example, one
participant said, “I would run better, having more oxygen capac-
ity . . . and also not having to be worried about getting colds or
other types of respiratory infections.” Another participant stated,
“My sense of smell would get a lot better and taste of food would
Expectancy Concept 5: Weight Gain
The basic principle of this concept was that abstinence would
occasion weight gain. One participant expressed, “I would just
start eating . . . and gain nine-hundred pounds.”
Expectancy Concept 6: Improved Attractiveness
The common theme of this category was that quitting smoking
would result in the improvement of one’s attractiveness. Partici-
pants often illustrated this expectancy by describing the detrimen-
tal effects that smoking currently has on their presentation to
others. For instance, one participant said, “Someone may not want
to kiss me because of how my breath smells or tastes.” Another
participant endorsed the expectation that she would “smell better,”
and that her “teeth wouldn’t get stained.”
Expectancy Concept 7: Enhanced Social Functioning/
Respondents commented that abstinence would enhance inter-
personal relationships and self-esteem. Participants indicated that
this would occur because smoking is a salient social stigma.
Several participants indicated that they would look forward to no
longer being treated like an “outcast” upon ceasing cigarette use.
Some participants noted that quitting smoking would improve
self-esteem because it represents a significant accomplishment.
For example, one participant said, “I would have some sense of
self-control and self-discipline if I quit.”
Expectancy Concept 8: Long-Term Health Outcomes
Participants endorsed the expectancy that quitting would im-
prove their long-term health outcomes. For example, one partici-
pant stated, “Health would improve. As the time goes on, basic
health improvements would long extend your life.” A minority of
participants expressed doubt that quitting would have a positive
impact on their long-term health outcomes. These participants
stated that because they have used cigarettes for such a long period
of time, they anticipated that it would be “too late” for abstinence
to have a beneficial effect on their health.
Demographic and Smoking History Characteristics of
M (SD; range)
Number of years smoking regularly
Cigarettes smoked per day
Fagerstro ¨m Test of Nicotine Dependence score
Carbon monoxide level, parts per million
Quit attempts of at least 24 hours
Quit attempts of at least seven days
Longest quit attempt, days
39.2 (11.7; 20–63)
18.9 (13.0; 2–48)
16.8 (2.7; 15–25)
3.7 (1.8; 1–7)
18.9 (13.0; 10–45)
9.3 (12.5; 0–50)
3.5 (4.8; 0–20)
315.9 (540.0; .5–1825)
Number of participants (%)
Hispanic/Latino (assessed across all
Educational level achieved
Some high school
High school graduate
HENDRICKS, WOOD, AND HALL
Expectancy Concept 9: Loss of Relationships
This concept was marked by the expectancy that quitting would
have a negative impact on certain relationships that center on
smoking behavior. One participant stated, “I’ve been introduced to
people by just hanging around the ashtray . . . so there would be a
certain blow to your social life or business life.” Another partici-
pant said, “You’re gonna be not able to click with the rest of the
group . . . you’ll be the odd one.”
Expectancy Concept 10: Loss of Positive Reinforcement
The common theme of this category was that quitting smoking
would represent the loss of an important pleasurable activity.
Participants took care to mention the specific aspects of the act of
smoking that they would miss. For example, one participant indi-
cated, “I would probably miss the taste.” Another mentioned, “I
would still miss something, the hand to mouth, and the nicotine.”
Expectancy Concept 11: Nicotine Replacement Therapy
The principle of this concept was that NRT represents a valuable
aid to smoking cessation. Participants reported that NRT would
control cravings to smoke and increase the likelihood of a suc-
cessful quit attempt. For instance, one participant said, “If I was
having a nicotine fit, the gum would calm me down and it would
help.” However, one participant stated that NRT would have little
bearing on the outcomes of abstinence.
Expectancy Concept 12: Alcohol and Other Drug Use
This concept was marked by the expectancy that alcohol or
other psychoactive substances would be used to compensate for
the absence of smoking. For example, one participant said, “I’d
expect to smoke more marijuana . . . as a crutch to get over smok-
ing.” Another participant stated, “[I would drink more] coffee. It’s
like a trip, going from one addiction to another . . . to make up for
what you did.”
Expectancy Concept 13: Cue Reactivity
The central theme of this category was the expectancy that, upon
quitting, certain smoking-related cues (e.g., locations or activities)
would elicit urges to smoke. Participants illustrated this expect-
ancy by describing the motivational influence of environmental
“triggers.” For instance, one participant said, “For me to
see somebody light up a cigarette, oh boy that looks like the
best . . . the next thing I know, I’m grabbing a pack.”
Expectancy Concept 14: Cessation-Related Social Support
The expectancy expressed by this category was that family,
friends, and co-workers would be supportive of a quit attempt. For
example, one participated noted, “People would support me by not
smoking around me.” However, one participant stated, “I’d like to
hear some positive feedback and support from those people when
I quit smoking, but . . . I don’t feel like there’s enough of that.”
Thus, not all participants indicated that their social network would
facilitate their quit attempt.
Expectancy Concept 15: Aversion to Smoking
The theme of this expectancy concept was that smoking would
lose its appeal over the course of abstinence and would eventually
elicit automatic feelings of disgust. For instance, one participant
Counting Analysis of Expectancy Concepts
N (%) of participants
who endorsed response
Pharmacologic withdrawal —The characteristic symptoms of smoking withdrawal would
—A coping tool for negative affect would be lost.
—The financial burden of cigarette use would be removed.
—Certain aspects of physical functioning and health would
—Weight gain would occur.
—Appearance would improve.
—Interpersonal functioning and self-esteem would be enhanced.
—Long-term health outcomes would improve.
—There would be no effect on long-term health outcomes.
—Relationships centered on smoking would be lost.
—An enjoyable activity would be lost.
—NRT would be a helpful cessation aid.
—NRT would not be a helpful cessation aid.
—The use of alcohol or other psychoactive substances would
—Smoking cues would elicit urges to smoke.
—Others would be supportive of the quit attempt.
—Others would not be supportive of the quit attempt.
—Smoking would become aversive.
—There would be sociopolitical implications.
Decreased monetary expense
Immediate physical functioning and health
Enhanced social functioning/self-esteem
Long-term health outcomes
Loss of relationships
Loss of positive reinforcement
Alcohol and other drug use
Cessation-related social support
Aversion to smoking
“Political process” implications
NRT ? nicotine replacement therapy.
SMOKERS’ EXPECTANCIES FOR ABSTINENCE
indicated that as a consequence of abstinence, the smell of a
cigarette would induce nausea.
Expectancy Concept 16: “Political Process” Implications
The general notion of this expectancy category was that quitting
is associated with certain sociopolitical implications. For example,
one participant indicated that quitting would be a welcomed op-
portunity to “stick it to Big Tobacco.” Another participant stated
that, despite quitting smoking, he would continue to support the
right to use cigarettes: “Everywhere I go you shouldn’t
smoke . . . that’s all I get. [But] it’s all up to you. If you want to
smoke and if you’re able to smoke, do it.”
The principal aim of this study was to gain an initial under-
standing of smokers’ expectancies for abstinence. As this was a
previously uncharted topic of investigation, we made use of qual-
itative methodology to extract the range of anticipated outcomes.
Consistent with our expectations, participants held a variety of
expectancies spanning a number of diverse subject matters. The
most commonly reported abstinence-related expectancies com-
prised pharmacologic withdrawal, behavioral withdrawal, de-
creased monetary expense, and prompt upturn of some features of
physical functioning and health. Interestingly, these expectancies
appeared to surround immediate consequences of abstinence.
Thus, consistent with contemporary expectancy theory, smokers’
expectancies for cessation may be especially oriented toward the
here and now versus the long term (see Goldman, 2002).
Many of our results were presaged by previous literature (e.g.,
McKee et al., 2005). However, a number of expectancies not fully
tapped by prior studies were uncovered in the current research.
These were expectancies for NRT effectiveness, alcohol and other
drug use, cue reactivity, cessation-related social support, aversion
to smoking, and “political process” implications.
With regard to NRT effectiveness, some participants endorsed
the expectancy that NRT would allay withdrawal symptoms and
increase the probability of maintaining abstinence. However, one
participant indicated the expectancy that NRT is inconsequential to
cessation outcomes. These findings parallel research indicating
that while smokers expect NRT to regulate craving, their positive
expectancies for smoking do not extend to NRT (Juliano & Bran-
Previous investigations have examined smoking-related cogni-
tions among those in treatment for addiction to alcohol and other
drugs (e.g., Martin et al., 2006). The current study expands this
line of research and suggests that some smokers expect abstinence
to result in the increased consumption of psychoactive substances.
Although it was unknown whether participants in the current
investigation were addicted to other drugs, it is possible that this
expectancy generalizes to smokers without problematic patterns of
With regard to cue reactivity, some participants reported the
expectancy that environmental smoking cues would elicit urges to
smoke. This expectancy is consistent with the empirical literature.
For example, the presence of smoking-related cues tends to pre-
cede cigarette use in the natural environment (e.g., Shiffman et al.,
Social support is an additional important determinant of quitting
success (Cohen & Lichtenstein, 1990). Previous research indicates
that heavy smokers are generally aware of this notion (Thompson
et al., 2003). Our results extend these findings and indicate that
some smokers may anticipate that their family and friends will
influence cessation outcome, for better or worse.
Expectancies for aversion to smoking and “political process”
implications were largely unheralded by the extant literature. How-
ever, they are consistent with anecdotal reports from clinicians.
Furthermore, public health messages have highlighted the role of
the tobacco industry as the driving force behind the smoking
epidemic (Ibrahim & Glantz, 2007). Nevertheless, because expect-
ancies are formed by a lifetime of learning history, the source of
these anticipated outcomes is difficult to ascertain.
Future Directions and Limitations
Novel treatment modalities have been developed to modify or
“challenge” both alcohol-related (Darkes & Goldman 1993, 1998;
Lau-Barraco & Dunn, 2008) and smoking-related (Copeland &
Brandon, 2000) outcome expectancies. No such modalities exist
for smoking-related abstinence expectancies. However, our results
provide preliminary indication regarding which abstinence-related
expectancies could be addressed by public health campaigns and
individual treatments to improve the efficacy of these interven-
The relatively small sample size of the current investigation may
have precluded data saturation. Indeed, the low endorsement rate
of some of the expectancy concepts may indicate that not all
expectancy domains were revealed. Note, however, that the count-
ing analysis did not quantify nonverbal communication, including
indicators of agreement that were common during focus group
meetings. It is therefore likely that the proportion of participants
holding the expectancies revealed in the current study was greater
than indicated by the counting analysis. Still, future qualitative
investigations may be warranted to examine for expectancies not
revealed by the current study. Conversely, the low endorsement
rates of some domains suggest that these expectancies characterize
idiosyncratic responses. Psychometric analyses will determine if
these concepts are represented in the final version of the SAQ.
Expectancies represent “shifting targets” that can vary with
context (see Kirchner & Sayette, 2007) and experience with to-
bacco (see Copeland et al., 1995). The expectancies delineated in
the present study should therefore not be considered conclusive.
For instance, unique sets of abstinence-related expectancies may
exist for the various cessation methods (e.g., “cold turkey,” NRT).
Moreover, lighter smokers may hold a different array of expect-
ancies for abstinence. These topics merit additional research.
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Received June 12, 2008
Revision received February 18, 2009
Accepted February 27, 2009 ?
SMOKERS’ EXPECTANCIES FOR ABSTINENCE