Positive and Negative Outcome Expectations of Smoking: Implications for Prevention

Background. To inform the development of messages for tobacco prevention programs, we examined seven positive and five negative outcome expectations of smoking as risk factors for smoking uptake. Methods. A cross-sectional, self-administered survey of 471 students in grades 6–12 who were never or experimental smokers was performed. Logistic regression was used to examine the relationship between outcome expectations and susceptibility to becoming a smoker in the future, a measure of intent and resistance to peer smoking. Results. A total of 36.1% of the sample was susceptible to smoking. All positive outcome expectations showed a strong and significant association with susceptibility. Students were most likely to be susceptible if they believed they would enjoy smoking (OR = 29.4). Three of the five negative outcome expectations were significantly associated with susceptibility, but the strength of these associations was much lower than that observed for the positive expectations (OR = 0.5 to 0.6). A strong belief in the negative outcomes of smoking did not alter the association between susceptibility and positive outcome expectations. Conclusions. These findings suggest that teaching adolescents and teens about the negative consequences of smoking is unlikely to change their intent to smoke. Preventive efforts should identify ways to address the positive expectations adolescents have about smoking, possibly by offering alternative means for achieving these outcomes.