Smoking Self-Efficacy Scales

Abstract

The Smoking Self-Efficacy Scales (SSES) are a widely utilized psychometric instrument designed to measure an individual’s perceived confidence in their ability to abstain from smoking across various high-risk situations. Developed primarily by DiClemente, Prochaska, and colleagues, the scale is theoretically grounded in the Transtheoretical Model (TTM) of intentional behavior change. The SSES identifies specific domains—Negative Affect, Social/Positive, and Habitual/Craving situations—that challenge adherence to smoking cessation goals. The instrument exists in both a comprehensive 20-item version and a shorter, validated 9-item form, making it a critical tool for predicting relapse and tracking progress during cessation interventions.

Keywords

Smoking Cessation, Self-Efficacy, Transtheoretical Model, TTM, Relapse Prevention, Negative Affect, Craving, Habitual Smoking, Confidence.

Authors

Carlo C. DiClemente, James O. Prochaska, Michael Gibertini.

Purpose

The primary purpose of the Smoking Self-Efficacy Scales is to quantitatively assess the strength of an individual’s belief (or confidence) in maintaining abstinence from smoking when confronted with situations that typically trigger the urge to smoke. This assessment is vital for tailoring intervention strategies, as low self-efficacy in specific contexts is a powerful predictor of relapse. By identifying these vulnerability areas, clinicians can target behavioral and cognitive therapy efforts more effectively to increase the likelihood of successful, long-term cessation.

Construct

The SSES measures the psychological construct of Self-Efficacy, as defined by Bandura, specifically applied to the domain of addictive behaviors. In the context of smoking, self-efficacy refers to the subject’s perceived capability to execute the necessary behaviors (i.e., resisting a cigarette) required to manage prospective situations. This measure is central to the Transtheoretical Model (TTM), where increasing self-efficacy is crucial for movement through the Stages of Change (e.g., from preparation to action and maintenance).

The scale operationalizes abstinence self-efficacy by presenting respondents with common relapse-provoking scenarios. The resulting scores reflect the individual’s confidence level across three distinct, empirically derived factors: situations involving negative emotional states, situations involving social interaction or positive emotional states, and situations related to habitual routines or physiological craving.

Validity

The SSES demonstrates strong construct validity, aligning conceptually with core tenets of both Social Cognitive Theory and the TTM. Research, particularly the foundational work by DiClemente, Prochaska, and others, has shown that self-efficacy scores derived from the SSES are reliably associated with an individual’s stage of change regarding smoking behavior, supporting its role as a key mechanism in the process of quitting. Furthermore, the scale has been shown to successfully differentiate between relapsers and maintainers in follow-up studies, confirming its predictive validity for long-term cessation success.

Reliability

The SSES exhibits excellent internal consistency, indicating high reliability across its factor structure. Based on findings reported by Velicer, DiClemente, et al. (1990), the three subscales demonstrate high Cronbach’s alpha coefficients, suggesting that the items within each factor measure the underlying construct consistently.

• Negative Affect: Internal consistency of .95
• Social/Positive: Internal consistency of .93
• Habit/Addictive (Habitual/Craving): Internal consistency of .92

These high reliability scores confirm the scale’s robustness for use in clinical and research settings focused on smoking cessation.

Factor Analysis

Factor analysis of the 20-item SSES reveals a stable three-factor structure that captures the major domains of relapse vulnerability. These factors are consistent across both the long and short forms of the instrument and are conceptually linked to common triggers experienced by individuals attempting to quit smoking.

The three dimensions identified are:

1. Negative Affect: Situations involving emotional distress, anger, frustration, depression, or anxiety.
2. Social/Positive: Situations involving social interaction, celebration, or relaxation where smoking cues are present.
3. Habitual/Craving: Situations involving physiological craving, routine activities (like waking up or having coffee), or general difficulty in maintaining abstinence.

Instrument

Test Type: Self-Report Questionnaire

Format: The SSES uses a 5-point Likert scale to assess confidence levels. The response format is standardized across both versions:

• 1 = Not at all confident
• 2 = Not very confident
• 3 = Moderately confident
• 4 = Very confident
• 5 = Extremely confident

Language Available: Primarily English, though translations may exist in published research.

Population Group: Adult smokers or ex-smokers engaged in or considering the process of smoking cessation.

Age Group: Adults (typically 18 years and older).

Population Details: Originally validated on populations seeking to change addictive behaviors, particularly those moving through the stages defined by the TTM.

Test Methodology: Respondents rate their confidence in their ability to resist the urge to smoke across a series of specific situational prompts. The total score, or scores across the three subscales, provides a measure of abstinence self-efficacy.

Keywords

Addictive Behavior, Scale Development, Psychological Assessment, Cessation Intervention, Transtheoretical Model, Self-Efficacy, Psychometric.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: The instrument can be accessed via the Habits Lab at the University of Maryland, Baltimore County (UMBC). The instrument can be found at: http://habitslab.umbc.edu/self-efficacy-scales/

Permissions & Fee and Test Year

The scale was initially developed and published in 1985 by DiClemente, Prochaska, and Gibertini. Specific details regarding current licensing fees and permissions should be sought directly from the primary authors or the institutions associated with the Habits Lab.

Reference’s

• DiClemente‚ C.C.‚ Prochaska‚ J.O.‚ and Gibertini‚ M. (1985). Self-Efficacy and the Stages of Self-Change of Smoking. Cognitive Therapy and Research‚ 9‚ 2‚ 181-200.
• DiClemente‚ C. C. (1986). Self-Efficacy and the addictive behaviors. Journal of Social and Clinical Psychology‚ 4‚ 302-315.
• Prochaska‚ J.O.‚ Velicer‚ W.F.‚ DiClemente‚ C.C.‚ & Fava‚ J. (1988). Measuring Processes of Change: Applications to the Cessation of Smoking. Journal of Consulting and Clinical Psychology‚ 56‚ 4‚ 520-528.
• Velicer‚ W.F.‚ DiClemente‚ C.C.‚ Rossi‚ J. S.‚ Prochaska‚ J. O. (1990). Relapse situations and self-efficacy: An integrative model. Addictive Behaviors‚ 15‚ 271-283.
• Prochaska‚ DiClemente‚ & Norcross‚ (1992). Inferred theoretical underpinning for the Transtheoretical Model (TTM).
• DiClemente‚ C. C.‚ Fairhurst‚ S. K.‚ & Piotrowski‚ N. A. (1995). Self-Efficacy and addictive behaviors. In J. E. Maddux‚ ed.‚ Self-Efficacy‚ adaptation‚ and adjustment: Theory‚ research‚ and application (pp. 109-141). New York: Plenum.
• Perz‚ C.A.‚ DiClemente‚ C.C.‚ & Carbonari‚ J.P. (1996). Doing the right Thing at the Right Time? The Interaction of Stages and Processes of Change in Successful Smoking Cessation. Health Psychology‚ 15‚ 6‚ 462-468.
• DiClemente‚ CC & Haug‚ N. (October‚ 2001) Smoking Cessation: Helping Patients through the Process. Journal of COPD Management. 2(4)‚ 4-9.
• Delahanty‚ J.C.‚ DiClemente‚ C.C.‚ Havas‚ S.‚ & Langenberg‚ P. (2008). Smoking status and stages of change for dietary behaviors among WIC women. American Journal of Health Behavior‚ 32(6)‚ 583-593.

Items of the Smoking Self-Efficacy Scales

20 items

1. At a bar or cocktail lounge ha‎ving a drink.
2. When I am desiring a cigarette.
3. When things are not going the way I want and I am frustrated.
4. With my spouse or close friend who is smoking.
5. When there are arguments and conflicts with my family.
6. When I am happy and celebrating.
7. When I am very angry about something or someone.
8. When I would experience an emotional crisis‚ such as an accident or a death in the family.
9. When I see someone smoking and enjoying it.
10. Over coffee while talking and relaxing.
11. When I realize that quitting smoking is an extremely difficult task for me.
12. When I am craving a cigarette.
13. When I first get up in the morning.
14. When I feel I need a lift.
15. When I begin to let down on my concern about my health and am less physically active.
16. With friends at a party.
17. When I wake up in the morning and face a tough day.
18. When I am extremely depressed.
19. When I am extremely anxious and stressed.
20. When I realize I haven’t smoked for a while.

20 Item Version Subscale Composition:

• Negative Affect: 3‚ 5‚ 7‚ 8‚ 18‚ 19
• Social/Positive: 1‚ 4‚ 6‚ 9‚ 10‚ 16
• Habitual/ Craving: 11‚ 13‚ 14‚ 15‚ 20

9 items – Short Form

1. With friends at a party.
2. When I first get up in the morning.
3. When I am very anxious and stressed.
4. Over coffee while talking and relaxing.
5. When I feel I need a lift.
6. When I am very angry about something or someone.
7. With my spouse or close friend who is smoking.
8. When I realize I haven’t smoked for a while.
9. When things are not going my way and I am frustrated.

9 Item Version Subscale Composition:

• Negative Affect: 3‚ 6‚ 9
• Social/Positive: 1‚ 4‚ 7
• Habitual/Craving: 2‚ 5‚ 8