Questions and statements on smoking behaviour and determinants of smoking cessation were part of the Dutch questionnaire ‘Questionnaire for research on smoking and smoking cessation’ [Meetinstrumenten voor onderzoek naar roken en stoppen met roken], developed by Maas- tricht University and STIVORO [Stichting Volksgezondheid en Roken, Foundation for Public Health and Smoking] (Mudde et al., 2006). This is a standardized and validated questionnaire for research on smoking
and smoking cessation. Mudde et al. (2006) used questions and state- ments which had already been pretested or used in publications in peer-reviewed journals (Mudde et al., p. 17-22 and p. 41-52) (Table 14). A five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) was used.
Smokers and ex-smokers answered questions about maternal and foe- tal health consequences of smoking cessation during pregnancy and craving symptoms in order to provide insight into their behavioural beliefs and attitude regarding smoking cessation (Table 14). Health con- sequences were measured as the mean of three items (‘attitude_health’, Cronbach’s α = 0.74), craving consequences as the mean of four items (‘attitude_craving’, Cronbach’s α = 0.80). Higher scores indicated a pos- itive attitude towards smoking cessation.
All respondents answered questions regarding perceived support and encouragement from their partner, family, and friends in smoking ces- sation and staying abstinent. They also answered questions about dis- approval of smoking during pregnancy by significant others. Perceived encouragement from partner, family, and friends in smoking cessation before or during early pregnancy was measured as the mean of two items (‘subj. norm_cessation’, Cronbach’s α = 0.88) as well as perceived support from partner, family and friends in staying abstinent during pregnancy (‘subj. norm_abstinence’, Cronbach’s α = 0.87). Higher scores indicated more perceived support. Perceived disapproval from significant others was measured as the mean of three items (‘subj. norm_disapproval’, Cronbach’s α = 0.60). Higher scores indicated more perceived disapproval.
There were six universal circumstances (Table 14) for relapse or contin- ued smoking (‘perceived behavioural control’, Cronbach’s α = 0.95). Smokers and ex-smokers were asked if they felt able to not smoke in these particular situations in order to establish their perceived behav- ioural control. Higher scores indicated higher perceived behavioural control.
Finally, only smokers were asked about their intention to quit. This item was also scored on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) and was coded into two levels: no or low intention to quit (scores 1 to 3) and moderate or high inten- tion to quit (scores 4 and 5).
Table 14: Questionnaire regarding smoking and smoking cessation based on constructs, beliefs, and items of the theory of planned behaviour (TPB)
Constructs of TPB Beliefs of TPB Items of TPB Cronbach’s α
Attitude Behavioral beliefs
Attitude_health Remaining abstinent will improve your health 0.74 Remaining abstinent is better for the health of
your unborn child
Remaining abstinent is better for the health of the people around you
Attitude_craving You will miss conviviality if you remain absti-
nent 0.80
You will have a harder time relaxing if you re- main abstinent
You will experience craving and withdrawal symptoms if you remain abstinent You will feel bored more frequently if you re- main abstinent
Subjective norm Normative beliefs
Subj. norm_cessation Your partner encourages you to quit smoking
due to your pregnancy 0.88
Your friends and family encourages you to quit smoking due to your pregnancy
Subj. norm_absti-
nence Your partner encourages you to remain absti-nent during your pregnancy 0.87 Your friends and family encourage you to re-
main abstinent during your pregnancy Subj. norm_disapprov-
al People around you tell you that smoking is un-healthy for your baby 0.60 People around you refuse to light your ciga-
rette or give you a cigarette
You think people around you have a negative opinion about your smoking behavior
Perceived behavio-
ral control Control beliefsPerceived behavioral
control You feel stressed or tense, do you manage not to smoke? 0.95 You are annoyed or angry, do you manage not
to smoke?
You are out for the evening (at a party, visiting friends), do you manage not to smoke? You feel sad or depressed, do you manage not to smoke?
Someone offers you a cigarette of your fa- vorite brand, do you manage not to smoke? You see someone enjoying a cigarette, do you manage not to smoke?
Intention You are considering quitting smoking
Questionnaire for research on smoking and smoking cessation, translation of ‘Meetinstrumenten voor onderzoek naar roken en stoppen met roken’, developed by Maastricht University and STIVORO (Mudde et al., 2006). The original Dutch questionnaire was used in this study.
11.3.4. Socio-demographic variables
The questionnaire included questions about age and educational level. Respondents were asked for their highest grade or year of completed education. This variable was coded into two levels: secondary school certificate or lower, meaning 12 years of education or less (low), and college or university degree (high).
11.3.5. Data analysis
Data were analysed using SPSS 22.0.
Descriptive statistics (mean, standard deviation and Chi²-test) were used to describe the characteristics of the respondents and their responses regarding the smoking cessation beliefs of the TPB. Pearson correlation and t-tests were used to determine the relationship between demographic characteristics (age and education) and the beliefs of the TPB. T-tests and two-way ANCOVA tests were performed to compare the beliefs of the TPB according to smoking behaviour and intention to quit, adjusted for age and education.