Understanding why smokers do not want to use nicotine dependence medications to stop smoking: qualitative and quantitative studies.

Smokers' expected outcomes of using nicotine dependence medications may act as barriers to their use. In Study 1, 27 smokers were interviewed. Framework analysis was used to identify key themes in smokers' expectations of using nicotine dependence medications. In Study 2, a convenience sample of 212 smokers completed a survey. Multiple regression and mediation analyses were used to examine relationships between self-efficacy, outcome expectations, and intentions to use nicotine dependence medications. In Study 1, three themes emerged as factors for smokers' decisions to use nicotine dependence medications: (a) their effectiveness, (b) their desirability, including adverse effects, and (c) access to nicotine dependence medications. In Study 2, outcome expectations explained large amounts of variance in models predicting intentions to use (a) nicotine replacement therapy (f (2) = .97), and (b) bupropion (f (2) = .73). Effectiveness outcome expectations were the principal predictors in both models. Mild adverse effects outcome expectations explained additional variance in model 1, and medication-aversion outcome expectations explained additional variance in model 2. The effect of craving control outcome expectations on intentions in models 1 and 2 were mediated by effectiveness outcome expectations. Effectiveness outcome expectations were strong predictors of intentions, whereas outcome expectations that these medications are desirable were additional predictors. Expectations of effectiveness appear to be influenced by the ability of the medications to control cravings to smoke. Interventions aimed at increasing the likelihood with which smokers use nicotine dependence medications may be more successful if they address these expectations.