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Presenting the Facts About Smoking to Adolescents
Effects of an Autonomy-Supportive Style
Geoffrey C. Williams, MD, PhD;
Elizabeth M. Cox, MD;
Ruth Kouides, MD, MPH;
Edward L. Deci, PhD
Arch Pediatr Adolesc Med. 1999;153:959-964.
Objectives To test the self-determination model of health-related behavior by examining whether the degree to which adolescents experience an appeal to not smoke as autonomy supportive would affect their autonomous motivation for not smoking and, in turn, their behavior of either refraining from smoking or smoking less, and to validate the measures of perceived autonomy support and autonomous motivation for not smoking.
Design Two studies of physicians presenting information about not smoking using 2 message styles, 1 of which was designed to be more autonomy supportive. The preliminary study involved nonrandomized assignment to message style and only immediate assessment of perceptions, motivation, and behavior, while the primary study involved randomized assignment and 4-month longitudinal assessments.
Setting and Participants Nearly 400 ninth- through 12th-grade students at 2 suburban high schools in upstate New York.
Main Outcome Measures Adolescents' perceptions of the presentations' autonomy supportiveness of the presenters, as well as adolescents' autonomous motivation for not smoking and their self-reports of smoking. The primary study also assessed change in students' autonomous motivation and change in their self-reported smoking during 4 months.
Results In both studies, the measures were reliable and valid. Students perceived significantly (P=.04 and P<.001, respectively) greater autonomy support in the "It's Your Choice" presentation, after controlling for whether the students were smokers. Perceived autonomy supportiveness of the presentation was positively correlated with autonomous reasons for not smoking in the preliminary study and with increases in autonomous motivation for not smoking in the primary study. Change in autonomous reasons for not smoking significantly (P<.001) predicted reduction in smoking during 4 months.
Conclusion When adolescents perceived messages about not smoking as autonomy supportive, they had more autonomous motivation for not smoking, and that, in turn, predicted a decrease in their self-reports of smoking.
From the Departments of Medicine (Drs Williams, Cox, and Kouides), Clinical and Social Sciences in Psychology (Drs Williams and Deci), and Pediatrics (Dr Cox), University of Rochester, the Department of Medicine, The Genesee Hospital, (Dr Williams), and the Departments of Medicine (Drs Cox and Kouides) and Pediatrics (Dr Cox), Rochester General Hospital, Rochester, NY.
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