Objective: To understand the mechanisms of action underlying behavioral interventions, researchers typically examine whether the treatment changes cognitions and whether changes in cognition predict behavior (cognitive change). This current research explores an alternative mechanism whereby the intervention increases the impact of pre-existing cognitions on behavior (cognitive activation). We tested whether cognitive change or cognitive activation explains the impact of cigarette pack messages on smoking restraint.
Design: The research comprised a validation experiment (N = 135) and a 4-week RCT (N = 719) with smokers.
Main outcome measures: At both baseline and follow-up of the RCT, smokers self-reported threat appraisals, coping appraisals, and smoking restraint.
Results: Intervention messages heightened the accessibility of threat appraisals compared to control messages (validation experiment). In the RCT, smoking restraint increased among intervention participants but not controls. Trial arm showed no corresponding change in threat or coping appraisals. However, trial arm interacted with baseline health cognitions such that synergies between threat appraisal components, and between threat appraisals and coping appraisals, predicted smoking restraint for intervention participants but not for controls.
Conclusion: Our findings support a cognitive activation process whereby health messages on cigarette packs increase the impact of pre-existing threat appraisals on smoking restraint.