Sex differences in the relationship between quit attempt and smoking cessation self-efficacy in adults with depressive symptoms.

Objective: Smoking self-efficacy is a key predictor of being able to maintain smoking cessation. Smokers with depression have lower confidence that they can abstain from smoking (i.e., lower smoking self-efficacy) than those without depression. Additionally, individuals assigned female at birth (AFAB) have greater difficulty quitting smoking and lower self-efficacy than those assigned male at birth (AMAB). However, limited attention has been given to the experience of making a quit attempt on changes in smoking self-efficacy among smokers with depressive symptoms and how this may differ by abstinence outcomes and sex. The purpose of the current study was to examine whether abstinence or a reduction in cigarettes smoked during a standard smoking cessation treatment predicted post-treatment changes in smoking self-efficacy, and whether assigned sex moderated this relationship.

Methods: Participants (n = 146; 72.6 % AFAB; mean age = 46.6 years) received 12-week standard smoking cessation treatment as part of a randomized controlled trial testing two adjunctive health- and fitness-based interventions. Pre- and post-treatment, participants reported smoking self-efficacy (i.e., confidence abstaining in negative/affective-, positive/social-, and habit/addiction-related situations).

Results: Multiple regression analyses showed that abstinence was associated with higher increases in smoking self-efficacy in all facets, and decreasing cigarette use from baseline to post-treatment was significantly associated with increases in total smoking self-efficacy. AMAB smokers had higher levels of positive/social related smoking self-efficacy than did AFAB smokers, and for AFAB smokers, a reduction in cigarettes smoked was associated with greater positive/social smoking self-efficacy.

Conclusions: Findings related to the role of self-efficacy in smoking cessation outcomes of smokers with depressive symptoms and how assigned sex impacts the role of self-efficacy provide insight for smoking cessation outcomes. Future research is needed to understand mechanisms underlying smoking self-efficacy and to improve smoking cessation interventions.