Smoking Self-Efficacy Scales

Abstract

The Smoking Self-Efficacy Scales (SSES), developed principally by Carlo C. DiClemente, James O. Prochaska, and Wayne F. Velicer, represent a foundational psychometric instrument designed to evaluate an individual's situational confidence in resisting the urge to smoke cigarettes across high-risk relapse contexts. Rooted in the synthesis of Albert Bandura's self-efficacy theory and the Transtheoretical Model (TTM) of behavior change, the instrument operationalizes perceived competence in avoiding nicotine use during specific intrapersonal and interpersonal challenges. While initially validated as a broader set of relapse-situation ratings, the primary standardized variations include a comprehensive 20-item long form and an abbreviated 9-item short form. Both versions assess self-efficacy along a 5-point Likert scale ranging from 1 (Not at all confident) to 5 (Extremely confident). Factor analytic research consistently corroborates a stable three-dimensional structure comprising: (1) Negative Affect (confidence in refraining during states of distress, anger, frustration, or depression), (2) Social/Positive situations (confidence in abstaining during celebrations, social gatherings, or while relaxing with others), and (3) Habitual/Craving circumstances (confidence in overcoming reflexive, physiological, and routine cues such as morning awakening or intense urges). The SSES demonstrates exceptional internal consistency, with subscale Cronbach's alpha coefficients typically exceeding .90 (.92 to .95), robust test-retest reliability, and strong criterion-related predictive validity regarding successful smoking cessation and relapse latency over longitudinal intervals. As an empirical cornerstone in health psychology, addiction medicine, and behavioral epidemiology, the scale serves vital functions in tailoring stage-matched clinical interventions, charting recovery trajectories, and testing cognitive-behavioral relapse prevention models.

Keywords

Smoking Self-Efficacy Scale, SSES, Transtheoretical Model, self-efficacy, smoking cessation, relapse prevention, nicotine dependence, addictive behaviors, behavioral medicine, psychometrics

Authors

The Smoking Self-Efficacy Scales were constructed and psychometrically validated through the sustained collaborative scholarship of leading researchers in clinical psychology, psychometrics, and health behavior change:

• Carlo C. DiClemente, Ph.D. — Emeritus Professor of Psychology at the University of Maryland, Baltimore County (UMBC). Dr. DiClemente is co-developer of the Transtheoretical Model and director of the Habits and Addictions Research Center (HABITS Lab), specializing in motivational factors and intentional behavior change across addictive disorders.
• James O. Prochaska, Ph.D. (1942–2023) — Former Professor of Clinical and Health Psychology and founder of the Cancer Prevention Research Center (CPRC) at the University of Rhode Island (URI). Internationally acclaimed for pioneering the Transtheoretical Model of Change and authoring seminal works on stages and processes of change.
• Wayne F. Velicer, Ph.D. (1944–2017) — Former Professor of Psychology and Co-Director of the Cancer Prevention Research Center at the University of Rhode Island. An internationally renowned psychometrician and quantitative methodologist who formulated structural equation models and longitudinal measurement paradigms for health behavior change.
• Joseph S. Rossi, Ph.D. — Professor of Psychology and Director of the Cancer Prevention Research Center at the University of Rhode Island. Specialist in advanced statistical modeling, research methodology, and measurement theory applied to public health and addiction cessation interventions.

Purpose

The primary purpose of the Smoking Self-Efficacy Scales is to quantify an individual's situational self-efficacy—specifically, the subjective degree of confidence an individual possesses in their capacity to abstain from smoking cigarettes across a spectrum of specific, high-risk cues and environments. Smoking cessation is rarely a discrete, singular event; rather, it is a dynamic, non-linear process characterized by fluctuating motivational drives, severe neurochemical cravings, conditioned behavioral triggers, and vulnerability to relapse. In this context, generalized assessments of self-esteem or broad optimism fail to capture the nuanced, context-dependent cognitive appraisals that govern behavioral execution. The SSES addresses this critical diagnostic gap by measuring situation-specific confidence.

In clinical practice, the SSES serves as a frontline diagnostic and intervention-tailoring instrument. Clinicians use the scale to identify particular high-risk domains where an individual's perceived coping capability is compromised. For instance, a patient demonstrating elevated self-efficacy in social contexts but critically low self-efficacy under negative emotional states requires distinct therapeutic strategies—such as distress tolerance training, cognitive restructuring, or emotional regulation techniques—rather than generic social assertiveness training. By disaggregating confidence across distinct environmental and internal modalities, the instrument allows behavioral health specialists, physicians, and cessation counselors to construct personalized, highly targeted relapse prevention plans.

In clinical and public health research, the SSES functions as an indispensable outcome measure and theoretical mediator. In randomized controlled trials (RCTs) evaluating pharmacotherapies (e.g., varenicline, nicotine replacement therapy) and psychological modalities (e.g., Cognitive Behavioral Therapy, Motivational Interviewing, Acceptance and Commitment Therapy), changes in SSES scores serve as a proximal marker of treatment efficacy. Furthermore, epidemiological and longitudinal studies utilize the scale to validate theoretical frameworks regarding the timeline of behavioral acquisition, tracking how situational confidence naturally ascends as an individual progresses from preparation to action and sustained maintenance stages of smoking cessation.

Psychological Construct

The underlying construct operationalized by the SSES is situational self-efficacy within the behavioral domain of nicotine consumption. Self-efficacy, as originally delineated by Albert Bandura (1977), refers not to an individual's repertoire of skills, but to their generative cognitive judgments regarding how adequately they can organize and execute courses of action required to manage prospective situations laden with ambiguity, strain, or conditioned triggers. Applied to substance dependence and smoking cessation, self-efficacy manifests as situational confidence in resisting the impulse to consume tobacco when confronting conditioned cues.

Theoretical and empirical analyses by Velicer et al. (1990) established that situational self-efficacy in smoking functions in complementary opposition to situational temptation. While temptation captures the perceived intensity of the urge to smoke in a given predicament, self-efficacy captures the cognitive appraisal of one's coping resources to withhold tobacco use in that exact scenario. The SSES systematically captures this construct across three empirically distinguished contextual dimensions:

1. Negative Affect Situations

This subscale captures perceived coping confidence in conditions characterized by intrapersonal psychological distress, negative affective states, or acute interpersonal friction. Specific cues involve anger, anxiety, cognitive frustration, loneliness, and severe emotional crises (such as mourning a family tragedy or navigating marital conflict). Nicotine functions as a rapid neurochemical modulator, stimulating dopamine, acetylcholine, and beta-endorphin release in the central nervous system, thereby serving as an automated, maladaptive coping mechanism for negative emotional regulation. Consequently, individuals with deficient Negative Affect self-efficacy are prone to immediate emotional relapse. SSES items assessing this domain quantify the degree to which an individual believes they can tolerate negative affect without resorting to the pharmacological soothing properties of tobacco.

2. Social and Positive Situations

The Social/Positive subscale assesses an individual's confidence in maintaining abstinence during rewarding, affiliative, or celebratory interpersonal environments. Cues include being at a bar having an alcoholic drink, attending social parties, sitting over coffee while conversing with friends, or being in the direct presence of close peers or a spouse who is actively smoking. In these circumstances, smoking is sustained via powerful classical and operant conditioning: social modeling, peer affiliation cues, behavioral mimicry, and the pharmacological synergy between alcohol and nicotine. High self-efficacy in this domain requires the psychological capacity to assert non-smoking identity boundaries, withstand social pressure, and detach positive celebration from the ritualized act of cigarette consumption.

3. Habitual and Addictive/Craving Situations

This subscale delineates confidence in abstaining when confronted with automatic conditioned routines, physiological withdrawal states, and visceral urges. Triggers encompass morning awakening (which coincides with overnight depletion of plasma nicotine levels), experiencing an unprovoked somatic craving, realizing that one has not smoked for a prolonged interval, feeling an urge for a physiological "lift," or experiencing cognitive fatigue regarding the difficulty of maintaining cessation. These cues operate largely below conscious deliberative control, driven by automated stimulus-response associations established through hundreds of thousands of lifetime inhalations. Self-efficacy in this factor reflects an individual's perceived agency in dismantling automatic behavioral sequences, enduring visceral neurochemical deprivation, and overriding habitual motor reflexes.

Theoretical Framework

The Smoking Self-Efficacy Scales reside at the intersection of two influential paradigms in behavioral psychology: Bandura's Social Cognitive Theory and the Transtheoretical Model (TTM) of Behavior Change.

Under Social Cognitive Theory, human functioning is viewed as the product of dynamic, reciprocal interactions between environmental influences, internal cognitive/biological events, and behavioral patterns. Bandura explicitly distinguished between outcome expectations (the belief that a given behavior will produce specific consequences, such as "quitting smoking will improve my cardiovascular health") and efficacy expectations (the conviction that one can successfully execute the behavior required to produce the outcomes, such as "I can refrain from smoking even when experiencing acute workplace stress"). While outcome expectations provide general motivation, efficacy expectations determine whether coping behavior will be initiated, how much effort will be expended, and how long persistence will be sustained in the face of obstacles and aversive experiences. The SSES isolates efficacy expectations, recognizing them as the proximal cognitive determinant of actual behavioral performance in relapse-provoking contexts.

The Transtheoretical Model, formulated by Prochaska and DiClemente, integrates self-efficacy as a central organizing construct across the stages of intentional change: Precontemplation (not intending to take action in the foreseeable future), Contemplation (intending to change within six months), Preparation (intending to take action within the next month with behavioral steps taken), Action (overt modification of behavior for less than six months), and Maintenance (sustained modification of behavior for more than six months). TTM research demonstrates a systematic, predictable trajectory for self-efficacy across these stages:

• During Precontemplation and Contemplation, self-efficacy scores on the SSES are exceptionally low, whereas temptation scores dominate. The individual perceives virtually no internal capability to withstand triggers.
• In the Preparation phase, self-efficacy begins an upward shift, signaling emerging cognitive readiness and the mental rehearsal of coping strategies.
• Throughout the Action stage, self-efficacy increases substantially, serving as an empirical barometer of therapeutic momentum and mastery experiences.
• In Maintenance, self-efficacy reaches its peak and stabilizes. Bandura postulated that self-efficacy is primarily bolstered through four sources: performance accomplishments (mastery experiences), vicarious learning, verbal persuasion, and physiological state interpretation. Each successive day of non-smoking in the Action and Maintenance stages provides direct mastery accomplishments, cementing elevated SSES scores and buffering the individual against relapse.

Additionally, the SSES integrates the relapse prevention framework conceptualized by G. Alan Marlatt. Marlatt posited that encountering a high-risk situation with an inadequate coping response triggers a drop in self-efficacy, which, combined with positive outcome expectancies for substance use, precipitates an initial lapse. The resulting cognitive dissonance and guilt—known as the Abstinence Violation Effect (AVE)—greatly escalates the probability of full-blown relapse. The SSES acts as an advance diagnostic system mapping the exact contours of an individual's high-risk situational topography.

Validity

The psychometric validity of the Smoking Self-Efficacy Scales has undergone extensive empirical verification across clinical, community, and international cohorts over several decades.

Construct Validity

Construct validity is evidenced by the scale's theoretical alignment with the stages of change. In cross-sectional and prospective studies (DiClemente et al., 1985; Velicer et al., 1990; Fava et al., 1995), mean SSES scores display a linear, monotonic increase across the TTM continuum. Precontemplators consistently display the lowest aggregate self-efficacy scores, contemplators exhibit modest elevations, preparers demonstrate intermediate values, while individuals in the action and maintenance stages post the highest scores. Structural equation modeling has established that self-efficacy serves as a primary mediator bridging cognitive change processes (e.g., consciousness raising, self-reevaluation) to overt behavioral maintenance.

Predictive and Criterion Validity

The SSES exhibits powerful predictive validity regarding future smoking cessation outcomes, abstinence duration, and relapse timing. In longitudinal clinical trials monitoring smokers undergoing cessation programs (DiClemente, 1986; Baer et al., 1989; Gulliver et al., 1995), post-treatment SSES scores consistently predicted biochemical-verified abstinence (via expired carbon monoxide and salivary cotinine) at 1, 3, 6, and 12-month follow-up evaluations. Individuals demonstrating lower baseline or post-treatment self-efficacy scores in the Negative Affect subscale exhibited significantly shorter latencies to relapse, validating the predictive utility of disaggregating situational dimensions. Conversely, rapid gains in SSES scores during the first two to four weeks of intervention strongly correlate with long-term (24-month) continuous abstinence.

Convergent and Discriminant Validity

Convergent validity is documented through robust inverse correlations with measures of physiological dependence, such as the Fagerström Test for Nicotine Dependence (FTND), and direct inverse correlations with the Smoking Temptation Measure (r values frequently ranging from -.60 to -.85). Discriminant validity has been confirmed through factor-analytic differentiation from generalized self-efficacy scales, trait anxiety inventories, and measures of social desirability. The SSES captures situation-specific behavioral confidence that explains substantial unique variance in smoking outcomes beyond that accounted for by generalized personality traits or general self-esteem.

Reliability

The internal consistency and temporal stability of the Smoking Self-Efficacy Scales are exceptionally robust across diverse demographic groups, smoking intensities, and clinical settings.

Internal Consistency

In the landmark validation study conducted by Velicer, DiClemente, Rossi, and Prochaska (1990), internal consistency analyses for the 20-item version revealed high Cronbach's alpha coefficients across all primary subscales:

• Negative Affect Subscale: α = .95
• Social/Positive Subscale: α = .93
• Habitual/Addictive Subscale: α = .92

The composite 20-item score typically yields an overall Cronbach's alpha of .96 to .97, indicating high item homogeneity and minimal measurement error. For the 9-item short form, reliability coefficients remain strong despite the substantial reduction in length, with subscale alphas spanning .80 to .89 and total scale alpha exceeding .90 across diverse clinical cohorts. Cross-cultural adaptations (including Spanish, French, Chinese, and Korean versions) report comparable internal consistency estimates, with alphas consistently exceeding the psychometric standard of .80.

Test-Retest Stability

Test-retest reliability has been evaluated across non-treatment-seeking cohorts and individuals in the maintenance phase where behavioral patterns remain stable. Across two-week and four-week intervals, intraclass correlation coefficients (ICCs) and Pearson correlation coefficients consistently fall between r = .82 and r = .90. Among individuals undergoing active psychosocial or pharmacological treatment, test-retest correlations are intentionally more variable, as the instrument is designed to be sensitive to state-like therapeutic shifts in cognitive confidence.

Factor Analysis

The dimensional architecture of the SSES has been verified through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Velicer, DiClemente, Rossi, and Prochaska (1990) conducted factor analyses to determine the structure of relapse situations across independent, large-scale samples of treatment-seeking and population-based smokers.

Exploratory Factor Analysis

Initial principal component and common factor analyses with varimax and oblimin rotations revealed a distinct, three-factor orthogonal and oblique solution. Across diverse samples, three distinct factors accounted for the majority of common variance (often exceeding 65% to 70% of total variance):

1. Factor 1: Negative Affect / Emotional Distress — Defined by high loadings (typically ranging from .68 to .86) for items involving frustration, anger, family conflict, anxiety, and depression.
2. Factor 2: Social / Positive Situations — Defined by loadings (.65 to .84) for items involving bars, parties, celebrations, relaxing with coffee, and observing peers smoking.
3. Factor 3: Habitual / Craving / Addictive — Defined by loadings (.60 to .81) for items addressing morning awakening, somatic cravings, realizing one has not smoked, and the feeling of needing an energy lift.

Confirmatory Factor Analysis and Structural Models

Confirmatory factor analytic investigations have systematically evaluated multiple competing models: a single-factor unidimensional model, an uncorrelated three-factor model, a correlated three-factor model, and a hierarchical second-order model where the three primary factors load onto a general Self-Efficacy superordinate construct.

Goodness-of-fit indices rigorously favor the correlated three-factor and second-order hierarchical configurations. In structural equation modeling studies, the correlated three-factor model consistently yields superior fit statistics (Comparative Fit Index [CFI] ≥ .94; Tucker-Lewis Index [TLI] ≥ .93; Root Mean Square Error of Approximation [RMSEA] ≤ .055; Standardized Root Mean Square Residual [SRMR] ≤ .045), significantly outperforming the unidimensional model (Δχ² p < .001). While the three subscales correlate moderately with one another (inter-factor correlations typically ranging between .50 and .72), their empirical separation is preserved across diverse demographic cohorts, demonstrating that self-efficacy is a multifaceted construct requiring multidimensional profiling.

Instrument / Measurement Tool

The operational features, administration protocols, and scoring procedures for the Smoking Self-Efficacy Scales are detailed below:

• Instrument Name: Smoking Self-Efficacy Scales (SSES)
• Alternative Designations: Self-Efficacy / Temptation Scale for Smoking; Situational Confidence Questionnaire for Smoking
• Primary Formats:
  • Standard Long Form: 20 items providing comprehensive diagnostic granularity.
  • Abbreviated Short Form: 9 items optimized for rapid clinical intake, epidemiological surveys, or longitudinal ecological momentary assessments (EMA).
• Administration Type: Self-administered paper-and-pencil questionnaire, clinician-administered interview, or digital computer/mobile assessment.
• Completion Time: Approximately 3 to 5 minutes for the 20-item version; 1 to 2 minutes for the 9-item short form.
• Target Population: Current cigarette smokers, individuals actively attempting smoking cessation, and former smokers in maintenance or relapse prevention phases (adolescent through adult populations).
• Response Scale: 5-point Likert-type rating scale measuring subjective confidence:
  • 1 = Not at all confident
  • 2 = Not very confident
  • 3 = Moderately confident
  • 4 = Very confident
  • 5 = Extremely confident
• Scoring Procedures:
  • Subscale Raw Scores: Calculated by summing the response values (1 to 5) of the items corresponding to each subscale and dividing by the number of items in that subscale, yielding a mean score ranging from 1.0 to 5.0.
  • 20-Item Subscale Allocations:
    • Negative Affect Subscale: Items 3, 5, 7, 8, 18, 19
    • Social/Positive Subscale: Items 1, 4, 6, 9, 10, 16
    • Habitual/Craving Subscale: Items 11, 13, 14, 15, 20 (frequently incorporating remaining craving/visceral items such as 2, 12, 17 depending on specific scoring protocol)
  • 9-Item Short Form Allocations:
    • Negative Affect Subscale: Short-Form Items 3, 6, 9
    • Social/Positive Subscale: Short-Form Items 1, 4, 7
    • Habitual/Craving Subscale: Short-Form Items 2, 5, 8
  • Total Composite Score: Calculated by summing all answered items and dividing by the total number of items, providing a global situational self-efficacy index between 1.0 and 5.0.
  • Standardized T-Scores: In formal clinical evaluations, raw scores are often converted into standardized T-scores (Mean = 50, SD = 10) anchored against normative stage-of-change samples.
• Interpretation Guidelines:
  • Scores 1.0 to 2.4: Low Self-Efficacy. Severe vulnerability to relapse when encountering triggers in this domain; indicates an urgent need for targeted cognitive and behavioral skills training.
  • Scores 2.5 to 3.4: Moderate Self-Efficacy. Ambivalent coping capacity; coping strategies may falter under compound stressors or heightened physiological cravings.
  • Scores 3.5 to 5.0: High Self-Efficacy. Strong perceived competence; indicates stable resilience and automated relapse prevention behaviors in the evaluated domain.

Permissions & Fee and Test Year

The foundation of the Smoking Self-Efficacy Scale originated in the initial work of Carlo C. DiClemente, James O. Prochaska, and Michael Gibertini published in 1985, with the definitive three-factor psychometric structure established by Wayne F. Velicer, Carlo C. DiClemente, Joseph S. Rossi, and James O. Prochaska in 1990.

Licensing and Availability: The instrument is placed within the academic public domain for scientific research, clinical evaluation, and non-commercial educational implementation. No commercial royalty or licensing fee is required for researchers or practitioners administering the scale for non-commercial clinical or scientific purposes. However, the original authors request that formal attribution and psychometric citations be included in all publications or derived assessment platforms. Researchers wishing to use the instrument in subsidized or commercial proprietary digital platforms should contact the Habits and Addictions Research Center (HABITS Lab) at the University of Maryland, Baltimore County (UMBC) or the Cancer Prevention Research Center (CPRC) at the University of Rhode Island.

References

• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
• Baer, J. S., Holt, C. S., & Lichtenstein, E. (1989). Self-efficacy and smoking cessation: A critical review of methods and predictions. Journal of Consulting and Clinical Psychology, 57(4), 469–476. https://doi.org/10.1037/0022-006X.57.4.469
• Delahanty, J. C., DiClemente, C. C., Havas, S., & Langenberg, P. (2008). Smoking status and stages of change for dietary behaviors among WIC women. American Journal of Health Behavior, 32(6), 583–593. https://doi.org/10.5993/ajhb.32.6.3
• DiClemente, C. C. (1986). Self-efficacy and the addictive behaviors. Journal of Social and Clinical Psychology, 4(3), 302–315. https://doi.org/10.1521/jscp.1986.4.3.302
• DiClemente, C. C., Fairhurst, S. K., & Piotrowski, N. A. (1995). Self-efficacy and addictive behaviors. In J. E. Maddux (Ed.), Self-Efficacy, Adaptation, and Adjustment: Theory, Research, and Application (pp. 109–141). Plenum Press. https://doi.org/10.1007/978-1-4419-6868-5_4
• DiClemente, C. C., & Haug, N. (2001). Smoking cessation: Helping patients through the process. Journal of COPD Management, 2(4), 4–9.
• DiClemente, C. C., Prochaska, J. O., & Gibertini, M. (1985). Self-efficacy and the stages of self-change of smoking. Cognitive Therapy and Research, 9(2), 181–200. https://doi.org/10.1007/BF01204849
• Fava, J. L., Velicer, W. F., & Prochaska, J. O. (1995). Applying the transtheoretical model to a representative sample of smokers. Addictive Behaviors, 20(2), 189–203. https://doi.org/10.1016/0306-4603(94)00062-X
• Gulliver, S. B., Hughes, J. R., Solomon, L. J., & Dey, A. N. (1995). An investigation of self-efficacy, satisfaction and relapse in a smoking cessation trial. Addictive Behaviors, 20(6), 749–758. https://doi.org/10.1016/0306-4603(95)00041-0
• Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. Guilford Press.
• Perz, C. A., DiClemente, C. C., & Carbonari, J. P. (1996). Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation. Health Psychology, 15(6), 462–468. https://doi.org/10.1037/0278-6133.15.6.462
• Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390
• Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102–1114. https://doi.org/10.1037/0003-066X.47.9.1102
• Prochaska, J. O., Velicer, W. F., DiClemente, C. C., & Fava, J. (1988). Measuring processes of change: Applications to the cessation of smoking. Journal of Consulting and Clinical Psychology, 56(4), 520–528. https://doi.org/10.1037/0022-006X.56.4.520
• Velicer, W. F., DiClemente, C. C., Rossi, J. S., & Prochaska, J. O. (1990). Relapse situations and self-efficacy: An integrative model. Addictive Behaviors, 15(3), 271–283. https://doi.org/10.1016/0306-4603(90)90070-E

13. Items of the Scale (Questionnaire)