Tob Control doi:10.1136/tobaccocontrol-2011-050139
  • Research paper

Patterns of cognitive dissonance-reducing beliefs among smokers: a longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey

  1. K Michael Cummings4
  1. 1Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  2. 2Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  3. 3The Cancer Council Victoria, Melbourne, Victoria, Australia
  4. 4Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
  1. Correspondence to Omid Fotuhi, Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada N2L 3G1; ofotuhi{at}
  1. Contributors OF proposed and performed the data analyses, the literature review, wrote most of the initial draft and coordinated input from other authors. GTF and MPZ helped with the design and analyses. They also provided input and edited the initial draft and subsequent drafts throughout this process. H-HY, KMC and RB each provided analytical suggestions, contributed to the content and edited the drafts of the manuscript.

  • Received 14 July 2011
  • Accepted 6 December 2011
  • Published Online First 3 January 2012


Objective The purpose of this paper is to assess whether smokers adjust their beliefs in a pattern that is consistent with Cognitive Dissonance Theory. This is accomplished by examining the longitudinal pattern of belief change among smokers as their smoking behaviours change.

Methods A telephone survey was conducted of nationally representative samples of adult smokers from Canada, the USA, the UK and Australia from the International Tobacco Control Four Country Survey. Smokers were followed across three waves (October 2002 to December 2004), during which they were asked to report on their smoking-related beliefs and their quitting behaviour.

Findings Smokers with no history of quitting across the three waves exhibited the highest levels of rationalisations for smoking. When smokers quit smoking, they reported having fewer rationalisations for smoking compared with when they had previously been smoking. However, among those who attempted to quit but then relapsed, there was once again a renewed tendency to rationalise their smoking. This rebound in the use of rationalisations was higher for functional beliefs than for risk-minimising beliefs, as predicted by social psychological theory.

Conclusions Smokers are motivated to rationalise their behaviour through the endorsement of more positive beliefs about smoking, and these beliefs change systematically with changes in smoking status. More work is needed to determine if this cognitive dissonance-reducing function has an inhibiting effect on any subsequent intentions to quit.


  • Funding This research was funded by grants from the National Cancer Institute of the USA (R01 CA 100362), the Roswell Park Transdisciplinary Tobacco Use Research Center (P50 CA111236), Robert Wood Johnson Foundation (045734), Canadian Institutes of Health Research (57897 and 79551), National Health and Medical Research Council of Australia (265903 and 450110), Cancer Research UK (C312/ A3726) and Canadian Tobacco Control Research Initiative (014578), with additional support from the Centre for Behavioural Research and Program Evaluation, National Cancer Institute of Canada/Canadian Cancer Society (now the Propel Centre for Population Health Impact at the University of Waterloo) and the Ontario Institute for Cancer Research. Additional funding to the first author was provided through a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship.

  • Competing interests All authors are employed by academic institutions or cancer control charities and have no competing financial interests.

  • Patient consent Obtained.

  • Ethics approval The study protocol was cleared for ethics by the institutional review boards or research ethics boards in each of the countries: the University of Waterloo (Canada), Roswell Park Cancer Institute (USA), University of Illinois–Chicago (USA), University of Strathclyde (UK) and The Cancer Council Victoria (Australia).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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