Implicit Attribution of Culpability and Impact on Experience of Treating Tobacco Dependence

• Published in: Health psychology 2019-12, Vol.38 (12), p.1069-1074
• Main Authors: Evers-Casey, Sarah, Schnoll, Robert, Jenssen, Brian P, Leone, Frank T
• Format: Article
• Language: English
• Subjects: Adult; Aged; Attribution; Attribution theory; Bias; Culpability; Decision making; Drug Dependency; Efficacy; Emotional responses; Female; Frustration; Guilt; Health care; Human; Humans; Hypertension; Innocence; Intervention; Latency; Male; Medical personnel; Middle Aged; Morbidity; Smoking; Smoking - psychology; Smoking Cessation; Social Motivation; Test Construction; Tobacco; Tobacco Smoking; Tobacco Use Disorder; Tobacco Use Disorder - psychology; Treatment Compliance; Treatment Guidelines; Treatment Withholding; United States; Uptake
• ISSN: 0278-6133; 1930-7810
• DOI: 10.1037/hea0000784

Objective: Given the number of annual interactions between people who smoke and health care providers, even low-efficacy interventions would be expected to have a large cumulative effect on smoking prevalence. Efforts to improve uptake of tobacco dependence treatment guidelines have had limited success. It remains unclear whether complex social motivations influence treatment decision-making among providers, despite widespread understanding of the condition's impact on morbidity. Method: Clinicians from across the United States participated in a computer-based survey of potential explicit tobacco treatment biases, relative to care of hypertension. Items corresponded to framework domains of Weiner's causal attribution theory of social motivation (Weiner, 1993). Single-word, open-response items were used to gain insight into the frequency of spontaneous perceptions regarding treatment of each condition. Implicit association testing (IAT) measured strength of association between images of smoking and evaluation of guilt versus innocence. Results: Significant differences in agreement scores were identified within the causal attribution, emotional response, and help investment domains. Single-word answers confirmed a significant difference in emotional response to tobacco treatment (28.1% vs. 10.5%, p = .02), and suggested the difference was driven by the frequent perception of frustration (75% vs. 0%, p = .07). IAT revealed incompatibility between images of smoking and words conveying "innocence" compared with "guilt" (latency 1,846 ms vs. 1,113 ms, p < .001). Conclusions: Complex social motivations may be operational in the context of tobacco dependence treatment, limiting provider willingness to follow treatment guidelines. If confirmed, this represents a critical obstacle to sophisticated guideline implementation, and should be addressed in future implementation strategies.