Using age-progression facial morphing technology to encourage smoking cessation in women and the role of the stress response

Walker, Lucy (2020) Using age-progression facial morphing technology to encourage smoking cessation in women and the role of the stress response. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Background: Women are at increased risk from smoking and experience specific barriers to smoking cessation. Age-progression interventions that demonstrate the ageing effect of smoking to the face, appear to be effective in changing smoking intentions and behaviour in women. One underlying theme of age-progression research is a shock reaction that is thought to create stress reactivity. The impact of this shock response on efficacy of the intervention has yet to be understood. Aim: The research within this thesis aimed to investigate the effectiveness of an ageprogression intervention for smoking cessation in women aged 18-55 years, and the role of the stress response elicited by the intervention on smoking outcomes. Methods: A systematic review updated and synthesised information regarding the effectiveness of appearance based interventions. A mixed methods approach was used in a pilot study, to develop aspects of research design, including the use of physiological stress measurement and intervention instruction types (Neutral and Reassuring) to influence levels of stress. A qualitative investigation also explored the experiences of women who received the intervention. Findings from the pilot were implemented in a randomised controlled trial that assessed the impact of psychological and physiological stress induced by the intervention and its impact on the long-term smoking outcomes. Results: Qualitative study indicated the age-progression technique continues to create shock, with more instances of accounts of shock reported by women that received the Reassuring instructions. The quantitative study showed this response was accompanied by an increase in subjective and physiological stress. Lastly, findings from the randomised controlled trial indicated the age-progression intervention delivered using Reassuring instructions produced changes in smoking intentions and abstinence. Importantly, stress elicited by the intervention, positively moderated intentions to quit. Conclusions: The synthesised findings from this thesis conclude that age-progression interventions for smoking cessation can reduce smoking behaviour in women. Additionally, when administered via Reassuring instructions, high levels of shortterm stress can increase the effectiveness of the intervention. Future research should ii focus on identifying the optimal stress levels induced by smoking cessation interventions that increase successful smoking cessation.