Much has been studied to further understand smoking initiation in adolescents and smoking cessation in adults, including the social cognitive theory of self-efficacy and outcome expectations. Nevertheless, their role as predictors of quitting smoking requires further study. It is important to develop measures of self efficacy to resist smoking in various situations identified by adolescents as high risk for initiating smoking and outcome expectations across psychosocial, emotional and physical aspects for quitting smoking for good. An age-appropriate criterion for quitting smoking completely in order to determine the perceived consequence of smoking cessation even among adolescents who smoked less than daily is important. A higher self-efficacy to refuse to give in to smoking would be associated with fewer cigarettes at follow up, as well as higher expectations of positive outcomes for stopping smoking.

There are three main motivational concepts predicting the intention to planned behavioral change, such as smoking cessation: self-efficacy, social influence and attitude. Attitude consists of perceived advantages and disadvantages of a behavior, which can be determined by assessing the beliefs involving this behavior and the evaluation of these beliefs. Self-efficacy can be measured by examining perceived capability to perform and maintain a specific behavior. Determining beliefs that involve the influence of social environment on a behavior can assess social influence.

A recent study in the United States by Solomon et al., (2005) showed that there was a significant relationship between the outcomes expectations and self-efficacy and the desire to quit smoking. Rating scales were drafted and data collected was factor analyzed using the scales. Scores were then examined a year later. The relationships between sub-scale scores acquired measured at baseline and cigarettes smoked per week measured at one-year follow up were determined. Self-efficacy measure was composed of two cohesive factors and that these sub-scales correlated consistently with predictions from the social cognitive theory construct. Higher self-efficacy to resist smoking in the presence of negative affect and social opportunities to smoke were prognostic of adolescent smokers smoking fewer cigarettes per week a year later, with baseline smoking behaviors adjusted. As predicted, higher expectations of negative emotional outcomes for quitting smoking were correlated with smoking more cigarettes per week a year later. The affect regulation properties of smoking predict further smoking even in occasional smokers. The effect of gender differences was also assessed if this factor would affect self-efficacy and outcome expectations at the one-year follow up. Women seemed to have significantly greater endorsement of negative emotional outcome expectations than did men; however, further analysis revealed that the difference was mostly due to an item regarding "concern about weight if quit smoking". Females scored significantly higher in this sub-scale than did men. This was the only gender related difference found in the study.

Thus, to motivate behavioral change in adolescents who currently smoke, one must emphasize on smoker's perception of the advantages and disadvantages of smoking cessation. The emotional aspect in dealing with these individuals should not be disregarded, since affect regulation may be an important consideration in helping adolescents manage their smoking.