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The use of tobacco and tobacco products is a leading cause of preventable health problems and results in many deaths. Thus, a better understanding of cigarette use and the mechanisms of addiction would advance the literature. This study aims to explain the addiction to smoking in accordance with the metacognitive approach, which has a current and innovator point of view, and provides evidence that the metacognitive approach might be a novel treatment for smoking dependency. The metacognitive approach has been used to understand and treat resistant psychological disorders, provide novel understanding regarding addiction mechanisms, and present a treatment approach that explains the following factors: initiating, perpetuating, and smoking dependency relapse. The findings of the few studies that have investigated the role of metacognitions in the mechanisms of cigarette use and quitting smoking are promising to demonstrate evidence of the validity of the metacognitive approach. According to the findings, possible interventions to improve policies are discussed.

Metacognitions about the positive and negative effects of smoking have been associated with cigarette use and nicotine dependence. The aim of the present study was to validate the Turkish version of the Metacognitions about Smoking Questionnaire (MSQ; Nikcevic et al., 2015). The sample consisted of 859 self-declared smokers (452 female) aged between 18 and 68 years (mean = 28.3; SD = 7.9). Once the English to Turkish translation of the MDQ was completed, confirmatory factor analyses were conducted based on the four-factor structure of the original measure. Initially results suggested that this model was an inadequate fit of the data obtained. However, by allowing three pairs of items (within factor) to co-vary, a re-specified model was tested that was found to be a satisfactory fit of the data. Internal reliability and predictive validity of the translated scale were observed to be good. The Turkish version of the MSQ exhibited suitable psychometric properties. This study also showed that metacognitions about smoking predict nicotine dependence independently of demographic variables, length of cigarette use, negative affect, and smoking outcome expectancies.

BACKGROUND: Both positive smoking outcome expectancies and metacognitions about smoking have been found to be positively associated with cigarette use and nicotine dependence. The goal of this study was to test a model including nicotine dependence and number of daily cigarettes as dependent variables, anxiety and depression as independent variables, and smoking outcome expectancies and metacognitions about smoking as mediators between the independents and dependents. METHODS: The sample consisted of 524 self-declared smokers who scored 3 or above on the Fagerstrom Test for Nicotine Dependence (FTND: Uysal et al., 2004). RESULTS: Anxiety was not associated with either cigarette use or nicotine dependence but was positively associated with all mediators with the exception of stimulation state enhancement and social facilitation. Depression, on the other hand, was found to be positively associated with nicotine dependence (and very weakly to cigarette use) but was not associated with either smoking outcome expectancies or metacognitions about smoking. Only one smoking outcome expectancy (negative affect reduction) was found to be positively associated with nicotine dependence but not cigarette use. Furthermore one smoking outcome expectancy (negative social impression) was found to be positively associated with cigarette use (but not to nicotine dependence). All metacognitions about smoking were found to be positively associated with nicotine dependence. Moreover, negative metacognitions about uncontrollability were found to be positively associated with cigarette use. CONCLUSIONS: Metacognitions about smoking appear to be a stronger mediator than smoking outcome expectancies in the relationship between negative affect and cigarette use/nicotine dependence. The implications of these findings are discussed.