Smoking behavior intervention based on implicit approach: a cross-sectional pilot study [version 2; peer review: 2 approved]

Introduction Indonesia is the country with the highest smoking rate in Southeast Asia and the third-highest globally. Smoking has become one of Indonesia’s biggest addiction problems. The goal of this research is to develop smoking behavior intervention based on an implicit approach. Methods This article contains a two-step study that was part of a comprehensive study on smoking behavior in Indonesia. The first study, applying measurement of Stroop task to 117 male-university-students to examine attention bias among smokers. In the second study, the research aims to develop an intervention by investigating the effects of the experimental retraining by manipulating the automatic-avoidance-action tendencies using an approach-avoidance task (AAT) on 40 male university student smokers that proved to have an attentional bias in the first study. Results The first study results revealed that smoking behavior was associated with attention bias shows a significant difference between smokers and nonsmoker participants in reaction time to smoking-related stimuli (F (3,85)=20.665, p value stimuli 0.000<0.05). This result is the basis for developing an implicit approach-based intervention. The results showed that direct AAT had significantly different results when compared to the control group (t(10)=2,685, p<.05). The outcomes of the studies showed that the direct form retraining (six weeks, twice a week) proved to shape the AAT effect and reduce the cigarettes consumption of the smokers. Conclusions This pilot research becomes initial step examine attentional bias that strengthen smoking addiction and the first attempt to develop smoking cessation interventions in Indonesia using an implicit cognition approach.