Time perspective as a predictor of smoking status: findings from the International Tobacco Control (ITC) Surveys in Scotland, France, Germany, China, and Malaysia

In recent explanatory models of health-risk and health-promoting behaviors, considerations of time frame have played a prominent role, in part because of the temporal asymmetry of costs and benefits involved [1]. Such temporal considerations can help to explain why so many people avoid health protective behaviors even though they might value their eventual outcomes, and engage in health risk behaviors, such as smoking, that confer long-term disadvantages.

Temporal asymmetries figure prominently in smoking behavior, given that the act of smoking can provide a range of immediate rewards to the smoker, including stress reduction, improved concentration, and feelings of social connectedness, with only minor immediate costs [2]. The overall balance of consequences shifts in the opposite direction over time, given that smoking is the leading cause of chronic disease and mortality in the world today, and prospective studies have found up to threefold increased mortality risk for smokers compared to non-smokers [3–5]. Despite these well-known risks, individuals may continue to smoke if the perceived immediate benefits of smoking outweigh the future health consequences. It follows then that greater consideration of the future costs over the immediate benefits of health-damaging behaviors such as smoking should facilitate behavior that is consistent with one’s long-term health interests.

The general tendency to consider the future consequences of one’s current behavior has been described as an individual difference variable called time perspective[1, 6–8]. Various definitions and measurements of this concept have been applied by researchers, including “personal time horizon” [9], “consideration of future consequences” [10], and “future orientation or future-orientedness” [6, 11]. These diverse conceptualizations share a common emphasis on the way individuals consider temporal factors in order to explain behaviors that might have implications for health status and longevity [1, 12].

Time perspective has been differentiated from related but separate individual difference variables such as impulsivity and sensation seeking on both a conceptual level and in terms of the hypothesized neural underpinnings of the constructs [13]. Impulsivity is generally thought to reflect the operation of lower brain reward centres of older evolutionary origin, and reflects a tendency to act without thinking. Time perspective, on the other hand, is associated with the higher cortical centres associated with abstract reasoning, and reflects a tendency to deliberate over short versus long term contingencies (rather than a lack of deliberation overall) [14, 15]. While both constructs have been described as relatively stable individual difference variables, evidence suggests that time perspective can be modified through targeted interventions, whereas targeting interventions based on impulsivity and sensation seeking involves identifying high-risk individuals and then tailoring interventions based on their existing level of the trait [16, 17].

The relationship between time perspective and health-related behavior has been documented in several health domains. In general, research supports the notion that individuals with a stronger future time perspective are more likely to engage in protective health behaviours and less li[kely to engage in risky health behaviours including substance use [1, 6, 7, 17–20]. An experimental study by Hall and Fong found that increasing future-orientation can lead to increases in physical activity, supporting the notion that there is a causal relationship between time perspective and health protective behavior [17]. In a more recent study, Hall and Fong also demonstrated a positive association between future-oriented time perspective and uptake of weight management behaviors (reduction of fatty food consumption and increase in regular physical activity), and this association was mediated by intention strength, suggesting that future orientation may generate stronger motivation to perform positive health behaviors such as weight management [20].

Only a few studies have specifically examined the role of time perspective in the domain of tobacco use [12, 13, 21, 22], but the evidence thus far indicates that time perspective can predict both smoking initiation among youth and cessation behavior among adult smokers. For instance, in a sample of high school students who completed the North American Student Smoking Survey (NASSS), scores on a time perspective scale were shown to predict smoking status as well as likelihood of initiation among those who had never smoked [8]. These findings are supported by a more recent study using a small sample of U.S. adults, in which future time perspective, as measured by two different scales, was associated with decreased risk of being a current smoker [21].

The relation between time perspective and quit behavior has been examined in a cohort study of smoking cessation among older English adults. Using a measure of financial planning as a proxy for time perspective, Adams found that those who reported more long-term periods for financial planning were less likely to be smokers, and among the smokers, those with a more future-oriented time perspective were more likely to quit [12]. A recent study of smokers in four English speaking countries (U.S., Canada, U.K. and Australia) found time perspective to be a significant predictor of quit attempts, and this relation was mediated by quit intentions [13]. In addition, Kovac and Rise have found that scores on a time perspective measure moderated the relation between intentions to quit and actual quitting behavior, suggesting that a future time perspective enhances smokers’ ability to follow through on their motivation to quit [22]. Therefore, the existing research suggests that future time perspective is negatively related to smoking behavior and positively associated with quitting among those who smoke.

In summary, from the modest number of studies that have examined the association between time perspective and smoking behavior, there is growing support for the notion that future time perspective is an important construct in understanding factors that make people more or less likely to smoke or to stop smoking. However, some of these studies were small scale samples, and none have examined the association between time perspective and smoking status across geographic regions that vary in language, cultural milieu, and ethnic composition. For this reason, we do not currently have precise estimates regarding the strength of association between time perspective and smoking behavior, nor do we know how well this association—if present—holds across different populations.

The goal of the present study was to test whether individual differences in time perspective predict smoking status (smoker vs. non-smoker) using large representative probability samples in multiple countries, with the a priori hypothesis that those with a stronger future time perspective would be more likely to be non-smokers. A secondary aim was to examine whether the relation between future time perspective and smoking status would differ across cultures. As most research on time perspective has been conducted only in high-income countries, it is important to examine whether the relation between time perspective and smoking status varies across a range of both high-income and lower-income countries, each with unique tobacco control situations and levels of tobacco use.

The main objective of this study was to examine whether individual differences in time perspective can distinguish between smokers and non-smokers cross-nationally. As predicted, our findings indicated that time perspective was indeed associated with smoking status, such that individuals who were more future-oriented were more likely to be non-smokers than smokers. Of the countries surveyed, the only exception to this trend was China; in Scotland, France, Germany and Malaysia, future-orientedness was associated with significantly lower odds of being a current smoker than present-orientedness.

One important strength of the current study is the use of large probability samples in five countries to estimate the strength of association between time perspective and smoking status. In contrast, most prior studies examining time perspective and health risk behaviors have been relatively small in size and unknown in representativeness. Furthermore, the multi-country nature of the sample allowed for comparison of the strength of association across and within different countries that vary in level of knowledge about smoking and potency of tobacco control legislation.

The relation between time perspective and smoking status was relatively uniform across the countries included in this study. Despite differences in sampling methods, the association was found in four of the five countries surveyed, although the strength of the relationship varied among these countries. As mentioned, future-oriented respondents in Malaysia had the highest odds of being a non-smoker. The weakest (non-significant) association between time perspective and smoking status was found in China, where the prevalence of future-orientation was also lowest.

One potential explanation for the non-significant relation between time perspective and smoking status in China relates to the extent to which the harms of smoking are salient among the Chinese people. China has only recently begun to take efforts towards reducing tobacco use, and ITC Project research has demonstrated that awareness in China of specific health risks of smoking is still very low compared to other countries [28, 29]. It may be the case then that in countries such as China where there is a lack of awareness of the future consequences of tobacco use, the role of time perspective is diminished. In other words, the effects of having a future time perspective on smoking behavior can only operate when the awareness exists of the trade-off between the long-term over the short-term consequences of smoking.

This study found that individual differences in time perspective – the tendency to consider short-term versus future consequences of one’s actions – predicts smoking status at the cross-national level. Analyses across five high- and lower-income countries found that the prevalence of future time perspective was significantly higher among non-smokers than among smokers, although the strength of the relationship varied among these countries and was not significant in China. These findings further establish time perspective as an important predictor of smoking status and suggest the potential value of smoking cessation interventions to enhance future time perspective.