Stages of smoking cessation:The research issue
Traditionally, addictive behaviours have been viewed as ‘either/or’ behaviours. Therefore, smokers were considered either ‘smokers’ or ‘non-smokers’. But DiClemente and Prochaska (1982) developed a trans-theoretical model to examine the stages of change in addictive behaviours. This model is now widely used in health psychology to both predict and understand behaviour, and it is central to many interventions designed to change behaviour. In particular, individuals are assessed at the beginning of any intervention to identify which stage they are at. The content of the intervention can then be tailored to match the needs of each person.
The stages of change model describes the following stages:
1. precontemplation (not seriously considering quitting in the next six months)
2. contemplation (considering quitting in the next six months)
3. action (making behavioural changes)
4. maintenance (maintaining these changes)
5. relapse (return to old behaviour)
The model is described as dynamic, not linear, with individuals moving backwards and forwards across the stages. For the present study, the authors sub-categorized those in the contemplation stage (stage 2) as either contemplators (i.e. not considering quitting in the next 30 days) or in the preparation stage (i.e. planning to quit in the next 30 days).
Design and procedure
The authors recruited 1466 participants for a minimum intervention smoking cessation programme from Texas and Rhode Island. The majority were white, female, started smoking at about 16 years of age, and smoked on average 29 cigarettes a day. The participants completed the following set of measures at baseline and were followed up at one month and at six months. The participants were classified into three groups according to their stage of change: precontemplators, contemplators and those in the preparation stage.
1. Smoking abstinence self efficacy (DiClemente et al., 1985), which measures the smoker’s confidence that they would not smoke in 20 challenging situations.
2. Perceived stress scale (Cohen et al., 1983), which measures how much perceived stress the individual has experienced in the last month.
3. Fagerstrom Tolerance Questionnaire (Fagerstrom, 1978), which measures physical tolerance to nicotine.
4. Smoking decisional balance scale (Velicer et al., 1985), which measures the perceived pros and cons of smoking.
5. Smoking processes of change scale (DiClemente & Prochaska, 1985), which measures the individual’s stage of change. According to this scale, participants were defined as precontemplators (n = 166), contemplators (n = 794) and those in the preparation stage (n = 506).
6. Demographic data, including age, gender, education and smoking history.
Results and implications
The results were first analysed to examine baseline difference between the three participant groups. The results showed that those in the preparation stage smoked less, were less addicted, had higher self efficacy, rated the pros of smoking as less positive and the costs of smoking as more negative, and had made more prior quitting attempts than the other two groups.
The results were then analysed to examine the relationship between stage of change and smoking cessation. At both one and six months, the participants in the preparation stage had made more quit attempts and were less likely to be smoking. The results provide support for the stages of change model of smoking cessation, and suggest that it is a useful tool for predicting the outcome of an intervention.
DiClemente, C.C., & Prochaska, J.O., 1982, ‘Self-change and therapy change of smoking behaviour: A comparison of processes
of change in cessation and maintenance’, Addictive Behaviours, 7, 133–42.
Traditionally, addictive behaviours have been viewed as ‘either/or’ behaviours. Therefore, smokers were considered either ‘smokers’ or ‘non-smokers’. But DiClemente and Prochaska (1982) developed a trans-theoretical model to examine the stages of change in addictive behaviours. This model is now widely used in health psychology to both predict and understand behaviour, and it is central to many interventions designed to change behaviour. In particular, individuals are assessed at the beginning of any intervention to identify which stage they are at. The content of the intervention can then be tailored to match the needs of each person.
The stages of change model describes the following stages:
1. precontemplation (not seriously considering quitting in the next six months)
2. contemplation (considering quitting in the next six months)
3. action (making behavioural changes)
4. maintenance (maintaining these changes)
5. relapse (return to old behaviour)
The model is described as dynamic, not linear, with individuals moving backwards and forwards across the stages. For the present study, the authors sub-categorized those in the contemplation stage (stage 2) as either contemplators (i.e. not considering quitting in the next 30 days) or in the preparation stage (i.e. planning to quit in the next 30 days).
Design and procedure
The authors recruited 1466 participants for a minimum intervention smoking cessation programme from Texas and Rhode Island. The majority were white, female, started smoking at about 16 years of age, and smoked on average 29 cigarettes a day. The participants completed the following set of measures at baseline and were followed up at one month and at six months. The participants were classified into three groups according to their stage of change: precontemplators, contemplators and those in the preparation stage.
1. Smoking abstinence self efficacy (DiClemente et al., 1985), which measures the smoker’s confidence that they would not smoke in 20 challenging situations.
2. Perceived stress scale (Cohen et al., 1983), which measures how much perceived stress the individual has experienced in the last month.
3. Fagerstrom Tolerance Questionnaire (Fagerstrom, 1978), which measures physical tolerance to nicotine.
4. Smoking decisional balance scale (Velicer et al., 1985), which measures the perceived pros and cons of smoking.
5. Smoking processes of change scale (DiClemente & Prochaska, 1985), which measures the individual’s stage of change. According to this scale, participants were defined as precontemplators (n = 166), contemplators (n = 794) and those in the preparation stage (n = 506).
6. Demographic data, including age, gender, education and smoking history.
Results and implications
The results were first analysed to examine baseline difference between the three participant groups. The results showed that those in the preparation stage smoked less, were less addicted, had higher self efficacy, rated the pros of smoking as less positive and the costs of smoking as more negative, and had made more prior quitting attempts than the other two groups.
The results were then analysed to examine the relationship between stage of change and smoking cessation. At both one and six months, the participants in the preparation stage had made more quit attempts and were less likely to be smoking. The results provide support for the stages of change model of smoking cessation, and suggest that it is a useful tool for predicting the outcome of an intervention.
DiClemente, C.C., & Prochaska, J.O., 1982, ‘Self-change and therapy change of smoking behaviour: A comparison of processes
of change in cessation and maintenance’, Addictive Behaviours, 7, 133–42.
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