Readiness for smoking change among middle-aged finnish men

According to the transtheoretical model of change, smoking cessation attempts are preceeded by three stages: precontemplation, contemplation, and preparation. These stages have shown great utility in predicting and impacting on behavior change. This cross-cultural study examined the distribution of the stages within a 33% random sample of middle-aged Finnish men. Of 490 regular smokers, 57.6% were in precontemplation, 29.4% in contemplation, and 13.0% in preparation. Five conceptual clusters were used to predict the stage membership. The number of lifetime quit attempts and the number of 24-h quit attempts in the past 12 months were found to be the best discriminators among the stages. The overall correct classification rate into stage using stepwise discriminant function analysis was 64.0%, substantially better than the chance rate. However, the analysis was successful for precontemplators only. Results showed that most smokers were precontemplators. Previous attempts to reduce smoking provided some predictive information concerning stage membership. Demographics, addiction to smoking, current smoking, smoking environment, and quit history were incomplete predictors of stage membership, as theoretically predicted. © 1992

Factor Structure of Decisional Balance and Temptations Scales for Smoking: Cross-Validation in Urban Female African-American Adolescents

Background: The transtheoretical model is an influential theoretical model in health psychology, particularly in its application to smoking cessation research. Decisional Balance (DB) and Temptations are key constructs within this framework. Purpose: This study examines the psychometric properties of the DB and Temptations scales for smoking in a predominantly African-American sample of urban adolescent girls. Methods: We used confirmatory factor analysis to compare the fit of previously published factor structures in smokers (n = 233) and nonsmokers (n = 598). External validity was tested by examining stages of change differences in the retained subscales. Results: Results supported the internal and external validity of the DB scale for smokers and nonsmokers. Notably, previously published three-factor (Social Pros, Coping Pros, Cons) and four-factor (Cons split into “Aesthetic Cons” and “Health Cons”) models fit equally well, with Cons subscales correlating highly. For Temptations, a previously published three-factor (Negative Affect, Social, Weight Control) hierarchical model fit well in nonsmokers. In smokers, previously published subscales were reliably measured, but their structural relationship remained unclear. Stage difference tests showed medium to large effect sizes of DB and Temptation subscales in smokers and nonsmokers. Conclusions: The use of DB was validated for both smokers and nonsmokers in this sample of primarily African-American adolescent females, where Cons can be combined or separated into “Aesthetic Cons” and “Health Cons” based on practical utility and preference. For Temptations, more research is needed but large stage differences in Temptations subscales underscore the importance of this concept in smoking acquisition and cessation

Stages of acquisition and cessation for adolescent smoking: An empirical integration

Adolescent cigarette smoking acquisition and cessation were integrated into a single nine-stages-of-change continuum using the transtheoretical model of change framework. Findings in a high school student sample (n \u3e 700) showed that a few of the never smokers were planning to try smoking, and half of the current smokers were contemplating quitting. More than half of former smokers were long-term quitters. The high pros of smoking scores assessing coping benefits of cigarettes were related to smoking acquisition and the high con (disadvantages) scores to long-term abstinence. Never smokers were most tempted to try smoking when they anticipated that smoking would help reduce negative and increase positive mood. Current and former smokers were tempted due to peer cigarette offers and negative mood. These temptations were significantly reduced among ex-smokers

A 2-year self-help smoking cessation manual intervention among middle- aged Finnish men: An application of the transtheoretical model

Background. A 2-year self-help manual smoking cessation intervention was conducted among a panel of middle-aged Finnish men (n = 265) who were recruited proactively in a longitudinal cardiovascular risk factor surveillance study. Methods. Intervention utilized the stages of change concept of the transtheoretical model. The stages were assessed in the treatment condition at baseline of the cessation study and after that by mail every sixth month. Assessments were followed by an immediate mailing of a stage-based self-help manual matching the stage of change at that time. A usual care group was assessed annually but received no treatment. Results. A significant time x intervention effect (P \u3c 0.05) and time x baseline stage effect (P \u3c 0.001) on quit rates were observed in the panel data over the 2- year period. An analysis of changes in the stages of change also revealed an accelerated cessation process in the treatment condition. Conclusions. We conclude that mailed stage-matched self-help smoking cessation manuals were able to accelerate the smoking cessation process but manuals alone may not constitute a sufficient long-term intervention. The effects of differential exposure to intervention, subject characteristics, measurement reactivity, and secular trends are discussed as potential confounds. © 1994 by Academic Press, Inc

Stage of change, decisional balance, and temptations for smoking: Measurement and validation in a large, school-based population of adolescents

Developing interventions for reducing adolescent smoking rates based on the Transtheoretical Model (TTM) requires the development of quality measures of the key constructs of the model. The goal of this investigation was to evaluate the psychometric properties of measures of Stage of Change, Decisional Balance and Situational Temptation for both smokers and nonsmokers and to test if the predicted relationships between these constructs were confirmed in a large (N=2808) sample of adolescents. A correlated three factor model (Social Pros, Coping Pros and Cons) provided an excellent fit to the 12-item Decisional Balance inventory for both smokers (CFI=0.957) and nonsmokers (CFI=0.963). A hierarchical four factor model (negative affect, positive social, habit strength and weight control) provided an excellent fit to the eight-item Situational Temptations inventory for smokers (CFI=0.969). A hierarchical five-factor model (same four as smokers plus Curiosity) provided an excellent fit to the 10-item Situational Temptations inventory for nonsmokers (CFI=0.943). The relationships between both the Decisional Balance and temptation scales and the Stages of Change were verified for both smokers and nonsmokers. The measures for adolescents are similar to but not the same as the measures of these constructs for adults. © 2001 Elsevier Science Ltd

Psychometric evaluation of the smoking cessation Processes of Change scale in an adolescent sample

The Processes of Change are the cognitions, behaviors, and emotions that people employ to change their behaviors. However, the processes of change remain the least studied dimension of the transtheoretical model. The present study presents a psychometric evaluation of the short form of the processes of change inventory for smoking cessation in an adolescent sample of 798 ninth-grade smokers from 22 Rhode Island high schools. The majority of the sample was white (87.2%), split approximately evenly as regards to gender (48.1% female), with an average age of 14.3 (SD = 0.6) years of age. The same hierarchical model established on the adult sample was fit to the 20-item inventory. This model included 10 primary factors representing the processes of change and two second order factors that grouped the processes into five behavioral and five experiential processes of change. Model fit indices (RMSEA = 0.08, CFI = 0.92) supported the hypothesized structure. External validation was established by testing for stage differences in the use of the ten processes. A significant MANOVA (F(4, 793) = 18.517, p \u3c 0.001) and separate ANOVAs demonstrated that the use of all ten processes increased across the stages, as predicted by the transtheoretical model of behavior change. The processes of change help guide researchers, clinicians, and intervention program developers towards effective strategies to assist individuals at all stages of change progress towards healthier behaviors. © 2005 Elsevier Ltd. All rights reserved

Computer-based smoking cessation interventions in adolescents: Description, feasibility, and six-month follow-up findings

The impact of adolescent smoking cessation clinics has been disappointing due to low participation rates, high attrition, and low quit rates. This paper describes two computerized self-help adolescent smoking cessation intervention programs: 1) a program utilizing the expert system which is based on the transtheoretical model of change and 2) a popular action-oriented smoking cessation clinic program for teens which was modified for computer presentation. High participation rates in the program among 132 smokers demonstrate the high feasibility and acceptability of the programs. Quit rates of up to 20% were oberved during the intervention, and an additional 30% made unsuccessful quit attempt(s). The 6-month follow-up findings indicated that adolescents were poorly prepared to maintain abstinence

Transtheoretical individualized multimedia expert systems targeting adolescents\u27 health behaviors

The transtheoretical model has advanced research and practice for many health behavior changes among adults, but few applications have been developed and applied among adolescents. This paper will describe an innovative and promising computer-bared technology for standardized assessment and individualized theory-based intervention delivery called expert systems. Two different studies utilizing multimedia expert systems technology for assessing and intervening with adolescents targeting several health behaviors will be described. One study includes high school students and targets smoking cessation or prevention, sun protection, and dietary fat reduction. The other study includes urban adolescent female clients recruited in family planning clinics and targets condom adoption and either smoking cessation or prevention. The advantages and disadvantages of expert systems technology are reviewed. Multimedia expert system technology has the potential to enhance health promotion and adherence by integrating the strongest components from both clinical and public health models of intervention

Validation of decisional balance and situational temptations measures for dietary fat reduction in a large school-based population of adolescents

Brief, validated, and reliable theory-based measures specifically designed for use in large survey research with adolescent populations are needed to assess attitudes and behaviors about dietary fat consumption. This study validated two transtheoretical model (TTM)-based instruments in 2639 ninth graders from 12 Rhode Island high schools. The Decisional Balance Questionnaire for Adolescent Dietary Fat Reduction (DBQA) measures the importance adolescents assign to the pros and cons of reducing dietary fat consumption, while the Situational Temptations Questionnaire for Adolescents (STQA) measures temptations to eat high-fat foods as both a global construct and across three categories of challenging situations. Four competing models were compared for each instrument. An eight-item, correlated two-factor Pros and Cons model was validated for the decisional balance measure and a nine-item, three-factor hierarchical model was validated for situational temptations. The theoretically predicted relationships between stage of change and the pros and cons, as well as stage and situational temptations were supported. These results demonstrate that both measures have sound psychometric properties and are externally valid. © 2001 Elsevier Science Ltd