Using the Stages of Change Model to Choose an Optimal Health Marketing Target

Background: In the transtheoretical model of behavior change, “stages of change” are defined as Precontemplation (not even thinking about changing), Contemplation, Preparation, Action, and Maintenance (maintaining the behavior change). Marketing principles suggest that efforts should be targeted at persons most likely to “buy the product.” Objectives: To examine the effect of intervening at different stages in populations of smokers, with various numbers of people in each “stage of change.” One type of intervention would increase by 10% the probability of a person moving to the next higher stage of change, such as from Precontemplation to Contemplation. The second type would decrease by 10% the probability of relapsing to the next lower stage, such as from Maintenance to Action, and also of changing from Never Smoker to Smoker. Nine hypothetical interventions were compared with the status quo, to determine which type of intervention would provide the most improvement in population smoking. Methods: Three datasets were used to estimate the probability of moving among the stages of change for smoking. Those probabilities were used to create multi-state life tables, which yielded estimates of the expected number of years the population would spend in each stage of change starting at age 40. We estimated the effect of each hypothetical intervention, and compared the intervention effects. Several initial conditions, time horizons, and criteria for success were examined. Results: A population of 40-year-olds in Precontemplation had a further life expectancy of 36 years, of which 26 would be spent in the Maintenance stage. In a population of former and current smokers, moving more persons from the Action to the Maintenance stage (a form of relapse prevention) decreased the number of years spent smoking more than the any other intervention. In a population of 40-year-olds that included Never Smokers, primary smoking prevention was the most effective. The results varied somewhat by the choice of criterion, the length of follow-up, the initial stage distribution, the data, and the sensitivity analyses. Conclusions: In a population of 40-year-olds, smokers were likely to achieve Maintenance without an intervention. On the population basis, targeting quitters and never-smokers was more effective than targeting current smokers. This finding is supported by some principles of health marketing. Additional research should target younger ages as well as other health behaviors

Smoking cessation patterns by socioeconomic status in Alaska

The ongoing disparity in smoking prevalence across levels of socioeconomic status (SES) is a significant concern in the tobacco control field, and surveillance of cessation-related activity is key to understanding progress. Historically, lower SES smokers have had much lower quit ratios but this measure can be insensitive to recent quit-related behavior. It is therefore important to examine recent quit-related behavior to assess progress toward addressing this disparity, especially in states with tobacco control programs that focus on this priority population.We compared recent quit attempts and successes among non-Native lower SES Alaska smokers to those of higher SES using data from the 2012–2013 Alaska Behavioral Risk Factor Surveillance System (BRFSS). We assessed quit ratios, one-year and five-year quit rates, and six-month abstinence between the two groups.Cessation-related measures restricted to those who smoked in the previous one year did not significantly vary by SES. However, five year quit rates were significantly lower for persons of lower SES vs. higher SES (14% vs. 32% respectively, p < .001). Results were consistent after adjustment for age, sex, and other factors.Results showed that in the previous year, smokers of lower SES in Alaska were trying to quit and succeeding at similar rates as their higher SES counterparts. However, the equivalent pattern of quit success was not reflected in the five-year time frame. Tobacco control programs should monitor cessation trends using both recent and longer-term time frames for this population. More research is needed on reasons for fewer long-term quits among lower SES smokers. Keywords: Smoking/epidemiology, Smoking/prevention and control, Smoking cessation, Social class, Socioeconomic factor

Demonstrating the Importance and Feasibility of Including Sexual Orientation in Public Health Surveys: Health Disparities in the Pacific Northwest

Objectives. We identified health disparities for a statewide population of lesbian, gay, and bisexual (LGB) men and women compared with their heterosexual counterparts

The Impact of Clean Indoor Air Exemptions and Preemption Policies on the Prevalence of a Tobacco-Specific Lung Carcinogen Among Nonsmoking Bar and Restaurant Workers

Objectives. We studied the impact of clean indoor air law exemptions and preemption policies on the prevalence of a tobacco-specific lung carcinogen—4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)—among nonsmoking bar and restaurant workers