Stage versus continuum models for smoking cessation

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DESCRIPTION (provided by applicant): Stage theories of health behavior have been increasingly popular over the past 20 years. Stage models are appealing because they bring structure and order to an otherwise complex and unwieldy skein of variables. To illustrate, consider the many variables that predict smoking cessation: smoking rates, past quit attempts, and various measures of nicotine dependence, to name a few. Whereas all these variables have been shown to be relevant to the process of smoking cessation, it is difficult to organize these variables into a coherent theory or description of how people quit smoking. A stage model could help bring structure and organization to these variables in a way that would inform interventions. If smokers could be arranged in an ordered set of categories leading to cessation, then interventions could be designed for each category of smoker. In other words, interventions could be matched to stage, because smokers in different stages would have different needs. The intuitive appeal of a stage model for smoking cessation is reflected by the widespread usage of the stages of change over past 20 years. The stages of change construct is the linchpin of a larger model know as the transtheoretical model (TTM). However, several researchers have recently expressed reservations regarding the basic tenets of the TTM. Weinstein et al. (1998) have proposed four principles for evaluating stage models: (1) stages should be qualitatively distinct categories, (2) stages should be an ordered sequence, (3) people within each stage should face similar barriers to change, and (4) people in different stages should face different barriers to change. A systematic review reveals that TTM does not accord well with these principles. The proposed research aims to evaluate whether a stage model for smoking cessation can be developed that would be consistent with the principles of Weinstein et al. Three qualitative (i.e., stage-like) distinctions are proposed: 1) Those who want to quit smoking as distinguished from those who to those who do not want to quit smoking. 2) Those who intend to quit smoking as distinguished from those who do not intend to quit smoking. 3) Those who have a specific plan of how to quit smoking as distinguished from those who have only a vague intention of quitting. Questionnaire items will be employed that are designed to reveal whether smoking cessation is better described as a stage process or a continuous process.