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Stages of change analysis of smokers attending clinics for the medically underserved

The Journal of Family Practice. 2002 December;51(12):1-1
December 1, 2002|Family Medicine
Karen M. Gil, PhD
Author and Disclosure Information

Karen M. Gil, PhD
Susan Labuda Schrop, MS
Sarah C. Kline, BS
Emily A. Kimble, BS
Gary McCord, MA
Kenelm F. McCormick, MD
Valerie J. Gilchrist, MD
Rootstown, Ohio
From the Office of Research and Sponsored Programs and the Departments of Behavioral Sciences (K.M.G.) and Family Medicine (S.L.S., G.M., K.F.M., V.J.G), Northeastern Ohio Universities College of Medicine (S.C.K., E.A.K.), Rootstown, OH. This article was presented previously as “Changing Health Behavior in Patients at Underserved Clinics” (poster presented at the Society of Teachers of Family Medicine, Patient Education Conference; November 2002; Albuquerque, NM) and “Decisional Balance in Smokers Seeking Medical Care at Clinics for the Underserved” (presented at the 19th Annual Meeting of the Society of Teachers of Family Medicine, Northeast Region; October 2000; Philadelphia, PA). The authors report no competing interests. Partial funding was provided by the Summer Research Fellowship Program, Northeastern Ohio Universities College of Medicine.

Characteristics

There were no differences in sex, race, and age of smokers or in the responses to questions about their smoking across the precontemplation, contemplation, and preparation stages Table 1. Ninety smokers smoked less than a pack a day; 110 smoked at least a pack a day. Less than a third of the smokers who were not planning to quit (precontemplation) smoked less than a pack a day (31%), whereas most smokers planning to quit within 6 months (contemplation) smoked less than a pack a day (58%). However, within the group of smokers who claimed that they were going to quit within 30 days (preparation), only 41% smoked less than a pack a day.

Experiential processes

Smokers planning to quit (contemplation and preparation) reported that they had experiences that were consistent with quitting more often than did people who were not planning to quit within 6 months (precontemplation; Table 2). There were no significant differences between subjects who claimed they planned to quit within 30 days and those planning to quit within 6 months (contemplation vs preparation).

Behavioral processes

Smokers planning to quit (contemplation and preparation) scored higher on statements related to quitting than did people who were not planning to quit within 6 months Table 3. There were no significant differences between subjects in the contemplation and preparation stages.

Pros vs cons of smoking

There were no differences in the response of smokers who were (contemplation and preparation) or were not (precontemplation) planning to quit on how important the pros of smoking were to their decision to smoke Table 4. In contrast, smokers who were planning to quit rated statements about the cons of smoking as more important to their decision to smoke than did smokers who were not planning to quit.

In relative terms, the pros of smoking were more important than the cons of smoking to smokers who were not planning to quit (precontemplation group, pros vs cons, t = 3.8, P < .001). This effect was reversed in smokers planning to quit. Smokers planning to quit within 6 months reported that the cons were slightly, but significantly, more important than the pros of smoking (contemplation group, pros vs cons, t = 2.2, P < .03). This reversal was even more pronounced in smokers claiming they would quit within 30 days (preparation group, pros vs cons, t = 3.5, P < .002).

Self-efficacy and temptation

Subjects who planned to quit were significantly more likely to claim they were tempted to smoke in social situations than were people who were not planning to quit within 6 months (F = 4.69, P < .02). There was no effect of intention to quit on claims that negative situations tempted subjects to smoke, and there was no effect of intention to quit on claims that subjects smoked from habit.

Amount smoked per day

Responses within each category also were examined as a function of the number of cigarettes smoked per day. Smokers who smoked a pack or more a day claimed that they were more tempted to smoke when they were angry (F = 8.8, P < .005) or frustrated (F = 5.6, P < .02) than did smokers who smoked less than a pack a day. Smokers who smoked a pack or more a day had higher scores on the habit statements than did smokers who smoked less than a pack a day. They were more tempted to smoke when they first got up in the morning (F = 16.1, P < .001), over coffee (F = 9.1, P < .003), and when they realized they had not smoked for awhile (F = 8.6, P < .005).

Smokers who smoked more than a pack a day reported that the pros of smoking were more important to them than did smokers who smoked less than a pack a day (F = 5.56, P < .02). This effect was due primarily to the heavier smokers reporting that they were relaxed and therefore more pleasant when they smoked (F = 9.08, P < .003). There was an interaction effect as smokers who were planning to quit but still smoked more than a pack a day rated the pros of smoking the same as those who smoked less than a pack a day (F = 3.3, P < .05). There was no effect of number of cigarettes smoked each day on the statements relating to the cons of smoking.

The scores on the questions related to behavioral processes that are consistent with quitting were higher for those who smoked less than a pack a day (F = 9.45, P < .003). This was due primarily to those smokers scoring higher on the statements that they “think about something else” or “do something else” instead of smoking (F = 7.95, P < .01). There was no difference between those who smoked more or less than a pack a day on any statements related to the experiential processes involved in quitting.

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