Social support and the transtheoretical model: Relationship of social support to smoking cessation stage, decisional balance, process use, and temptation

The Transtheoretical Model (TTM) has been shown to be a powerful basis for describing and explaining behavior change and designing effective interventions. Previous research has documented its usefulness in the context of smoking cessation as well as other areas but predominantly in US samples. The goal of this study was to provide further data on the applicability of the TTM and the relationship of some of its core constructs (stage of change, self-efficacy, decisional balance) in a German sample of smokers and ex-smokers. Participants (N = 401) were ever-smokers (age M = 47 years, range 35-65, 62% male) who participated in a health check-up for cardiovascular risk factors at their general practitioner's office. For current smokers, significant differences in the number of quit attempts across the stages of change supported the criterion validity of the staging algorithm; differences in number of cigarettes per day were non-significant. Self-efficacy for non-smoking behavior showed an almost linear increase across the stages of change, with significant differences between pre-action and action stages. The pros for smoking cessation also increased significantly across the stages, mainly due to a significantly lower perception of pros by participants in the Precontemplation stage. As expected, the cons for smoking cessation decreased significantly, being lower in Action and Maintenance than in earlier stages. Although the generalizability of the results for the stage distribution is limited by the selectivity of the sample, the results underline the applicability and replicability of these TTM core constructs for smoking cessation with newly developed instruments in a German sample.

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Cross-validation of transtheoretical model smoking cessation measures in Chicago WIHS women smokers with and at risk for HIV

Translational Behavioral Medicine ◽

10.1093/tbm/ibz001 ◽

2019 ◽

Vol 10 (2) ◽

pp. 457-468

Author(s):

Colleen A Redding ◽

David Goldberg ◽

Kathleen M Weber ◽

Hui-Qing Yin ◽

Andrea L Paiva ◽

...

Keyword(s):

At Risk ◽

Smoking Cessation ◽

Negative Affect ◽

Transtheoretical Model ◽

Cross Validation ◽

Decisional Balance ◽

Confirmatory Factor Analyses ◽

Women Smokers ◽

Measurement Models ◽

Tailored Interventions

Abstract People with and at risk for HIV have high rates of smoking, increasing their morbidity and mortality. Effective cessation interventions are needed for this group. Transtheoretical model (TTM)-tailored interventions have demonstrated efficacy, but measures need cross-validation in this population. TTM cessation measures were evaluated in women smokers with and at risk for HIV (N = 111) from Chicago Women’s Interagency HIV Study (WIHS). Confirmatory factor analyses evaluated measurement models. MANOVAs examined relationships between constructs and stage subgroups. For decisional balance, the two-factor uncorrelated model was best (χ2(20) = 13.96; comparative fit index [CFI], 1.0; root mean square error of approximation [RMSEA] = .00), with good (pros α = .78) and fair (cons α = .55) four-item alphas. The one-factor temptations model (α = .90) showed reasonable fit (χ2(18) = 80.22; CFI = .89; RMSEA = .177). Processes of change subscales had fair to good two-item alphas (α = .49–.77) and fit a 10-factor fully correlated model (χ2(125) = 222.72; CFI = .88; RMSEA = .084). MANOVAs by stage of change replicated expected patterns for the pros, overall temptations, and two process subscales with medium-sized effects (η2 = .06–.18). Contrary to expectations, no differences by stage were found for cons or temptation negative affect subscales. The structures of these TTM measures replicated with good internal and external validity, except for the cons, which needs refinement. Negative affect temptations was structurally sound, but did not vary by stage group potentially reflecting this sample’s moderate depression levels and/or their reliance on smoking to deal with negative affect. Results support the use of most TTM measures in research and tailored interventions to increase smoking cessation among women smokers with and at risk for HIV and highlight the importance of managing negative affect in cessation materials targeting this group.

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Do the Transtheoretical Model processes of change, decisional balance and temptation predict stage movement? Evidence from smoking cessation in adolescents

Addiction ◽

10.1111/j.1360-0443.2009.02519.x ◽

2009 ◽

Vol 104 (5) ◽

pp. 828-838 ◽

Cited By ~ 15

Author(s):

Boliang Guo ◽

Paul Aveyard ◽

Antony Fielding ◽

Stephen Sutton

Keyword(s):

Smoking Cessation ◽

Transtheoretical Model ◽

Decisional Balance ◽

Processes Of Change

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Characteristics in Stages of Change and Decisional Balance among Smokers: The Burden of Obstructive Lung Diseases (BOLD)-Australia Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183372 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3372

Author(s):

Marsha A. Ivey ◽

Graeme P. Maguire ◽

Brett G. Toelle ◽

Guy B. Marks ◽

Michael J. Abramson ◽

...

Keyword(s):

Smoking Cessation ◽

Stages Of Change ◽

Transtheoretical Model ◽

Lung Diseases ◽

Decisional Balance ◽

Smoking History ◽

Health Providers ◽

Negative Consequences ◽

Obstructive Lung Diseases ◽

Readiness To Quit

Smoking cessation remains a health promotion target. Applying the Transtheoretical Model to Australian Burden of Obstructive Lung Diseases (BOLD) data, we examined differences in stages of change (SoC) and readiness to quit decisional behaviours. Factors were identified likely to influence readiness of smokers, ≥40 years old, to quit. Analysis was restricted to current smokers classified to one of three stages: pre-contemplation (PC), contemplation (C) or preparation (P) to quit. Their ability to balance positive and negative consequences was measured using decisional balance. Among 314 smokers, 43.0% females and 60.8% overweight/obese, the distribution of SoC was: 38.1% PC, 38.3% C and 23.5% P. Overweight/obesity was associated with readiness to quit in stages C and P and there were more negative than positive attitudes towards smoking in those stages. Males were significantly heavier smokers in PC and C stages. Females used smoking cessation medication more frequently in PC stage, were more embarrassed about smoking and had greater negative reinforcements from smoking. Age started smoking and factors related to smoking history were associated with readiness to quit and increased the odds of being in stage C or P. An overweight/obese smoker was likely to be contemplating or preparing to quit. In these stages, smokers have more negative attitudes toward smoking. Starting smoking later, taking advice on cessation from health providers and using quit medications indicate increased readiness to quit. Evaluating these factors in smokers and developing cessation gain-framed messages may prove useful to healthcare providers.

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Theories Used in Nursing Research on Smoking Cessation

Annual Review of Nursing Research ◽

10.1891/0739-6686.27.33 ◽

2009 ◽

Vol 27 (1) ◽

pp. 33-62 ◽

Cited By ~ 3

Author(s):

Kathleen A. O’Connell

Keyword(s):

Social Support ◽

Smoking Cessation ◽

High Risk ◽

Clinical Diagnosis ◽

Transtheoretical Model ◽

Clinical Guidelines ◽

Expert Knowledge ◽

Formal Theory ◽

Nursing Research ◽

Research Findings

Theories tell how and why things work; how and why one variable is related to another. Research findings that are theory based can be placed in a framework that advances science further than findings that are unconnected to formal theory. However, much of the research in smoking cessation is atheoretical. This review of nursing research on smoking cessation published from 1989 through 2008 revealed that nearly half of the studies were based on explicit formal theories. The transtheoretical model and self-efficacy theory were the most frequently used explicit theories with most theories emanating from psychology. Five nursing theories were identified in this review. Studies that used implicit rather than explicit theories dealt with five major concepts: nicotine dependence, social support, high-risk situations, mood–affect, and the influence of clinical diagnosis. Largely missing from this set of studies were investigations based on biobehavioral models, including genetics and neuroscience. The relevance of the theories and concepts identified in this review to current clinical guidelines on smoking cessation is discussed. With their grounding in theory and their expert knowledge of clinical issues, nurses are in an excellent position to develop theories that will help researchers in every discipline make sense of smoking cessation.

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