Baseline Stage, Severity, and Effort Effects Differentiate Stable Smokers from Maintainers and Relapsers

Abstract

This cross-sectional study (N = 4,144) compared three longitudinal dynatypes (Maintainers, Relapsers, and Stable Smokers) of smokers on baseline demographics, stage, addiction severity, and transtheoretical model effort effect variables. There were significant small-to-medium-sized differences between the Stable Smokers and the other two groups on stage, severity, and effort effect variables in both treatment and control groups. There were few significant, very small differences on baseline effort variables between Maintainers and Relapsers in the control, but not the treatment group. The ability to identify Stable Smokers at baseline could permit enhanced tailored treatments that could improve population cessation rates.

RÉSUMÉ

L’étape initiale, la gravité, et les variables effet par rapport à la tentative font les différences entre les fumeurs actuels, les fumeurs qui ont arrêté de fumer, et les récidivistes.

Cette étude transversale (N = 4,144) a comparé trois types de fumeurs (fumeurs actuels, les fumeurs qui ont arrêté de fumer et les récidivistes) sur la démographie initiale, l’étape dans le processus d ‘arrêter de fumer, la gravité de la toxicomanie et variables effet par rapport à la tentative dans la modèle transthéorique. Nous avons trouvé des différences significatives de taille petite à taille moyenne entre les fumeurs actuels et les deux autres groupes à propos de l’étape, de la gravité initiale et des variables sur l'effet par rapport à la tentative. Ces différences étaient pareilles dans le groupe de traitement ainsi que la groupe témoin. Il y avait peu de différences significatives petits sur les variables d'effort initial entre les fumeurs qui ont cessé de fumer et les récidivistes dans le groupe témoin. Cependant il n'y avait pas des différences significatives dans le groupe de traitement. La capacité d'identifier les fumeurs actuels au début pourrait permettre la création des traitements individualisés, lesquels pourraient améliorer les taux de réussite parmi ceux qui essaient d'arrêter de fumer.

RESUMEN

La etapa inicial, la gravedad y los efectos del esfuerzo en el punto de partida diferencian a los fumadores habituales de los ex-fumadores y los re-incidentes.

Este estudio transversal (N = 4,144) compara tres tipos de fumadores (fumadores habituales, ex-fumadores y reincidentes) tomando como punto de partida sus datos demográficos, etapa en el proceso de dejar de fumar, gravedad de la adicción y variables TTM de esfuerzo—efecto. Encontramos diferencias significativas de tamaño pequeño o medio entre los fumadores habituales y los otros dos grupos en cuanto a etapa inicial, gravedad y variables de esfuerzo—efecto en grupos de tratamiento y control. Había pocas diferencias significativas de pequeño tamaño cuando se tomaba como punto de partida variables de esfuerzo entre los ex-fumadores y los reincidentes en el grupo control, pero no en el grupo de tratamiento. La capacidad de identificar fumadores habituales al inicio del tratamiento podría mejorar los porcentajes de éxito entre aquellos que intentan dejar de fumar.

Keywords :

• smoking cessation
• maintenance
• relapse
• stages of change
• addiction severity
• transtheoretical model
• processes of change
• pros and cons
• self-efficacy

THE AUTHORS

Colleen A. Redding, Ph.D., is a Research Professor at the Cancer Prevention Research Center and an Adjunct Professor of Psychology at the University of Rhode Island (URI). She has published more than 70 papers and chapters on diverse topics in Health Psychology and Behavioral Medicine. Her contributions include pioneering the development and application of tailored computer-delivered interventions for health behavior change, especially in high-risk populations. She is one of the principal researchers using the TTM of behavior change in new research areas such as sexual health promotion, multiple health risk behaviors, sun protection, healthy diet, sustainability, and stress management. In addition to the TTM and mechanisms of behavior change, she is also interested in familial and multilevel influences on health risk behaviors. She is an editor and reviewer for many behavioral science journals. She has been an investigator on at least 25 NIH and CDC research grants.

James O. Prochaska, Ph.D., is the Director of Cancer Prevention Research Center and a Professor of Clinical and Health Psychology at the URI. He is the author of over 350 publications, including three books, namely, Changing for Good, Systems of Psychotherapy, and The Transtheoretical Approach. He is internationally recognized for his work as a developer of the stage model of behavior change. He is the principal investigator on over $70 million dollars in research grants for the prevention of cancer and other chronic diseases. He is the founder of Pro-Change Behavior Systems. Dr. Prochaska has won numerous awards, including the Top Five Most Cited Authors in Psychology from the American Psychology Society and an Innovator's Award from the Robert Wood Johnson Foundation, and is the first psychologist to win a Medal of Honor for Clinical Research from the American Cancer Society.

Andrea Paiva, Ph.D., received her bachelor's degree in Psychology and Health Policy Management from the Providence College and her MA and Ph.D. degrees in Experimental Psychology/Behavioral Science from the URI. Dr. Paiva is an Assistant Research Professor at the Cancer Prevention Research Center and an Adjunct Professor of Psychology at the URI. Her primary interest is the application of the TTM for health behavior change. She has worked with a variety of health behaviors, including smoking cessation, adolescent drug and alcohol use, college drinking, diet, exercise, and decision-making for health care, organ donation, and blood donation. In addition to the mechanisms of behavior change, her research interests include methodology and statistics and use of technology in behavior change interventions.

Joseph S. Rossi, Ph.D., is a Professor and the Director of the Behavioral Science Ph.D. program in the Department of Psychology, and the Director of Research at the Cancer Prevention Research Center at the URI. He has been the principal investigator or co-investigator on more than 50 grants and has published more than 150 papers and chapters. In 1996, the American Psychological Society and the Institute for Scientific Information listed Dr. Rossi 5th in author impact (citations/paper) and 12th in number of citations (APS Observer, January 1996, pp. 14–18). In 2006, he was named one of the most highly cited researchers in the world in the fields of psychology/psychiatry by Thomson Reuters (http://isihighlycited.com/). He won the URI's Scholarly Excellence Award in 2003, was elected to membership in the Society of Multivariate Experimental Psychology in 1995, and is a fellow of Division 5 of the American Psychological Association. Dr. Rossi is one of the principal developers of the TTM of health behavior change. His areas of interest include quantitative psychology, health promotion and disease prevention, and expert system development for health behavior change. Dr. Rossi is a member of the URI's Institutional Review Board.

Wayne Velicer, Ph.D., is the Co-Director of the Cancer Prevention Research Center and a Professor of Psychology at the URI. He has published more than 250 papers on topics in health psychology and behavioral statistics. In health psychology, his contributions include pioneering the application of computer-based interventions to health promotion. He is one of the principal developers of the TTM of behavior change. In behavioral statistics, his contributions include refining factor analysis and component analysis, pioneering the application of time series analysis to the behavioral sciences, and improving methods for measurement development. He was identified as one of the highest impact authors in psychology (average citation per paper) by the major studies in 1992, 1996, and 2003. He has been the Principal Investigator or co-PI on more than $100 million in research grants. He has been a Visiting Professor at the University of Western Ontario (London, Canada), Macquarie University (Sydney, Australia), the University of Maastricht (Maastricht, the Netherlands), the University of New South Wales (Sydney, Australia), the University of Marburg (Marburg, Germany), and the Queensland University of Technology (Brisbane, Australia).

Bryan J. Blissmer, Ph.D., is an Associate Professor in the Department of Kinesiology and an Associate Research Professor at the Cancer Prevention Research Center at the URI. Dr. Blissmer's research focuses on delivering interventions to promote a healthy lifestyle as well as analysis of psychosocial outcomes of those interventions. He collaborates with faculty in Psychology and Nutrition and his research has included populations ranging from adolescents to older adults. His funding from the American Cancer Society examined the best ways to get individuals with multiple risk factors (smoking, sedentary, poor diet) to change their behaviors to promote health and reduce their risk of developing cancer. He teaches both graduate and undergraduate courses in the Department of Kinesiology.

Geoffrey W. Greene, Ph.D., received his bachelor's degree in Anthropology from Columbia College, Columbia University, his MS degree in Nutrition and Public Health from Teachers College, Columbia University, an MPH in International Health from University of Hawaii at Manoa, and his Ph.D. in Nutrition from the Pennsylvania State University. His professional employment includes WIC Program Coordinator, Department of Health, State of Hawaii; Nutritionist, Waikiki Health Center; Nutrition Coordinator, College of Medicine and Dentistry of New Jersey—New Jersey School of Osteopathic Medicine; and Assistant Professor, Pennsylvania State University. He is currently a Professor and the Director of Dietetic Internship, URI. Dr. Greene's research focuses on behavior change for chronic disease risk reduction and obesity prevention.

Mark L. Robbins, Ph.D., is a Clinical Health Psychologist and an Associate Professor in the Psychology Department at the URI. He has developed a program of research applying the TTM to decision-making in deceased and living organ donation and transplantation, blood donation, and advanced care planning. He has been the Principal Investigator on three HRSA-funded randomized clinical trials to increase family consent for organ donation and to increase organ donation intent. He is currently funded by NHLBI to develop a TTM-based intervention to increase blood donation among African-Americans in the context of sickle cell disease. His research has had an emphasis on addressing health disparities and on cultural tailoring for health decision-making. Dr. Robbins teaches undergraduate courses and mentors graduate students in URI's APA-approved Clinical Psychology graduate program.

Xiaowu Sun, Ph.D., Senior Principal Scientist at CareFusion Clinical Research, has 20 years of experience in biostatistics. He was a postdoctoral fellow at Cancer Prevention Research Center at the URI, and has served as a biostatistician for multiple NIH projects. Dr. Sun conducts methodological and applied research on risk-adjustment models and hospital-acquired infections. His research interests include observational data analysis, public reporting, and outcomes research. He has coauthored over 20 publications.