Preparation Stage Of Change Research Articles

Experiences of Participants with Spinal Cord Injury at an Active Rehabilitation Camp.

This study explored the physical, social, and psychological benefits of an active rehabilitation (AR) camp as experienced by participants with spinal cord injury (SCI), and perceived fitness and mastery of being physically active six months after the camp. The study used a mixed-method design with pre- (n = 23), post- (n = 23), and follow-up questionnaires (n = 18) and individual interviews (n = 8). Fuzzy qualitative comparative analysis (fsQCA) was used to analyze the quantitative data and qualitative content analysis was used to analyze the qualitative data. Results showed that benefits were mainly experienced in the social and psychological domains. As for the physical domain, younger and more recently injured persons with tetraplegia reported more benefits. Six months after the camp, being in the preparation stage of change and being somewhat physically active were necessary and sufficient conditions for experiencing mastery of physical activity regardless of injury type, but only persons with paraplegia experienced fitness benefits. Qualitative data shed further light on the perceived benefits of the camp. The knowledge gained from this study might help practitioners to tailor interventions to individual needs and researchers to ask questions that take into consideration the complexity of active rehabilitation and changes in physical activity behavior for people with SCI.

Readiness to Refrain from Carbonated Drinks among High School Female Students: The Transtheoretical Model of Change as a Theoretical Framework

Objective: This study is a part of randomized controlled trial. This study aims to identify high school female students’ readiness to refrain from carbonated drinks. Method: The study included a simple random sample of 144 high school female students who were recruited from Al-Russafa High School for females in Baghdad City. The study instrument consists of participants’ sociodemographic characteristics of age, living arrangement, and family’s socioeconomic status, Stages of Change for Carbonated Drinks Consumption Behavior Scale (Short Form), Stages of Change for Carbonated Drinks Consumption Behavior Scale (Continuous Measure), The Processes of Change for Carbonated Drinks Consumption Behavior Scale, The Self-Efficacy for Carbonated Drinks Consumption Behavior Scale which includes 18 Decisional Balance Scale for Carbonated Drinks Consumption Behavior. Data were analyzed using the statistical package for social science (SPSS) for Windows, version 26. Results: More than half are in the Precontemplation Stage of Change (n = 84; 58.3%), followed by those who are in the Preparation Stage of Change (n = 30; 20.8%), those who are in the Contemplation Stage of Change (n = 28; 19.5%), and those who are in the Maintenance Stage of Change (n = 2; 1.4%).The regression model displays that the family’s socioeconomic status, Self-Liberation, and students’ age positively predicted the Stages of Change to refrain from carbonated drinks (p-value = .004, .009, 035) respectively. Conclusion: The regression model displayed that Self-Liberation and students’ age positively predicted the Stages of Change to refrain from carbonated drinks. This finding implies that .The regression model displayed that students’ age positively predicted the Stages of Change to refrain from carbonated drinks. Keywords: Carbonated Drinks; Readiness to Refrain; High School Female Students.

How Ready Are Gym Users to Refrain from Performance-Enhancing Substances? The Transtheoretical Model of Change as a Theoretical Framework

Methods: A descriptive predictive correlational design was be used to guide this study.The study included a convenience sample of male gym users who agreed to participate in this study. The study subjects were recruited from six private gyms.The study instrument includes subjects’ sociodemographic characteristics of age, living arrangement, family’s socioeconomic status, the performance-enhancing substances that the gym users use. It also includes the Transtheoretical Model of Change measures of Stages of Change for Performance-Enhancing Substances Scale (Short Form), the Stages of Change for Performance-Enhancing Substances Scale (Continuous Measure), the Processes of Change for Performance-Enhancing Substances Scale, the Self-Efficacy for Performance-Enhancing Substances Scale, the Decisional Balance Scale for Performance-Enhancing Substances. Data were analyzed using the statistical package for social science (SPSS) for windows, version 28. Results: The study results revealed that around a half are in the Precontemplation Stage of Change, followed by those who are in the Contemplation Stage of Change, those who are in the Action Stage of Change, those who are in the Termination Stage of Change, and those who are in the Preparation Stage of Change. Conclusion: The greater the Pros, the higher the Stages of Change for performance-enhancing substance use the gym user would therein.The greater the Social Liberation, the higher the Stages of Change for performance-enhancing substance use the gym user would therein. The greater the Helping Relationships, the higher the Stages of Change for performance-enhancing substance use the gym user would therein. Keywords: Gym Users; Performance-Enhancing Substances; Transtheoretical Model

Using the Transtheoretical Model of Change to Understand High School Students’ Hookah Smoking Behavior

Objective(s): The aim of this study is to understand high school students’ hookah smoking behavior. Methodology: Part of the study was an experimental randomized controlled trial used to guide this study. The study was carried out at Tuz High School for males in Tuz Khurmatu District, Salah-Aldeen Governorate. The study included a simple random sample of 144 high school students. The study instrument includes students’ sociodemographic data. It also includes the Stages of Change Scale for Hookah Smoking, The Processes of Change Scale for Hookah Smoking, The Self-Efficacy/ Temptation Scale for Hookah Smoking, and The Decisional Balance Scale for Hookah Smoking. Data were collected using a self-reported method for the period from November 1st, 2021 to March 31th, 2022. Data were analyzed using the statistical package for social science (SPSS) for Windows, version 26. Results: The study results revealed that more than two-fifth of subjects in the study group were in the Precontemplation Stages of Change, followed by those who were in the Contemplation, and those in the Preparation Stage of Change. The administered intervention made subjects use more Processes of Change, enhanced their Self-Efficacy and Decisional Balance of hookah smoking cessation. Conclusion: The Stage-matched intervention efficaciously made students use more Processes of Change of hookah smoking, enhanced their Self-Efficacy/Temptation of hookah smoking, and Decisional Balance of hookah smoking. The lower the Stage of Change, the poorer the Self-Efficacy for hookah smoking cessation.

COLLEGIANS’ READINESS TO CONSUME GRAINS: THE TRANSTHEORETICAL MODEL OF CHANGE AS A THEORETICAL FRAMEWORK

A descriptive predictive design was used to guide this study. The study was conducted in Al-Qadisiyah University. The study included a convenience sample of 400 undergraduate students. The study instrument includes students’ sociodemographic sheet of age, gender, marital status, and grade. It also includes Stages of Change Scale for Grain Consumption, The Decisional Balance Scale for Grain Consumption, The Self-Efficacy Scale for Grain Consumption. Data Collection: Data were collected using an online google form for the period from March 5th, 2021 to April 22nd, 2021. Data were analyzed using the statistical package for social science, version 26. The descriptive statistical measures of frequency, percent, mean, and standard deviation were used to describe subjects’ sociodemographic characteristics. The inferential statistical measures of linear regression, Independent-Sample T-Test, and One-Way Analysis of Variance. The study results revealed that around a half were in the Contemplation Stage of Change for consuming grains, followed by those who are in the Preparation Stage of Change, and those who are in the Maintenance Stage of Change. According to the findings, the higher the family's socioeconomic position, the higher the perceived value of eating grains. Grains consumption has more drawbacks when one's BMI rises. There is a need by the community health nurses; in collaboration with Iraqi Ministry of Health and Mass Media, to initiate health education materials that raise the health awareness of individuals who are both overweight and obese about the vital role of consuming grain. There is a need to incorporate materials that highlight the vital role of consuming each of grain regularly into the curricula of various educational levels in Iraq.

Perceptions About Mindfulness and Text Messaging for Smoking Cessation in Vietnam: Results From a Qualitative Study

BackgroundWith 15.6 million smokers, Vietnam is one of the top 10 largest cigarette-consuming countries in the world. Unfortunately, smoking cessation programs are still scarce in Vietnam. Mindfulness-based and text messaging–based interventions have been increasingly used in smoking cessation studies in developed countries, with promising results. Given the exponential growth of mobile phone usage in Vietnam in recent years, mobile health interventions could be a potential strategy to increase smoking cessation in Vietnam. However, substantial cultural adaptations are needed to optimize the effectiveness of these interventions among Vietnamese smokers.ObjectiveThis study aims to involve qualitative research to inform the development of a mindfulness-based text messaging smoking cessation intervention for Vietnamese smokers.MethodsA total of 10 focus groups were conducted with 71 Vietnamese male smokers aged between 18 and 65 years (5-9 participants per focus group). Overall, 5 focus groups were conducted with smokers who had the intention to quit (ie, preparation stage of change in the transtheoretical model), and 5 focus groups were conducted with smokers who did not have the intention to quit (contemplation or precontemplation stage). The focus groups were audio recorded, transcribed verbatim, and analyzed using NVivo 12 software (QSR International).ResultsThe major themes included smoking triggers, barriers and facilitators for quitting, the perceptions of text messaging and mindfulness approaches for smoking cessation, and suggestions for the development of a text messaging–based smoking cessation program. Common smoking triggers included stress, difficulties concentrating, and fatigue. Frequently encountering other people who were smoking was a common barrier to quitting. However, participants indicated that concerns about the harmful effects of smoking on themselves and their wives and children, and encouragement from family members could motivate them to quit. The participants preferred diverse message content, including information about the consequences of smoking, encouragement to quit, and tips to cope with cravings. They suggested that text messages be clear and concise and use familiar language. Most smokers perceived that mindfulness training could be useful for smoking cessation. However, some suggested that videos or in-person training may also be needed to supplement teaching mindfulness through text messages.ConclusionsThis study provides important insights to inform the development of a text messaging–based smoking cessation program that incorporates mindfulness for Vietnamese male smokers. The results could also be useful for informing similar programs in other low- and middle-income countries.

Understanding sustainability: Perspectives of Canadian occupational therapists

ABSTRACT Background. In 2012, the World Federation of Occupational Therapists released a position statement on sustainability and sustainable practice, urging occupational therapists to address the global environmental sustainability crisis in practice. However, there is a lack of research exploring sustainability within occupational therapy practice in Canada. Purpose. This study examined perspectives of Canadian occupational therapists on addressing social, environmental, and economic sustainability in personal and professional lives. Method. This mixed-methods, exploratory study recruited 81 Canadian occupational therapists through professional associations to complete an online survey. Responses were analysed using descriptive statistics and directed content analysis and guided by the Transtheoretical Model of Change. Findings. Canadian occupational therapists are in the preparation stage of change. Although sustainability issues and barriers toward sustainable practice are recognised, there is a discrepancy between personal values and professional actions. Implications. Further exploration is needed into realistic targets of change and feasible methods of incorporating sustainability into occupational therapy practice.

Understanding Participants' Perceptions of Access to and Satisfaction With Chronic Disease Prevention Programs.

Despite the promise of incentive-based chronic disease prevention programs, comprehensive evidence on their accessibility among low-income populations remains limited. We adapted Aday and Andersen's framework to examine accessibility and consumer satisfaction within the Medicaid Incentives for the Prevention of Chronic Disease (MIPCD) cross-site demonstration. MIPCD provided 10 states with 5-year grants to implement incentivized chronic disease prevention and management programs for low-income and/or disabled-Medicaid enrolled-Americans. We conducted 36 focus group discussions between July 2014 and December 2015 with Medicaid enrollees participating in the MIPCD programs. We assessed participants' satisfaction by program type (i.e., diabetes prevention, diabetes management, hypertension reduction, smoking cessation, and weight management) related to three components: program enrollment and participation, staff courtesy, and program convenience. Based on Aday and Andersen's framework, we conducted thematic analysis to determine similarities and differences across MIPCD programs by type. Participant feedback confirmed the importance of several features of the Aday and Andersen framework, particularly programs with easy enrollment and participation procedures, courteous and helpful staff, and those that are convenient and flexible for participants. Participants valued programming around the clock via telephone and flexible, in-person hours of operation as well as proximity of the program to reliable transportation. We observed that most participants, despite enrollment and participation barriers, perceived programs as accessible and were willing to engage and continue to participate. This finding may reflect behavior change theory's perspective on personal readiness to change. Individuals in the preparation stage of change can effectively change health habits despite barriers they may encounter. In some cases, personal readiness to change was more impactful than consumer satisfaction at encouraging ongoing participation and perceived access to the programs. Thus, program developers may want to consider individual participant readiness to change and its impact on consumer satisfaction when designing, implementing, and evaluating behavior change initiatives.

Outcome Evaluation of a Short-Term Hospitalization and Community Support Program for People Who Abuse Ketamine.

Ketamine is a popular recreational drug among young people in Hong Kong. Long-term abuse of ketamine can lead to acute urological and medical issues, which often require immediate care at emergency rooms. Many patients require short-term hospitalization for medical management. This opens a brief time window, within which mental health professionals could engage young people who abuses ketamine in psychosocial, functional, and lifestyle interventions. The Crisis Accommodation Program (CAP) is a short-term hospitalization and community support program that addresses the health care needs of young people who abuse ketamine. During short-term hospitalization, the patient participates in a range of cognitive and psychosocial assessments, motivational interviewing, emotions management, and lifestyle re-design interventions. Upon discharge, social work professionals of non-government agencies continue to work with the patients on their action plans in the community. This evaluation study uses a quasi-experimental non-equivalent group design, in which the outcomes of the treatment group (n = 84) are compared with a comparison group (n = 34) who have a history of ketamine abuse but who have not joined the treatment program. The results confirm that the treatment group showed significant increases in motivation for treatment, reduction in drug use, improvement in cognitive screening tests, healthy lifestyle scores, and self-efficacy in avoidance of drugs over 13 weeks. When compared with the comparison group, the treatment group had significant decreases in anxiety and treatment needs and had moved from pre-contemplation to the contemplation or preparation stage. However, there were no significant changes in outcome measures covering lifestyle or self-efficacy in drug avoidance. Overall, the CAP is effective in reducing drug use, anxiety, and helping patients to move from pre-contemplation to the contemplation or preparation stage of change. The study results suggest that health care professionals can successfully engage young people who abuse ketamine to participate in a package of psychosocial interventions, motivational interviewing, and lifestyle re-design during their hospital stay for management of urological problems. The CAP also highlights the importance of collaboration between hospitals and community social services in the management of addiction.

Smoking Cessation Following Text Message Intervention in Pregnant Women.

Smoking during pregnancy has detrimental effects on mother and fetus. Text messaging has been utilized to improve patient care. To evaluate the impact of text messaging on smoking cessation rates among pregnant women in addition to standard of care (SOC) smoking cessation services. Our SOC includes pharmacist-driven education with or without nicotine patch or bupropion. This randomized, open-label, prospective trial was conducted at a maternal fetal care center from May 2014 to January 2016. Pregnant patients in the preparation stage of change were randomized to text messaging or SOC. The primary outcome was smoking cessation verified with exhaled carbon monoxide levels (eCO) 2 weeks from quit date. All received clinical pharmacist weekly calls for 3 weeks and biweekly visits until pharmacotherapy completion. The text messaging group also received predetermined motivational messages. Of 49 randomized patients, 13 withdrew, and 6 were lost to follow-up. The remaining included 14 texting and 16 SOC patients. eCO-verified cessation was achieved by 57.1% in the texting group versus 31.3% in the control ( P = 0.153). Overall, 64.3% of the texting group achieved an eCO below 8 ppm at ≥1 visit versus 37.5% in the control group ( P = 0.143). No difference was found in birth outcomes. The study was underpowered because of slow enrollment and high drop-out rates. Text messaging had minimal impact on improving smoking cessation rates in the obstetric population. However, further research is warranted because of the underpowered nature of this trial. Given the detrimental effects of smoking in pregnancy, more comprehensive cessation strategies are warranted.

Mailed distribution of free nicotine patches without behavioral support: Predictors of use and cessation

IntroductionThere is growing evidence that the mailed distribution of free nicotine replacement therapy (NRT), usually as part of smokers' helplines, can been effective in increasing the odds of cessation on a population level. However, limited information is available on the utilization of NRT when it is provided for free, and factors associated with regimen adherence have remained largely unexplored. MethodsIn the context of a randomized controlled trial, 500 adult smokers across Canada hypothetically interested in free NRT were mailed a 5week supply of nicotine patches, but no other support was offered. Analyses evaluated which a priori-defined demographic and smoking characteristics predicted nicotine patch use at 8week follow-up of 421 patch recipients, as well as examined the association between patch use and smoking cessation at 6months. ResultsAt 8weeks, 10.9% had used all, 47.5% had used some but not all, and 41.6% had not used any of the provided nicotine patches. Lower age, unemployment, past NRT use and intent to quit in the next 30days at baseline (preparation stage of change) were all identified as independent predictors of some nicotine patch use. Only use of all patches was associated with greater odds of smoking cessation, compared to non-users (Adj. OR=2.96; 95%CI=1.06–8.27). ConclusionsThe mailed distribution of free nicotine patches to smokers at large can be effective at promoting cessation, particularly among financially disadvantaged groups, those with previous NRT experience and among individuals with already advanced intent to quit.

Gender Differences in Self-Conscious Emotions and Motivation to Quit Gambling

Considerable gender differences have been previously noted in the prevalence, etiology, and clinical features of problem gambling. While differences in affective states between men and women in particular, may explain differential experiences in the process of gambling, the role of affect in motivations for quitting gambling and recovery has not been thoroughly explored. The aim of this study was to examine gender differences within a sample of problem gamblers motivated to quit with or without formal treatment, and further, to explore the interactions between gender, shame and guilt-proneness, and autonomous versus controlled reasons for change. Motivation for change and self-conscious emotional traits were analyzed for 207 adult problem gamblers with an interest in quitting or reducing their gambling (96.6% not receiving treatment). Overall, gender differences were not observed in clinical and demographic characteristics. However, women exhibited greater shame [F(1,204)=12.11, p=0.001] and guilt proneness [F(1,204)=14.16, p<0.001] compared to men, whereas men scored higher on trait detachment [F(1,204)=7.08, p=0.008]. Controlling for demographic and clinical characteristics, general linear models revealed that autonomous motivation for change was associated with higher guilt-proneness, greater problem gambling severity, and the preparation stage of change; whereas controlled forms of motivation were significantly associated with higher shame-proneness and greater problem gambling severity. No gender effects were observed for either motivation for change. These findings suggest that the process of change can be different for shame-prone and guilt-prone problem gamblers, which may impact behavioral outcomes.

Stages of change in adults who have failed an online hearing screening.

Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

Evaluation of a Smoking Cessation Program for HIV Infected Individuals in an Urban HIV Clinic: Challenges and Lessons Learned.

Introduction. HIV infected persons have high prevalence of smoking and tobacco-associated health risks. Few studies describe smoking cessation programs targeting this population. The Infectious Disease Practice (IDP) in Newark, New Jersey, initiated a smoking cessation program (SCP) for HIV infected smokers. We report participation, abstinence rates, and predictors of abstinence. Methods. This is a prospective cohort study, comparing participants to non-SCP smokers, during April 1, 2011, to October 31, 2012. Intervention included one individualized counseling session with an offer of pharmacotherapy. Univariate and multivariate analyses were performed with self-reported seven-day point prevalence abstinence at six months as primary outcome measure. Results. Among 1545 IDP patients, 774 (51%) were current smokers of whom 123 (16%) participated in the SCP. Mean six-month abstinence rate amongst SCP participants was 16%. A history of cocaine or heroin use was predictive of continued smoking (odds ratio [OR] adjusted 0.20, 95% confidence interval [CI] 0.07–0.55) while smokers in the preparation stage of change were more likely abstinent at six months (OR adjusted 8.26, 95% CI 1.02–66.67). Conclusions. A low-intensity smoking cessation intervention in an HIV treatment setting is effective in a minority of participants. Further research is needed to better address barriers to smoking cessation such as substance use.

Baseline transtheoretical and dietary behavioral predictors of dietary fat moderation over 12 and 24 months

Longitudinal predictors of dietary behavior change are important and in need of study. This secondary data analysis combined primary data across three randomized trials to examine transtheoretical model (TTM) and specific dietary predictors of successful dietary change at 12 and 24months separately in treatment and control groups (N=4178). The treatment group received three TTM-tailored print interventions over 12months between 1995 and 2000. Chi-square and MANOVA analyses were used to examine baseline predictors of dietary outcome at 12 and 24months. Last, a multivariable logistic regression was conducted with all baseline variables included. Across all analyses in both treatment and control groups, the most robust predictors of successful change were for TTM-tailored treatment group, preparation stage of change, and increased use of dietary behavior variables such as moderating fat intake, substitution of lower fat foods, and increasing intake of healthful foods. These results provide strong evidence for treatment, stage and behavioral dietary severity effects predicting dietary behavior change over time, and for targeting these variables with the strongest relationships to outcome in interventions, such as TTM-tailored dietary interventions.

Ongoing Self‐Engagement in Quit Attempts and Cessation Outcomes Among Rural Smokers Who Were Unable to Quit After 2 Years of Repeated Interventions

As many smokers experience repeated failures with cessation attempts, it has been postulated that we may create a cadre of highly resistant smokers who are unlikely to engage in treatment or succeed in quitting. Our purpose was to follow a group of recalcitrant rural smokers and examine their ongoing engagement in smoking cessation activities. At the end of a 24-month disease management program for rural smokers, we identified participants who reported ongoing daily smoking despite exposure to 4 previous cycles of smoking cessation interventions. At month 36 (1 year after conclusion of the study), we contacted these participants and assessed changes in smoking status and ongoing engagement in cessation activities over the preceding 6 months. We assessed quit attempts and use of pharmacotherapy during the prior 6 months, as well as smoking abstinence at 36 months. Among 333 recalcitrant smokers, 49% reported at least one 24-hour quit attempt during the preceding 6 months, 29% tried smoking cessation pharmacotherapy, and 5% quit smoking. Significant predictors of having at least one 24-hour quit attempt were lower numbers of cigarettes smoked per day, being in preparation stage of change, and more pharmacotherapy-assisted quit attempts during the original 24-month trial. Higher motivation to quit and more previous pharmacotherapy-assisted quit attempts significantly predicted cessation medication use. Use of varenicline was strongly associated with cessation. Many recalcitrant rural smokers continue to engage in treatment and make quit attempts even in the absence of active interventions.

Smoking behavior, nicotine dependency, and motivation to cessation among smokers in the preparation stage of change

Objective:To investigate selected constructs of the transtheoretical model (TTM) of behavior change regarding smoking behavior among people in the preparation stage, as well as motivation for cessation and nicotine dependency.Methods:A convenience sample of 123 smokers, during between June to and September 2011, completed the Persian version of the short form of a smoking questionnaire based on TTM, the Fagerstrom nicotine dependence test, and the motivational test.Results:Motivation for cessation was great (16.35 ± 2.45). The negative affects of self-efficacy were higher than those to other situations (4.02 ± 0.84). The pros and cons of smoking were 2.69 ± 1.00 and 3.78 ± 0.78, respectively. Temptation was influenced by nicotine dependency (P < 0.05). Early initiation of smoking was significantly associated with severe nicotine dependency (P < 0.05).Conclusion:The results confirm the role of temptation, increase in the cons, decrease in the pros, and nicotine dependency.

Perception of Smoking Risks and Motivation to Quit Among Nontreatment-Seeking Smokers With and Without Schizophrenia

We examined perceived consequences/benefits of cigarette smoking and motivation for quitting in nontreatment-seeking smokers who had schizophrenia or schizoaffective disorder (N = 100) or had no Axis I psychiatric disorder (normals, N = 100). Participants completed questionnaires and provided a breath carbon monoxide (CO) sample 10-15 minutes after smoking 1 preferred-brand cigarette. Primary assessments included the Smoking Consequences Questionnaire-Adult, the Reasons for Quitting Scale, and the Stages of Change. There were no differences between the schizophrenia and control group in mean age of smoking onset (16.2 ± 5.4 vs 15.6 ± 5.5 y, P = .44), number of cigarettes daily (17.9 ± 11.6 vs 17.0 ± 7.9, P = 0.51), or in breath CO (28.0 ± 14.5 vs 22.9 ± 8.0 ppm, P = .61). Compared with normals, people with schizophrenia report greater stimulation/state enhancement (P < .0001) and social facilitation (P < .004) from smoking. People with schizophrenia had less appreciation of health risks associated with smoking than normal controls (P < .0001) and were less motivated to quit smoking than normal controls (P = .002), even though they were as likely to be in the preparation stage of change. Immediate reinforcement (P = .04) and health concerns (P = .002) were rated lower as motivators for considering quitting smoking in schizophrenia than normals. People with schizophrenia reported greater motivation to stop smoking due to social pressure/rewards than normals (P = .047). This study underscores the degree to which people with schizophrenia perceive the state-enhancing effects of smoking and their lower appreciation for health risks of smoking compared with normal controls.

Cluster Subtypes within the Preparation Stage of Change for Sun Protection Behavior

Objective: Numerous effective tailored interventions for smoking cessation and other behaviors have been developed based on the Transtheoretical Model. Recent studies have identified clusters within each stage of change. The goal of this study is to determine if replicable clusters exist within the Preparation stage of change for sun protection. Method: Secondary data analysis of baseline data from a sample of participants in a home-based expert system intervention was performed. Two random samples of approximately 128 participants were selected from subjects in the Preparation stage (N = 258). Cluster analyses were performed using Ward's Method on the standardised scores from the three scales of Pros, Cons, and Self-Efficacy. Interpretability of the pattern, pseudo F test, and dendograms were used to determine the number of clusters. Results: A four-cluster solution replicated across subsamples. Differences between clusters on eight of the nine Processes of Change, and on behavioral measures, were found. Discussion: The cluster solutions were robust, easily interpretable, and demonstrated good initial external validity. They replicated patterns found for other behaviors that have demonstrated long-term predictability and can provide the basis for a tailored intervention.

Gender Specific Differences in the Pros and Cons of Smoking among Current Smokers in Eastern Kentucky: Implications for Future Smoking Cessation Interventions

This study investigated gender differences in the perceived “pros” and “cons” of smoking using the constructs of decisional balance (DB) and stage of change from the Transtheoretical Model. The population distribution for stage of change among a population-based, cross-sectional survey of 155 current smokers over 40 years was: precontemplation (22.6%), contemplation (41.9%), preparation (35.5%). Results of stepwise regression models indicated significant gender differences in DB were in the preparation stage of change; scores on the DB measure increased 3.94 points (95% CI: 1.94, 5.93) for male smokers. Interventions targeting the “pros” and “cons” of smoking may need to be gender specific.