Stages Of Change For Smoking Cessation Research Articles

The Pap smear screening as an occasion for smoking cessation and physical activity counselling: effectiveness of the SPRINT randomized controlled trial

BackgroundThe organized Cervical Cancer Screening Programme (CCSP) in Italy might represent an occasion to deliver smoking cessation (SC) counselling to women attending the Pap test examination. Evidence of effectiveness of physical activity (PA) promotion and intervention in adjunct to SC counselling is not strong.Objective of the SPRINT trial was to evaluate the effectiveness of a standard SC counselling intervention delivered by trained midwives in the CCSP, and whether the adjunct of a PA counselling to the SC counselling might increase quit rates.Methods/DesignWe undertook a randomized controlled trial of 1,100 women undergoing the Pap examination in the three study centres Florence, Turin, and Mantua: 363 were randomly assigned to the SC counselling arm, 366 to the SC + PA counselling arm, and 371 to the control group. The intervention was a standard brief SC counselling combined with a brief counselling on increasing PA, and was tailored according to the Di Clemente-Prochaska motivational stages of change for SC and/or PA. Primary outcomes were quit rates, improvement in the motivational stages of change for SC, and reduced daily cigarette consumption. Analysis was by intention to treat.ResultsParticipants randomized in both intervention arms and in the preparation stage of change for SC doubled their likelihood of quitting at 6-month follow-up in comparison to controls (odds ratio [OR]=2.1, 95% confidence interval [95% CI]:1.0-4.6). Moreover, participants in the intervention arms and in the contemplation stage were more likely to reduce their daily cigarette consumption after the intervention (OR=1.8, 95% CI:1.1-3.0). Our study did not show any effect of PA counselling on various outcomes.ConclusionsSmoking cessation counselling delivered by midwives to smokers in preparation and contemplation stages of change during the Pap-smear screening was effective and should be recommended, given the high number of women attending the cervical cancer screening programme in Italy. Moreover, the daily number of women invited for the Pap-smear examination should be slightly lowered, in order to let midwives deliver SC counselling to smokers.Trial registrationCurrent Controlled Trials ISRCTN52660565

Smoking in pregnancy: The role of the transtheoretical model and the mother's attachment to the fetus

This study investigated whether pregnant smokers demonstrated cognitive and behavioural patterns hypothesised to underpin the different stages of change (SOC) and whether fetal attachment varied according to this process. A cross-sectional design with women categorised by SOC was used and the sample was recruited from hospital maternity services in the U. K at their booking clinics with a mean gestation of 14 weeks. Experiential and behavioural processes together with self-efficacy and attachment to the fetus were measured in 637 women. As predicted by the transthoretical model experiential processes were used mostly by women in contemplation and preparation; behavioural processes mostly by women in preparation and action. However, self-efficacy remained constant between precontemplation, contemplation and preparation, but women in action showed significantly higher levels. Women in preparation were significantly more attached to the fetus than women in precontemplation and never smokers. The relevance of the transtheoretical model with pregnant smokers is supported. Foetal attachment may be differentially associated with different SOC in smoking cessation and yield potential for the development of new interventions.