The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to date have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stag...

The Transtheoretical Model of Health Behavior Change

Community-based research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and to integrate the knowledge gained with action to benefit the community involved. This review provides a synthesis of key principles of community-based research, examines its place within the context of different scientific paradigms, discusses rationales for its use, and explores major challenges and facilitating factors and their implications for conducting effective community-based research aimed at improving the public’s health.

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Review of community-based research: assessing partnership approaches to improve public health.

Holding a strong goal intention (“I intend to reach Z !”) does not guarantee goal achievement, because people may fail to deal effectively with self‐regulatory problems during goal striving. This review analyzes whether realization of goal intentions is facilitated by forming an implementation intention that spells out the when, where, and how of goal striving in advance (“If situation Y is encountered, then I will initiate goal‐directed behavior X !”). Findings from 94 independent tests showed that implementation intentions had a positive effect of medium‐to‐large magnitude ( d = .65) on goal attainment. Implementation intentions were effective in promoting the initiation of goal striving, the shielding of ongoing goal pursuit from unwanted influences, disengagement from failing courses of action, and conservation of capability for future goal striving. There was also strong support for postulated component processes: Implementation intention formation both enhanced the accessibility of specified opportunities and automated respective goal‐directed responses. Several directions for future research are outlined.

/pdf/implementation-intentions-and-goal-achievement-a-meta-4awoi9wm93.pdf

Implementation intentions and goal achievement: A meta-analysis of effects and processes

This article presents an introduction to the Health Belief Model (HBM). The HBM states that the perception of a personal health behavior threat is influenced by at least three factors: general health values, interest and concern about health; specific beliefs about vulnerability to a particular health threat; and beliefs about the consequences of the health problem. Once an individual perceives a threat to his health and is simultaneously cued to action, if his perceived benefits outweighs his perceived costs, then the individual is most likely to undertake the recommended preventive health action. Key words: health promotion, health belief model, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy. Content available only in Romanian.

Health Belief Model

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

OBJECTIVE: To identify variables predictive of smoking cessation in a cohort of cigarette smokers followed for five years. DESIGN: Data analysed in this paper come from a cohort tracking telephone survey of 13415 cigarette smokers aged 25-64 years from 20 American and two Canadian communities who were interviewed in 1988 and re-interviewed in 1993 as part of the National Cancer Institute9s Community Intervention Trial for Smoking Cessation. Predictors of smoking cessation evaluated in this study included measures of past and current smoking behaviour, past quit attempts, stated desire to quit smoking, and demographic characteristics. OUTCOME MEASURES: Smoking cessation was based on self report. A "quitter" was defined as a cohort member who, at the final annual contact in 1993, reported not smoking any cigarettes for the preceding six months or longer. Any smoker who reported having made a serious quit attempt between 1988 and 1993 was asked to indicate reasons that contributed to their decision to try to stop smoking. RESULTS: 67% of smokers reported making at least one serious attempt to stop smoking between 1988 and 1993 and, of these, 33% were classified as having quit smoking in 1993. The most common reasons given for quitting smoking were concern over health (91%), expense (60%), concern about exposing others to secondhand smoke (56%), and wanting to set a good example for others (55%). Statistically significant predictors of smoking cessation included male gender, older age, higher income, less frequent alcohol intake, lower levels of daily cigarette consumption, longer time to first cigarette in the morning, the use of premium cigarettes, initiation of smoking after age 20, history of past quit attempts, a strong desire to stop smoking, and the absence of other smokers in the household. Predictor variations with the largest relative risks for smoking cessation were those associated with nicotine dependence such as amount smoked daily and time to first cigarette in the morning. CONCLUSIONS: Despite the fact that most smokers expressed a strong desire to stop smoking in 1988, the majority, especially the most dependent heavy smokers (>25 cigarettes/day), struggled unsuccessfully to achieve this goal.

https://tobaccocontrol.bmj.com/content/tobaccocontrol/6/suppl_2/S57.full.pdf

Predictors of smoking cessation in a cohort of adult smokers followed for five years.

Background: Health warnings on cigarette packages are among the most common means of communicating the health risks of smoking. However, few studies have evaluated the impact of package warnings on consumer knowledge about tobacco risks. Objective: The aim of the current study was to use nationally representative samples of adult smokers from the United States (USA), the United Kingdom (UK), Canada (CAN), and Australia (AUS) from the International Tobacco Control Four Country Survey (ITC-4) to examine variations in smokers’ knowledge about tobacco risks and the impact of package warnings. Methods: A telephone survey was conducted with 9058 adult smokers from the following countries: USA (n  =  2138), UK (n  =  2401), CAN (n  =  2214) and AUS (n  =  2305). Respondents were asked to state whether they believed smoking caused heart disease, stroke, impotence, lung cancer in smokers, and lung cancer in non-smokers. Respondents were also asked whether the following chemicals are found in cigarette smoke: cyanide, arsenic and carbon monoxide. Findings: Smokers in the four countries exhibited significant gaps in their knowledge of the risks of smoking. Smokers who noticed the warnings were significantly more likely to endorse health risks, including lung cancer and heart disease. In each instance where labelling policies differed between countries, smokers living in countries with government mandated warnings reported greater health knowledge. For example, in Canada, where package warnings include information about the risks of impotence, smokers were 2.68 (2.41–2.97) times more likely to agree that smoking causes impotence compared to smokers from the other three countries. Conclusion: Smokers are not fully informed about the risks of smoking. Warnings that are graphic, larger, and more comprehensive in content are more effective in communicating the health risks of smoking.

https://tobaccocontrol.bmj.com/content/tobaccocontrol/15/suppl_3/iii19.full.pdf

Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey

Background: The International Tobacco Control (ITC) Four Country Survey (ITC-4) is a prospective cohort study designed to evaluate the psychosocial and behavioural impact of national-level tobacco control policies enacted in the Australia, Canada, the UK, and the USA. Wave 1 of ITC-4 survey was conducted between October 2002 and December 2002. Wave 2 survey was conducted between May 2003 and August 2003. Objective: To test for individual-level predictors of smoking cessation behaviours (that is, quit attempts and smoking cessation) among cigarette smokers in the ITC Four Country Study measured between Wave 1 and Wave 2. This set of predictors will serve as the base for evaluating the added effect of tobacco control policies and other factors. Methods: Respondents included in this study are 6682 adult current smokers in the Wave 1 main survey who completed the Wave 2 follow-up (1665 were in Canada, 1329 were in the USA, 1837 were in the UK and 1851 were in Australia). Results: Factors predictive of making a quit attempt included intention to quit, making a quit attempt in the previous year, longer duration of past quit attempts, less nicotine dependence, more negative attitudes about smoking, and younger age. Lower levels of nicotine dependence were the main factor that predicted future cessation among those that made a quit attempt. Conclusion: Intention to quit and other cognitive variables were associated with quit attempts, but not cessation. Behavioural variables related to task difficulty, including measures of dependence, predicted both making attempts and their success. Predictors of making quit attempts and cessation were similar for each of the four countries, but there were some differences in predictors of success.

https://tobaccocontrol.bmj.com/content/tobaccocontrol/15/suppl_3/iii83.full.pdf

Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey.

Objectives: To gain an understanding of the role of pack design in tobacco marketing.

Methods: A search of tobacco company document sites using a list of specified search terms was undertaken during November 2000 to July 2001.

Results: Documents show that, especially in the context of tighter restrictions on conventional avenues for tobacco marketing, tobacco companies view cigarette packaging as an integral component of marketing strategy and a vehicle for (a) creating significant in-store presence at the point of purchase, and (b) communicating brand image. Market testing results indicate that such imagery is so strong as to influence smoker's taste ratings of the same cigarettes when packaged differently. Documents also reveal the careful balancing act that companies have employed in using pack design and colour to communicate the impression of lower tar or milder cigarettes, while preserving perceived taste and “satisfaction”. Systematic and extensive research is carried out by tobacco companies to ensure that cigarette packaging appeals to selected target groups, including young adults and women.

Conclusions: Cigarette pack design is an important communication device for cigarette brands and acts as an advertising medium. Many smokers are misled by pack design into thinking that cigarettes may be “safer”. There is a need to consider regulation of cigarette packaging.

https://tobaccocontrol.bmj.com/content/tobaccocontrol/11/suppl_1/i73.full.pdf

Kenneth Michael Cummings

Papers

Predictors of smoking cessation in a cohort of adult smokers followed for five years.

Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey

Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey.

The cigarette pack as image: new evidence from tobacco industry documents

Community Intervention Trial for Smoking Cessation (Commit) .1. Cohort Results from A 4-Year Community Intervention: