Prevalence of tobacco use experiences and/or the number of cigarettes smoked by individuals are commonly used measures to monitor the effectiveness of tobacco control, prevention, and cessation efforts. However, prevalence of cigarette smoking, either in one's lifetime or in the last 30 days, is a rather insensitive measure of the activities and experiences that facilitate the process of change that moves a person toward smoking initiation or cessation.
The Stages of Change for Smoking Cessation take into account smoking-related attitudes, intentions, and behaviors and offer a more sensitive measure of change than smoking prevalence rates alone. These stages of change for cessation have been examined in the State of Maryland, using data derived from the 2000 and 2002 Maryland Adult Tobacco Survey (MATS).
Click on the links below for more detailed information on surveys of Maryland State Specific Prevalence Data:
- Initial Findings from the Baseline Tobacco Study
- First Annual Tobacco Study
- Monitoring Changing Tobacco Use Behaviors in Maryland
- 2000-2008 Monitoring Changing Tobacco Use Behaviors
Stages of Change for Smoking Cessation
Description Quitting smoking is a complex health behavior change. The process of quitting smoking can be conceptualized as progressing through a series of stages of change according to the Transtheoretical Model developed by Dr. DiClemente in collaboration with colleagues.1, 2 Once individuals become dependent on nicotine individuals move through five sequential stages in order to achieve long-term sustained health behavior change. These five stages are Precontemplation, Contemplation, Preparation, Action, and Maintenance.
Prec
ontemplation The Precontemplation stage encompasses individuals who are not seriously considering changing their smoking in the foreseeable future (next 6 months or a year) either because they unconvinced of the problem, see change as impossible, or are unwilling to change.
Contemplation 
In the Contemplation stage, individuals are seriously considering the problem that smoking poses to their health and the possibility of change. Typically they are engaged in a risk reward analysis and are evaluating the pros and cons of both their smoking behavior and the aftermath of quitting.
Preparation 
Once a decision is made individuals move into the Preparation stage where they need to make a firm commitment and a plan to quit smoking in the near future.
Action 
The Action stage represents the implementation of the change plan and the actual behavioral change (i.e., quitting smoking).
Maintenance 
If successful action is continued for 6 months, individuals move into the Maintenance stage of change when the behavior change (abstinence from smoking) becomes an integral part of the individual’s new lifestyle.
These stages represent important tasks that need to be accomplished adequately in order to establish successful smoking abstinence. Their sequence is often not linear but cyclical with success achieved only after recycling through the stages several times until the smoker finally successfully masters the tasks needed to quit smoking and become a maintained abstainer who can terminate the cycle of change.2, 3
Algorithm
Stages of Change (Smoking Cessation)
1. Are you currently a smoker?
- Yes, I currently smoke.
- No, I quit within the last 6 months. (ACTION STAGE)
- No, I quit more than 6 months ago. (MAINTENANCE STAGE)
- No, I have never smoked. (NONSMOKER)
Smokers only: 2. In the last year, how many times have you quit smoking for at least 24 hours?
Initial Findings from the Baseline Tobacco Study (2001) and the Supplemental Appendices for more detailed information on weighting procedures) in order to take information from the sample and generalize it to the general state population. Weighted data was analyzed at the county level only.
Limitations of Survey Because the MATS was a telephone survey, the results underrepresented individuals who do not live in a stable environment, those without phones, those who screen calls, and those who did not elect to participate in the survey. Also, minority groups are underrepresented because the sample was too small to be descriptive of an entire ethnic population.
Distribution of the Stages of Change for Smoking Cessation Table 1 presents the distribution of the Stages of Change for Smoking Cessation for the 2000, 2002, 2006 and 2008 Maryland Adult Tobacco Surveys (MATS). At all time points, more than one-quarter of the sample were former smokers (i.e., in Action or Maintenance). A significant percentage of individuals were in the Precontemplation Stage at all time points, suggesting there are still a significant number of individuals who are unwilling or unable to change their smoking behavior.
Table 1. Distribution of the Stages of Change for Smoking Cessation
| Stages of Change | 2000 | 2002 | 2006 | 2008 |
|---|---|---|---|---|
| Precontemplation | 1,664 (40.5%) | 2,153 (36.6%) | 1,704 (45.3%) | 617 (25.6%) |
| Contemplation | 691 (16.8%) | 963 (16.4%) | 773 (20.5%) | 600 (24.9%) |
| Preparation | 621 (15.1%) | 966 (16.4%) | 310 (8.2%) | 410 (17.0%) |
| Action | 229 (5.6%) | 403 (6.9%) | 216 (5.7%) | 411 (17.0%) |
| Maintenance | 904 (22.0%) | 1,396 (23.7%) | 762 (20.2%) | 373 (15.5%) |
Stage of Change for Smoking Cessation and County of Residence: Change Over Time Table 2 shows the distribution of the Stage of Change for Smoking Cessation for current smokers (i.e., Precontemplation, Contemplation, and Preparation) in 2000, 2002, 2006 and 2008.
Interpreting Table 2: You want to see decreases over time in the percentage of individuals in Precontemplation (i.e., not thinking about quitting) and increases in the percentage of individuals in Contemplation (i.e., considering a quit attempt) and Preparation (i.e., planning on making a quit attempt within the next 30 days).
1 DiClemente, C. C. & Prochaska, J. O. (1998). Toward a comprehensive, transtheoretical model of change. In W. R. Miller & N. Heather (Eds.), Treating Addictive Behaviors (2nd ed., 3-24). New York: Plenum. 2 Prochaska, J.O., DiClemente, C.C., & Norcross, J. (1992). "In search of how people change: Applications to addictive behaviors." American Psychologist 47: 1102-1114. 3 DiClemente, C.C. (2003). Addiction and Change: How Addictions Develop and Addicted Individuals Recover. New York: Guilford.
