Smoking Behavior and the Transtheoretical Model of the Stages of Change

BioPsychoSocial Health CategoryWelcome to the New Year. Have you made any resolutions for 2009? Have you ever wondered what motivates people to change their behavior? There are some who are always seeking self-improvement. Others may feel content and they may see no reason to change certain habits or behaviors. Do you have any New Year’s resolutions that you plan to keep this year? 

The famous transtheoretical model (TTM) of behavior change is often used to guide clinicians who are trying to promote smoking cessation. Smokers often need help in order to quit successfully. It can be very difficult to overcome a long-time habit or addiction if you do not have the proper guidance from a professional. When the TTM is applied in the setting of smoking cessation, the goal is to move a patient from one stage to the next stage. This is a gradual progression that takes time and people usually don’t jump through several stages at one time.

SmokedThe stages of change within the TTM are:

Precontemplation: At this stage the person is not even thinking about the behavior change. The person may be unaware of the need for change, or the person may be in denial. He or she has not personally considered making a change in lifestyle or behavior. In the case of smoking, the person has no thoughts of quitting. He or she has never considered quitting and has never thought about the harmful effects of smoking. There is no motivation to quit since the person has never seriously entertained the thought.

Contempation: Once a person reaches contemplation, he or she begins to seriously consider the pros/cons associated with the change. The person may do some research and may learn more about the aspects of the behavior change. The individual may ask certain questions and read some books about successful quitting techniques. Eventually, he or she considers actually making the change. Many smokers are in this stage because they hear about the health hazards associated with smoking and they begin to wonder whether they should try quitting. They don’t have any set plans to quit, but they consider what their life might be life if they were to quit.

Preparation: At this stage, the person begins to make plans and prepares for the necessary change. Most of this is mental and psychological preparation, but there may be some lifestyle changes that also take place as the person begins to prepare for action. For smokers, this may involve a mental preparation of quitting. They may plan ahead by setting a quit date and marking it on the calendar. They may also tell others about their quit date so that they have some accountability from others.

Action: This is where the individual implements the change in behavior. This is when the quit date arrives and the smoker stops smoking. If the action stage occurs and the behavior change isn’t maintained, then people fall back into a previous stage. Some people give up while others get motivated to prepare and plan for another quit date. Others are able to maintain their behavior change for a while, but then they may relapse and have to go through the stages of change again.

Maintenance: This is where one maintains the changed behavior and incorporates the new behavior as a way of life. Some people do not include this as a stage of change since at this point the person has already made the change. However, since people often revert back to original behaviors, this maintenance stage is a necessary step for many. Most smokers who quit for the first time relapse at some point. Hence, it often takes many efforts to get smokers to quit permanently.

Have you been wondering about making some type of lifestyle behavior change in your life? Perhaps you are a smoker and you find yourself in the contemplation stage. Where do you find yourself? As the New Year begins, consider what types of changes you need to make in your own life. Talk with your doctor about health habits that may need to change, such as smoking.


P AVEYARD, L MASSEY, A PARSONS, S MANASEKI, C GRIFFIN (2008). The effect of Transtheoretical Model based interventions on smoking cessation Social Science & Medicine DOI: 10.1016/j.socscimed.2008.10.036

Christopher J. Armitage, Madelynne A. Arden (2008). How useful are the stages of change for targeting interventions? Randomized test of a brief intervention to reduce smoking. Health Psychology, 27 (6), 789-798 DOI: 10.1037/0278-6133.27.6.789

  • Victim of Wowsers

    What a load of rubbish.

    I gave up smoking for 7 years and ended up with a non-smokers disease, ulcerative colitis – and was told by my doctor I would require a colonectomy within 10yrs or I would die from bowel cancer. The related Crohn’s Disease is the same. 1/3 of all lung cancers only happen in non-smokers (and the rest are now being recognised as viral in origin).

    Cancer is a disease, not caused by the “sin” of smoking. Statistics show smoking provides 5-10% protection against herpes induced throat cancer. Lung cancer was almost unheard of until the Spanish Flu epidemic of 1918 and has been with us ever since.

    Why am I alive 27years later? Contemplating an early death I thought I would take up cigarettes and cannabis smoking and at least enjoy the rest of my short remaining time. I went into remission 1 week later and only relapse when overseas and not smoking pot (average time to flare-up is 2-3 weeks abstinence). It took another 18 years for me to stumble upon the research that the two were related – that’s how intense this deadly temperance based propaganda is.

    Do-gooder religious based nutters are murdering us with their fraudulent data – misleading the public and deluding the medical profession with their lies.

    Here is some REAL health advice doctors would do well to tell their patients: Get the herpes vaccine, smoke (cigarettes and pot), drink (red wine especially) and be happy. Get moderate amounts of sun (vitamin D), steer clear of nano-particle sunscreens and buy a dog if you want to live a long healthy life.

    Big pharma can’t bottle those so they push deadly chemicals on us. These do kill through suicide – and smoking with a nicotine patch killed a family member in seconds. Anti-smoking profits make tobacco profits look like small change. I may have a protective coating of tar on my lungs, but they have blood on their hands.

    Only dopes think cannabis is harmful.

    “Don’t let poets tell you lies” – Bjork. Looks like some poets have used TTM on you guys. Instead of wasting your time on pseudoscience, woo and snake oil, why don’t you work on a stem cell cure for the emphysema I’m likely to get now that I’ve outlived one death sentence? Or won’t the pope let you?


  • wtf

    Ever tried intestinal parasites? Less side effects than smoking. Smoking is a risk factor for many diseases. Just as certain genes are. Disease manifestation is a collaborative effort of various factors working together. Saying that smoking doesn’t cause cancer or other diseases just because it has one positive side effect and doesn’t cause cancer in everyone who does do it (like that negates all the other negatives) is stupid and ignorant.

  • madeleine

    What I don’t understand is, why would people warn others to stop smoking if it really wasn’t that healthy? Are they just doing it for fun? I mean, I understand that huge tobacco companies would want to promote smoking, because they earn billions of dollars on it each year. But the health psychologists and health care system see what a great burden smokers are on the system, because smoking is the number one preventable death in USA. Yes, some people, like you, might be lucky and never develop any cancers, but many people do. And some people have been healthy all their life, and still get sick. But if you look at the big picture, smoking is deadly, and responsible for cardiac and heart disordes, lung diseases, cancer etc.

    Of course people should live a balanced life, and it is healthy to stay in the “golden middle” not on the extreme ends. Too obsessed over health isn’t good if it makes you depressed. A glass of red wine is healthy if you drink it moderately, and it is important to be optimistic about life. HOWEVER, I do not think smoking would make me happy, and there is nothing I am missing out in life when I am not smoking, so why should I? Smoke pot all you want, but you know it impairs short-term memory and makes you slow? But if it really makes you happy, go for it. It is your life after all, and as long as it doesn’t harm other people, it’s ok. But you know that smoking harms others? Second-hand..

Joseph Kim, MD, MPH

Joseph Kim, MD, MPH, is a physician, engineer, technologist, and avid writer. He enjoys writing about advances in technology that are revolutionizing healthcare. Dr. Kim studied engineering at MIT, then received his medical degree from the University of Arkansas College of Medicine. He also has a master’s degree in public health from the University of Massachusetts Amherst School of Public Health.

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