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

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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