Personal and partner measures in stages of consistent condom use among African-American heterosexual crack cocaine smokers.

Participants' personal condom use measures and those of their last sex partner's were examined in five stages of change for consistent condom use among 449 urban sexually active, heterosexual, African-American crack smokers. The measures included participants' personal and their last sex partner's perceived responsibility, personal and perceived negative attitudes, and participants' self-efficacy to use condoms. The relationships between the measures and the stages were examined using analyses of variance and multivariate logistic regression. Over 90% of participants did not use condoms, consistently. Two-thirds of the inconsistent users were in the precontemplation stage. The rest were equally divided between the contemplation and preparation stages. Personal responsibility outperformed other measures in initial intention to become a regular condom user; partner's perceived responsibility dominated continued intention and actual consistent condom use. Negative attitudes and self-efficacies had strong relationships to the stages of consistent condom use in univariate analyses but these relationships became substantially weaker when the responsibility, attitude, and self-efficacy concepts were entered simultaneously into multivariate analyses.

Texas Tobacco Prevention Pilot Initiative: processes and effects.

The study was designed to examine how intensity of anti-smoking media campaigns and differing types of anti-smoking community-based programs influence young adolescents' tobacco use and related psychosocial variables. Sixth grade students attending 11 middle schools in eight study communities assigned to varying intervention conditions were assessed by a pre-intervention survey conducted in spring 2000. The assessment was followed by summer and fall 2000 media and community interventions that were evaluated by post-intervention data collection taking place with a new cohort of sixth graders in the same 11 schools in late fall 2000. In analyses conducted at the school level, the enhanced school and comprehensive community program conditions outperformed the no intervention program condition to reduce tobacco use and intentions to use tobacco. Combining the intensive or low media campaign with the comprehensive community program was most effective in suppressing positive attitudes toward smoking, while the enhanced school program alone was less effective in influencing attitudes. The most consistent changes, at least short-term, to reduce teen tobacco use, susceptibility to smoking and pro-smoking attitudes were achieved by combining the intensive media campaign with the comprehensive community program condition.

Effects of motivational interviewing on smoking cessation in adolescents with psychiatric disorders.

OBJECTIVE: To test the hypothesis that among adolescent smokers hospitalised for psychiatric and substance use disorders, motivational interviewing (MI) would lead to more and longer quit attempts, reduced smoking, and more abstinence from smoking over a 12 month follow up. DESIGN: Randomised control trial of MI versus brief advice (BA) for smoking cessation, with pre- and post-intervention assessment of self efficacy and intentions to change, and smoking outcome variables assessed at one, three, six, nine, and 12 month follow ups. SETTING: A private, university affiliated psychiatric hospital in Providence, Rhode Island, USA. PATIENTS OR OTHER PARTICIPANTS: Consecutive sample (n = 191) of 13-17 year olds, admitted for psychiatric hospitalisation, who smoked at least one cigarette per week for the past four weeks, had access to a telephone, and did not meet DSM-IV criteria for current psychotic disorder. INTERVENTIONS: MI versus BA. MI consisted of two, 45 minute individual sessions, while BA consisted of 5-10 minutes of advice and information on how to quit smoking. Eligible participants in both conditions were offered an eight week regimen of transdermal nicotine patch upon hospital discharge. MAIN OUTCOME MEASURES: Point prevalence abstinence, quit attempts, changes in smoking rate and longest quit attempt. Proximal outcomes included intent to change smoking behaviour (upon hospital discharge), and self efficacy for smoking cessation. RESULTS: MI did not lead to better smoking outcomes compared to BA. MI was more effective than BA for increasing self efficacy regarding ability to quit smoking. A significant interaction of treatment with baseline intention to quit smoking was also found. MI was more effective than BA for adolescents with little or no intention to change their smoking, but was actually less effective for adolescents with pre-existing intention to cut down or quit smoking. However, the effects on these variables were relatively modest and only moderately related to outcome. Adolescents with comorbid substance use disorders smoked more during follow up while those with anxiety disorders smoked less and were more likely to be abstinent. CONCLUSIONS: The positive effect of MI on self efficacy for quitting and the increase in intention to change in those with initially low levels of intentions suggest the benefits of such an intervention. However, the effects on these variables were relatively modest and only moderately related to outcome. The lack of overall effect of MI on smoking cessation outcomes suggests the need to further enhance and intensify this type of treatment approach for adolescent smokers with psychiatric comorbidity.

Stage of change, decisional balance, and temptations for smoking: measurement and validation in a large, school-based population of adolescents.

Developing interventions for reducing adolescent smoking rates based on the Transtheoretical Model (TTM) requires the development of quality measures of the key constructs of the model. The goal of this investigation was to evaluate the psychometric properties of measures of Stage of Change, Decisional Balance and Situational Temptation for both smokers and nonsmokers and to test if the predicted relationships between these constructs were confirmed in a large (N=2808) sample of adolescents. A correlated three factor model (Social Pros, Coping Pros and Cons) provided an excellent fit to the 12-item Decisional Balance inventory for both smokers (CFI=0.957) and nonsmokers (CFI=0.963). A hierarchical four factor model (negative affect, positive social, habit strength and weight control) provided an excellent fit to the eight-item Situational Temptations inventory for smokers (CFI=0.969). A hierarchical five-factor model (same four as smokers plus Curiosity) provided an excellent fit to the 10-item Situational Temptations inventory for nonsmokers (CFI=0.943). The relationships between both the Decisional Balance and temptation scales and the Stages of Change were verified for both smokers and nonsmokers. The measures for adolescents are similar to but not the same as the measures of these constructs for adults.

Validation of decisional balance and situational temptations measures for dietary fat reduction in a large school-based population of adolescents.

Brief, validated, and reliable theory-based measures specifically designed for use in large survey research with adolescent populations are needed to assess attitudes and behaviors about dietary fat consumption. This study validated two transtheoretical model (TTM)-based instruments in 2639 ninth graders from 12 Rhode Island high schools. The Decisional Balance Questionnaire for Adolescent Dietary Fat Reduction (DBQA) measures the importance adolescents assign to the pros and cons of reducing dietary fat consumption, while the Situational Temptations Questionnaire for Adolescents (STQA) measures temptations to eat high-fat foods as both a global construct and across three categories of challenging situations. Four competing models were compared for each instrument. An eight-item, correlated two-factor Pros and Cons model was validated for the decisional balance measure and a nine-item, three-factor hierarchical model was validated for situational temptations. The theoretically predicted relationships between stage of change and the pros and cons, as well as stage and situational temptations were supported. These results demonstrate that both measures have sound psychometric properties and are externally valid.

Validation of the modified Fagerström tolerance questionnaire with salivary cotinine among adolescents.

This study was conducted to gain evidence of validity for a nicotine dependence measure for adolescent smokers. We hypothesized that the individual item responses and the total Fagerström Tolerance Questionnaire (FTQ) score would be positively correlated with cotinine values. We examined the relationship between a seven-item modified FTQ and saliva continine among 131 adolescent volunteers in a smoking cessation program. As anticipated, the total FTQ score was related to saliva cotinine (r = .40, p < .01), as were six of the seven individual FTQ items (p < .05). Our findings provide preliminary evidence that the modified FTQ scale is valid and applicable to adolescent smokers.

Effects of thirty-four adolescent tobacco use cessation and prevention trials on regular users of tobacco products.

Since 1991, adolescent tobacco use rates have increased while adult use has steadily decreased. The failure of adolescent tobacco use cessation and prevention programs to reduce this overall smoking rate indicates that research must be advanced in this area. As a start, the current status of cessation and prevention research that targets adolescent regular tobacco users should be stated. This paper contributes to that goal by reviewing the last two and a half decades of research in this area. A total of 34 programs, equally divided between cessation and prevention (targeting regular tobacco users), are presented and relevant data are provided for each. Among the cessation studies, an emphasis of programming on immediate consequences of use, and instruction in coping strategies, may have led to relatively successful programs. Prevention studies arguably may have achieved lower success rates but were applied to a larger sample with a longer follow-up period. Despite showing some success, it is apparent that the scientific status of cessation research is less refined than prevention research. More research is needed to define the most successful approaches for cessation of adolescent tobacco use.

Transtheoretical measures for adolescent and adult smokers: similarities and differences.

BACKGROUND: The prevalence of smoking among adolescents has remained stable and has increased in the past few years. Longitudinal results from a multitude of efforts to reduce adolescent smoking have been mostly disappointing. METHODS: This paper discusses, in light of the theoretical knowledge obtained among adults and the empirical data collected among adults and adolescents, the applicability of the central concepts of the Trantheoretical Model of Change to the adolescent smoking problem. RESULTS: According to the stage of change distributions, adolescent smokers appeared to be somewhat less prepared to quit than adults. Both adults and adolescents utilize identical cognitive and behavioral activities to change their smoking although teens' process use appears to differ from that of adults at each stage of change. According to the decisional balance measure, the pros of smoking among adults and teens exceeded the cons in early stages of change and then reversed once smokers took action to quit. The levels of temptations to smoke among adults and adolescents were almost identical at each stage. CONCLUSIONS: Both age groups turned out to be remarkably similar in the Transtheoretical measures, and, except for the processes of change, both groups exhibited similar behavior at different stages of the smoking cessation process.

Stages of acquisition and cessation for adolescent smoking: an empirical integration.

Adolescent cigarette smoking acquisition and cessation were integrated into a single nine-stages-of-change continuum using the transtheoretical model of change framework. Findings in a high school student sample (n > 700) showed that a few of the never smokers were planning to try smoking, and half of the current smokers were contemplating quitting. More than half of former smokers were long-term quitters. The high pros of smoking scores assessing coping benefits of cigarettes were related to smoking acquisition and the high con (disadvantages) scores to long-term abstinence. Never smokers were most tempted to try smoking when they anticipated that smoking would help reduce negative and increase positive mood. Current and former smokers were tempted due to peer cigarette offers and negative mood. These temptations were significantly reduced among ex-smokers.

Computer-based smoking cessation interventions in adolescents: description, feasibility, and six-month follow-up findings.

The impact of adolescent smoking cessation clinics has been disappointing due to low participation rates, high attrition, and low quit rates. This paper describes two computerized self-help adolescent smoking cessation intervention programs: 1) a program utilizing the expert system which is based on the transtheoretical model of change and 2) a popular action-oriented smoking cessation clinic program for teens which was modified for computer presentation. High participation rates in the program among 132 smokers demonstrate the high feasibility and acceptability of the programs. Quit rates of up to 20% were observed during the intervention, and an additional 30% made unsuccessful quit attempt(s). The 6-month follow-up findings indicated that adolescents were poorly prepared to maintain abstinence.

Decisional balance and stage of change for adolescent drinking.

The Transtheoretical Model of Change has been proven very effective in explaining both the acquisition and cessation of many health related behaviors. In this study, this model was applied to the domain of immoderate alcohol use among adolescents (usually drinking three or more drinks per occasion). Measures for two constructs of the model were developed: Stage of Change and Decisional Balance. A total of 853 tenth and eleventh graders who attend vocational training programs were administered a 37-item decisional balance questionnaire and a 5-item staging measure. A short (16-item) psychometrically sound Decisional Balance Inventory was developed based on an exploratory factor analysis that identified two factors, the Pros and Cons of Alcohol Use. The factor structure was confirmed using structural modeling techniques on a hold-out sample. Based on a combination of model fit and parsimony considerations, an uncorrelated model was selected (IFI2 = .909). Students were classified into one of nine stages of acquisition or cessation. External validity was established by the significant and meaningful differences between the stages of change on the pros and cons of alcohol use. Implications of this research are discussed.

Respiratory response to cigarette smoking among adolescent smokers: a pilot study.

BACKGROUND: Because cigarette smoking affects the respiratory system earlier than many other systems of the human body, an attempt was made to identify objective and subjective respiratory problems among adolescent smokers. METHODS: Two studies based on a pulmonary function test (PFT), respiratory symptom assessment, and other smoking-related variables were undertaken. Study 1 involved cigarette smokers (N = 18, 22% males, mean age 18.7 years) from a freshman college class who participated in an acute smoking experiment that involved performing a PFT before and after smoking a single cigarette. Study 2 was performed on a combined group of vocational-technical high school students and freshman college students (N = 44, 48% males, mean age 17.8 years) where PFT parameters, respiratory symptoms, and smoking-related health vulnerability were assessed among smokers vs nonsmokers. RESULTS: In Study 1, the average reduction across PFT parameters was 4.4% and the mean estimated lung age increased from 27.15 to 29.84 years. In Study 2, a consistent trend toward reduction of PFT values among smokers vs nonsmokers was observed; the mean forced expiratory volume in 1 sec/forced vital capacity ratio (90.51% vs 94.59%), peak expiratory flow rate (80.32% vs 92.06%), and flow rate of 50% of forced vital capacity (88.39% vs 102.81%) differed significantly. Significant differences in respiratory symptoms were also observed among smokers vs nonsmokers. CONCLUSIONS: The beginning of respiratory health disorders can be identified among adolescent smokers. These findings might provide important clues on how to improve outcomes from health care provider-based adolescent smoking cessation counseling.

Measuring nicotine dependence among high-risk adolescent smokers.

In the present study we tested our hypothesis that because of the higher prevalence and greater intensity of cigarette smoking among vocational-technical students (N = 110; 51.8% males; mean age 17 years), adolescents might demonstrate the nicotine dependence patterns comparable to those measured in a similar fashion in a group of adult smokers (N = 173; 50% males; mean age 42 years). A modified version of the Fagerström Tolerance Questionnaire (FTQ) utilized in the adolescent sample was coded to make it comparable to the original FTQ used in the adult sample. The tests of item structure and internal consistency of the modified FTQ for adolescents were satisfactory; the overall mean FTQ score correlated significantly with the intensity and duration of smoking. Although the FTQ values were generally lower in the adolescent sample, 20% of students had an overall FTQ score of 6 and above, indicating substantial nicotine dependence (compared to 49% in adults). Reasons for failure of the existing adolescent smoking cessation programs as well as the rationale for adding a nicotine replacement option to the behavioral smoking cessation treatment for a subset of high-risk nicotine-dependent adolescents are discussed.

A 2-year self-help smoking cessation manual intervention among middle-aged Finnish men: an application of the transtheoretical model.

BACKGROUND: A 2-year self-help manual smoking cessation intervention was conducted among a panel of middle-aged Finnish men (n = 265) who were recruited proactively in a longitudinal cardiovascular risk factor surveillance study. METHODS: Intervention utilized the stages of change concept of the transtheoretical model. The stages were assessed in the treatment condition at baseline of the cessation study and after that by mail every sixth month. Assessments were followed by an immediate mailing of a stage-based self-help manual matching the stage of change at that time. A usual care group was assessed annually but received no treatment. RESULTS: A significant time x intervention effect (P < 0.05) and time x baseline stage effect (P < 0.001) on quit rates were observed in the panel data over the 2-year period. An analysis of changes in the stages of change also revealed an accelerated cessation process in the treatment condition. CONCLUSIONS: We conclude that mailed stage-matched self-help smoking cessation manuals were able to accelerate the smoking cessation process but manuals alone may not constitute a sufficient long-term intervention. The effects of differential exposure to intervention, subject characteristics, measurement reactivity, and secular trends are discussed as potential confounds.

Readiness for smoking change among middle-aged Finnish men.

According to the transtheoretical model of change, smoking cessation attempts are preceded by three stages: precontemplation, contemplation, and preparation. These stages have shown great utility in predicting and impacting on behavior change. This cross-cultural study examined the distribution of the stages within a 33% random sample of middle-aged Finnish men. Of 490 regular smokers, 57.6% were in precontemplation, 29.4% in contemplation, and 13.0% in preparation. Five conceptual clusters were used to predict the stage membership. The number of lifetime quit attempts and the number of 24-h quit attempts in the past 12 months were found to be the best discriminators among the stages. The overall correct classification rate into stages using stepwise discriminant function analysis was 64.0%, substantially better than the chance rate. However, the analysis was successful for precontemplators only. Results showed that most smokers were precontemplators. Previous attempts to reduce smoking provided some predictive information concerning stage membership. Demographics, addiction to smoking, current smoking, smoking environment, and quit history were incomplete predictors of stage membership, as theoretically predicted.

Patterns of self-initiated smoking cessation among young adults.

Prochaska and DiClemente's (1984) cyclic-stage model of self-initiated smoking cessation divides the cessation process into five stages. This model was applied to a young adult population to determine the cross-sectional distribution of stages and the frequency and pattern of changes among stages over time. Compared to older adults, the distribution of the stages differed substantially: There were twice as many relapsers and only half as many maintainers among young adults. One-year changes in stages were examined using a static model, which did not take into account the cyclic nature of the change process, and a more realistic dynamic model, which did. Both models, especially the dynamic model, suggested substantially more movement among stages in younger than in older adults.

Validity of telephone surveys in assessing cigarette smoking in young adults.

Self-reports of cigarette smoking in a sample of young adults, aged 17 to 21 (n = 359) obtained by telephone were validated by home interview and saliva cotinine measurement. While most subjects were in agreement for their reported behaviors, the telephone methodology underestimated cigarette smoking rates by 3 to 4 per cent. Reported quitting by telephone was an unstable category with 35 per cent of quitters reporting smoking on home interview. Reliance on telephone methods alone may underestimate smoking behavior. Validation of surveys, preferably by biochemical methods, is recommended.

Predictors of non-adoption of cigarette smoking following experimentation.

The Childhood Antecedents of Smoking Study (CASS) investigated patterns of cigarette smoking among junior and senior high school students in an upper midwest school district. Four biannual school-based surveys were conducted over two years. A cohort of 72 smokers was identified and followed to determine who continued smoking and who quit. Discriminant analysis was used to study social, psychological, and environmental factors predictive of quitting smoking. Compared to continuing smokers, quitters reported having fewer friends and siblings who smoked, they were less likely to view the cigarette smoker's image as positive, and lived in families where parental involvement with teenagers was high (based on the reports of parents). These results are consistent with the view that social influences are strong determinants of patterns of adolescent smoking behaviour.

Predicting experimentation with cigarettes: the childhood antecedents of smoking study (CASS).

In a two-year investigation of cigarette smoking incidence in a population of Minnesota adolescents, the perceived smoking behavior of friends at baseline was a strong predictor of smoking onset. Additional predictors included: siblings' smoking behavior, parents' education level, and seven psychosocial scales including independence and rebelliousness. Smoking prevention strategies which teach youth to cope with social influences are well founded. Results also indicate that younger adolescents may yet be dissuaded from beginning smoking by knowledge of the health consequences of smoking.

Response to O'Malley: cigarette smoking among high school seniors.

P. M. O'Malley (Prev. Med. 13, 421-426, 1984) has stimulated discussion on the issues of self-reported smoking, the use of validation procedures to enhance self-report of smoking behavior, and the question of trends toward increases in underreporting of adolescent smoking. O'Malley's analysis was prompted by an earlier report of data from the Childhood Antecedents of Smoking Study. In response to O'Malley, further analysis comparing data from the Childhood Antecedents of Smoking Study with data from the Monitoring the Future study is presented, and recent evidence on the "bogus pipeline" methodology is reviewed.