Assessing the validity of the stages of change: the example of smoking cessation

1. Assessing the validity of the stages of change: the example of smoking cessation Thaddeus A. Herzog, Ph.D. West Virginia University

2. Presentation Background SOC is part of the larger TTM Derived from �Background and Significance� section of R01 Grant Converted to Health Psychology article (published September, 2008) Credit to Weinstein, Rothman, & Sutton (1998)

3. Preliminary Comments Use common sense instead of SOC Motivation to quit smoking is important I�m not against stage models in general Critical of one particular stage model

4. Prominence of the Transtheoretical Model (TTM) Often cited (1400 for 1992 article) Much grant funding Used for a variety of health behaviors (smoking, exercise, drug use, diet, etc.) Taught everywhere (medical, public health, psych, nursing, pharmacy, social work, etc.)

5. Stages of Change Centerpiece of the Transtheoretical Model A set of five classifications: Precontemplation Contemplation Preparation Action Maintenance

6. Stages of Change Algorithm

7. PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE Conscious raising Dramatic relief Environmental re-evaluation Self-reevaluation Self-liberation Reinforcement Management Helping relationships Counterconditioning Stimulus control From Prochaska, DiClemente & Norcross, 1992

8. Why is the TTM Popular? Stage Model Simple Intuitive Aggressive marketing Optimistic interpretation of results What is the evidence?

9. Most Frequent Types of TTM Studies Cross-sectional Stage of change as a predictor of cessation Predicting progressive stage movements TTM interventions

10. Cross-sectional Studies Most common type of TTM study Provides the weakest kind of evidence Herzog, Abrams, Emmons, Linnan, & Shadel (1999), Health Psychology

11. Typical Cross-Sectional Pattern

12. Stage of Change (SOC) as a Predictor of Cessation SOC is a modest stand-alone predictor of cessation Control for other predictors Necessary but not sufficient Need to know how to foster stage movements Abrams, Herzog, Emmons, & Linnan (2000), Nicotine & Tobacco Research

13. PRECONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE Conscious raising Dramatic relief Environmental re-evaluation Self-reevaluation Self-liberation Reinforcement Management Helping relationships Counterconditioning Stimulus control From Prochaska, DiClemente & Norcross, 1992

14. Predicting Progressive Stage Movements A central tenet of the model There is no evidence that the POC predict stage movements Discuss invalid study designs and inferences Herzog, Abrams, Emmons, Linnan, & Shadel (1999), Health Psychology Herzog, Abrams, Emmons, & Linnan (2000), Psychology & Health

15. Intervention Studies 5 of 6 reviews of TTM interventions found disappointing results Interventions inconsistent with model Booklet interventions Individually tailored interventions

16. Intervention Studies (Continued) Inadequate comparison interventions Even with the unwarranted advantages, TTM interventions still do not perform particularly well

19. Stages of Change Algorithm

20. Why does SOC Underestimate MTQ The SOC items do not accord with the way most smokers think Most smokers intend to quit, but don�t know when or how Herzog (2007), Psychology of Addictive Behaviors

21. Distribution of Smokers