highlighted the processes involved in the transition from a smoker to a non-smoker and
from a drinker to a non-drinker. They argued that cessation involves a shift across five
basic stages:1 precontemplation: defined as not seriously considering quitting;
2 contemplation: having some thoughts about quitting;
3 preparation: seriously considering quitting;
4 action: initial behaviour change;
5 maintenance: maintaining behaviour change for a period of time.Prochaska and DiClemente maintain that individuals do not progress through these
stages in a straightforward and linear fashion but may switch backwards and forwards
(e.g. from precontemplation to contemplation and back to precontemplation again).
They call this ‘the revolving door’ schema and emphasize the dynamic nature of cessa-
tion. This model of change has been tested to provide evidence for the different stages for
smokers and outpatient alcoholics (DiClemente and Prochaska 1982; 1985; DiClemente
and Hughes 1990), and for the relationship between stage of change for smoking cessa-
tion and self-efficacy (DiClemente 1986). In addition, DiClemente et al. (1991) examined
the relationship between stage of change and attempts to quit smoking and actual
cessation at one- and six-month follow-ups. The authors categorized smokers into either
precontemplators or contemplators and examined their smoking behaviour at follow-up.
They further classified the contemplators into either contemplators (those who were
smoking, seriously considering quitting within the next six months, but not within the
next 30 days) or those in the preparation stage (those who were seriously considering
quitting smoking within the next 30 days). The results showed that those in the prepara-
tion stage of change were more likely to have made a quit attempt at both one and six
months, that they had made more quit attempts, and were more likely to be not smoking
at the follow-ups. This study is described in detail in Focus on research 5.1, page 115.
Research has also used the health beliefs and structured models outlined in Chapter 2
to examine the predictors of both intentions to stop smoking and successful smoking
cessation. For example, individual cognitions such as perceptions of susceptibility,
past cessation attempts and perceived behavioural control have been shown to relate
to reductions in smoking behaviour (Giannetti et al. 1985; Cummings et al. 1988; Godin
et al. 1992). In addition, the theory of planned behaviour (TPB) has been used as a
framework to explore smoking cessation in a range of populations, including those
following a worksite ban (Borland et al. 1991), pregnant women and the general
population (Godin et al. 1992).
Along these lines, one study examined the usefulness of the TPB at predicting inten-
tion to quit smoking and making a quit attempt in a group of smokers attending health
promotion clinics in primary care (Norman et al. 1999). The results showed that the best
predictors of intentions to quit were perceived behavioural control (i.e. ‘How much
control do you feel you have over not smoking over the next six months?’) and perceived
susceptibility (i.e. ‘How likely do you think it might be that you will develop any of the
following problems in the future if you continue to smoke?’). At follow-up, the best
predictors of making a quit attempt were intentions at baseline (i.e. ‘How likely is it that114 HEALTH PSYCHOLOGY