Effects of a theory-driven educational package and social support on durability of cigarette smoking cessation behavior
A community-based program
Keywords:
2 Ph.D. of Health Education and Promotion, Professor, Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, IranAbstract
Background: According to a World Health Organization (WHO) report, the prevalence of smoking in Iranian individuals aged 15-64 is up to 12%.
Objective: The aim of the current study was to determine the durability of smoking cessation behavior based on a trans-theoretical model.
Methods: This educational experimental study was conducted on smokers in Khomein City, Iran, in 2015. Sampling was done through a public announcement and then a random allocation of participants into two study group (50 persons) and control group (60 persons). Tools to gather data were as follows: an individual characteristics form and DiClemente’s stages of change, Velicer’s self-efficacy, Prochaska’s processes of change, Velicer’s decisional balance, and Fagerstrom’s nicotine dependency questionnaires. The study group received five sessions of 45-minute individual counseling each and were followed-up three and six months later. Data were analyzed by SPSS version 16, using paired-samples t-test, independent-samples t-test, and chi-square.
Results: Within six months of follow-up, 20 persons (40%) of the intervention group reached the maintenance stage of smoking cessation, while no one from controls managed to do that. Except for the perceived barriers and benefits of smoking cessation, all other constructs of the trans-theoretical model (cognitive and behavioral processes and smoking temptation) showed significant changes among the intervention group during six months’ follow-up (p<0.05). There was no significant relationship between variables of having smoker friends, occupation, marital status, education status, and success or failure in cigarette smoking cessation (p>0.05).
Conclusion: According to our study, selection of cigarette smokers who are willing to quit, delivery of individual counseling according to specific personal characteristics, and also provision of free nicotine replacement therapies should be taken into account in cigarette smoking cessation programs.
References
Smith SC Jr, Greenland P, Grundy SM. AHA Conference Proceedings. Prevention conference V: Beyond
secondary prevention: Identifying the high-risk patient for primary prevention: executive summary.
American Heart Association. Circulation. 2000; 101(1): 111-6. doi: 10.1161/01.CIR.101.1.111. PMID:
Health UDo, Services H. Preventing tobacco use among youth and young adults: a report of the Surgeon
General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and
Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health. 2012; 3.
Leistikow BN. The human and financial costs of smoking. Clin Chest Med. 2000; 21(1): 189-97. doi:
1016/S0272-5231(05)70017-4. PMID: 10763099.
Nair AK, Brandt EN Jr. Effects of smoking on health care costs. J Okla State Med Assoc. 2000; 93(6): 245- 50. PMID: 10860294.
Mermelstein R, Colby SM, Patten C, Prokhorov A, Brown R, Myers M, et al. Methodological issues in
measuring treatment outcome in adolescent smoking cessation studies. Nicotine Tob Res. 2002; 4(4): 395- 403. doi: 10.1080/1462220021000018470. PMID: 12521399.
Mehrabi S, Delavari A, Moradi Gh, Esmailnasab EN, Pooladi A, Alikhani S, et al. Smoking among 15-to
-year-old Iranian people in 2005. iranian Journal of epidemiology. 2007; 3(1-2): 1-9.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot.
; 12(1): 38-48. doi: 10.4278/0890-1171-12.1.38. PMID: 10170434.
Hayden JA. Introduction to health behavior theory. Jones & Bartlett Publishers. 2013.
Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice.
John Wiley & Sons. 2008.
John U, Meyer C, Rumpf HJ, Hapke U. Relation among stage of change, demographic characteristics,
smoking history, and nicotine dependence in an adult German population. Prev Med. 2003; 37(4): 368-74.
doi: 10.1016/S0091-7435(03)00149-X. PMID: 14507495.
Carlson LE, Taenzer P, Koopmans J, Casebeer A. Predictive value of aspects of the Transtheoretical Model
on smoking cessation in a community-based, large-group cognitive behavioral program. Addict Behav.
; 28(4): 725-40. doi: 10.1016/S0306-4603(01)00268-4. PMID: 12726786.
Andersen S. Adding addiction to the transtheoretical model for smoking cessation. Addictive behaviors.
; 32(5): 1099-1104. doi: 10.1016/j.addbeh.2006.07.005. PMID: 16935434.
Cobb S. Presidential Address-1976. Social support as a moderator of life stress. Psychosom Med. 1976;
(5): 300-14. doi: 10.1097/00006842-197609000-00003. PMID: 981490.
Drentea P, Clay OJ, Roth DL, Mittelman MS. Predictors of improvement in social support: Five-year
effects of a structured intervention for caregivers of spouses with Alzheimer's disease. Soc Sci Med. 2006;
(4): 957-67. doi: 10.1016/j.socscimed.2006.02.020. PMID: 16616406.
World Health Organization. WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco
advertising, promotion and sponsorship. World Health Organization. 2013.
Erol S, Erdogan S. Application of a stage based motivational interviewing approach to adolescent smoking
cessation: the Transtheoretical Model-based study. Patient Educ Couns. 2008; 72(1): 42-8. doi:
1016/j.pec.2008.01.011. PMID: 18304775.
DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of
smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J
Consult Clin Psychol. 1991; 59(2): 295-304. doi: 10.1037/0022-006X.59.2.295. PMID: 2030191.
Velicer WF, DiClemente CC, Rossi JS, Prochaska JO. Relapse situations and self-efficacy: An integrative
model. Addict Behav. 1990; 15(3): 271-83. doi: 10.1016/0306-4603(90)90070-E. PMID: 2378287.
Prochaska JO, Velicer WF, DiClemente CC, Fava J. Measuring processes of change: applications to the
cessation of smoking. J Consult Clin Psychol. 1988; 56(4): 520-8. doi: 10.1037/0022-006X.56.4.520.
PMID: 3198809.
Velicer WF, DiClemente CC, Prochaska JO, Brandenburg N. Decisional balance measure for assessing and
predicting smoking status. J Pers Soc Psychol. 1985; 48(5): 1279-89. doi: 10.1037/0022-3514.48.5.1279.
PMID: 3998990.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerström test for nicotine dependence:
a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict. 1991; 86(9): 1119-27. doi:
1111/j.1360-0443.1991.tb01879.x. PMID: 1932883.
Sharifirad GR, Eslami AA, Charkazi A, Mostafavi F, Shahnazi H. The effect of individual counseling, line
follow-up, and free nicotine replacement therapy on smoking cessation in the samples of Iranian smokers:
Examination of transtheoretical model. J Res Med Sci. 2012; 17(12): 1128-36. PMID: 23853630, PMCID:
PMC3703164.
Eslami AA, Charkazi A, Mostafavi F, Shahnazi H, Badeleh MT, Sharifirad GR. Smoking behavior,
nicotine dependency, and motivation to cessation among smokers in the preparation stage of change. J
Educ Health Promot. 2012; 1: 47. doi: 10.4103/2277-9531.104818. PMID: 23555150, PMCID:
PMC3577406.
Banville D, Desrosiers P, Genet-Volet Y. Translating questionnaires and inventories using a cross-cultural
translation technique. Journal of teaching in physical education. 2000; 19(3): 374-87.
Cohen J. Statistical power analysis for the behavioral sciences (revised ed). New York: Academic Press.
Dino G, Kamal K, Horn K, Kalsekar I, Fernandes A. Stage of change and smoking cessation outcomes
among adolescents. Addict Behav. 2004; 29(5): 935-40. doi: 10.1016/j.addbeh.2004.01.004. PMID:
Jonsdottir H, Jonsdottir R, Geirsdottir T, Sveinsdottir KS, Sigurdardottir T. Multicomponent individualized
smoking cessation intervention for patients with lung disease. J Adv Nurs. 2004; 48(6): 594-604. doi:
1111/j.1365-2648.2004.03248.x. PMID: 15548250.
Stapleton JA, Russell MA, Feyerabend C, Wiseman SM, Gustavsson G, Sawe U, et al. Dose effects and
predictors of outcome in a randomized trial of transdermal nicotine patches in general practice. Addiction.
; 90(1): 31-42. doi: 10.1111/j.1360-0443.1995.tb01007.x. PMID: 7888977.
Association AP. American Psychiatric Association Practice Guidelines. for the treatment of psychiatric
disorders: compendium 2006. American Psychiatric Pub. 2006.
Alberg AJ, Stashefsky Margalit R, Burke A, Rasch KA, Stewart N, Kline JA, et al. The influence of
offering free transdermal nicotine patches on quit rates in a local health department's smoking cessation
program. Addict Behava. 2004; 29(9): 1763-78. doi: 10.1016/j.addbeh.2004.04.007. PMID: 15530720.
McAlister AL, Rabius V, Geiger A, Glynn TJ, Huang P, Todd R. Telephone assistance for smoking
cessation: one year cost effectiveness estimations. Tob Control. 2004; 13(1): 85-6. doi:
1136/tc.2003.004515. PMID: 14985603, PMCID: PMC1747824.
Park ER, Puleo E, Butterfield RM, Zorn M, Mertens AC, Gritz ER, et al. A process evaluation of a
telephone-based peer-delivered smoking cessation intervention for adult survivors of childhood cancer: the
partnership for health study. Prev Med. 2006; 42(6): 435-42. doi: 10.1016/j.ypmed.2006.03.004. PMID:
Kim YH. Adolescents’ smoking behavior and its relationships with psychological constructs based on
transtheoretical model: A cross-sectional survey. International journal of nursing studies. 2006; 43(4): 439- 46. doi: 10.1016/j.ijnurstu.2005.06.008. PMID: 16150450.
Published
Issue
Section
License
Copyright (c) 2022 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
