Biomedical subjects
J O Prochaska
Publications and source records attributed to J O Prochaska.
Predicting change in smoking status for self-changers.
Fourteen different measures were investigated as predictors of change in smoking status for self-change efforts at smoking cessation. Adult subjects (N = 866) were classified into five stages of change: precontemplation, contemplation, action, maintenance, and relapse. Subjects were assessed on 10 change processes, self-efficacy, temptations to smoke, and their decisions weighing the advantages and disadvantages of smoking; and these 14 variables were used as predictors of change in smoking status 6 months later. Six significant functions were found which predicted movement for each of the stages. These predictors are of both theoretical interest and practical significance because they may be modified in self-change efforts to overcome addictive behaviors. Overall, the change processes of self-reevaluation and the helping relationship and the self-efficacy and decisional balance variables were the most efficacious predictor variables. A general pattern emerged in which processes oriented more toward environmental events, such as dramatic relief and social liberation, tended to predict failure or no progress whereas more experientially oriented processes predicted progress.
Subject characteristics as predictors of self-change in smoking.
Subject characteristics served as predictors of smokers' success or failure in their self-change efforts at smoking cessation over a 6-month period. Seven hundred and three adult subjects represented five stages of change based on the transtheoretical model: precontemplation, contemplation, action, maintenance, and relapse. Step-wise multiple discriminant functions were used to predict movement across the stages. Health problems, problem duration, daily cigarettes, previous attempts to quit, and smoking for pleasure predicted movement through various stages of change. The stronger the smoking habit, the less apt the smoker is to quit or maintain a nonsmoking status. Smokers with higher incomes and more years of education are more likely than persons of lower socioeconomic levels to be successful in their self-change efforts. The advantages of process-oriented rather than static variables for predicting self-change are discussed.
Decisional balance measure for assessing and predicting smoking status.
The Decisional Balance Sheet of Incentives has been proposed by Janis and Mann (1977) as a general schema for representing both the cognitive and motivational aspects of human decision making. In this study, a brief 24-item paper and pencil measure was constructed to study the decision-making process in smoking cessation. Two scales were identified and labeled the Pros of Smoking and the Cons of Smoking. These scales were successful in differentiating between five groups representing stages of change in the quitting process. The two scales were also successful when employed as predictors of smoking status at a 6-month follow-up. The Decisional Balance Scale appears to be a powerful construct of potentially wide application in behavior change.
Factor structure of the levels of attribution and change (LAC) scale in samples of psychotherapists and smokers.
Investigated the factor structure of the Levels of Attribution and Change (LAC) Scale, a 60-item, Likert-format instrument designed to assess the levels and loci of causal attributions about a problem behavior. Principal component analyses were performed on two samples, 194 adult smokers and 140 professional psychotherapists. In both cases, nine distinct and interpretable components were retained, which accounted for 63% and 68% of the total variance, respectively. Coefficients of congruence indicated that the two component patterns were quite similar. Item cross-classification revealed that the nine components closely resemble the 10 theoretical scales, with 2 scales (Familial Conflicts, Interpersonal Conflicts) represented by one component. Estimates of internal consistency averaged .84 and .87 for the two samples. The LAC theoretical scales and the scoring system have considerable empirical justification. The LAC Scale appears to be an internally consistent, multidimensional inventory with a robust factor structure.
Factor structure of the Profile of Mood States (POMS): two partial replications.
Examined the factor structure of the Profile of Mood States (POMS) in samples of psychiatric outpatients (N = 165) and adult smokers (N = 298). Principal component analyses (oblique rotation) yielded seven interpretable components in both cases, which accounted for 66% and 64% of the total variance, respectively. Coefficients of congruence indicated that the two component structures were quite similar. Three of the six POMS scales (Anger-Hostility, Vigor-Activity, Fatigue-Inertia) were replicated successfully in both samples. The remaining three scales were factorally complex and tended to merge, partially attributable to social desirability, to high scale intercorrelations, and to the inherent confluence of psychopathology. The POMS appears to be an internally consistent, multidimensional instrument with a relatively stable factor structure. Caution is recommended in the separate scoring and interpretation of several POMS scales.
Self change processes, self efficacy and decisional balance across five stages of smoking cessation.
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Stages and processes of self-change of smoking: toward an integrative model of change.
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Self-changers versus therapy changers versus Schachter.
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Self-change and therapy change of smoking behavior: a comparison of processes of change in cessation and maintenance.
Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: Aversion Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.
Life changes, cessation and maintenance of smoking: a preliminary report.
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Self-change processes, self-efficacy and self-concept in relapse and maintenance of cessation of smoking.
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Congruency of sex-role identification in normal and disturbed adolescent males.
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Sex-role development and parental expectations among disturbed adolescent males.
Seventeen pre-delinquent, 17 mixed psychiatric, and 17 normal adolescents and their parents were compared for the possession of certain personality traits traditionally classified as masculine or feminine. The parents were also compared in regard to the characteristics they expected their sons to possess. The main findings centered around three personality traits that differentiated the adolescents, and also between the expectations of both the mothers and fathers. In general, the parents of the normal adolescents expected their sons to be more achieving, dominating, and enduring than the parents of the other adolescents, which is consistent in regard to the personality traits that differentiated the adolescents from each other. The results suggest that the possession of certain traits, such as dominance and endurance, appear to be important for adequate functioning in adolescent males.
Symptom and dynamic cues in the implosive treatment of test anxiety.
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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.
An expert system intervention for smoking cessation.
Intervention efficacy can be increased when the treatment is maximally matched to the needs of the client. One means of achieving such matching is through use of an expert system, a computer-based decision-making system designed to utilize client information to produce unique, matched information and interventions. An expert system can combine the individual matching possible in a clinic-based intervention and the low cost associated with a public health approach. This paper begins by discussing several alternative implementations of the expert system approach within the general context of communication theory. Second, the theoretical model and related empirical evidence which form the basis of the expert system is described briefly. Third, the details of a computer-driven, expert system intervention specifically developed for smoking cessation is described. Finally, empirical results from a study comparing the expert system intervention to three alternative interventions for smoking cessation are presented. In general, the expert system approach can provide a cost effective, viable, and efficacious means of intervening in a specific problem behavior area. Implications and potential areas of development are discussed.
Applying the transtheoretical model to a representative sample of smokers.
Interrelationships among key constructs of the Transtheoretical Model are examined for the first time on a large (N = 4,144) representative sample of smokers. The posited relationships between the early Stages of Change (Precontemplation, Contemplation, Preparation) and the Processes of Change, Decisional Balance, and Situational Temptation are generally supported. Precontemplators are found to use the Processes of Change the least and those in Preparation use them the most. Precontemplators also have the least negative attitudes toward their smoking behavior. Precontemplators and Contemplators are tempted to smoke in more situations than those in Preparation. Precontemplators are also the most addicted to smoking, followed by those in Contemplation and Preparation, respectively, when examined on traditional measures of smoking behavior. The implications for smoking cessation efforts are also discussed.