Velicer W F, Fava J L, Prochaska J O, Abrams D B, Emmons K M, Pierce J P
Cancer Prevention Research Center, University of Rhode Island, Kingston 02881, USA.
Prev Med. 1995 Jul;24(4):401-11. doi: 10.1006/pmed.1995.1065.
A key variable for the design of individual and public health interventions for smoking cessation is Stage of Change, a variable which employs past behavior and behavioral intention to characterize an individual's readiness to change. Reactively recruited samples distort estimates of the stage distribution in the population because such samples attract a disproportionate number of late-stage participants. Three representative samples are described which provide accurate estimates of the stage distribution in the population. These samples are of adequate size to permit within-sample comparisons with respect to sex, age, Hispanic or non-Hispanic origin, race, and education level. The implications of using stage distribution as a tool for planning intervention is discussed.
The first sample of 4,144 smokers was from the state of Rhode Island and involved a random-digit-dial survey. The second sample of 9,534 smokers was from the state of California and involved a stratified random-digit-dial survey. The third sample of 4,785 smokers was from a total of 114 worksites located in four different geographic locations.
The stage distributions were approximately identical across the three samples, with approximately 40% of the sample in Precontemplation, 40% in Contemplation, and 20% in Preparation. The stage distribution was generally stable across age groups with the exception of the 65 years and older group. Education level did affect the stage distribution with the proportion of the sample in Precontemplation decreasing as education level increased. In all three samples, minor differences in stage distribution were related to Hispanic origin and race, but the pattern was not consistent across the samples.
The pattern of stage distribution has important implications for the design of interventions. Existing interventions are most appropriate for the Preparation stage, but the majority of the three samples were in the first two stages, resulting in a likely mismatch between the smoker and the intervention. The stability of distribution across age suggests that interventions that are appropriately matched to stage can be applied across all age groups. The differences found with respect to education, Hispanic origin, and race can serve as a guide to the tailoring of intervention materials.
“改变阶段”是为戒烟设计个人和公共卫生干预措施的一个关键变量，该变量利用过去的行为和行为意图来描述个体改变的意愿程度。因反应性招募的样本会吸引不成比例的晚期参与者，从而扭曲了总体人群中阶段分布的估计值。本文描述了三个具有代表性的样本，它们能提供总体人群阶段分布的准确估计值。这些样本规模足够大，能够就性别、年龄、西班牙裔或非西班牙裔血统、种族和教育水平进行样本内比较。本文还讨论了将阶段分布用作规划干预措施工具的意义。
第一个包含4144名吸烟者的样本来自罗德岛州，采用随机数字拨号调查。第二个包含9534名吸烟者的样本来自加利福尼亚州，采用分层随机数字拨号调查。第三个包含4785名吸烟者的样本来自位于四个不同地理位置的总共114个工作场所。
三个样本的阶段分布大致相同，约40%的样本处于前意向阶段，40%处于意向阶段，20%处于准备阶段。除65岁及以上年龄组外，阶段分布在各年龄组中总体稳定。教育水平确实会影响阶段分布，随着教育水平的提高，处于前意向阶段的样本比例会下降。在所有三个样本中，阶段分布的微小差异与西班牙裔血统和种族有关，但各样本之间的模式并不一致。
阶段分布模式对干预措施的设计具有重要意义。现有的干预措施最适合准备阶段，但这三个样本中的大多数处于前两个阶段，这可能导致吸烟者与干预措施不匹配。各年龄组分布的稳定性表明，与阶段相匹配的干预措施可以应用于所有年龄组。在教育、西班牙裔血统和种族方面发现的差异可为干预材料的定制提供指导。
