Pathways to Change

Previous research has predicted that an estimated 500 million people will die from tobacco use. Modest breakthroughs in developing interventions for smokers could prevent millions of premature deaths and billions of lost years of life.

The program involves a computer-based support system that delivers individually tailored reports to help adults quit smoking. Each report is divided into four sections: (1) a description of the person's stage of change, including their pros and cons for quitting; (2) feedback on their use of change processes, noting how subjects compared to successful self-changers and to their previous assessment; (3) a description of situations in which it is tempting to smoke, with feedback on how to enhance self-confidence; and (4) strategies for taking small steps to progress to the next stage.

In the study, individualized, interactive computer reports were sent to participants at the start of the intervention, at month 3, and at month 6.

Study participants included adult smokers in Rhode Island households, recruited through random digit dialing. The study sample was predominantly Caucasian though also included people of African American, Asian, Hispanic and other origins.

The program can be delivered by mail to the home.

The Pathways to Change manual and assessment instruments are required.

The study tested a computer-based expert system intervention that has the potential to increase successful smoking cessation. The intervention is based on stages of change. Research on how people quit smoking on their own has identified five stages of change: pre-contemplation, contemplation, preparation, action, and maintenance.

Participants completed a brief phone survey and were randomly assigned to an Expert System Intervention (ES) or an Assessment Only Condition (AS). Those assigned to the ES condition were mailed a series of three computer reports at the start of treatment and at 3 and 6 months. At 3 and 6 months, ES subjects were mailed a progress questionnaire.

Intervention follow-up took place at 6, 12, 18, and 24 months after the intervention.

Results of the study indicate the following:

• Smoking cessation rates were significantly higher for the ES condition at each time interval (2.3 at 6 months, 3.5 at 12 months, 5.1 at 18 months, and 5.9 at 24 months).
• Similarly, results for having quit for 7 days, 30 days, and 6 months at the 6, 12, 18, and 24 month marks reveal a significant difference between the AS and ES groups.
• For subjects in the contemplation and preparation stages at baseline, the ES group outperformed the AS group at each of the four follow-ups. For subjects originally in the pre-contemplation stage, however, the ES did not produce greater abstinence until the 24-month follow-up. This is the type of delayed action effect that can be expected from a stage-matched intervention.