Characteristics in stages of change and decisional balance among smokers: The burden of obstructive lung diseases (BOLD)-Australia study

Marsha A. Ivey, Graeme P. Maguire, Brett G. Toelle, Guy B. Marks, Michael J. Abramson, Richard Wood-Baker

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Smoking cessation remains a health promotion target. Applying the Transtheoretical Model to Australian Burden of Obstructive Lung Diseases (BOLD) data, we examined differences in stages of change (SoC) and readiness to quit decisional behaviours. Factors were identified likely to influence readiness of smokers, ≥40 years old, to quit. Analysis was restricted to current smokers classified to one of three stages: pre-contemplation (PC), contemplation (C) or preparation (P) to quit. Their ability to balance positive and negative consequences was measured using decisional balance. Among 314 smokers, 43.0% females and 60.8% overweight/obese, the distribution of SoC was: 38.1% PC, 38.3% C and 23.5% P. Overweight/obesity was associated with readiness to quit in stages C and P and there were more negative than positive attitudes towards smoking in those stages. Males were significantly heavier smokers in PC and C stages. Females used smoking cessation medication more frequently in PC stage, were more embarrassed about smoking and had greater negative reinforcements from smoking. Age started smoking and factors related to smoking history were associated with readiness to quit and increased the odds of being in stage C or P. An overweight/obese smoker was likely to be contemplating or preparing to quit. In these stages, smokers have more negative attitudes toward smoking. Starting smoking later, taking advice on cessation from health providers and using quit medications indicate increased readiness to quit. Evaluating these factors in smokers and developing cessation gain-framed messages may prove useful to healthcare providers.

Original languageEnglish
Article number3372
Number of pages12
JournalInternational Journal of Environmental Research and Public Health
Issue number18
Publication statusPublished - 2 Sept 2019


  • Burden of Obstructive Lung Disease (BOLD)
  • Decisional balance
  • Gender difference
  • Smoking cessation
  • Stages of change

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