An integrative model of change was applied to the study of 872 subjects changing their smoking habits on their own. The subjects represented the following five stages of change: precontemplation, contemplation, action, maintenance, and relapse. Ten processes of change were expected to receive differential emphases during particular stages of change. Results indicate that self-changers: (a) use the fewest processes of change during precontemplation; (b) emphasize consciousness raising during the contemplation stage; (c) emphasize self-reevaluation in both contemplation and action stages; (d) emphasize self-liberation, a helping relationship, and reinforcement management during the action stage; and (e) use counterconditioning and stimulus control the most in both action and maintenance stages. Relapsers were found to respond like a combination of contemplaters and people in action. Results are discussed in terms of developing a model of self-change of smoking and enhancing a more integrative general model of change.Formalized treatment programs for smoking fail with a majority of smokers (Hunt, Barnett, & Branch, 1971). Nevertheless, 30 million Americans quit smoking in the past decade, with 70% to 80% quitting on their own (Adult Use of Tobacco, 1975). Furthermore, 70% of smokers surveyed indicated that if they were to quit, they would not attend a formal treatment program (McAlister, 1975). In spite of the preponderance of and preference for self-change approaches, research on smoking cessation has focused primarily on formalized treatments. The present study reports on the change processes that were emphasized by 872 self-changers representing five different stages of quitting smoking.In one of the few studies on self-change, self-changers did not differ from individuals in formalized treatments on smoking habits, locus of control, and measures of the Jackson Personality Inventory (Pederson & Lefcoe, 1976). DiClemente and Prochaska (1982) also found that self-changers did not differ from subjects in two types of therapy programs in terms of smoking history variables,

The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to data have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stage-matched programs is the similarity between participants reactively recruited who reached us for help and those proactively recruited who we reached out to help. If results with stage-matched interventions continue to be replicated, health promotion programs will be able to produce unprecedented impacts on entire at-risk populations.

Charles A. Kiesler shows that models of mental health policy based on health care policy have resulted in more expensive and less effective mental health services. Why Is There No Study of Cultural Equivalence inStandardized Cognitive Ability Testing?Janet E. Helms writes on the limits of the nature-versus-nurture debate about Black-White score differences on tests of cognitive ability.

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Goldstein, M., DePue, J. et al. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer and receive regular mammograms.