The stages of change of rural African-American smokers

Cigarette smoking remains the most important preventable cause of death in the United States, and the burden is especially great for African Americans. A promising approach to better understanding smoking behavior involves the application of a stages-of-change model. The purpose of this study was to analyze the smoking behavior of a population-based sample of African Americans in two rural southern counties using this model. Data were collected using a door-to-door household survey. The study sites were two rural counties in central Virginia. A total of 556 African-American smokers and recent quitters completed a questionnaire concerning their smoking behavior and beliefs about quitting. Overall, 51% of the respondents were in the pre-contemplation stage, 28% in the contemplation stage, 17% in the preparation stage, and 4% in the action stage. In a multivariate model, eight factors were significantly associated with the stage of change among current smokers: age, number of prior cessation attempts; confidence in becoming a nonsmoker; scales measuring both the pros and cons of smoking; perceived desires of others; believing quitting would improve health; and number of doctor visits in the past year. This study provides support for applying a stages-of-change model to African Americans who smoke. Many of the predictors of the stage of change are the same as those found in other populations. In addition, finding an association between stages and both physician visits and believing stopping smoking can improve health has important implications for providing smoking cessation services in health care settings.