Distributions of smokers by stage: international comparison and association with smoking prevalence

The goals of this study were to describe the distribution of smokers by stage of change in Geneva, Switzerland; to compare this result with distributions observed in other countries; and to assess whether, across samples from different countries, the stage distribution of current smokers was associated with the prevalence of smoking.

Two mailed surveys were conducted in Geneva in 1995-1996, in a representative sample of residents (n = 742) and in a representative sample of university members (n = 2,270). A literature review produced seven studies describing the stage distribution in representative samples.

In the Geneva population, 74% of smokers were in the precontemplation stage, 22% in contemplation, and 4% in preparation. In the university sample, the corresponding figures were 72, 20, and 8%. Our results were similar to other European samples, but less favorable than in American samples, where these distributions were typically 40, 40, and 20%, respectively. Across all samples, a low prevalence of smoking was associated with a more favorable stage distribution (r = 0.88, P = 0.002).

Interventions in Europe need to take into account the large proportion of precontemplators repeatedly observed among smokers. A shift to the right of the distribution of current smokers across stages may help increase quit rates and thereby reduce smoking prevalence. This hypothesis should be tested in prospective intervention studies.