Are most precontemplators contemplating smoking cessation? Assessing the validity of the stages of change.

OBJECTIVE: To assess the validity of the stages of change (SOC) algorithm for current smokers. DESIGN: This study was a mail-based, cross-sectional survey study of 242 adult smokers. MAIN OUTCOME MEASURES: The main outcome measures were the SOC algorithm and a variety of alternative questionnaire items measuring motivation to quit smoking. RESULTS AND CONCLUSION: The results revealed that the SOC algorithm systematically underestimated motivation to quit smoking relative to a variety of other measures. Further, the stages of change do not appear to be qualitatively distinct categories. More than half the precontemplators were contemplating cessation, and many precontemplators intended to quit. Most contemplators were not merely contemplating cessation but rather were trying to quit currently. In summary, there is a divergence between the concepts underlying the SOC - precontemplation, contemplation, and preparation - and the operational definitions of these concepts.