Jennifer A. Parsons

Measuring readiness and motivation to quit smoking among women in public health clinics

We conducted a pilot test of an instrument to assess stage of readiness and level of motivation to change smoking behavior among 495 women smokers in public health clinics. The stages of readiness were based on those proposed by Prochaska and DiClemente but with finer discrimination within the precontemplation stage, where a substantial minority (41%) of the target smokers were situated. Subdividing this earliest group, we found that 8% of the total sample planned no change in smoking ever; 8% were seriously thinking of cutting down; and 25% were seriously thinking of quitting but not within 6 months. Scales in the questionnaire included general motivation to change smoking behavior and confidence in ones ability to do so. The womens scores differed on these scales and on action toward quitting across the five stages of readiness, except that the lowest two groups did not differ on confidence. Pregnancy enhanced readiness to quit. The instrument accommodates the brevity and low literacy requirements for use in these applied settings and is suitable for use in either self-administered questionnaire or interview format.

The measure of stage of readiness to change : Some psychometric considerations

Previous research in the smoking cessation literature has shown that the key component of the transtheoretical model of change, the stage of readiness to change, is a valid independent measure (C. C. DiClemente & J. O. Prochaska, 1985; C. C. DiClemente et al., 1991; W. F. Velicer, J. S. Rossi, J. O. Prochaska, & C. C. DiClemente, 1996). Recently, however, other health service researchers (e.g., A. J. Farkas et al., 1996b) have begun to question the utility of this model; especially its predictive validity (e.g., A. J. Farkas et al., 1996a). However, no research to date has examined the reliability and stability of the stage of readiness to change measure. In this study, the longitudinal measurement of stage of readiness to change was treated as a quasi-simplex model (K. G. Joreskog, 1970). Estimates of the stability and reliability for 261 female smokers in a general community sample were obtained. Results indicate that the stage of change measure has desirable psychometric properties.

Measuring readiness and motivation to quit smoking among women in public health clinics: predictive validity

We conducted an independent pilot test of the internal consistency, stability, and predictive validity of the instrument presented by Crittenden, Manfredi, Lacey, Warnecke, and Parsons (1994) using a two-wave panel of female smokers in 12 public health clinics. This instrument subdivides the precontemplation stage proposed by Prochaska and DiClemente into three more distinct stages: not contemplating quitting or cutting down, not contemplating quitting, and not contemplating quitting within 6 months. Findings confirm that the instrument is useful for evaluating movement toward quitting for populations that are largely concentrated in the precontemplative stage. The concurrent and predictive validity of the elaborated stages and the reliability and stability of smoking motivation and confidence indicate that the instrument is sensitive enough to track changes in readiness and motivation across the full readiness continuum.

Factors Associated With Response Rates in a National Survey of Primary Care Physicians

This article addresses the results and implications of offering a national sample of primary care physicians an option to complete a questionnaire by mail or phone. An overall cooperation rate of 62.7% was achieved; 55% of the interviews were completed via telephone. Noticeable differences in rate of cooperation and mode preference were observed across the four physician specialties surveyed. The importance of a lengthy field period, due to differences between early and late responders on variables important to the study, is also demonstrated.

Interviewer effects on self-reported substance use among homeless persons

This study examines respondent editing of survey responses to questions regarding substance use. Previous research has identified several types of interviewer effects that may be associated with respondent editing, including direct and social distance effects. Little is known, however, regarding how these potential effects may influence self-reported substance use behavior. Data analyzed for this study were collected as part of a survey of substance use among homeless persons conducted in Cook County, Illinois. A total of 481 respondents were sampled at random in emergency and transitional shelters, soup kitchens, drop-in centers, and single room occupancy (SRO) hotels. Overall, a direct, gender-based effect was observed, with homeless respondents of both genders more willing to reveal substance use behaviors to male interviewers. Some race- and age-related direct effects were also identified, with White and older interviewers obtaining more reports of substance use. These findings yield important evidence regarding respondent editing of self-reported substance use and have implications for the common practice of demographically matching interviewers and respondents.

Changes in self-efficacy and readiness for smoking cessation among women with high school or less education.

The most common theory of smoking cessation postulates that readiness to quit begins with changes in attitudes that move the smoker toward behavioral change and eventual cessation. However, trends in smoking indicate that many who currently smoke are not ready to quit. Hence, strategies that both enhance readiness and focus on quitting are likely to be most effective. We hypothesize that an intervention addressed to motivating behavior change will enhance readiness to change, which will in turn increase the smokers self-efficacy regarding further change. A smoking cessation intervention that combined a self-help booklet and televised segments was developed to address these issues in a population of women smokers with high school or less education. Readiness to quit was measured prior to the intervention, immediately following the intervention, and again at six and 12 months after intervention. The results indicate that the intervention had its effects on readiness to quit, which in turn affected self-efficacy, which further enhanced readiness to quit. These findings indicate that interventions aimed at this group of smokers may need to provide achievable objectives that focus on preparing the smoker to quit as well as promote cessation.

The Effect of Interviewer Characteristics On Gatekeeper Resistance in Surveys of Elite Populations

This article focuses on the interviewers role in obtaining access to an elite respondent through a gatekeeper and considers the characteristics of interviewers that may make some more successful than others in circumventing gatekeepers. Analysis of data from a national survey of physicians suggests that experienced interviewers have greater success than inexperienced interviewers in bypassing gatekeepers. These findings persist after taking into account the number of interviewing hours and the portion of the field period worked, two considerations that have been neglected in previous investigations of interviewer effects.

Examining the Effectiveness of a Community-Based Self-Help Program to Increase Women's Readiness for Smoking Cessation

This study investigated the effectiveness of two components of a smoking cessation intervention: a reading manual and a series of televised programs. Female smokers in the Chicago metropolitan area with a high school education or less were interviewed at 4 different times: baseline, immediate postintervention, and 6 and 12 months. We examined the effects of several baseline measures (race, age, number of cigarettes smoked, and stage of readiness to change) and exposure to the intervention components on subsequent stage of change. Race, baseline smoking rate, baseline stage, and exposure to both intervention components had direct effects on stage at immediate postintervention, with both intervention components increasing readiness to quit. Furthermore, exposure to the manual interacted with baseline stage, such that the manual benefited women at earlier stages more than women at later stages. Effects of both components were sustained at 6 months, and the effects of the manual were sustained at 12 months.

The role of the National Practitioner Data Bank in the credentialing process

Federal law requires hospitals and permits other entities to seek information from the National Practitioner Data Bank (NPDB) but places no requirements on how that information should be used. Our survey of NPDB users demonstrates that although the NPDB has generated substantial controversy and its information is nominally available from other sources, it still plays an important role in the credentialing process. Most institutions make timely NPDB inquiries that facilitate widespread use of the information in credentialing activities (4-5 individuals or committees). However, in 3% to 7% of cases, a decision was reached before the institution had the NPDB report. Between 5% and 30% of privileging and licensure applications involving an NPDB report were not granted “as requested,” suggesting the NPDB data are important to the process. Unfortunately, underreporting was also evident: 60% to 75% of reportable actions were not reported, limiting the information to which health care entities have access.

Awareness and knowledge of alcohol beverage warning labels among homeless persons in cook county, illinois.

In 1988 Congress passed the Alcohol Beverage Labeling Act, requiring that two specific health warning labels appear on all alcoholic beverage containers sold in the United States after November 1989. The following year, a random sample of 481 homeless persons interviewed in shelters, soup kitchens, drop-in centers, and single room occupancy (SRO) hotels in Cook County, Illinois were asked about their awareness and knowledge of these messages. As a group traditionally considered at high risk for alcohol abuse, the degree to which the newly-mandated warning messages have been communicated to homeless persons has important implications for the success of this public health measure. Findings revealed that age and level of alcohol consumption were each associated with label awareness and content familiarity, suggesting that alcohol beverage warning labels may be reaching homeless persons.