Testing the transtheoretical model of change in young adult male smokeless tobacco users

Oklahoma is one of the states with high tobacco use rates among adolescents and young adults. Prevalent among adolescent and young adult males is the use of SLT. Among high-school age smokeless tobacco (SLT) users in Oklahoma, 36% began before the age of 13, resulting in profound addiction. The rationale for the study was the poor cessation rates from traditional tobacco cessation programs. The purpose of this research was to study SLT use habits, cessation behaviors and critical characteristics of the Transtheoretical Model in young adults so that interventions can be planned that are effective in helping individuals to stop using SLT.

The Transtheoretical Model of Change served as the theoretical framework, and included (1) stages of change, (2) decisional balance, (3) self-efficacy, (4) processes of change, (5) temptation, (6) dependence, and (7) withdrawal. The study involved a descriptive, comparative design with N = 113 for initial data collection. Final analysis included 99 young adult SLT users who were between the ages of 18–25.

The study centered on the use of a survey to measure the concepts of the Transtheoretical Model. The Smokeless Tobacco survey was a modified version of the smoking behavior survey developed by Prochaska and DiClemente (1983). The survey includes four scales, with separate subscales that measure temptation to use SLT, the behavioral and cognitive processes used to assist in change activity, the pros and cons of continuing use of SLT, and withdrawal symptoms that prevent or hinder cessation attempts. Although not an inherent concept of the model, tobacco dependence was also addressed in the study.

Only three of the ten processes of change were significant in assisting young adult SLT users move toward action: self-reevaluation [F (2,96) = 6.41, p < .002]; self-liberation [F (2,96) = 7.75, p < .05], and counterconditioning [F (2,96) = 4.36, p = .02]. The young adult SLT users valued the cons of smoking as they moved toward active change [F (2,96) = 7.75, p = .0011. The expectation of severe withdrawal symptoms was not significant [F (2,96) = 1.34, p = .05]. Although SLT users did not score significantly higher on the dependency scale, there was a significant difference by low, moderate, or high ranking on SLT dependence among the three stages of change. The survey was reliable in measuring the concepts of change, with specific scale alpha coefficients increasing when identified weak items were removed: Temptation Scale (.86 to .87), Pros subscale (.67 to .73), Cons subscale (.74), Impacts of SLT Use scale (.88 to .92), and Withdrawal scale (.90). Factor analysis supported construct validity of the model in young adult SLT users, with the exception of the Impacts on SLT use scale. The 10 processes of change appeared to be the weakest concepts of the model in this sample.