Smoking Algorithm
CLASSIFICATION OF THE STAGES OF CHANGE FOR SMOKING CESSATION
Smoking Stage of Change
Client ID#_______________________
Short Form Date:_________/_________/_______
Assessment Point:_________________
1. Are you currently a smoker?
- A) Yes, I currently smoke.
- B) No, I quit within the last 6 months.
- C) No, I quit more than 6 months ago.
- D) No, I have never smoked.
Smokers only:
2. In the last year, how many times have you quit smoking for at least 24 hours? _____
3. Are you seriously thinking of quitting smoking?
- A) Yes, within the next 30 days
- B) Yes, within the next 6 months
- C) No, not thinking of quitting
Smoking Stage of Change
Short Form
Scoring Sheet
1. Are you currently a smoker?
- A) Yes, I currently smoke.
- B) No, I quit within the last 6 months. (ACTION STAGE)
- C) No, I quit more than 6 months ago. (MAINTENANCE STAGE)
- D) No, I have never smoked. (NONSMOKER)
Smokers only:
2. In the last year, how many times have you quit smoking for at least 24 hours? ______
3. Are you seriously thinking of quitting smoking?
- A) Yes, within the next 30 days (PREPARATION STAGE if they have one 24-hour quit attempt in the past year; if there was no quit attempt in the past year, then CONTEMPLATION STAGE)
- B) Yes, within the next 6 months (CONTEMPLATION)
- C) No, not thinking of quitting (PRECONTEMPLATION)
References
- DiClemente, C.C., Prochaska, J.O., Fairhurst, S., Velicer, W.F., Rossi J.S., & Velasquez, M. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation and contemplation/action. Journal of Consulting and Clinical Psychology, 59, 295-304.
- Velicer, W.F., Fava, J.L., Prochaska, J.O., Abrams, D.B., Emmons, K.M., & Pierce, J. (1995). Distribution of smokers by stage in three representative samples. Preventive Medicine, 24, 401-411.