[Factors associated with stages of behavior change in Cuban smokers].
OBJECTIVE
To describe the distribution of Cuban smokers in the first two stages of the process of behavior change (precontemplation (that is, no desire to quit smoking) and contemplation (thinking about quitting)), the characteristics of these smokers, and the relationship between these characteristics and some variables of interest.


METHODS
The First National Survey of Risk Factors and Chronic Non-communicable Disease Prevention Activities was carried out in Cuba in 1996. As a part of that Survey, a probability sample was selected using three-stage clustering, with stratification of the primary units, which were the census districts in the 14 provinces and 169 municipalities that make up the country. The census districts were selected in proportion to their number of dwellings. A total of 4 835 smokers 15 years old or older were selected to answer a questionnaire on sociodemographic variables and smoking-related behaviors. The sociodemographic variables included age, sex, skin color, level of schooling completed, and work status (working, looking for work, retired, housewife, or student). The smoking-related behaviors included knowledge of tobacco's harmful effects on health, age when smoking began, number of cigarettes smoked daily, willingness to give up the habit, and the number of attempts made to quit smoking. The questionnaire information made it possible to place the smokers in one or the other of the two initial stages of smoking behavior change. The probability of being in the precontemplation stage was modeled through logistic regression. The standardized coefficients that the model produced were used to calculate the weight of the explanatory variables included in the model. To calculate the estimates and their errors, the SAS 6.12 and SUDAAN 7.5 statistical software packages were used, taking into account the complex design of the sample. The level of significance was set at 0.05.


RESULTS
We found that 46.4% of the smokers surveyed were in the precontemplation stage, and 53.6% were in the contemplation stage. Women were more prepared to quit the habit than were men. The more formal the education that a person had, the stronger was the desire to quit smoking. Persons who were retired were the ones least likely to be considering giving up smoking. The probability of being in the precontemplation stage decreased with an increase in the age of beginning to smoke, the number of cigarettes smoked daily, and the number of attempts made to quit smoking.


CONCLUSIONS
The proportion of Cuban smokers in the contemplation stage places the country in a favorable position for developing effective smoking prevention interventions. The majority of the factors identified (age when smoking began, number of cigarettes consumed daily, and number of attempts to give up the habit) can be modified through preventive actions. Identifying the stages in the process of change and the factors linked to them are necessary for designing and implementing effective smoking prevention and control programs.
Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Ciudad de La Habana, Cuba. patriciav@inhem.sld.cu
Patricia Varona
PV
Pérez
Mariela
M
Rodríguez
Karen
K
Alfonso
Mariano
M
Bonet
René Guillermo
RG
García
Niurys Fernández
NF
Larrea
Rosa Marina García
RM
Pérez
D000293:Adolescent; D000328:Adult; D000368:Aged; D001240:Aspirations, Psychological; D001290:Attitude; D001519:Behavior; D003462:Cuba; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013850:Thinking