title: The transtheoretical model of behavior change and smokers in southern Appalachia.
abstract: BACKGROUND
  The southern Appalachian states show a high prevalence of smoking, with associated high rates of both heart disease and cancer, yet cultural differences raise questions concerning the applicability of the most frequently used model for smoking cessation, the transtheoretical model, for smokers from this region of the country.
  
  
  OBJECTIVE
  To identify, by examining the applicability of the transtheoretical model for southern Appalachian smokers, the percentage of individuals in each of the five stages of change, the use of the processes of change from the trans-theoretical model, and the scores on recognized predictors of smoking cessation including the temptation to smoke, the perceived barriers to cessation, the pros and cons of smoking, and nicotine dependence.
  
  
  METHODS
  This population-based, descriptive, cross-sectional study used a random sample of 3,800 telephone numbers, which were called up to eight times. The 659 smokers or former smokers who agreed to participate were mailed a written questionnaire consisting of six well-established scales that measure constructs from the transtheoretical model. The final sample consisted of 357 usable questionnaires.
  
  
  RESULTS
  The distribution of smokers in northeastern Tennessee differed from national samples across the first three stages of change, with 56% in precontemplation, as compared with previous findings of 40% in national samples. The subjects' scores for the pros of smoking were similar across the stages of change in this sample, and although the scores for the cons differed significantly across the stages in the sample, post hoc analysis indicated that the only significant change occurred between precontemplation and contemplation. The scores for temptation to smoke did not differ significantly across the stages of change in this sample.
  
  
  CONCLUSIONS
  Smokers from Appalachian Tennessee differ from smokers in other parts of the United States, and these findings raise questions about the applicability of the transtheoretical model for this population.
authors.affiliation: Department of Family/Community Nursing, East Tennessee State University College of Nursing, Johnson City, TN 37614, USA. Macneec@mail.etsu.edu
authors.forename: Carol L
authors.initials: CL
authors.lastname: Macnee
authors.forename: Susan
authors.initials: S
authors.lastname: McCabe
mesh_terms: D000328:Adult; D000368:Aged; D001061:Appalachian Region; D001294:Attitude to Health / Q000208:ethnology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D015995:Prevalence; D020377:Self Efficacy; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology*; D016540:Smoking Cessation / Q000208:ethnology* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D013714:Tennessee / Q000453:epidemiology