Naturalistic Changes in the Readiness to Quit Tobacco Smoking in a German General Population Sample

Background. This study examines naturalistic changes, i.e., changes that occur without formal interventions, in the motivational readiness to quit tobacco smoking. The transtheoretical model (TTM) with the proposed five stages of change (precontemplation, contemplation, preparation, action, maintenance) is used as the theoretical framework. Methods. Data were collected as part of a representative general population study in Germany. A total of 786 individuals was assessed two times, 6 months apart, with respect to stage of change. Latent Transition Analysis (LTA) was employed as a special statistical method to analyze stage movements over time. Results. The best-fitting model to describe naturalistic stage movements included both forward and backward movements. A high proportion of the sample was in the precontemplation stage across both measurement occasions. There were high rates of stage regressions over the 6-month period. Conclusions. In a German representative population of smokers, smoking behavior change toward abstinence does not occur naturally in a substantial amount over the 6-month period without intervention. Differing findings in studies for populations in the United States could be due to methodological differences or differences in tobacco-control conditions.