Increasing Readiness to Change Among Smokers in a Primary Care Setting

INCREASING READINESS TO CHANGE AMONG SMOKERS IN A PRIMARY CARE SETTING Sheila F. Collicott Old Dominion University, 2000 Director. Dr. Robin J. Lewis This study compared the effectiveness of two brief interventions, direct advice and motivational interviewing, for increasing motivation to quit among male smokers in the pre-contemplation and contemplation stages of change who were primary care patients at an Eastern urban VA medical center. Contrary to expectations, participants receiving motivational interviews did not increase more in readiness to change, motivation, and actions to quit, than those receiving direct advice or a control conversation, nor did they smoke fewer cigarettes per day. As expected, contemplators reported more cutting down and quit attempts than pre-contemplators. Factors that may have limited the effectiveness of interventions are discussed. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. To Bud, my husband and best friend. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNO WLEDG MENTS I would like to express my appreciation to the many people who have contributed, each in his or her own way, to this project Many thanks to Dr. Robin Lewis, who agreed to be my committee director and was particularly generous with her expertise and guidance during the design and analysis phases. She helped keep things on track and greatly facilitated the administrative parts of the process. Thanks, too, to Dr. Clint McSherry, who provided the initial idea for the study, abundant and invaluable feedback, enthusiasm for clinical research and a sense of perspective when they were most needed. Dr. Susan Garvey was immensely generous with her time, energy, professional knowledge, and even her home. I appreciate the hospitality she and Dave Potvin, extended when I was in Virginia Beach. I also want to thank Dr. Pete Mikulka and Dr. Delanyard Robinson for serving on my committee. 1 am grateful to the many people at the Washington VA without whom I could never have completed the data-collection phase of this study. Chief among them is Dr. Neil Bien who kindly sponsored me and found time for paperwork whenever it was required. LaQuita Townes was ever-helpful in negotiating whatever challenges came up from day to day. James Edwards was enthusiastic, reliable, and unstinting in his support of the project and I greatly enjoyed working with him. Special thanks to all the participants for their cooperation. Their time and trust are deeply appreciated. Ed Kenlon deserves special recognition for so cheerfully working his magic with PCs and Macs to create the graphs for the manuscript Thanks to family and friends whose support has meant so much to me. I appreciate early encouragement of my interest in learning by my parents, Roy and Marian Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Fairieigh, and my grandmother, Faye Ewert. Thanks to Lisa Petrica for sharing the challenges and achievements of graduate school with me and for her continuing friendship. I’m enduringly grateful for Genece Warren and the many adventures we’ve shared. She and her husband, Bob, generously provided my home away from home during the graduate program, a time when her thoughtfulness, encouragement, and wonderful, creative dinners were even more appreciated than usual. Special thanks to Bob for his unfailing ability to find the humor in nearly any circumstance. Thanks to Sara Ebenreck for her steadfast focus on the soul in things and for being a delightful friend. My gratitude to Kim for his wisdom and example. And most of all, thanks from the bottom of my heart to Bud. His belief encouraged me to dream and his support has sustained my efforts. He truly is my anchor. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.