Stages of Change and Outcomes of Nicotine-Replacement Therapy in Chronic Schizophrenic Patients

ABSTRACT
Objectives. To examine the association between the stages of change and the outcomes of smoking-cessation along with reduction among schizophrenic patients receiving transdermal nicotine patches.
Methods. The authors were willing to attest the value of readiness to change smoking behaviors by using the concept of stages of change proposed by Prochaska et al. (1991). This study enrolled 150 chronic schizophrenic patients who were randomly assigned to different dose of NRT ( 20.8mg or 31.2mg). At baseline, participants were categorized into 3 stages: preparation, contemplation and precontemplation based on readiness to change smoking behaviors. Stages of change, smoking behaviors, scores of psychopathology and measures of smoking reduction were assessed at baseline and reassessed at 2-months post-baseline. Outcomes measures: daily cigarettes consumption more than 25% along with 50% after 8-week and 7-day point prevalence of abstinence. Logistic regression model was used to analyze the association between the stages of change and outcomes with adjustments for other confounding factors.
Results. Stages of change was predictive of 25% smoking-reduction outcomes. Contemplators were more likely to reduce 25% cigarettes amount than precontemplators (OR = 5.1, 95% CI = 1.7-15.6, p = 0.004); preparators were more likely to reduce 25% cigarettes amount than precontemplators (OR = 16.3, 95% CI = 2.7-100, p = 0.002). Contemplators were more likely to reduce 50% cigarettes amount than precontemplators (OR = 4, 95% CI = 1.03-15., p = 0.044); preparators were more likely to reduce 50% cigarettes amount than precontemplators (OR = 3, 95% CI = 0.4-22.6, p = 0.29).
Conclusions. Stages of change is a predictor of smoking-reduction outcomes among chronic schizophrenic patients with NRT. For precontemplators, boosting them with cognitive behavioral therapy and motivational enhancement to the stages of contemplation and preparation before and during NRT program is critical to maximize the smoking-reduction effects.
Key words: transtheoretical model (TTM), stages of change, smoking cessation, smoking reduction, schizophrenia, nicotine-replacement therapy (NRT)