An Integrative Review of Adolescent Smoking Cessation Using the Transtheoretical Model of Change

Published:February 28, 2011DOI:



      The purpose of this literature review is to report the effectiveness of trials using the Transtheoretical Model of Change for achieving smoking cessation among adolescents.


      An integrative literature review was performed. Two reviewers searched the Internet for randomized, controlled trials or observational studies of adolescent smoking cessation trials reported between 1999 and June 2009 that used the Transtheoretical Model of Change.


      Six randomized controlled trials remained after all inclusion and exclusion criteria were met. Each study was reviewed qualitatively and odds ratio and quit rates were calculated. Four studies demonstrated an odds ratio of greater than 1.0, and in four studies significantly better quit rates were found in the intervention arm versus the control arm at the endpoint evaluation.


      Evidence exists for the effectiveness of stage-based interventions in promoting smoking cessation in adolescents.

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        • Adelman W.P.
        • Duggan A.K.
        • Hauptman P.
        • Joffe A.
        Effectiveness of a high school smoking cessation program.
        Pediatrics. 2001; 107: 1-8
        • Albrecht S.
        • Payne L.
        • Stone C.
        • Reynolds M.
        A preliminary study of the use of peer support in smoking cessation programs for pregnant adolescents.
        Journal of the American Academy of Nurse Practitioners. 1998; 10: 119-125
        • Bridle C.
        • Reimsma R.
        • Pattenden J.
        • Sowden A.
        • Mather L.
        • Watt L.
        • Walker A.
        Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model.
        Psychology and Health. 2005; 20: 283-301
      1. Centers for Disease Control and Prevention. (2008). ACIP provisional recommendations for use of pneumococcal vaccines. Retrieved from

      2. Centers for Disease Control and Prevention. (2009). Tobacco use: Targeting the nation’s leading killer. Retrieved from

        • Colby S.M.
        • Monti P.M.
        • O’Leary Tevyaw T.
        • Barnett N.P.
        • Spirito A.
        • Rohsenow D.J.
        • Lewander W.
        • et al.
        Brief motivational intervention for adolescent smokers in medical settings.
        Addictive Behaviors. 2005; 30: 865-874
        • Curry S.
        • Emery S.
        • Sporer A.
        • Mermelstein R.
        • Flay B.
        • Berbaum M.
        • Wells H.
        • et al.
        A national survey of tobacco cessation programs for youths.
        American Journal of Public Health. 2007; 97: 171-177
        • Curry S.
        • Mermelstein R.
        • Sporer A.
        Therapy for specific problems: Youth tobacco cessation.
        The Annual Review of Psychology. 2009; 60: 229-255
        • Fritz D.J.
        • Hardin S.B.
        • Gore P.A.
        • Bram D.
        A computerized smoking cessation intervention for high school smokers.
        Pediatric Nursing. 2008; 34: 13-17
        • Garrison M.
        • Christakis D.
        • Ebel B.
        • Wiehe S.
        • Rivara F.
        Smoking cessation interventions for adolescents: A systematic review.
        American Journal of Preventive Medicine. 2003; 25: 363-367
        • Grimshaw G.
        • Stanton A.
        Tobacco cessation interventions for young people.
        Cochrane Database of Systematic Reviews 4. 2009; (Article CD003289)
        • Guo B.
        • Aveyard P.
        • Fielding A.
        • Sutton S.
        The factor structure and factorial invariance for the decisional balance scale for adolescent smoking.
        International Journal of Behavioral Medicine. 2009; (Retrieved from)
        • Hollis J.F.
        • Polen M.R.
        • Whitlock E.P.
        • Lichtenstein E.
        • Mullooly J.P.
        • Velicer W.F.
        • Redding C.A.
        Teen reach: Outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.
        Pediatrics. 2005; 115: 981-989
        • Johnston L.
        • O’Malley P.
        • Bachman J.
        • Schulenberg J.
        More good news on teen smoking: Rates at or near record lows.
        University of Michigan News Service. 2008 December 11; (Retrieved from)
        • Kaufman N.
        • Yach D.
        Tobacco control: Challenges and prospects.
        Bulletin of the World Health Organization. 2000; 78: 867
        • Kleinjan M.
        • Brug J.
        • van den Eijnden R.
        • Vermulst A.
        • van Zundert R.
        • Engels R.
        Associations between the transtheoretical processes of change, nicotine dependence and adolescent smokers’ transition through the stages of change.
        Addiction. 2007; 103: 331-338
        • Kleinjan M.
        • Engels R.
        • van Leeuweb J.
        • Brug J.
        • van Zundert R.
        • van den Eijnden R.
        Mechanisms of adolescent smoking cessation: Roles of readiness to quit, nicotine dependence, and smoking of parents and peers.
        Drug and Alcohol Dependence. 2008; 99: 204-214
        • Kleinjan M.
        • van den Eijnden R.
        • Dijkstrab A.
        • Brug J.
        • Engels R.
        Excuses to continue smoking: The role of disengagement beliefs in smoking cessation.
        Addictive Behaviors. 2006; 31: 2223-2237
        • Kleinjan M.
        • van Zundert R.
        • Engels R.
        • van den Eijnden R.
        An integration of parents’ and best friends’ smoking, smoking-specific cognitions, and nicotine dependence in relation to readiness to quit smoking: A comparison between adolescents with and without asthma.
        Journal of Pediatric Psychology. 2008; 33: 821-832
        • Lipkus I.M.
        • McBride C.M.
        • Pollak K.I.
        • Schwartz-Bloom R.D.
        • Tilson E.
        A randomized trial comparing the effects of self-help materials and proactive telephone counseling on teen smoking cessation.
        Health Psychology. 2004; 23: 397-406
        • Marshall L.
        • Schooley M.
        • Ryan H.
        • Cox P.
        • Easton A.
        • Healton C.
        • Homsi G.
        • et al.
        Youth tobacco surveillance—United States, 2001-2002.
        CDC Surveillance Summary. 2006; 55: 1-56
        • McDonald P.
        • Colwell B.
        • Backinger C.
        • Husten C.
        • Maule C.
        Better practices for youth tobacco cessation: Evidence of review panel.
        American Journal of Health Behavior. 2003; 27: S144-S158
        • Prochaska J.
        • DiClemente C.
        • Norcross J.
        In search of how people change: Applications to addictive behaviors.
        American Psychologist. 1992; 47: 1102-1114
        • Robinson L.A.
        • Vander Weg M.W.
        • Riedel B.W.
        • Klesges R.C.
        • McLain-Allen B.
        “Start to stop”: results of a randomised controlled trial of a smoking cessation programme for teens.
        Tobacco Control. 2003; 12: Iv26-Iv33
        • Stevens S.
        • Pailler M.
        • Diamond G.
        • Levy S.
        • Latif S.
        • Kinsman S.
        Providers’ experiences caring for adolescents who smoke cigarettes.
        Health Psychology. 2009; 28: 66-72
        • Sussman S.
        Effects of sixty-six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting.
        Tobacco Induced Diseases. 2002; 1: 35-81
        • Sussman S.
        • Lichtman K.
        • Ritt A.
        • Pallonen U.
        Effects of thirty-four adolescent tobacco use cessation and prevention trials on regular users of tobacco products.
        Substance Use & Misuse. 1999; 34: 1469-1505
        • Sussman S.
        • Sun P.
        • Dent C.
        A Meta-analysis of teen cigarette smoking cessation.
        Health Psychology. 2006; 25: 549-557


      Lisa M. Robinson, FNP-C, MSN, CEN, Nurse Practitioner, ApolloMD, Woodstock, GA.


      Sara R. Vail, FNP-C, MSN, CEN, Nurse Practitioner, ApolloMD, Dallas, GA.