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Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm assessing personal goals, self-efficacy, and smoking behavior. Logistic regression and event history analyses indicated group differences in return to smoking at 6 weeks and 3, 6, and 12 months postpartum. The percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage, that is, at 6 weeks 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had returned to smoking. Results lend support for the stages of change for postpartum smoking abstinence. Stage-based interventions may be developed to assist women in maintaining abstinence postpartum.

Research on the transtheoretical model has provided substantial support for both stages of change and processes of change (coping strategies influencing successful behavior change). This study examined whether timing of process use (using particular change processes during one stage and not during others) influences quit success. Hypothesized patterns of optimal process use were those marked by more use of experiential processes and less use of behavioral processes during contemplation and preparation and by the reverse pattern during action. Participants (N = 388) began in contemplation or preparation and took action during a 4-6 week period. Multivariate analyses of covariance examined the relationship between patterns of process use and success in staying quit both at 1-month follow-up and 5-6 months later. For the most part, results supported the hypothesis that successful stage transitions involve doing the right thing at the right time: engaging in experiential process activities during contemplation and preparation stages and shifting to behavioral process activities during action.

Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.