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Smoking remains a significant health problem. Smoking interventions are important but selection of successful quitters can be difficult. To characterise smokers with emphasis on two constructs of the transtheoretical model, the stages of change and decisional balance. A random sample from adults aged 40 and over in Reykjavik, Iceland, and Uppsala, Sweden. Smokers were defined as being in the stage of pre-contemplation (not thinking of quitting within the next 6 months), contemplation (thinking of quitting within the next 6 months) or preparation (thinking of quitting within the next 30 days, having managed to quit for at least 24 h within the last 12 months). A total of 226 participants were smokers: 72 (32%) were in the pre-contemplation stage, 126 (56%) in the contemplation stage and 28 (12%) in the preparation stage. A younger age, higher body mass index (BMI) and higher educational level were significantly related to being in a more advanced stage. A significant association was observed between decisional balance and stages of change such that decreased importance of the positive aspects of smoking and increased importance of the negative aspects of smoking were independently associated with an increased readiness to quit. The motivated smoker is likely to be young and educated with an above average BMI. A smoker in the contemplation stage is likely to maintain the negative aspects of smoking at a high level. Decreasing the value of the pros of smoking may facilitate the shift towards the stage of preparation. Please cite this paper as: Fjalldal SB, Janson C, Benediktsdóttir B, Gudmundsson G, Burney P, Buist AS, Vollmer WM and Gíslason T. Smoking, stages of change and decisional balance in Iceland and Sweden. The Clinical Respiratory Journal 2011; 5: 76-83. [ABSTRACT FROM AUTHOR]