Among earlier reports of robust results of TTM interventions in
various populations, Prochaska noted a ‘magnitude of abstinence’ of
22% to 26% of adult smokers at long-term follow-up.22 However,
adding more telephone counsellors or doubling the number of
TTM-tailored communications did not increase intervention
efficacy in these studies.22,23 A meta-analysis by Priest et al.24
reported evidence of relative success among several types of interventions
to reduce children’s exposure to environmental tobacco
smoke, including a school-based curriculum-based approach;
intensive home visiting programme for at-risk mothers with
education about preventive child health; smoking cessation
telephone counselling to mothers recruited through ‘well child’
clinics; brief educational information provided to parents of sick
children in a clinical setting; education provided by nurses to
mothers attending ‘well child’ visits; and health advice provided to
mothers of sick children. The author suggested that interventions for
smoking control could achieve more significant differences between
intervention and control group outcomes by using intensive counselling
rather than brief counselling by physicians; however, evidence
was lacking to support this among parents in child healthcare
settings.24 More study may be needed to investigate whether
stage-matching or ‘tailoring’ may reduce robust results.
Certain limitations may have affected some results of this study.
Firstly, because biochemical results (urine or saliva cotinine results)
were not included as outcome measures, the significance of results is
limited by the nature of self-report. Secondly, individuals may regress
to a lower stage of behaviour change when they encounter new
difficulties or barriers. Thus, long-term follow-up may be needed
to track the maintenance of passive smoking avoidance behaviour.
Conclusions
TTM is an applicable model for designing passive smoking
prevention programmes and is able to improve knowledge, experiential
and behavioural processes and self-efficacy among pregnant
women and women with young children. Results of this study
showed that our TTM-based programme was potentially effective
in passive smoking prevention among pregnant women and
women with young children and may encourage more women
with young children to make progress in avoiding passive smoking.
Acknowledgements
The authors thank all participating women. Their gratitude also goes
to the Academic Paper Edition Clinic, NTNU.
Funding
This work was supported by grants from the Bureau of Health
Promotion; the Department of Health (BHP-92-Anti-Tobacco-
2I06) for programme development; and the National Science
Council (NSC-94-2314-B-010-066) for main intervention.
Conflict of Interest: None declared.
Key points
A TTM-based intervention programme focused on stages of
change may improve the knowledge and self-efficacy about
prevention of passive smoking among the pregnant women
and women with young children.
A higher percentage of mothers with young children had
progressed in stages of change post-intervention compared
with pregnant women.
The study provided an intervention programme designed to
protect non-smoking women and children from the health
hazards of passive smoking