Staging pediatric residents' counseling behaviors for passive smoking within a health behavior framework

Academic Article


  • The Transtheoretical Model (TTM) of health behavior describes behavior change as a progression through five stages: precontemplation, contemplation, preparation, action, and maintenance. Staging behavioral readiness allows interventions to be more specific and more effective. Purpose: To stage pediatric residents' counseling behaviors for passive smoking (PS) and to determine whether their readiness to counsel improves during residency training, Methods: We surveyed 102 pediatric residents from three pediatric residency programs in Alabama and North Carolina. Items assessed counseling frequency in a matter compatible with TTM for four counseling behaviors: asking about household smokers (ASK), informing parents about PS effects on children (INFORM), advising smokers to smoke away from children (AWAY), and advising smokers to quit smoking (QUIT). Differences in staging were analyzed using Chi-square and Fisher's Exact tests. Results; The number of pediatric residents in action or maintenance stages (A/M) for each behavior: Behavior All residents First Year Residents Third Year Residents p ASK 95 (94%) 32 (89%) 33 (97%) NS INFORM 85 (84%) 26 (72%) 31 (91%) NS AWAY 86 (85%) 27 (75%) 32 (94%) .046 QUIT 68 (67%) 19 (53%) 24 (71%) NS The majority of residents report counseling behaviors consistent with A/M stages even though 80% report they never received training in counseling strategies. Though the number of residents in A/M stages increases between the first and third years, the difference was significant only for counseling smokers to smoke away from their children. Across behaviors, residents report highest rates for asking and lowest rates for counseling about smoking cessation. Staging did not differ significantly between UAB and non-UAB residency programs. Conclusions: Most pediatric residents report desirable levels of passive smoking counseling. Fewer residents counsel on cessation and this does not appear to improve during residency. Resident educational interventions in this area should thus focus on improving cessation counseling.
  • Published In

    Author List

  • Amaya MI; Steele RA; Kohler CL; Fargason CA; Nelson KG
  • Volume

  • 44
  • Issue

  • 1