Pathways to Change

Program Title Pathways to Change
Purpose Reports on a computer-base expert system intervention with the potential to increase successful smoking cessation. (2001)
Program Focus Smoking Cessation
Population Focus Current Smokers
Topic Tobacco Control
Age Adults (40-65 years), Older Adults (65+ years), Young Adults (19-39 years)
Gender Female, Male
Race/Ethnicity Asian, Black, not of Hispanic or Latino origin, Hispanic or Latino, White, not of Hispanic or Latino origin
Setting Home-based, Rural, Suburban, Urban/Inner City
Origination United States
Funded by NCI (Grant number(s): CA50087, CA27281)
User Reviews (Be the first to write a review for this program)
RTIPs Scores
This program has been rated by external peer reviewers. Learn more about RTIPs program review ratings.
Research Integrity
Intervention Impact
Dissemination Capability
(1.0 = low    5.0 = high)
RE-AIM Scores
Beginning in 2012, new programs are scored on RE-AIM criteria. This program was posted prior to the inclusion of RE-AIM scores and does not have these scores included. Click on the information icon next to "RE-AIM Scores" above to learn more about RE-AIM.

The Need

Previous research has predicted that an estimated 500 million people will die from tobacco use. Modest breakthroughs in developing interventions for smokers could prevent millions of premature deaths and billions of lost years of life.

Back to Top

The Program

The program involves a computer-based support system that delivers individually tailored reports to help adults quit smoking. Each report is divided into four sections: (1) a description of the person's stage of change, including their pros and cons for quitting; (2) feedback on their use of change processes, noting how subjects compared to successful self-changers and to their previous assessment; (3) a description of situations in which it is tempting to smoke, with feedback on how to enhance self-confidence; and (4) strategies for taking small steps to progress to the next stage.

Back to Top

Community Preventive Services Task Force Finding

Guide to Community Preventive Services This program is an example of internet-based cessation interventions (Tobacco Control) which has an insufficient evidence finding from the Community Preventive Services Task Force, as found in the Guide to Community Preventive Services. Insufficient evidence means the available studies do not provide sufficient evidence to determine if the intervention is or is not effective. This does not mean that the intervention does not work. It means that additional research is needed to determine whether the intervention is effective. To expand understanding of this intervention category consider communicating with members from NCI's Research to Reality (R2R) community of practice who may be able to help you with your research efforts. Following is a link to start an online discussion with the R2R community of practice, after completing registration on the R2R site:
Back to Top

Time Required

In the study, individualized, interactive computer reports were sent to participants at the start of the intervention, at month 3, and at month 6.

Back to Top

Intended Audience

Study participants included adult smokers in Rhode Island households, recruited through random digit dialing. The study sample was predominantly Caucasian though also included people of African American, Asian, Hispanic and other origins.

Back to Top

Suitable Settings

The program can be delivered by mail to the home.

Back to Top

Required Resources

The Pathways to Change manual and assessment instruments are required.

Back to Top

About the Study

The study tested a computer-based expert system intervention that has the potential to increase successful smoking cessation. The intervention is based on stages of change. Research on how people quit smoking on their own has identified five stages of change: pre-contemplation, contemplation, preparation, action, and maintenance.

Participants completed a brief phone survey and were randomly assigned to an Expert System Intervention (ES) or an Assessment Only Condition (AS). Those assigned to the ES condition were mailed a series of three computer reports at the start of treatment and at 3 and 6 months. At 3 and 6 months, ES subjects were mailed a progress questionnaire.

Intervention follow-up took place at 6, 12, 18, and 24 months after the intervention.

Results of the study indicate the following:

  • Smoking cessation rates were significantly higher for the ES condition at each time interval (2.3 at 6 months, 3.5 at 12 months, 5.1 at 18 months, and 5.9 at 24 months).
  • Similarly, results for having quit for 7 days, 30 days, and 6 months at the 6, 12, 18, and 24 month marks reveal a significant difference between the AS and ES groups.
  • For subjects in the contemplation and preparation stages at baseline, the ES group outperformed the AS group at each of the four follow-ups. For subjects originally in the pre-contemplation stage, however, the ES did not produce greater abstinence until the 24-month follow-up. This is the type of delayed action effect that can be expected from a stage-matched intervention.
Graph of study results
Back to Top


Publication(s) used as the main outcome study


Supplemental publication(s) used in the review


Back to Top

User Reviews (0 Reviews)

(Be the first to write a review for this program) Back to Top
Last Modified: 08/06/2013
  • View Notes

Use this area to take notes about how this program might work for you. Read More about RE-AIM.


Absolute number, proportion and representativeness of individuals who participate in the program.

(Max. 8 characters)

(Max. 8 characters)
(No max # of characters)
(No max # of characters)


Impact on important outcomes, including potential negative effects, quality of life and economic factors.

(No max # of characters)
(No max # of characters)
(No max # of characters)


Absolute number, proportion and representativeness of settings and intervention agents willing and able to initiate the program.

(No max # of characters)


At the setting level- refers to the fidelity to the various elements of an intervention's protocol, including consistency of delivery as intended and the time and cost of the intervention. At the individual level- refers to clients' use of the intervention strategies.

(No max # of characters)


Please note that RE-AIM stands for Reach, Effectiveness, Adoption, Implementation and Maintenance. However, since ?Maintenance? occurs after a program has been implemented, a notes section for this is not included as a part of this tool.