The problems of relapse and recidivism have received increasing attention in smoking research over the past ten years. Researchers and clinicians alike have come to understand smoking as a complex process consisting of a number of stages. This paper reviews recent models and theories of the change process as well as those studies which have examined the determinants of the quitting process. Finally, the implications of these developments for smoking cessation strategies directed at the prevention of relapse are discussed.

General practice is a critical setting for the identification, assessment, treatment, follow-up and onward referral of smokers. General practitioners (GPs) are in a unique position to play a part in reducing preventable morbidity and mortality attributable to tobacco use. During the past decade, numerous trials have been conducted in general practice and have shown that GP intervention with smokers has a variable degree of success depending on the intensity of contact. Although there are many positive reasons for GP involvement, there are also barriers to implementing smoking cessation strategies in general practice. In this paper we discuss some of these issues. The Stages of Change framework developed by Prochaska and DiClemente (1986) has been used to describe the stages a smoker goes through in the process of becoming a non-smoker. However, the incorporation of smoking cessation interventions in a GP's routine practice also involves a process of psychological change. In this paper, therefore, we apply the Stages of Change model to GPs' recognition, uptake and maintenance of smoking cessation interventions.

Effective mass-reach smoking-cessation interventions are required in order to accelerate the decline in the prevalence of smoking in Australia and other industrialised countries. Such large-scale interventions still rely, to a major extent, on theoretical principles derived from research with clinical or other opportunistic samples. Schachter (1982) argues that this type of research provides information which is unrepresentative of smokers in the general population. We compared a population-probability sample with a sample of smokers enrolling in a smoking-cessation program offered by a community health centre. The health centre sample was composed of predominantly female, older smokers who had higher smoking rates, had made more previous attempts to stop smoking, and tended to attribute their last relapse to irritability. We discuss some potential implications for research relevant to population-wide smoking control strategies.

This paper evaluates the impact of a large scale campaign to encourage increased protection from solar ultra violet radiation (UVR). Broadly representative household surveys were conducted both before and after the campaign. The initial survey showed high levels of awareness of a skin protection message. The survey following the campaign showed large increases in awareness of the campaign slogan. There were high levels of reporting about taking extra precautions for sun protection and of encouraging other people, particularly children, to increase their sun protection. Within the limitations of the design, the results are interpreted as demonstrating an impact of the campaign. There is high community awareness of the need to take precautions against overexposure to solar UVR, coupled with high knowledge of appropriate behaviours and increased reporting of actually taking these precautions.

Fifty women with a history of breast lumps, and fifty control women matched for age and educational level, were administered a self-report questionnaire to determine knowledge of breast cancer, frequency and proficiency of breast self-examination (BSE), and health beliefs relating to BSE. Although women with previous breast lumps were more knowledgeable about breast cancer than those without, the two groups did not differ in attitudes or preventive behaviours. Overall knowledge of cancer and of BSE practice was low. This suggests a need for educational campaigns to increase knowledge and awareness, as a first step towards behaviour change, and a need for research to identify more effective predictors of BSE practice.

This study assessed the capacity of modelling videotapes to promote Pap smear screening. A total of 245 women watched videotapes modelling the process of Pap smear testing, and completed pre- and post-questionnaires which assessed knowledge and attitudes relating to Pap smears and cervical cancer. 186 also completed follow-up questionnaires five weeks later. Behavioural effects were strong. One third of those women identified as due for a Pap smear reported having had the test by follow-up. Initial levels of knowledge of Pap smears and of risk factors for cervical cancer were low, but increased significantly at post-test and follow-up. Health Belief Model variables, particularly perceived barriers, were associated with reported Pap smear behaviour, but a large proportion of the variance remained unexplained. The results suggest that modelling videotapes of this type, combined with appropriate encouragement and reassurance from medical practitioners, could significantly increase Pap smear rates and thus increase the detection and treatment of cervical cancer in its early stages.