Smoking Decisional Balance Scales

Abstract

The Smoking Decisional Balance Scales (SDBS) are a psychological instrument designed to quantify an individual’s evaluation of the perceived costs and benefits associated with smoking behavior. Developed within the framework of the Transtheoretical Model (TTM), the scales measure the relative weights assigned to the Pros of Smoking (the perceived advantages or benefits) and the Cons of Smoking (the perceived disadvantages or costs). This assessment is crucial for determining an individual’s current stage of smoking cessation readiness, which is fundamental for tailoring effective intervention strategies based on their motivational state.

Keywords

Decisional Balance, Transtheoretical Model, TTM, Smoking, Tobacco Use, Smoking Cessation, Pros and Cons, Readiness to Change, Addiction.

Authors

Wayne F. Velicer, Carlo C. DiClemente, James O. Prochaska.

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Purpose

The primary purpose of the Smoking Decisional Balance Scales is to measure the psychological construct of Decisional Balance specifically related to tobacco use. This involves quantifying the subjective importance of maintaining the current behavior (smoking) versus committing to change (quitting). The scales provide a quantitative metric for understanding the cognitive dynamics underlying addictive behavior.

In the context of the Transtheoretical Model, the scales are utilized to track predictable shifts in the balance of pros and cons as an individual moves through the stages of change, from Precontemplation to Action. A notable finding is that a shift toward the dominance of the Cons over the Pros is highly indicative of increased motivation and readiness for smoking cessation.

Construct

The scale measures the construct of Decisional Balance, which is a core component of the Transtheoretical Model. This construct reflects the cognitive process whereby individuals weigh the perceived positive and negative consequences of maintaining or changing a problematic behavior. This weighing process is central to motivational theory.

The instrument is structurally divided into two primary, theoretically distinct subscales: the Pros of Smoking (reflecting the perceived benefits or gains) and the Cons of Smoking (reflecting the perceived costs or losses). The items within the Pros subscale capture instrumental and affective benefits (e.g., relaxation, pleasure, concentration), while the Cons subscale items assess perceived health risks, social disapproval, and self-esteem issues associated with continued smoking.

Validity

The Smoking Decisional Balance Scales demonstrate strong construct validity, as factor analyses confirm that the Pros and Cons subscales emerge as distinct, yet related, factors, thereby supporting the theoretical structure of Decisional Balance. The scales have been extensively tested and adapted across various populations, confirming that the items reliably group into the intended subscales.

Furthermore, the scales exhibit high predictive validity, consistently demonstrating expected patterns across the stages of change defined by the TTM. Specifically, studies show that the ratio of Cons to Pros systematically increases as individuals move from the Precontemplation stage (low readiness) to the Preparation and Action stages (high readiness), making the instrument a robust predictor of behavioral progression toward quitting.

Reliability

The reliability of the Smoking Decisional Balance Scales has been well-established in psychological literature. Both the long (20-item) and short (6-item) forms consistently exhibit high levels of internal consistency. Academic literature typically reports Cronbach’s alpha coefficients ranging robustly between 0.80 and 0.95 for both the Pros and Cons subscales across various study contexts, confirming that the items within each subscale measure a homogenous construct.

In addition to internal consistency, the stability of the instrument over time has been supported by test-retest reliability studies, confirming that the measurement of the perceived importance of smoking consequences is stable and consistent, assuming no significant changes in the participant’s stage of change occurred between testing periods.

Factor Analysis

Initial and subsequent factor analyses of the 20-item instrument consistently confirm a clear, robust two-factor structure corresponding precisely to the theoretical constructs of Pros (advantages) and Cons (disadvantages). These two factors are typically found to be either orthogonal or moderately inversely correlated, indicating that they measure independent dimensions of the decisional process.

The 6-item short form, developed for efficiency in large-scale studies or clinical practice, has been rigorously validated through confirmatory factor analysis (CFA). Research, such as that conducted by Ward, Velicer, and Rossi (2004), has verified that the abbreviated version maintains strong factorial invariance and structural integrity, ensuring its utility while reducing respondent burden.

Instrument

Test Type: Self-report questionnaire, Psychological assessment

Format: Likert-type scale (5-point rating scale)

Language Available: Primarily English (widely translated for use in international TTM research)

Population Group: Adult smokers, adolescents, clinical and non-clinical populations

Age Group: Typically 18 and older, though validated adaptations exist for specific adolescent groups

Population Details: Used extensively among individuals who currently smoke cigarettes, as well as those contemplating or actively engaged in cessation attempts.

Test Methodology: Respondents rate the importance of each consequence item (e.g., “Smoking cigarettes is pleasurable”) on a 5-point scale, typically anchored by 1 = Not important at all, and 5 = Extremely important. Scores are derived by summing the ratings for the Pros subscale and the Cons subscale separately.

Keywords

Addiction, Health Psychology, Behavior Change, Decisional Balance, TTM, Quitting, Motivation, Assessment Scales.

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Authors

Author ORCID Identifier: Specific ORCID identifiers for the original authors are typically found through institutional research profiles.

Affiliation Email addresses: Contact information is generally managed through the research laboratories associated with the TTM, such as the Cancer Prevention Research Center at the University of Rhode Island or the Habits Lab at UMBC.

Correspondence Address: Inquiries regarding scale use are often directed to the Habits Lab at UMBC or Dr. James O. Prochaska’s research group.

Permissions & Fee and Test Year

The foundational research and validation of the Decisional Balance measure for smoking status were published in 1985 (Velicer, DiClemente, and Prochaska). The instrument is considered a fundamental tool within the TTM methodology and is widely available for non-commercial academic research use, often without charge.

For large-scale applications, modifications, or commercial use, researchers should consult the primary authors or their affiliated institutions regarding formal permissions. The instrument and related TTM scales are available online via research sites such as: http://habitslab.umbc.edu/decisional-balance-scales/

Reference’s

• Velicer, W.F., DiClemente, C.C., and Prochaska, J.O. (1985). Decisional balance measure for assessing and predicting smoking status. Journal of Personality and Social Psychology, 48, 1279-1289.
• Prochaska, J.O., Velicer, W.F., DiClemente, C.C., & Fava, J. (1988). Measuring Processes of Change: Applications to the Cessation of Smoking. Journal of Consulting and Clinical Psychology, 56, 4, 520-528.
• Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Marcus, B.H., Rakowski, W., Fiore, C., Harlow, L.L., Redding, C.A., Rosenbloom, D., and Rossi, S.R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13, 39-46.
• Carey, K.B., Maisto, S.A., Carey, M.P., and Purnine, D.M. (2001). Measuring readiness to change substance misuse among psychiatric outpatients: Reliability and validity of self-report measures. Journal of Studies on Alcohol, 62, 79-88.
• Ward, R.M., Velicer, W.F., and Rossi, J.S. (2004). Factorial invariance and internal consistency for the decisional balance inventory – short form. Addictive Behaviors, 29, 953-958.
• Collins, Susan E., Carey, Kate B., and Otto, Jacqueline M. (2009). A New Decisional Balance Measure of Motivation to Change Among At-Risk College Drinkers. Psychol Addict Behav, 23(3): 464–471. doi: 10.1037/a0015841.

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Items of the Smoking Decisional Balance Scales

Long Form

How important is this to me?

1. Smoking cigarettes is pleasurable.
2. My smoking affects the health of others.
3. I like the image of a cigarette smoker.
4. Others close to me would suffer if I became ill from smoking.
5. I am relaxed and therefore more pleasant when smoking.
6. Because I continue to smoke‚ some people I know think I lack the ch‎aracter to quit.
7. If I try to stop smoking I’ll be irritable and a pain to be around.
8. Smoking cigarettes is hazardous to my health.
9. My family and friends like me better when I am happily smoking than when I am miserable trying to quit.
10. I’m embarrassed to have to smoke.
11. I like myself better when I smoke.
12. My cigarette smoking bothers other people.
13. Smoking helps me concentrate and do better work.
14. People think I’m foolish for ignoring the warnings about cigarette smoking.
15. Smoking cigarettes relieves tension.
16. People close to me disapprove of my smoking.
17. By continuing to smoke I feel I am making my own decisions.
18. I’m foolish to ignore the warnings about cigarettes.
19. After not smoking for a while a cigarette makes me feel great.
20. I would be more energetic right now if I didn’t smoke.

Short Form

Importance in making a decision about smoking: 1=Not important at all‚ 2=Slightly important‚ 3=Moderately important‚ 4=Very important‚ 5=Extremely important

How important is this to me?

1. Smoking cigarettes relieves tension.
2. I am embarrassed to have to smoke.
3. Smoking helps me concentrate and do better work.
4. My cigarette smoking bothers other people.
5. I am relaxed and therefore more pleasant when smoking.
6. People think I am foolish for ignoring the warnings about cigarette smoking.

Scoring Key:

20 Item Version

Pros of Smoking 1‚ 3‚ 5‚ 7‚ 9‚ 11‚ 13‚ 15‚ 17‚ 19

Cons of Smoking 2‚ 4‚ 6‚ 8‚ 10‚ 12‚ 14‚ 16‚ 18‚ 20

6 Item Version

Pros of Smoking 1‚ 3‚ 5

Cons of Smoking 2‚ 4‚ 6