Readiness and Motivation to Quit Smoking Questionnaire (RMQ)

1. Abstract

The Readiness and Motivation to Quit Smoking Questionnaire (RMQ) is an 11-item psychometric measurement instrument designed to assess a smoker’s cognitive, behavioral, and motivational readiness to reduce or cease tobacco consumption. Developed originally by Kathleen S. Crittenden, Clara Manfredi, Loretta Lacey, Richard B. Warnecke, and Judy Parsons in 1994, the instrument was specifically engineered to address critical measurement challenges encountered when applying conventional cessation models to socioeconomically disadvantaged and minority populations, particularly low-income women attending public health clinics. The scale measures three correlated yet distinct latent dimensions: Change Smoking Behavior (items evaluating behavioral intentions, discrete quit attempts, and future temporal planning), Motivation to Cut Down and Quit (items capturing desire and psychological determination), and Confidence (measuring situational self-efficacy regarding reduction and total abstinence).

The RMQ utilizes an intentionally differentiated response format tailored to each item’s cognitive demand, including dichotomous choices (Yes/No), 4-point Likert-type intensity rating scales (e.g., ranging from Not at all to Very much), and categorical temporal planning milestones (ranging from 1 month to more than 6 months). Psychometric investigations across diverse cohorts have confirmed robust reliability coefficients, with subscale Cronbach’s alpha values typically ranging between 0.70 and 0.85, along with demonstrated stability across test-retest intervals. Exploratory and confirmatory factor analyses validate its multidimensional architecture, supporting both discrete dimensional profiling and algorithmic staging aligned with the Transtheoretical Model (TTM). Demonstrating high predictive validity for subsequent cessation attempts and strong convergent validity with measures of nicotine dependence and health locus of control, the RMQ remains an indispensable clinical assessment and empirical research tool in public health psychology, preventive medicine, and behavioral epidemiology.

2. Keywords

Readiness and Motivation to Quit Smoking Questionnaire, RMQ, Smoking Cessation, Transtheoretical Model, Stages of Change, Self-Efficacy, Tobacco Cessation, Health Disparities, Public Health Clinics, Psychometrics

3. Authors

The RMQ was formulated and psychometrically validated by an interdisciplinary team of researchers associated with the Health Research Center and the Survey Research Laboratory at the University of Illinois at Chicago:

• Kathleen S. Crittenden, Ph.D. — Professor Emerita, Department of Sociology, University of Illinois at Chicago, Chicago, Illinois, United States.
• Clara Manfredi, Ph.D. — Research Professor, Health Research Center, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States.
• Loretta Lacey, Dr.P.H., R.N., F.A.A.N. — Late Professor of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States.
• Richard B. Warnecke, Ph.D. — Professor Emeritus of Epidemiology and Biostatistics, Director of the Center for Health Promotion and Disease Prevention, University of Illinois at Chicago, Chicago, Illinois, United States.
• Judy Parsons, Ph.D. — Research Associate, Prevention Research Center, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States.
• Young Ik Cho, Ph.D. — Senior Research Methodologist and Biostatistician, Survey Research Laboratory, University of Illinois at Chicago, Chicago, Illinois, United States (collaborator on longitudinal structural modeling).

4. Purpose

The primary purpose of the Readiness and Motivation to Quit Smoking Questionnaire (RMQ) is to provide an empirically grounded, nuanced diagnostic evaluation of an individual’s readiness, internal motivation, and perceived self-efficacy to modify their smoking habits. When the RMQ was formulated in the mid-1990s, the predominant clinical paradigm for evaluating cessation readiness relied heavily on rudimentary algorithms derived from the Transtheoretical Model of health behavior change. These standard algorithms routinely categorized individuals into rigid, mutually exclusive stages—namely Precontemplation, Contemplation, and Preparation—using single-item or brief multi-item decision-tree sequences based primarily on arbitrary 30-day or 6-month timelines.

Crittenden and her colleagues recognized significant psychometric and conceptual limitations in applying these simplistic categorical algorithms to economically underserved populations. In public health clinics serving low-income, predominantly African American and Hispanic women, smoking behaviors and cessation trajectories are frequently characterized by severe environmental stressors, high rates of nicotine dependence, intermittent access to formal cessation resources, and non-linear patterns of harm reduction. Standard assessment tools frequently misclassified these individuals as unmotivated (Precontemplators) simply because they lacked immediate, concrete plans to quit within an arbitrary 30-day window, completely overlooking their genuine desire to reduce consumption or their incremental behavioral modifications.

The RMQ was specifically engineered to overcome these diagnostic deficiencies by decomposing the cessation readiness construct into continuous, granular behavioral and psychological components. Its clinical and research applications encompass:

• Harm Reduction and Incremental Progress Tracking: Measuring readiness to cut down consumption alongside readiness for total cessation, acknowledging that reduction is often an indispensable precursor to eventual abstinence among heavily dependent smokers.
• Precision Clinical Staging: Allowing clinicians in community health centers, primary care clinics, and specialized smoking cessation programs to tailor cognitive-behavioral, pharmacological, and motivational interviewing interventions directly to the patient’s specific readiness profile.
• Epidemiological and Health Disparity Research: Offering public health researchers a validated, reliable instrument that operates equitably across socio-demographic strata, eliminating educational and linguistic comprehension biases that often distort standard psychometric assessments.
• Intervention Evaluation: Serving as a sensitive outcome metric capable of detecting subtle psychological and motivational shifts resulting from public health media campaigns, clinic-based self-help manuals, or counselor-led cessation initiatives.

5. Psychological Construct

The Readiness and Motivation to Quit Smoking Questionnaire measures a multidimensional psychological construct that integrates cognitive appraisal, motivational intensity, self-efficacy beliefs, and intentional behavioral planning. Unlike unidimensional models that conceptualize readiness as a static threshold, the construct measured by the RMQ recognizes that quitting tobacco is an intricate, non-linear process involving distinct sub-constructs:

Change Smoking Behavior

This dimension encompasses concrete behavioral milestones, cognitive intentions, and structured temporal commitments related to both smoking reduction and total cessation. It comprises items 1, 5, 6, 9, and 10. Rather than viewing behavior purely as completed cessation, this component assesses whether the individual has initiated tangible cognitive restructuring (e.g., seriously considering cutting down or quitting) and empirical self-regulation attempts (such as making a deliberate attempt to stop smoking for at least 24 hours within the preceding year). Additionally, it quantifies intentional prospective planning by evaluating whether a concrete quit date has been scheduled within specific temporal horizons (ranging from 1 month to beyond 6 months). For example, an individual who has executed a 24-hour cessation attempt and formulated an explicit 1-month plan exhibits advanced behavioral change momentum compared to someone whose thoughts remain abstract and detached from temporal boundaries.

Motivation to Cut Down and Quit

The second dimension reflects the affective intensity and internal drive directed toward reducing tobacco intake and achieving complete abstinence. Comprising items 2, 4, 7, and 11, this subscale evaluates both the subjective “want” (desire) and the executive “determination” (resolve). Motivation is systematically stratified into two complementary objectives: motivation focused on cutting down cigarette consumption and motivation focused on quitting entirely. This dual focus captures the psychological reality of many smokers who feel overwhelmed by immediate total abstinence but possess powerful motivation to restrict daily smoking. Determination represents a volitional commitment that bridges the gap between passive contemplation and active behavioral execution, reflecting the strength of internal resolve when confronted with nicotine craving and psychological distress.

Confidence (Self-Efficacy)

The third core dimension, assessed by items 3 and 8, captures the construct of situation-specific perceived self-efficacy, deeply rooted in social cognitive theory. This dimension quantifies an individual’s subjective certainty regarding their capability to successfully execute behavioral reduction and total cessation if they choose to do so. Smoking cessation often fails not due to lack of desire, but because of perceived behavioral helplessness stemming from past relapse experiences or low self-regulatory confidence. The RMQ separates self-efficacy into reduction confidence (how sure the individual feels about being able to cut down) and cessation confidence (how sure they feel about quitting completely). This distinction reveals crucial diagnostic profiles: an individual may demonstrate high motivation to quit paired with critically low confidence, indicating an urgent clinical need for self-efficacy enhancement and coping-skills training rather than motivational education.

6. Theoretical Framework

The conceptual foundation of the RMQ is firmly anchored within two prominent theoretical models of behavioral science: the Transtheoretical Model (TTM) of Health Behavior Change pioneered by James O. Prochaska and Carlo DiClemente, and the Social Cognitive Theory developed by Albert Bandura.

Integration with the Transtheoretical Model

The Transtheoretical Model posits that health behavior modification is not an all-or-nothing, instantaneous event, but rather a progression through five discrete stages: Precontemplation (no intention to change within the next six months), Contemplation (awareness of the problem and intention to change within six months), Preparation (intending to take action within the next 30 days, accompanied by behavioral steps), Action (overt behavioral modification lasting up to six months), and Maintenance (sustained change exceeding six months). While traditional TTM operationalizations categorized individuals using rigid, single-item classification rules, Crittenden and colleagues (1994, 1998) argued that these categorical boundaries oversimplify the continuum of change.

The RMQ operationalizes the core tenets of the TTM by treating readiness as a continuous multidimensional space. By decomposing stage markers into distinct questions regarding intention, recent past attempts (such as a 24-hour deliberate quit attempt, a hallmark marker of the Preparation stage), and variable future planning intervals (1 month, 3 months, 6 months), the RMQ allows researchers to map participants onto stage classifications using empirically verifiable multi-item criteria. Furthermore, the questionnaire explicitly accounts for smoking reduction as an intermediate developmental milestone along the cessation trajectory, providing a bridge across the traditionally wide gulf separating Precontemplation from Contemplation.

Incorporation of Social Cognitive Theory

Bandura’s Social Cognitive Theory identifies perceived self-efficacy—the belief in one’s agency to organize and execute courses of action required to manage prospective situations—as the principal cognitive determinant of behavioral execution. In nicotine addiction, self-efficacy functions as a cognitive mediator between motivational intention and successful cessation maintenance. In designing the RMQ, Crittenden et al. directly incorporated self-efficacy as an essential, independent dimension (Confidence).

The interplay between determination (motivation) and confidence (self-efficacy) within the RMQ framework acknowledges that high motivation without corresponding self-efficacy typically generates anxiety, demoralization, and anticipatory failure. Conversely, high self-efficacy paired with low motivation results in clinical complacency. By measuring these constructs concurrently, the RMQ reflects the theoretical understanding that successful progression through the stages of change requires both an affective/volitional commitment to abandon tobacco use and a firm cognitive belief in one’s self-regulatory competence.

7. Validity

The psychometric validity of the RMQ has been extensively corroborated across diverse demographic samples, with particular emphasis on socioeconomically vulnerable populations, inner-city public health clinic attendees, and low-education cohorts.

Construct and Structural Validity

Construct validity was established through sequential exploratory and confirmatory factor analyses by Crittenden et al. (1994, 1998). Factor analytic procedures demonstrated that the 11 items load cleanly onto three coherent, theoretically consonant latent constructs: Change Smoking Behavior, Motivation to Cut Down, and Confidence. Structural equation modeling (SEM) conducted by Crittenden, Flay, and Warnecke (1998) demonstrated that treating readiness as a continuous multidimensional construct yielded vastly superior goodness-of-fit indices compared to traditional unidimensional or single-threshold classification models, confirming that behavioral planning, motivational drive, and self-efficacy represent interrelated but statistically distinct dimensions of readiness.

Convergent and Discriminant Validity

Convergent validity has been repeatedly substantiated by demonstrating robust statistical associations between RMQ subscale scores and established markers of tobacco addiction and health behavior. Specifically, the Motivation and Confidence subscales exhibit strong positive correlations (typically $r = .45$ to $.65$, $p < .001$) with validated self-efficacy inventories, such as the Smoking Self-Efficacy Questionnaire (SEQ-12), and negative correlations with the Fagerström Test for Nicotine Dependence (FTND). Individuals scoring higher on RMQ Change Smoking Behavior and Motivation consistently report lower average daily cigarette consumption and a longer interval between waking and their first cigarette.

Discriminant validity was established by evaluating RMQ scores against generalized, non-smoking psychological constructs such as general trait anxiety and broad internal-external health locus of control scales. While RMQ subscales correlated moderately with smoking-specific constructs, correlations with generalized personality traits remained minimal ($r < .18$), confirming that the RMQ specifically isolates smoking-related cognitive-behavioral processes rather than generic response styles or non-specific negative affectivity.

Predictive and Criterion Validity

Longitudinal predictive validity represents one of the RMQ’s most significant psychometric strengths. In longitudinal studies tracking low-income women who received public health clinic interventions (Crittenden et al., 1998; Warnecke et al., 2001), baseline scores on the RMQ significantly predicted subsequent quit attempts and biochemically verified 24-hour, 7-day, and 6-month point prevalence abstinence rates. Participants categorizing themselves within advanced behavioral planning tiers (items 9 and 10) who also exhibited high confidence (items 3 and 8) were more than four times as likely to achieve sustained cessation at follow-up compared to those scoring low on these RMQ dimensions (odds ratios ranging from $2.8$ to $4.6$, $p < .01$).

8. Reliability

The reliability of the Readiness and Motivation to Quit Smoking Questionnaire has been confirmed through repeated psychometric evaluations demonstrating strong internal consistency and temporal stability.

Internal Consistency

Internal consistency analyses across multiple clinical validation cohorts indicate robust reliability. In the foundational validation studies conducted by Crittenden et al. (1994, 1998), Cronbach’s alpha coefficients for the derived subscales exhibited satisfactory to high internal consistency:

• Motivation to Cut Down and Quit: Cronbach’s $\alpha$ consistently ranges between 0.78 and 0.85 across cohorts, reflecting high inter-item homogeneity among items capturing desire and determination.
• Confidence (Self-Efficacy): Despite comprising only two items (items 3 and 8), the Spearman-Brown corrected reliability coefficient and Pearson correlation between the items range between 0.74 and 0.81, indicating exceptional coherence between reduction confidence and cessation confidence.
• Change Smoking Behavior: Because this subscale incorporates both past behavioral history (item 5), current cognitive intentions (items 1 and 6), and categorical temporal planning (items 9 and 10), composite reliability for this scale generally ranges between 0.68 and 0.76, which meets established psychometric standards for complex behavioral indices.

Test-Retest Stability and Longitudinal Reliability

In a dedicated technical evaluation of psychometric stability conducted by Morera, Johnson, Freels, Parsons, Warnecke, Crittenden, and Flay (1998) through the University of Illinois Survey Research Laboratory, the temporal stability of the RMQ was modeled using structural equation modeling across repeated measurements. Over short test-retest intervals (2 to 4 weeks), stability coefficients for the latent Motivation and Confidence constructs were estimated at $r_{xx} = .82$ and $r_{xx} = .79$, respectively. These findings indicate that while the RMQ is adequately stable over short time horizons in the absence of active intervention, it remains sufficiently sensitive to capture real developmental changes across longitudinal clinical interventions.

9. Factor Analysis

Extensive factor analytic investigations confirm the three-factor structure of the 11-item RMQ, establishing its factorial validity and measurement invariance across demographic groups.

Exploratory Factor Analysis (EFA)

During early scale formulation, Crittenden et al. (1994) performed principal components and principal axis factoring with both orthogonal (Varimax) and oblique (Promax/Oblimin) rotations on sample data gathered from over 1,000 public health clinic patients. Scree plot analyses, eigenvalue criteria ($ ext{eigenvalues} > 1.0$), and parallel analysis conclusively converged on a three-factor solution that accounted for approximately 62% to 68% of the total item variance. The rotated factor patterns revealed distinct item clusters:

• Factor 1: Change Smoking Behavior — Marked by primary loadings from Item 1 (.64), Item 5 (.52), Item 6 (.78), Item 9 (.83), and Item 10 (.71).
• Factor 2: Motivation to Cut Down / Quit — Characterized by substantial primary loadings from Item 2 (.72), Item 4 (.81), Item 7 (.79), and Item 11 (.84).
• Factor 3: Confidence — Defined cleanly by Item 3 (.85) and Item 8 (.88), with negligible cross-loadings onto other factors.

Confirmatory Factor Analysis (CFA) and Model Fit

Subsequent confirmatory structural modeling by Crittenden, Flay, and Warnecke (1998) formally evaluated alternative factor architectures, comparing a single-factor unidimensional model, a two-factor model (collapsing Motivation and Behavior into a single domain), and the hypothesized three-factor correlated model. The three-factor model demonstrated superior fit to empirical data:

• Comparative Fit Index (CFI): .962 to .978 (well exceeding the standard .95 benchmark).
• Tucker-Lewis Index (TLI): .951 to .968.
• Root Mean Square Error of Approximation (RMSEA): .042 to .051 (90% CI [.034, .059]), denoting excellent model fit.
• Standardized Root Mean Square Residual (SRMR): .038.

Factor intercorrelations among the three latent dimensions were moderate to strong (ranging from $phi = .42$ to $.61$), supporting the conceptual premise that these dimensions represent interrelated components of an overarching cessation readiness process while maintaining distinct psychometric identities.

10. Instrument / Measurement Tool

• Instrument Name: Readiness and Motivation to Quit Smoking Questionnaire (RMQ)
• Authors: Kathleen S. Crittenden, Clara Manfredi, Loretta Lacey, Richard B. Warnecke, Judy Parsons, et al.
• Original Publication Year: 1994 (with expanded psychometric validations in 1998 and 2001)
• Construct Measured: Multidimensional readiness, motivation, and self-efficacy to reduce and quit cigarette smoking
• Target Population: Adult smokers across diverse settings, particularly validated among low-income, minority, and public health clinic populations
• Administration Format: Self-administered paper-and-pencil questionnaire, interviewer-administered survey, or interactive digital assessment
• Administration Time: Approximately 3 to 5 minutes
• Total Number of Items: 11 items
• Subscales & Item Composition:
  • Change smoking behavior: Items 1, 5, 6, 9, and 10
  • Motivation to cut down: Items 2, 4, 7, and 11
  • Confidence: Items 3 and 8
• Response Formats:
  • Dichotomous (Yes / No): Items 1, 5, 6, and 9 (Scored: No = 0, Yes = 1)
  • 4-point Intensity Scale (Not at all to Very much): Items 2 and 7 (Scored: 1 = Not at all, 2 = A little, 3 = Some, 4 = Very much)
  • 4-point Certainty Scale (Not at all sure to Very sure): Items 3 and 8 (Scored: 1 = Not at all sure, 2 = A little sure, 3 = Somewhat sure, 4 = Very sure)
  • 4-point Determination Scale (Not at all determined to Very determined): Items 4 and 11 (Scored: 1 = Not at all determined, 2 = A little determined, 3 = Somewhat determined, 4 = Very determined)
  • Categorical Temporal Horizon: Item 10 (Scored: 1 = More than 6 months, 2 = 6 months, 3 = 3 months, 4 = 1 month; or used categorically for TTM stage classification)
• Scoring and Interpretation Procedures:
  • Dimensional Subscale Scoring: Subscale scores can be computed by calculating the arithmetic mean or sum of standardized item scores within each factor (Change Smoking Behavior, Motivation, Confidence). Higher subscale scores denote greater behavioral intent, elevated motivational drive, and stronger perceived self-efficacy.
  • TTM Stage Categorization: Items 5, 6, 9, and 10 are frequently utilized in an algorithmic decision-tree to classify smokers into conventional Transtheoretical Model stages:
    • Precontemplation: Not seriously thinking about quitting (Item 6 = No) and no plan to quit within 6 months.
    • Contemplation: Seriously thinking about quitting (Item 6 = Yes) or planning to quit within 6 months (Item 10 = 6 months or 3 months), but without an immediate 30-day plan or past-year quit attempt.
    • Preparation: Planning to quit within 1 month (Item 10 = 1 month) and having made a deliberate quit attempt of at least 24 hours in the past year (Item 5 = Yes).

11. Permissions & Fee and Test Year

The Readiness and Motivation to Quit Smoking Questionnaire was formally developed in 1994 under the auspices of research grants funded by the National Institutes of Health (NIH) and the National Cancer Institute (NCI) conducted at the University of Illinois at Chicago. As an instrument developed through federally funded academic research and published in peer-reviewed scientific journals, the RMQ is placed in the public domain for non-commercial academic, clinical, and scientific research purposes.

No royalty fees, licensing charges, or commercial permissions are required for researchers or healthcare practitioners utilizing the 11-item questionnaire for non-profit clinical evaluation or empirical research. Researchers and clinicians employing the tool are expected to properly cite the foundational peer-reviewed publications (Crittenden et al., 1994, 1998). Commercial developers seeking to integrate the RMQ into proprietary diagnostic software or fee-for-service digital therapeutics should contact the original authors and institutional representatives at the University of Illinois at Chicago Office of Technology Management.

12. References

Crittenden, K. S., Flay, B. R., & Warnecke, R. B. (1998). The measure of stage of readiness to change: Some psychometric considerations. Psychological Assessment, 10(2), 182–186. https://doi.org/10.1037/1040-3590.10.2.182

Crittenden, K. S., Manfredi, C., Lacey, L., Warnecke, R. B., & Parsons, J. (1994). Measuring readiness and motivation to quit smoking among women in public health clinics. Addictive Behaviors, 19(5), 497–507. https://doi.org/10.1016/0306-4603(94)90005-1

Crittenden, K. S., Manfredi, C., Lacey, L., Warnecke, R. B., Parsons, J., & Cho, Y. I. (1998). Measuring readiness and motivation to quit smoking among women in public health clinics. Addictive Behaviors, 23(2), 191–199. https://doi.org/10.1016/S0306-4603(97)00037-4

Morera, O. F., Johnson, T. P., Freels, S., Parsons, J., Warnecke, R. B., Crittenden, K. S., & Flay, B. R. (1998). Estimating stability and reliability of stage of readiness to change in a self-help smoking intervention (Technical Report No. 98-1). Chicago: University of Illinois, Survey Research Laboratory.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390

Warnecke, R. B., Morera, O., Turner, L., Mermelstein, R., Johnson, T. P., Freels, S., Parsons, J., & Crittenden, K. S. (2001). Changes in self-efficacy and readiness for smoking cessation among women with high school or less education. Journal of Health and Social Behavior, 42(1), 97–110. https://doi.org/10.2307/3090229

13. Items of the Scale