Thus, a person’s educational status may indicate not only their ability to understand treatment compound libraries materials (which should be at an appropriate reading level) but also their access to treatment, exposure to stressful events, and exposure to other tobacco smokers. Future research may reveal associations between education level and causal paths to relapse. At present, the WI-PREPARE merely informs clinicians of the risk posed by this variable. Although the present study supports the use of the WI-PREPARE for predicting relapse, some limitations and concerns need to be addressed with future research. First, this measure was designed to be short and easy to use in a clinical setting, but it was developed in the context of placebo-controlled, randomized clinical trials.

Therefore, the results need to be replicated in broader populations of smokers (i.e., other than those who volunteer for intensive experimental cessation treatments) because they may not generalize beyond smokers who are strongly motivated to quit. Second, although the predictive validity of this measure has been evaluated across three clinical trials that differed in ethnic composition of the samples, all three trials were from the same region of the country. Therefore, these findings need to be replicated in other areas, with additional populations, to support their external validity. Third, the WI-PREPARE was developed using secondary data analysis of clinical trial data, and the final seven WI-PREPARE items have never been administered together as a cohesive questionnaire.

The psychometric characteristics of the items might change when all items are presented together on a single form. Fourth, future research is needed to determine whether the WI-PREPARE can predict relapse in the context of different treatments, either different pharmacotherapies or different psychosocial interventions. Further, it is possible that other sorts of items (e.g., motivation) or broader assessment of certain constructs (e.g., self-efficacy) also might improve the predictive validity of the WI-PREPARE. In the present
Blacks suffer disproportionately from smoking-related diseases, including cancer, stroke, and heart disease (U.S. Department of Health and Human Services [USDHHS], 1998). Although the greater incidence and prevalence of smoking-related diseases in this population are well documented, few data are available concerning the short-term health consequences of smoking among Blacks.

Research with non-Black samples suggests numerous early health consequences of smoking, for example, respiratory tract symptoms, persistent coughing, shortness of breath, wheezing, reduced respiratory functioning, bronchial irritation (Amigo, Oayrzun, Bustos, & Rona, 2006; Arday et al., 1995; Jindal & Gupta, 2004), Batimastat and retinal deficiencies (Wills et al., 2008). Whether Black smokers, who tend to smoke at lower intensity levels, experience such consequences remains understudied.