A randomized comparison of Worksite-sponsored smoking cessation programs. A comprehensive worksite cancer prevention intervention: behavior change results from a randomized controlled trial (United States). Long-term smoking intervention at the worksite: effects of quit-smoking groups and an "enriched milieu" on smoking cessation in adult white-collar employees. The Working Healthy Project: a worksite health-promotion trial targeting physical activity, diet, and smoking. Tools for health: the efficacy of a tailored intervention targeted for construction laborers. Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial. Promoting smoking cessation at the workplace. Results of a randomized controlled intervention study. Long-term effectiveness of two Dutch work site smoking cessation programs. [Randomized controlled trial for smoking cessation among city office employees]. Maintaining abstinence from cigarette smoking: effectiveness of group counselling and factors predicting outcome. Effects of a tailored health promotion program for female blue-collar workers: health works for women. Hypnosis and behavioral treatment in a worksite smoking cessation program. Evaluation of a worksite-controlled smoking program. Payroll contracting for smoking cessation: a worksite pilot study. Programming social support for smoking modification: an extension and replication. The impact of increasing intensity of health promotion intervention on risk reduction. Work site-based cancer prevention: primary results from the Working Well Trial. The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study. Smoking cessation at the workplace. Results of a randomised controlled intervention study. Worksite physicians from the AIREL group. One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial. Computerized smoking cessation program for the worksite: treatment outcome and feasibility. Worksite wellness programs: incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization. Effectiveness of a low-intensity intra-worksite intervention on smoking cessation in Japanese employees: a three-year intervention trial. The Paris Cardiovascular Risk Factor Prevention Trial. Effects of two years of intervention in a population of young men. The effects of contingent payment and frequent workplace monitoring on smoking abstinence. The Belgian heart disease prevention project: changes in smoking habits after two years of intervention. Randomized controlled trial of relapse prevention and a standard behavioral intervention with adult smokers. A double blind study of 2 mg versus 4 mg nicotine-gum in an industrial setting. Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives. Randomized trial of brief individual treatment for smoking using nicotine chewing gum in a workplace setting. Results of a year-long incentives-based worksite smoking-cessation program. Effectiveness of smoking-cessation intervention in all of the smokers at a worksite in Japan. The SUCCESS project: the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. The effectiveness of a worksite self-help smoking cessation program: a randomized trial. Take heart: results from the initial phase of a work-site wellness program. Smoking intervention in the workplace using videotapes and nicotine chewing gum. A worksite smoking cessation intervention involving the media and incentives. Effects of physician counseling on the smoking behavior of asbestos-exposed workers. The effectiveness of an education program on stages of smoking behavior for workers at a factory in Turkey. [The effect of smoking cessation counseling at health checkup]. Co-worker social support in a worksite smoking control program. A comprehensive worksite smoking control, discouragement, and cessation program.
This worksite study assesses the relative effectiveness of three smoking cessation programs. Computerized medical files indicated that 29% of 13,171 employees were current smokers. Of smokers responding to a worksite-wide survey, 79% indicated interest in a smoking cessation program; 402 smokers agreed to participate and were randomly allocated, within their preference for a group or self-help approach, to the three different programs. Overall, 11% of smokers participated, an excellent rate for a large worksite. Participants were followed for 12 months (91% follow-up). Smokers in the group preference had better short-term results than did those following the self-help approach. The Multiple Component Program had 61% who quit, the Relapse Prevention Program had 37%, and the American Cancer Society Quitter's Guide had 12%. Long-term quit rates ranged from 16% to 26%; all groups exceeded the usual spontaneous quit rate of 5%. Workplace cancer prevention initiatives have been least successful with blue-collar workers. This study assess whether an intervention integrating health promotion with occupational health and safety results in significant and meaningful increases in smoking cessation and consumption of fruits and vegetables, compared to a standard health promotion intervention, for workers overall and for blue-collar workers in particular.
                A randomized controlled design was used, with 15 manufacturing worksites assigned to a health promotion (HP) or a health promotion plus occupational health and safety intervention (HP/OHS), and compared from baseline (1997) to final (1999). The response rates to the survey were 80% at baseline (n = 9019) and 65% at final (n = 7327). Both groups targeted smoking and diet; the HP/OHS condition additionally incorporated reduction of occupational exposures.
                Smoking quit rates among blue-collar workers in the HP/OHS condition more than doubled relative to those in the HP condition (OR = 2.13, p = 0.04), and were comparable to quit rates of white-collar workers. No statistically significant differences between groups were found for mean changes in fruits and vegetables.
                Integration of occupational health and safety and health promotion may be an essential means of enhancing the effectiveness of worksite tobacco control initiatives with blue-collar workers. Maximizing the potential of worksites for smoking intervention remains elusive. We hypothesized that long-term effectiveness of group intervention would be enhanced when offered within an "enriched milieu" (full program) compared with relative isolation (group only). The data failed to support the hypothesis. Although sustained abstinence rates were higher at full-program sites (50%) than at group-only sites (44%), the difference did not achieve statistical significance. Initial (35% vs. 47%) and 12-month (18% vs. 22%) quit rates at full-program and group-only sites also failed to demonstrate the "benefit" of the "enriched milieu." Worksites are a key channel for delivery of interventions designed to reduce chronic disease among adult populations. Although some evaluations of worksite physical-activity interventions have been conducted, to date very few randomized trials of worksite health promotion have included the goal of increasing physical-activity levels as part of a comprehensive multiple risk factor approach to worksite health promotion. This article presents the results regarding behavior change found among the cohort of 2055 individuals who completed three health-behavior assessments as part of their worksites' participation in The Working Healthy Project (WHP), a multiple risk factor intervention implemented in 26 manufacturing worksites. In this study, a randomized matched-pair design was used. Fifty-one percent (n = 2,761) of the employees who completed the baseline assessment also completed the interim survey. Eighty-three percent of those who completed the interim assessment also completed the final survey. The WHP intervention targeted smoking, nutrition, and physical activity. At baseline, 38% of the sample reported engaging in regular exercise, and subjects reported consuming an average of 2.7 servings of fruits and vegetables per day, 7.9 grams of fiber per 1000 kilocalories, and 35.4% calories from fat per day; 28% of the sample were smokers. By the time of both the interim (intervention midpoint) and final (end of intervention) assessments, participants in the intervention condition had significantly increased their exercise behavior, compared with the control condition. There was also increased consumption of fruits and vegetables and fiber in the intervention condition by the time of the final assessment, compared with the control condition. No differences by condition were found with regard to percentage of calories from fat consumed or smoking cessation. These results suggest that among a cohort of participants in a worksite health promotion study, there were significant health behavior changes across two risk factors over time. These data suggest that further investigation of multiple risk factor worksite health promotion is warranted, particularly with a focus on ways to increase participation in these programs and to diffuse intervention effects throughout the entire workforce. Novel approaches to worksite health promotion are needed for high-risk workers who change job sites frequently, and thus may have limited access to worksite health promotion efforts. The objective of this study was to test a behavioral intervention among construction laborers.
                Using a randomized-controlled design, we tested the efficacy of a tailored telephone-delivered and mailed intervention to promote smoking cessation and increased fruit and vegetable consumption (n = 582).
                At baseline, 40% of control group participants and 45% of intervention group participants reported using any tobacco in the last seven days. At final, 8% of baseline cigarette smokers in the control group had quit, compared to 19% in the intervention group (p = 0.03). In both groups, the mean consumption of fruits and vegetables at baseline was over five servings per day. At final, the intervention group had increased consumption by approximately one and one-half servings, compared to a slight decrease in consumption in the control group (p < 0.001).
                A tailored intervention can be efficacious in promoting tobacco use cessation and increased fruit and vegetable consumption among construction laborers, a high-risk, mobile workforce. Smoking is considered as an addiction to nicotine for most subjects consuming 10 cigarettes or more per day. Hence, nicotine replacement therapy by way of gum, patch, or spray has been advocated. The rationale of this study is to evaluate the possible beneficial effects of adding nicotine gum to the routine of subjects using the nicotine patch. The effect of the nicotine patch against the placebo, both groups receiving placebo nicotine gum, has also been assessed.
                Healthy subjects (374) were randomized at their work-setting in a 1-year double-blind placebo-controlled trial: 149 subjects to active nicotine patch + active gum (group 1), 150 to active nicotine patch + placebo gum (group 2), and 75 to placebo patch + gum (group 3). Treatment duration was 12 weeks with a 16-hr transdermal patch of 15 mg, followed by a 6 + 6-weeks weaning period on respectively 10 and 5 mg patches. Gum use was not restricted during the first 6 months, with recommendations to use at least four pieces a day. A strict definition of smoking abstinence was used in this study, which did not allow smoking any cigarette after Week 1. Nonsmoking status at each visit, as reported by the subjects, was verified by CO below 10 ppm in expired air.
                Abstinence rates in group 1 against group 2 were 34.2 and 22.7% (P = 0.027) at 12 weeks, 27.5 and 15.3% (P = 0.010) at 24 weeks, and 18.1 and 12.7% (P = 0.191) at 52 weeks. In group 3, abstinence rates were 17.3, 14.7, and 13.3% respectively at 12, 24, and 52 weeks. Using logistic regression with adjustment for six baseline covariates, odds ratios for abstinence (with 95% CI) were computed. For group 1/group 2, OR at 12, 24, and 52 weeks were 1.72 (1.03-2.94) (P = 0.039), 2.04 (1.14-3.57) (P = 0.018), and 1.47 (0.76-2.76) (P = 0.125). No significant differences in OR were observed when comparing groups 2 and 3. Time to relapse is significantly longer in group 1 as compared to that of group 2 (P = 0.041), whereas no significant differences between groups 2 and 3 were observed. No significant differences between the three groups in systemic and local adverse drug events were observed.
                Adding active gum use to active patch use in subjects smoking 10 cigarettes or more a day increased abstinence rates, which are statistically significant up to 24 weeks. This paper presents results from a preliminary short-term work-site intervention study aimed at smoking cessation. The 3-month intervention included consultation for employers on the adoption of a nonsmoking policy, training for nonsmokers to provide assistance to smokers attempting to quit, and cessation classes for smokers. Eight work sites from Bloomington, Minnesota were recruited to the study and randomly assigned to an intervention or comparison condition after a baseline survey of all employees. To assess the effect of the intervention, smokers were surveyed 1 and 6 months after the intervention was completed. At the 1-month follow-up, the overall quit rate in the intervention group was 12% compared to 5% in the control group (P < .05). At the 6-month follow-up, 12% of smokers in the intervention group reported quitting, compared to 9% in the control group (P < .05). Co-worker support for quitting was higher in the intervention group compared to the comparison group. Cessation was highest overall among smokers whose co-workers frequently asked them not to smoke and among those who worked with a high proportion of nonsmokers. These results indicate that a short-term, multifaceted smoking cessation program implemented in work sites can affect smoking cessation rates as well as the work-site norms about smoking. This article reports on one of the few experimental studies in Europe to examine work site smoking cessation. The study examined whether a comprehensive intervention (self-help manuals, group courses, a mass media campaign, smoking policies, and a second-year program) is more effective than a minimal intervention (self-help manuals only). Eight work sites participated in the study. The effect of treatment on smoking cessation depended on nicotine dependency levels: Heavy smokers had more success with the comprehensive smoking cessation intervention than with the minimal intervention (with respect to both 14-month quit rate and 6-month prolonged abstinence). For heavy smokers, exposure to mass media exhibitions or to group courses had a beneficial effect on prolonged abstinence. Comprehensive programs may be most appropriate in Dutch work sites with large proportions of heavily addicted smokers. To evaluate the effect of a smoking cessation program by health professionals, a randomized intervention study was carried out in the Omihachiman city office in 1993. Participants (n = 53), volunteers from current smokers in the city office, were randomly divided into intervention and control groups. The intervention group received intensive education for five months (i.e., the effect of smoking on health, the beneficial aspects of quitting smoking, how to stop smoking and how to deal with the withdrawal symptoms). Group lectures (two times) and individual counseling (three times) were used for health education. After five months, the control group was also given the same advice on smoking cessation. Comparison of smoking cessation rates between the two groups was performed at the end of the intervention period. Follow-up of all participants occurred at six and 12 months post intervention. After the five months of intervention, smoking cessation rate in the intervention group (19.2%) tended to be higher than that in the control group (7.4%), but was not significant (chi 2 = 1.62). Over all smoking cessation rates of all participants (n = 53) at the end of the 10 month intervention was 32.1% and at six months and 1 year after the end of the 10 month intervention were 24.5% and 13.2%, respectively. Comparison of participants who successfully stopped smoking and those who did not, it was revealed that younger age, lower expired air CO concentration (p < 0.01), and attitude for smoking cessation at the beginning were significantly related to smoking cessation. In our study, after five months, smoking cessation rate in the intervention group was about two times that of the control group, although the effectiveness of our smoking cessation program could not be validated due to small sample size. Taking into account the rate of smoking cessation after one year, We believe that programs by health professionals are effective for smoking cessation. The aim of the study was to assess the effectiveness of worksite group counselling interventions designed to prevent smoking relapse after abstinence has been achieved following 3 months therapy using group support and/or transdermal nicotine replacement therapy. After 3 months, abstinent subjects were randomly allocated either to a counselling group led by professional psychologists (PG), to a counselling group led by former smokers (SG) or to no intervention group (NG). The 3 and 12 months abstinence were defined, respectively, as a sustained smoking cessation during the last month, and the last 9 months. Complete abstinence was confirmed by expired carbon monoxide and by urine cotinine concentrations. The abstinence rate at 3 months was 35.1%. After 12 months abstinence rates were not statistically different in the PG, the SG and the NG (respectively 57.8, 53.4 and 49.6% of those randomised). In multivariate analyzes, baseline variables associated with 12 months abstinence were non-smoking family, gender (male), lower daily intake of nicotine and better psychological adjustment. Mean weight gain at 3 months in abstinent versus relapsed subjects, was respectively, 4.1 and 2.4 kg. Baseline variables associated with weight gain at 3 months were higher Fagerström score, gender (male) and professional status (blue collar worker). Group support after abstinence has been achieved did not significantly improve the abstinence. This study shows the difficulty of preventing smoking relapse with monthly group counselling. The results indicate the need to investigate further specific programmes focusing on factors such as gender, family, nicotine dependence, psychological and weight concerns/issues which may precipitate relapse. This study assessed the effects of the Health Works for Women (HWW) intervention on improving multiple behaviors including nutrition and physical activity among rural female blue-collar employees in North Carolina.
                Nine small to mid-size workplaces were randomly assigned to either intervention or delayed intervention conditions. After a baseline survey, an intervention consisting of two computer-tailored magazines and a natural helpers program was conducted over 18 months. Delayed worksites received one tailored magazine. Approximately 77 and 76% of baseline respondents completed follow-up surveys at 6 and 18 months, respectively, and 538 women (63%) completed all three surveys.
                At the 18-month follow-up, the intervention group had increased fruit and vegetable consumption by 0.7 daily servings compared to no change in the delayed group (P < 0.05). Significant differences in fat intake were observed at 6 months (P < 0.05) but not at 18 months. The intervention group also demonstrated improvements in strengthening and flexibility exercise compared to the delayed group. The rates of smoking cessation and cancer screening did not differ between study groups.
                The HWW project was a successful model for achieving certain health behavior changes among blue-collar women.
                (C)2002 American Health Foundation and Elsevier Science (USA). In the initial study, 48 subjects of the total (N = 63) ultimately used, were assigned to one of three treatments: four hypnotic sessions with a booster, two hypnotic sessions, or two hypnotic and two behavioral sessions with a booster. A follow-up group was later recruited composed of 15 subjects who received four hypnotic sessions and a booster session with less time between sessions. The results indicated no difference in smoking cessation 6 months after treatment regardless of the frequency, length between sessions, or addition of behavioral methods. Successful subjects were more educated, less able to utilize their imagination, and had fewer smokers at home. nan Twenty-one men and 38 women participated in a worksite smoking cessation/smoking reduction program that combined financial contracts, organized through payroll deduction, and biweekly group treatment sessions. At the end of the program the smoking cessation rate was 51%, validated by expired air carbon monoxide. Six months later the validated cessation rate was 12%. We conclude that payroll incentives may be effective in helping workers quit smoking and offer suggestions for ways to promote better maintenance of this important behavior change. In an extension and replication of previous work on social support in worksite smoking programs, 29 employees were assigned to either a basic smoking control program or to a basic treatment plus significant other support condition. Within a multiple baseline across behaviors design, all subjects received a 6 week treatment program that focused on achieving sequential reductions in nicotine content of brand smoked, number of cigarettes smoked per day, and percent of the cigarette smoked. Both treatment conditions were equally successful in producing abstinence (verified by biochemical analyses) and in producing reductions in smoking behavior among nonabstinent subjects at both posttest and 6-month follow-up assessments. In contrast to previous research with this program, there was considerable relapse in both conditions by follow-up. Consistent with previous findings, supportive social interactions were not related to treatment outcome, but the level of negative (nonsupportive) social interactions was inversely correlated with treatment success. Implications of these findings and directions for future research are discussed. The HealthWise Stepped Intervention Study (1988-1990) at Pacific Gas and Electric was conducted to evaluate how a health promotion program affects behavior change and whether increasing levels of preventive interventions improve health status. The basic intervention components consisted of health risk assessment and health newsletter (Levels 1, 2, 3, and 4). Additional interventions were health resource center and self-care books (Levels 2, 3, and 4), behavioral change workshops and Division Healthwise team (Levels 3 and 4), and case management and environmental policy (Level 4). The study employed a quasi-experimental design with nonequivalent control groups. The overall risk status has significantly improved at all four intervention levels. The comparison across the four intervention levels found that Level 4, combining environmental policy with "high risk" targeting, showed the most impressive performance. Participants in Level 4 consistently showed significantly greater improvement in life-style factors, and their overall risk status also showed the greatest improvement. This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date.
                The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28,000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work-site environment.
                There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant.
                Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors. This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking.
                A randomized, controlled intervention study used the work site as the unit of intervention and analysis; it included 24 predominantly manufacturing work sites in Massachusetts (250-2500 workers per site). Behaviors were assessed in self-administered surveys (n = 2386; completion rates = 61% at baseline, 62% at final). Three key intervention elements targeted health behavior change: (1) joint worker-management participation in program planning and implementation, (2) consultation with management on work-site environmental changes, and (3) health education programs.
                Significant differences between intervention and control work sites included reductions in the percentage of calories consumed as fat (2.3% vs 1.5% kcal) and increases in servings of fruit and vegetables (10% vs 4% increase). The intervention had a significant effect on fiber consumption among skilled and unskilled laborers. No significant effects were observed for smoking cessation.
                Although the size of the effects of this intervention are modest, on a populationwide basis effects of this size could have a large impact on cancer-related and coronary heart disease end points. To compare the effects of a worksite intervention by the occupational physician offering simple advice of smoking cessation with a more active strategy of advice including a "quit date" and extra support.
                Employees of an electrical and gas company seen at the annual visit by their occupational physicians. CRITERIA END POINTS: Smoking point prevalence defined as the percentage of smokers who were non-smokers at one year. Secondary criteria were the percentage of smokers who stopped smoking for more than six months and the difference in prevalence of smoking in both groups.
                Randomised controlled trial. The unit of randomisation was the work site physician and a random sample of the employees of whom he or she was in charge. The length of the follow up was one year. Each of 30 work site physicians included in the study 100 to 150 employees.
                Among 504 subjects classified as smokers at baseline receiving simple advice (group A) and 591 the more active programme (group B), 68 (13.5%) in group A and 109 (18. 4%) were non-smokers one year later (p=0.03; p=0.01 taking the occupational physician as the statistical unit and using a non-parametric test). Twenty three subjects (4.6%) in group A and 36 (6.1%) in group B (p=0.26) declared abstinence of six months or more. Among non-smokers at baseline, 3.4% in both groups were smokers after one year follow up. The prevalence of smokers did not differ significantly at baseline (32.9% and 32.4%, p=0.75). After the intervention the prevalence of smoking was 30.8% in group A and 28. 7% in group B (p=0.19). An increase of the mean symptoms score for depression in those who quit was observed during this period.
                A simple cessation intervention strategy during a mandatory annual examination, targeting a population of smokers independently of their motivation to stop smoking or their health status, showed a 36% relative increase of the proportion of smokers who quit smoking as compared with what can be achieved through simple advice. To assess the effectiveness of a smoking cessation intervention at the workplace. The intervention was adapted to smokers' tobacco dependence, and included minimal structured counselling at the first visit (5-8 minutes), nicotine patches for three months, and three sessions of counselling for reinforcement of abstinence (2-3 minutes) over a three month period.
                Open randomised trial with two groups: the intervention group, and the control group which was subjected to standard clinical practice, consisting of short (30 seconds to one minute) sporadic sessions of unstructured medical antismoking advice. The trial was carried out among 217 smokers of both sexes, aged 20-63 years, motivated to quit smoking and without contraindications for nicotine patches, who were employees at a public transport company and at two worksites of an electric company. The main outcome measure was self reported tobacco abstinence confirmed by carbon monoxide in expired air </=10 ppm. Analysis was performed according to intention-to-treat.
                The rate of continuous abstinence at 12 months was 20.2% for the intervention versus 8.7% for the control group (OR: 2.58; 95% CI: 1.13 to 5.90; p = 0.025). In subgroup analyses, effectiveness of the intervention did not vary substantially with age, tobacco dependence, number of cigarettes smoked per day, number of years of tobacco consumption, degree of desire to quit smoking, time spent with smokers, subjective health, and presence of tobacco related symptoms. Weight gain at 12 months was similar for both groups (1.69 kg in the intervention v 2.01 kg in the control group; p = 0.21).
                A simple and easily generalisable intervention at the workplace is effective to achieve long term smoking cessation. In a setting similar to ours, nine subjects would have to be treated for three months for one to achieve continuous abstinence for 12 months. This study demonstrated the effectiveness of a computer-delivered smoking cessation program for the worksite. 58 VA Medical Center employees were randomly assigned to a computer group (computerized nicotine fading and stop-smoking contest) or a contest-only group. In comparison with the contest-only group, the computer group had nonsignificantly higher abstinence rates across follow-up, had marginally lower CO levels at the 3- and 6-month follow-ups, and smoked cigarettes with lower nicotine levels at the 10-day and 6-month follow-ups. Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking.
                Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years.
                Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and those who participated showed significantly better maintenance of improvements where follow-up was provided.
                The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements. To test the effectiveness of a low-intensity intervention program for smoking cessation targeting the worksite environment in employees who had a low readiness to quit, we conducted an intervention trial at six intervention and six control worksites in Japan. A total of 2,307 smokers at baseline who remained at their worksite throughout the three-year study period were analyzed (1,017 in intervention and 1,290 in control groups). The multi-component program at the worksites consisted of (1) presenting information on the harms of tobacco smoking and the benefits of cessation by posters, websites, and newsletters; (2) smoking cessation campaigns for smokers; (3) advice on designation of smoking areas; and (4) periodic site-visits of the designated smoking areas by an expert researcher. At baseline, the intervention and control groups each had high prevalence of immotive or precontemplation, that reflected low readiness to quit (71.5% and 73.2%, respectively). The smoking cessation rate, as not having smoked for the preceding six months or longer, assessed at 36 months after the baseline survey by a self-administered questionnaire was significantly higher in the intervention group than the control group (12.1%, vs. 9.4%, p=0.021). The intervention program still had a significant effect on the smoking cessation rate after multiple logistic regression analysis adjusted for sex, age, type of occupation, age of starting smoking, quit attempts in the past, number of cigarettes per day, and readiness to quit (odds ratio: 1.38, 95% confidence interval: 1.05-1.81, p=0.02). The cost per additional quitter due to the intervention was calculated to be Yen 70,080. These findings indicate that this program is effective and can be implemented in similar workplaces where the prevalence of smoking is high and smokers' readiness to cease smoking is low. The Paris Cardiovascular Risk Factor Prevention Trial was designed to determine whether individualised intervention could induce a reduction in the coronary risk factor levels in young men. Three thousand three hundred and thirty-six men aged 25 to 35, working in the 160 sections of a large Parisian administration, were examined. The section were randomly allocated to a control and an intervention group. Advice concerning diet, cigarette smoking, and physical activity was provided repeatedly to the subjects in the intervention group. Two years after the first intervention, the first 1292 subjects who entered the study, whether from the intervention or the control group, were recalled; 86% of the intervention group and 84% of the control group responded. The changes in weight, blood pressure, and cigarette smoking in the intervention group, corrected for changes in the control group, were respectively -0.4 kg (p = 0.06), -1.4 mm Hg (p less than 0.05), and -1.2 cigarettes (p less than 0.01). There was no difference between the two groups in serum cholesterol change. Most of these results concerning young men are in agreement with recently reported results of community intervention programmes in middle-aged men. This study examined the relative contribution of contingent payment and worksite CO monitoring to the long-term maintenance of smoking abstinence. Forty-seven hospital employees who had abstained from smoking for five days (confirmed by CO analysis) were randomly assigned to one of three follow-up groups: (a) contingent payment/frequent monitoring (n = 17); (b) noncontingent payment/frequent monitoring (n = 16); or (c) non-contingent payment/infrequent monitoring (n = 14). Contingent payment combined with frequent CO monitoring delayed but did not ultimately prevent subjects relapse to smoking by the end of the six month follow-up. Contingent subjects maintained CO values less than or equal to 11 ppm significantly longer than did either the Non-contingent or the Control subjects (p = .03). CO monitoring alone had no effect on abstinence outcomes; both Noncontingent and Control subjects showed high rates of early relapse. nan A previously evaluated behavioral intervention (SB) was modified to focus on relapse prevention (RP) in order to improve adult smokers' ability to cope with high-risk situations and maintain abstinence. Treatment-seeking smokers (N=79) working at four mid-sized businesses attended either an SB (n=38) or an RP intervention (n=41). Both interventions consisted of 6 and 90-min sessions over 8 weeks and included nicotine replacement therapy. Immediately following the interventions, 42.1% of the SB group and 41.5% of the RP group were abstinent (p=.95). The one-year point-prevalence abstinence rates were 28.9% in the SB group and 17.1% in the RP group (p=.21). As there were no significant group differences on abstinence at follow-up, the RP intervention was not found to be more efficacious than a standard behavioral intervention among treatment-seeking adult smokers. Motivation, on the other hand, was a significant predictor of short- and long-term abstinence. In a double blind randomised trial to aid smoking cessation a 2 mg nicotine gum (n = 101) was compared with a 4 mg gum (n = 98), in smokers of at least 15 cigarettes/day. The trial involved blue and white collar workers and took place at their working place (industrial setting). Intervention during the one year follow-up period was minimal. At 3 months 36.2% of the 2 mg nicotine gum group reported to have stopped smoking, against 44.8% in the 4 mg group (non-significant difference). At one year in the 2 and 4 mg groups respectively 22.3 and 32.2% reported smoking abstinence (non significant difference). However in a sub-group with a higher nicotine-dependence score, only 18.5% were abstainers at one year in the 2 mg nicotine gum group against 32.9% in the 4 mg nicotine gum, which is a significant difference at the p = 0.05 level. This is however a post-hoc finding and should be taken with caution. This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies.
                Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months.
                Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels.
                Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact. In a controlled trial of brief treatment for smoking using nicotine chewing gum in a workplace setting, 270 of 334 cigarette smokers who expressed interest were invited to take part in the program, which consisted of two individual consultations; 172 attended. The remaining 64 smokers constituted a no-intervention control group. Using a criterion of sustained one-year abstinence with biochemical validation, success rates were 12 per cent among participants, 1 per cent among those who were invited but did not attend, and 2 per cent in the control group. This study evaluated the impact of a year-long incentives-based worksite smoking-cessation program. Nineteen moderate-sized worksites, employing a total of approximately 1100 smokers, were randomized to Incentive or No Incentive conditions. All identified smokers in the worksite were considered as subjects, whether or not they participated in the intervention. Analyses were conducted at both the worksite and individual level, and using both self-reported and biochemically validated cessation as endpoints. The incentive program did not significantly improve cessation rates at either the 1-year or 2-year follow-up assessments. We conclude that more broadly focused interventions that also address worksite smoking policies, skills training, and cessation resources, or programs that target additional risk factors are needed to substantially enhance quit rates. In Japan, the prevalence of smoking among males and females was 56.1% and 14.2%, respectively, in 1997. Male smoking prevalence was exceedingly high as compared to those in other industrialized countries. We conducted a randomized controlled intervention study on smoking cessation for all smokers in a worksite regardless of their willingness to quit smoking. All of the male smokers in a radiator manufacturing factory (n=263) were randomly allocated to an intervention group (n=132) or a control group (n=131). Subjects in the intervention group received individual counseling by a doctor, and those who signed a Smoking Cessation Declaration underwent a five-month intervention. Subjects in the control group received equivalent delayed intervention for four months. The cessation rate after the original intervention was 12.9% (17/132) and 3.1% (4/131) in the intervention and control groups, respectively (p=0.003). Among those who once succeeded in quitting, 48.6% (18/37) maintained cessation at the long-term survey. Overall, the cessation rate was 8.4% (22/263) and the prevalence of smoking among males significantly decreased from 62.9 to 56.7% (p=0.038). As a conclusion, intervention in all smokers at a worksite regardless of their willingness to quit is effective and impacts the overall smoking rate. This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs.
                Twenty-four worksites were randomized to 6 conditions that differed in cessation program format and the use of incentives. Programs were offered for 18 months in each worksite. A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation.
                A total of 407 (16.9%) of the smoker cohort registered for programs; on the 12- and 24-month surveys, 15.4% and 19.4% of the cohort, respectively, reported that they had not smoked in the previous 7 days. Registration for programs in incentive sites was almost double that of no-incentive sites (22.4% vs 11.9%), but increased registration did not translate into significantly greater cessation rates. Program type did not affect registration or cessation rates.
                Although incentives increase rates of registration in worksite smoking cessation programs, they do not appear to increase cessation rates. Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites. A 2 x 2 randomized, factorial pretest/posttest group design was used to evaluate the effectiveness of self-help smoking cessation methods at the worksite. The study investigated the effect of a multicomponent health education and skill intervention versus the effect of a monetary incentive to the employee for quitting. All employees received, in addition, a standardized self-help smoking cessation manual and maintenance manual. Following agreement to participate and a baseline smoking history, all participants were followed for 6 weeks, 6 months, and 12 months. Saliva was obtained for thiocyanate (SCN) analysis of smoking status. Of the estimated 2000 smokers at the site, 387 smokers were recruited. Employees were randomly assigned to one of four groups. Results of this random trial indicate that those employees receiving a multicomponent program were most successful in quitting and remaining abstinent. The monetary incentive appears to have no effect on quit rate. The purpose of this study was to evaluate the short-term effects of a low-intensity work-site heart disease risk reduction program using a matched pair design with work site as the unit of analysis.
                Twenty-six heterogeneous work sites with between 125 and 750 employees were matched on key organization characteristics and then randomly assigned to early or delayed intervention conditions. Early intervention consisted of an 18-month multifaceted program that featured an employee steering committee and a menu approach to conducting key intervention activities tailored to each site.
                Cross-sectional and cohort analyses produced consistent results. At the conclusion of the intervention, early and delayed intervention conditions did not differ on changes in smoking rates, dietary intake, or cholesterol levels. There was considerable variability in outcomes among work sites within each condition.
                Despite documented implementation of key intervention activities and organization-level changes in terms of perceived support for health promotion, this intervention did not produce short-term improvements beyond secular trends observed in control work sites. Research is needed to understand determinants of variability between work sites. This article reports a series of randomized controlled studies in four companies in the United Kingdom which were designed to evaluate minimal smoking intervention programs based on the use of motivational videotapes or nicotine chewing gum. In the videotape studies, groups of smokers (N = 603) were randomly assigned to watch one of several different videotapes. They were followed-up, along with nonparticipants (N = 1,015), at 3 months and again at 1 year, and a biochemical validation of abstinence was performed. There were significant differences between the videotape conditions with regard to attitudes assessed immediately after exposure (intention and fear) and the proportion of smokers who tried to stop, but there were no significant differences in cessation, even in the short term. Using a strict definition of abstinence, long-term abstinence rates were under 10% in all four studies. In one company, we also investigated the effect of offering brief individual treatment based on nicotine chewing gum to a randomly chosen 50% sample of the videotape group (N = 161) still smoking at the 3-month follow-up. The treatment course was administered by occupational health nurses and consisted of four short consultations over a 12-week period. The results were encouraging: 16% of those who took the offer stopped during treatment and were still abstinent 1 year after the start of treatment compared with only 2% of the randomized no-intervention control group and 0% of those who were invited but did not attend. This study evaluated an attempt at 38 workplaces to help employees stop or reduce their levels of smoking. In past research, worksite support groups, in combination with a media smoking cessation program and self-help manuals, were found to be effective in helping employees quit smoking. Unfortunately, recidivism was found at the follow-up evaluations. The present study replicated the results of the previous worksite smoking cessation program with support groups, a television intervention, and self-help manuals. At this postpoint, 42% of employees provided groups plus incentives were abstinent compared to only 15% who were only provided self-help materials. An important difference in this study was that there were also monthly follow-up support groups and incentives. Work settings can be a source of stress and conflict, which can precipitate relapse. At a 12-month follow-up, 26% of those participants who were provided support and incentives were abstinent compared to 16% who were only provided the self-help materials. Physician antismoking advice has been shown to increase smoking cessation, particularly among patients who have medical problems or perceive themselves to be at risk. The present study tested three hypotheses: (a) providing 3 to 5 min of behavioral counseling regarding a cessation strategy would be more effective than simply warning the smoker to quit smoking; (b) smokers with abnormal pulmonary function would be more likely to comply with medical advice than would smokers with normal pulmonary function; and (c) that smokers with abnormal pulmonary function who receive behavioral counseling would be the group most likely to achieve prolonged abstinence. Asbestos-exposed smoking men undergoing screening in a mandated program for naval shipyard workers were categorized as having normal or abnormal pulmonary status on the basis of chest X ray and pulmonary function tests (PFT). They were then randomly assigned within PFT categories to receive either a simple warning or 3 to 5 min of behavioral cessation counseling from the physician who gave them the results of their pulmonary tests. Subjects' smoking status was evaluated at 3- and 11-month intervals following the physician intervention. Smokers who received behavioral counseling were more likely to quit and remain abstinent over the 11-month period (8.4% abstinent) than were smokers given a minimal warning (3.6% abstinent). Prolonged abstinence rates among abnormal PFT subjects (3.7%) did not differ from those of normals (5.9%). The group with normal PFT who received behavioral counseling achieved the highest level of abstinence (9.5%). Maintaining adequate physician compliance with the counseling protocol proved difficult; implications of this for future efforts are discussed. The aim of the study was to determine the smoking behavior based on "stages of change" model of the workers and to assess the effectiveness of a education program at a workplace. The first step was descriptive and the second step was an experimental study. The intervention group received an smoking cessation education. Before intervention 36% of the intervention group were at precontemplation stage. Six months after the intervention decline the percentage of those at precontemplation stage was significantly lower. In the control group there was not a significant reduction in the percentages of smokers at precontemplation stage before and after the intervention. After the 6 months the "maintenance" stage rates were 6% and 2% in the intervention and control groups, respectively. The study showed that the education in factory for workers could not be successful in quiting, however it impacted the intention and preparation of to quit in the future. Smoking cessation counseling is an important element of tobacco control in the workplace, but it is not easy to persuade workers to stop smoking. We performed a controlled intervention trial to evaluate the effectiveness of a new cessation program developed by Nakamura et al., which consisted of one brief individual counseling session and 4 follow-up telephone calls. Two hundred and twenty-eight smokers who visited our center for an annual health checkup were randomly divided into two group: 117 were assigned to the intervention group, and 111 were controls. Smoking status questionnaires were administered to assess the smoking habit of each subject and to evaluate their stages of change toward smoking cessation before the counseling session. Stage-matched cessation counseling was then provided to the intervention group by nurses who had completed training courses for this program. During the counseling session, carbon monoxide in expired air and nicotine metabolites in urine were measured to enhance self-perception of smoking. Only those clients who set a quit date during their counseling sessions received follow-up telephone calls. It was easy to implement this program (15 to 20 minutes long) during a health checkup. No significant differences were observed in the baseline characteristics of the two groups. The cross-sectional smoking cessation rates at 6 months and 1 year of follow-up were 6.2 times higher in the intervention group than in the control group. The continuous smoking cessation rate at 1 year of follow-up was 7.6 times higher in the intervention group than in the control group. In the intervention group, the lower level of nicotine metabolites in urine and higher smoking stage were related to cessation success, but other baseline characteristics were similar in those who quit smoking and those who did not. The effectiveness and easy applicability of this cessation program was proved in the present study. Further examinations in various settings are expected to clarify the effectiveness of this program. We evaluated the effects of adding a social support component to a worksite controlled smoking treatment program. Twenty-four participants were randomly assigned to either a controlled smoking or a controlled smoking plus partner support condition. Within a multiple baseline across behaviors design, smokers in both conditions made efforts to achieve sequential 50% reductions in: nicotine content of brand smoked, number of cigarettes smoked per day, and percentage of each cigarette smoked. Self-monitoring records, laboratory analyses of spent cigarette butts, and carbon monoxide determinations indicated that both conditions were effective in producing significant reductions in each of the three target behaviors and in carbon monoxide levels. All participants who quit smoking during the program maintained their abstinence at a 6-month follow-up, and those who did not quit were smoking less at follow-up than they had at pretest on all dependent variables. However, few differences were observed between controlled smoking and controlled smoking plus partner support conditions either during treatment or at the 6-month follow-up. Results are discussed with regard to previous worksite studies, future directions for research on social support, and variables that may have mediated treatment outcome. The effectiveness of a comprehensive program of worksite smoking control, discouragement, and cessation was compared with a program of smoking cessation alone. Two comparable oil refineries served as the research sites. Outcome variables consisted of employee self-reported smoking rate assessed by the use of a smoking questionnaire and unobtrusive observations of smoking behavior before and after the intervention. One company was randomly assigned to the comprehensive program of smoking control, discouragement, and cessation while the other company only received smoking cessation. Humorous antismoking posters emphasizing the benefits of quitting smoking were distributed throughout the first worksite and changed every 2 weeks. Large banners stating "Go SmokeFree" were also placed at all locations to this plant and left up for the duration of the study. Three weeks after the initiation of the smoking discouragement program at one refinery, a group smoking cessation program was begun at both plants. At a 5-month follow-up, participants in the smoking cessation treatment at the plant receiving the comprehensive program achieved a 5-month abstinence rate of 43% in comparison with a rate of 21% at the refinery receiving only smoking cessation.
1. We found strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling and pharmacological treatment to overcome nicotine addiction. All these interventions show similar effects whether offered in the workplace or elsewhere. Self-help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low.
2. There was limited evidence that participation in programmes can be increased by competitions and incentives organized by the employer.
3. We failed to detect an effect of comprehensive programmes in reducing the prevalence of smoking.