Effectiveness of annual interventions for smoking cessation in an occupational setting in Japan

Objective  To examine the effectiveness of a small-scale smoking cessation intervention program conducted annually for ten years in an occupational setting in Japan. Methods  We conducted an annual intervention program promoting smoking cessation in male smokers from 1993 to 2002 in an occupational setting in Hyogo, Japan. Trends in smoking prevalence in this worksite were compared with a control group from two similar worksites of the same company. The intervention program was carried out by medical students (the fourth year of a six-year course) who received training on the protocol prior to the intervention. This protocol consisted of one initial group session, followed by periodical correspondence for two months. Successful cessation of smoking was determined by self-declaration of abstinence for longer than four weeks after intervention, confirmed by an expiratory carbon monoxide concentration of less than nine ppm. Smoking prevalence was determined by a self-administered questionnaire provided at the annual health checkup. Results  The proportion of smokers who participated in the program was 3.47% on average. Abstinence rates following each intervention ranged from 13.3% to 60.0%, with the prevalence of male smokers at the intervention worksite decreasing from 56.2% in 1993 to 47.0% in 2002. In contrast, the smoking prevalence of the control worksites remained largely unchanged, being 60.2% in 1995 and 57.6% in 2002. At the end of the study, the intervention worksite had a significantly lower prevalence of smokers in either the crude or age-adjusted rate. Conclusion  A small-scale but repeated smoking cessation intervention program at a worksite can reduce smoking prevalence more efficiently than the natural trends.     

Smoking habits and smoking cessation among North Carolina nurses

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.     

Characteristics of American Indian women cigarette smokers: prevalence and cessation status

A high rate of cigarette smoking is documented among the American Indian population in California, but data on Indian women smokers have not been widely studied. This paper reports on a survey conducted in a smoking cessation project implemented and evaluated as part of a National Cancer Institute (NCI) cooperative agreement. Characteristics of Indian women smokers are presented and cessation status is examined. The overall goal of the project was to increase long-term smoking cessation among American Indian populations through a reproducible clinic-based smoking cessation program. To ascertain smoking prevalence and tobacco use patterns, a self-administered survey was completed by 1,369 adult male and female American Indian health clinic users in Northern California. Study results reported several important characteristics of Indian women smokers. Single and divorced participants had a higher smoking rate (40.4% and 42%) than married participants (34.4%); 54.5% of unemployed women smoked; and level of education was strongly associated with smoking status (p = .011). Almost 80% (79.9%) of women former smokers quit using the "cold turkey" method. Fewer than 50% of Indian women smokers reported willingness to quit at the following smoking cessation stages: "immediately" or "ready" (12.4%), "in one month" (10.5%), and "in six months" (25.2%). This points to a need for effective tobacco cessation interventions for American Indians, which will take into consideration Indian women smokers' demographic characteristics, lenient attitudes toward smoking, and smoking behaviors.     

Smoking cessation in women concerned about weight.

BACKGROUND. Weight gain after smoking cessation is often cited by women smokers as a primary reason for not attempting to quit smoking or for relapsing after a cessation attempt. METHODS. A randomized trial of 417 women smokers was conducted to test the addition of two weight control strategies to a smoking cessation program. Participants received the standard smoking cessation program, the program plus nicotine gum, the program plus behavioral weight control, or the program plus both nicotine gum and behavioral weight control. Weight and smoking status were measured at the end of treatment and at 6 and 12 months posttreatment. RESULTS. Smoking cessation rates were highest in the group receiving the smoking cessation program plus nicotine gum. Weight gain did not vary by treatment condition, so its effect on relapse could not be examined by group. There was no significant relationship between weight gained and relapse in individuals. CONCLUSIONS. The added behavioral weight control program was attractive to the participants and did not reduce smoking cessation rates. However, it did not produce the expected effect on weight, thereby restricting our ability to examine the effect of weight control on smoking cessation and relapse.     

Effectiveness of a low-intensity intra-worksite intervention on smoking cessation in Japanese employees: a three-year intervention trial

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.     

Tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among medical students: results of a pilot study of Global Health Professions Students Survey (GHPSS) in Italy

Aim

The aims of this study were to examine tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among students attending Italian medical schools using the Global Health Professions Student Survey approach and to identify possible factors associated with smoking status.

Subjects and Methods

A multicentre cross-sectional pilot study was carried out in five Italian Schools of Medicine from March to April 2009. Questionnaires were administered in anonymous, voluntary and self-administered form to third year students attending medical schools. The outcome measure was ??being a current smoker??. A logistic regression was used to evaluate possible factors associated with smoking status.

Results

The prevalence of current smokers was 31.4%. More than half considered health professionals as models for patients, and around 90% thought health professionals have a role in giving advice or information about smoking cessation. Only 5.8% of responders had received smoking cessation training during medical school. Medical students who considered healthcare professionals as behavioural models had lower likelihood of smoking (OR?=?0.52).

Conclusions

Given the high prevalence of smokers among medical students and the poorness of smoking cessation programmes, it is important to create tobacco control training programmes addressed to healthcare students.     

Randomized controlled trial for smoking cessation among city office employees

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.     

Feasibility and Acceptability of a Text Messaging Program for Smoking Cessation in Israel

Text messaging programs on mobile phones have been shown to promote smoking cessation. This study investigated whether a text-messaging program for smoking cessation, adapted from QuitNowTXT, is feasible in Israel and acceptable to Israeli smokers. Participants (N = 38) were given a baseline assessment, enrolled in the adapted text messaging program, and followed-up with at 2 weeks and 4 weeks after their quit date. The authors used an intent-to-treat analysis and found that 23.7% of participants reported having quit smoking at the 4-week follow-up. Participants sent an average of 12.9 text replies during the study period, and the majority reported reading most or all of the texts. However, 34.2% of participants had unsubscribed by the 4-week follow-up. Moderate levels of satisfaction were reported; more than half agreed that they would recommend the program. Suggestions for improvement included adding advice by an expert counselor, website support, and increased customization. Results indicate that a text messaging smoking cessation program developed by modifying the content of QuitNowTXT is feasible and could be acceptable to smokers in Israel. The experience adapting and pilot testing the program can serve as a model for using QuitNowTXT to develop and implement such programs in other countries.     

Factors associated with successful smoking cessation among adolescent smokers undergoing a smoking cessation program involving nicotine replacement therapy

OBJECTIVE: To identify factors associated with successful smoking cessation among adolescent smokers in a smoking cessation program involving nicotine replacement therapy. METHODS: We recruited adolescent smokers who were prepared to quit smoking and participated in the smoking cessation program in Kanagawa prefecture. All participants fulfilled a questionnaire beforehand, covering gender, age at the beginning of the study, age at onset of smoking, the number of quit attempts, the number of cigarettes per day and the smoking status of their families and friends. Seven nicotine patches (nicotine 52.5 mg/day) were given to them free of charge for daily use. Their smoking status and the use of nicotine patches were confirmed by telephone or postcard at the 1 and 6 month follow-ups. The relationships between successful smoking cessation and different factors among eligible participants were analyzed using the Fisher's exact test and the Mann-Whitney U test. RESULTS: The subjects included 39 adolescent smokers (mean 16.4 years). The mean age at onset of smoking and the mean duration of smoking were 13.3 years and 2.3 years, respectively. The average daily number of cigarettes smoked was 12.8. Of 39 eligible participants at the one month follow up, 14 (35.9%) were found to be abstaining from smoking. The subjects treated with nicotine patches were significantly more likely to be abstinent than those without them (P<0.05). However, no significant associations with other factors were found. Of 39 participants at the six months follow up, 10 (25.6%) were still abstinent but there were no significant associations with any of the factors, including use of nicotine patches. Subjects living with smokers were significantly less likely to be successful in their efforts to quit than those living with non-smokers (P< 0.05). There were no significant associations with other factors, including using nicotine patches. No adverse events relating to the use of the nicotine patches were encountered during the study period. CONCLUSION: The smoking cessation program involving NRT provided for adolescent smokers appeared effective at the one month follow up. Those adolescents living with smokers had more difficulties in quitting smoking than those with non-smokers at the 6 month follow up. In order to increase the number of adolescent smokers in the smoking cessation study, the need to obtain parental consent might be considered as a barrier to be overcome. Additionally, more effective follow-up procedures should be considered for the purpose of avoiding dropouts during the study.     

A school nurse-delivered adolescent smoking cessation intervention: a randomized controlled trial

BACKGROUND: The aim of the present study was to evaluate the efficacy of a school nurse-delivered smoking cessation intervention to improve abstinence rates among adolescents interested in quitting. METHODS: Seventy-one high schools in Massachusetts were randomized to either a four-session one-on-one school nurse-delivered smoking cessation intervention (37 schools, n = 571) or usual smoking cessation care control condition (34 schools, n = 577). Adolescents in grades 9-12 who smoked in the past 30 days completed surveys at baseline, 6 weeks and 3 months. The study was conducted during the 2002-2003 school year. RESULTS: Thirty-day self-reported abstinence rates were significantly greater in students in the intervention compared to control condition at 6 weeks (18% vs. 2%, respectively) and 3 months (24% vs. 5%, respectively). After adjusting for school and potential confounders, students in the intervention schools had odds of quitting 8 times greater than students in the control schools at 6 weeks (OR = 8.4; 95% CI 3.7, 20.6) and 6 times greater at 3 months (OR = 6.4; 95% CI 3.4, 11.4). School nurses delivered intervention with a high degree of fidelity. CONCLUSIONS: A four-session smoking cessation intervention can feasibly be delivered by school nurses and increase self-reported short-term abstinence rates among students interested in quitting smoking.     

The effect of smoking cessation counseling at health checkup]

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.     

Impact of the life skills training curriculum on middle school students tobacco use in Marion County, Indiana, 1997-2000

Evaluation of school-based tobacco prevention and control programs have yielded mixed results. This study assessed the impact of the Life Skills Training curriculum on Marion County, Ind., middle school students' knowledge, attitudes, and ability to make good lifestyle decisions. From 1997 to 2000, students in grades six to eight in the study schools received the Life Skills Training curriculum. Survey data (n = 1,598) were used to compare tobacco use behavior, attitudes, and knowledge of those exposed with those not exposed to the program. Of the students surveyed, 12.5% were currently smoking. There were significantly fewer current smokers, and more students exposed to the program indicated they intended to stay smoke-free. Fewer of those participating in the program "hung out" with smokers and more said they could easily refuse a cigarette if offered one. Students completing the Life Skills Training curriculum were more knowledgeable about the health effects of smoking. Program effects were different for male and female students as well as for White and Black students.     

Smoking behaviour,knowledge and attitudes among Family Medicine physicians and nurses in Bosnia and Herzegovina

Background

Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies.

Methods

The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses.

Results

Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two thirds of health professionals felt very or somewhat prepared to counsel their patients on how to quit smoking.

Conclusions

Our study indicates that almost half of Family Medicine health professionals in Bosnia and Herzegovina are smokers. This indicates a severe public health problem throughout the country. Steps need to be taken at a national level to address the fight against tobacco.

     

Patient referral to a smoking cessation program: who follows through?

BACKGROUND. While health care providers are often urged to refer smokers to a smoking cessation program, little information is available about patient adherence to such advice. METHODS. A group of primary care patients who smoked (N = 1380) received brief advice to quit from their provider, and were then asked to stay and talk to a counselor for more information. Counselors randomly delivered one of two interventions. For the intervention group, referral to a specific group cessation program was emphasized, and for the control group, quitting advice was merely repeated. The referral intervention included a video in which role models testified to the acceptability and usefulness of the HMO's group program. The usual program fees were waived, and patients received a supportive, follow-up telephone call 1 week after their visit. RESULTS. In the referral intervention group, 53.2% of patients agreed to go to the cessation program and 11.3% actually attended, compared with only .006% of the patients who received advice only. Logistic regression analyses revealed that patients who were contemplating quitting were more than five times as likely to respond to the referral compared to precontemplators (smokers who were not seriously considering quitting). Older, heavier smokers were also more likely to attend a group session. CONCLUSIONS. An intensive, specific referral to a group smoking cessation program can increase participation by patients. Most patients, however, will not attend a group program; therefore, a brief office-based intervention for all smokers should precede referral.     

Results of a quit-smoking research project in a randomly selected population.

In the spring of 1973, 58 strictly randomized heavy smokers from a defined population of men born in 1914 were asked to quit smoking, at least for 8-9 weeks, as a part of a research project focused upon the relationship between smoking and peripheral blood flow, fibrinolysis, and lung function. Eighty-eight per cent of the smokers were willing to try to quit smoking. Seven (12%) refused at the outset, as they regarded quitting as impossible. Of the remaining 51 it was possible to keep 31 (60%) free from smoking for 8-9 weeks with the aid of an intense anti-smoking program lasting 6 weeks. Checks of continued smoking abstention were made by questionnaire and COHb-determination. After six weeks, no further information was given to the subjects. A follow-up after 8-9 months revealed that 33% of the 51 participants (i.e. 29% of the original 58) were still non-smokers. The long-lasting effect of our quit-smoking method was equal to the best reported by others and 30% is probably the highest rate of long-term success to be achieved in smoking cessation.     

Evaluation of a "stop smoking" contest in Japan

BACKGROUND: In 1988, the Osaka Cancer Prevention and Detection Center developed a self-help smoking cessation program, the "stop smoking" contest, based on the Quit and Win strategy developed in the United States in the early 1980's. It consisted of a two-week preparation period, followed by a four-week complete abstinence period. Participants were asked to try to achieve their goals on their own, using self-help materials, mailed to all applicants. Successful participants--"contest winners"--were awarded prizes by lot. The purpose of the present study is to examine the applicability of the Quit and Win strategy in Japan, through evaluating the effectiveness of the program in general and identifying predictors of successful quitting. METHOD: We analyzed the results of three consecutive programs conducted in 1998, 1999, and 2000. The programs defined as "participants" all those who demonstrated that their intentions were sincere by signing on for the contest. Of the participants, those who reported complete abstinence for four weeks were defined as "winners." Finally, of the winners, those who reported successful abstinence during the following six- and twelve-month periods were defined as continuing winners. "Abstinent" status was confirmed through self-reporting letters signed by the subject and two witnesses. We hypothesized that successful quitting would be predicted by demographic and smoking-related variables. Predictors of successful quitting were analyzed statistically using logistic regression. RESULTS: Of 4,221 applicants, 2,550 (60%) smokers eventually joined the program as "participants." Forty-six percent of the participants reported complete tobacco abstinence during the four-week contest period. Twenty percent of the participants maintained abstinence during the following six months. Fifteen percent maintained abstinence for a full year. Significant predictors of tobacco abstinent for the four-week contest period were as follows; male, more advanced age, being married, lower nicotine dependence, greater readiness for quitting, higher confidence in quitting, and better health. Of these, sex and psychological characteristics for quitting such as readiness and confidence were the only factors significantly correlated with successful abstinence throughout the follow-up periods. Previous longer abstinence experiences and chronic disease did not predict four-week abstinence, though it was significantly correlated with abstinence maintenance during the follow-up periods. CONCLUSION: The present "stop smoking" contest, a "Quit and Win" type population-based, self-help smoking cessation program combined with incentives, could be successfully implemented in Japan. The success rate was essentially comparable to those of similar programs previously conducted in other countries, and other types of professional-assisted programs in Japan.     

Smoking intervention: combination therapy using nicotine chewing gum and the American Lung Association's "Freedom from Smoking" manuals

The smoking cessation efficacy of a two-session group program using the American Lung Association's "Freedom from Smoking" self-help manuals, nicotine gum, and brief, repeated professional supervision was estimated in an uncontrolled clinical trial. Of the 39 participants, 12 (31%) remained cigarette free for 1 year, and 4 others (10%) had not smoked during the 3 months prior to the 1-year follow-up. Claims of cessation were verified by expired-air carbon monoxide measurement. Nearly all successful abstainers were able to achieve 48-hr cessation during their first week using the gum. This finding suggests that nicotine gum is best used to help the smoker quit abruptly, rather than as an aid in a tapering-off strategy. This study's smoking intervention program appears to provide a relatively low-cost method of improving the success rates among smokers who wish to quit.     

A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women

Research has shown that pregnant women who smoke cigarettes increase their risk of having low birthweight (LBW) infants. Recent randomized trials indicate that women who quit smoking early in pregnancy reduce their risk of delivering a LBW infant. Using various sources, we estimated the cost-effectiveness of a smoking cessation program for preventing LBW and perinatal mortality. Assuming the program would cost $30 a participant and that 15% of the participants would quit smoking, we determined that a program offered to all pregnant smokers would shift 5,876 LBW infants to normal birthweight and would cost about $4,000 for each LBW infant prevented. Since infants born to smokers are at 20% greater risk for a perinatal death, a smoking cessation program could prevent 338 deaths at a cost of $69,542 for each perinatal death averted. Compared with the costs of caring for these LBW infants in a neonatal intensive care unit (NICU), smoking cessation programs would save $77,807,054, or $3.31 per $1 spent. The ratio of savings to costs increases to more than six to one when we include reducing long-term care for infants with disabilities secondary to LBW in the benefits from smoking cessation programs. These findings argue for routinely including smoking cessation programs in prenatal care for smokers.