Translating an adolescent smoking cessation program into policy and practice in an Australian context

Although Australia's restrictive tobacco control policies have made it an international leader in reducing smoking prevalence, and only 7% of teens smoke weekly, cessation efforts are still needed among adolescents. Of the campaigns and programs implemented in Australia to reduce this problem among adolescents, most have provided only abstinence messages and few have been effectively evaluated and translated into policy and practice. This article describes the translation of a harm minimization cessation program for teens, the Smoking Cessation for Youth Project (SCYP), derived from an approach developed with adults. In addition, the article describes the unique sociopolitical context of Australia in which the SCYP program was developed and the significant conceptual, contextual, and methodological factors that enabled and limited this program's effective implementation and translation.     

Adapting smoking cessation programming to the Bulgarian context

Tobacco control efforts are among Bulgaria's leading health priorities, although enforcement of policies translated from other regions is challenging due to the high national smoking prevalence, especially among health professionals and school personnel. This article reviews the sociocultural and economic background relevant to health policy change and smoking cessation initiatives. Recommendations are made for effective Bulgarian tobacco control.     

The dentist's role in cessation of cigarette smoking

Dentists in general practice were surveyed by mail questionnaire to determine the actions they were taking to promote cigarette smoking cessation among their patients. Findings are based on replies from 376 of the 466 dentists in western New York State to whom the questionnaire was sent in 1981. The responses indicate that less than 18 percent of western New York State dentists smoke. The proportion is continuing its gradual decline, and dentists lead the general population in smoking abstention. Sixty-two percent of the dentists in the survey do not permit smoking in their waiting rooms, and 84 percent advise patients not to smoke. There is clear evidence of a relationship between the dentists' own smoking habits and their inclination to promote smoking cessation among patients. As fewer dentists smoke, more will be inclined to foster nonsmoking. Dentists can use a variety of smoking cessation techniques. To carry out a minimal program of antismoking measures, dentists in general practice can serve as nonsmoking role models for their patients, provide information about the health hazards of smoking, give advice, refer patients to cessation programs, recommend cessation measures, and monitor patients' efforts to quit smoking. While smoking cessation measures taken by dentists are not likely to convert more than 1 or 2 percent of patients who smoke per year, in time the dentists' efforts to promote smoking cessation can have an appreciable impact.     

Predictors of cigarette smoking and smoking cessation among adults with asthma

OBJECTIVES: This study sought to determine the predictors of smoking and time until smoking cessation in a cohort of adults with asthma. METHODS: Adults with asthma (n = 374) in northern California completed structured telephone interviews at baseline and 18-month follow-up. RESULTS: Of the 374 subjects, 156 reported ever having smoked, and 39 indicated that they currently smoked. Earlier birth cohort, lower educational attainment. White race, and presence in childhood residence of an adult who smoked were associated with a greater risk of ever smoking. Lower educational attainment, early smoking initiation, higher daily cigarette consumption, and late-childhood-onset asthma were associated with a longer interval until smoking cessation. CONCLUSIONS: Persons with asthma at high risk of cigarette smoking and delayed quitting can be identified on the basis of clinical and demographic characteristics.     

Pulmonary function in relation to cigarette smoking and smoking cessation. MRFIT Research Group.

BACKGROUND. More than half of the subjects in the MRFIT smoked at baseline and 10% of the subjects stopped smoking permanently during the first year of the trial. In this report, rates of decline in forced expiratory volume in 1 sec (FEV1) are compared for early permanent quitters and smokers who continued to smoke throughout the trial. METHODS. Since pulmonary function testing was not standardized across all centers until the third annual visit cycle, change in FEV1 is examined over the latter half of the trial; the level of FEV1 is analyzed cross-sectionally at the midpoint of the trial. Analyses are limited to 4,926 subjects who never used beta-blockers or smoked cigars, cigarillos, or pipes during the trial and who had annual FEV1s measured over 2-4 years in the latter half of the trial. RESULTS. Quitters during the first 12 months experienced smaller declines in FEV1 over the latter half of the trial than continuing smokers, with -50.7 ml/year versus -59.0 ml/year, respectively, adjusted for the level of FEV1 (P = 0.05). Cross-sectionally, those who had never smoked, former smokers, quitters, and continuing smokers showed a gradient of decreasing FEV1, and all four smoking groups were significantly different from each other (P less than 0.05). CONCLUSIONS. These data suggest that if a middle-aged, healthy smoker stopped smoking permanently, he could expect his FEV1 to deteriorate at a more gradual rate 3-4 years after stopping smoking than a similar smoker who continued to smoke. No information was available for the complete MRFIT cohort on the pulmonary function effects immediately following smoking cessation.     

Effects of a community-wide smoking cessation program

The evaluation of a low-cost community-wide smoking cessation campaign conducted in a major metropolitan area demonstrated a major impact on the number of people smoking, amount of cigarettes smoked, and expenses associated with smoking. The American Lung Association's 20-day self-conducted Freedom From Smoking program was used in conjunction with TV coverage. Standard telephone survey techniques determined that 5300 stopped and 26,500 reduced smoking. Major features of the program were evaluated and important differences were analyzed between males and females, users and non-users of the program manual, and success groups. Behavioral factors as opposed to historical factors appeared to be most important for success.     

A description of cigarette smoking cessation and resumption in the Framingham Study

Cigarette smoking cessation and resumption patterns are presented from biennial examination data from the Framingham Study for the years 1956-1978. At 22 yr of follow-up, 68% of men and 53% of women stated they had stopped smoking for at least 1 year. Younger participants had lower cessation rates than older, and those who smoked more cigarettes per day had lower cessation rates than those who smoked fewer. Lower cessation rates were found in men who drank alcohol, and in women who drank coffee, were leaner, or were of lower education. Resumption of cigarette smoking after nonsmoking for at least 1 year occurred in 35% of women and 25% of men over 20 years of observation. Most resumption occurred in the first 4 years after quitting. Men who smoked a greater number of cigarettes prior to quitting were observed to have a smaller probability of resumption. This latter finding is paradoxical and needs confirmation from other studies.     

Evaluation of a multicomponent group smoking cessation program

BACKGROUND. Participants who had completed a multicomponent group smoking cessation program were interviewed to determine their smoking status and satisfaction with the program. METHODS. The follow-up interviews occurred an average of 20 months after entry to the program, with a response rate of 80% (89 out of 111 enrollees). Most individuals interviewed (82%) were able to quit for at least 24 hr; 25% were able to maintain nonsmoking status for 1 year or longer. RESULTS. Initial quit rates were comparable for both men and women, but women were more than twice as likely to have relapsed by the time of the follow-up interview. Participants rated self-monitoring as the most helpful of 10 program components, including nicotine fading, nicotine gum, group support, health information, and talks by ex-smokers. Ratings for the program overall were higher than the rating of any individual component. CONCLUSIONS. Since earlier studies have found that successful quitters use more coping strategies than relapsers, multicomponent programs offer participants an opportunity to learn a variety of techniques and choose the combination that works best for them.     

Hollywood quits--behind the scenes of a Hollywood-based smoking cessation program

OBJECTIVES: To develop, implement, and assess the efficacy of a comprehensive, evidence-based smoking cessation program for entertainment industry workers and their families. METHODS: Study participants were recruited from 5 outpatient medical clinics and a worksite setting. Tobacco use data were collected during the initial counseling visit and at 6-month follow-up. Univariate and multivariate regressions were used in analysis. RESULTS: More than 50% of participants (n=470) self-reported 7-day abstinence at follow-up. The majority of participants used combination cessation medications, with more than 50% still using at least 1 medication at 6 months. CONCLUSIONS: This evidence-based smoking cessation program using behavioral counseling and combination pharmacotherapy was successful with entertainment industry workers.     

Effectiveness evaluation of the N-O-T smoking cessation program for adolescents

OBJECTIVE: To evaluate the effectiveness of the Not-On-Tobacco Program. METHODS: Forty-four high schools implemented the program (n=241 students), with 27 comparison schools (n=251 students). Students reported smoking in the last 7 and 30 days at baseline and follow-up. RESULTS: Those in the program had an increased likelihood of reporting 30-day abstinence at end of program (OR = 4.2) but not at 6 or 12 months. For 7-day abstinence there was no significant difference for any time point. CONCLUSIONS: In this effectiveness evaluation the N-O-T Program increased quitting during the program, but the effects were not present at 6 or 12 months.     

Evaluation of the "Time to Quit" self-help smoking cessation program.

Public health and hospital nurses have widespread contact with smokers; an effective smoking cessation program administered by nurses has tremendous potential. This study evaluated: 1) the effectiveness of the self-help cessation program, "Time to Quit"/"Moi aussi, j'écrase" (TTQ), provided on a one-to-one basis; and 2) a smoking cessation training program for baccalaureate nursing students. Nursing students recruited 307 smokers who were randomly assigned to receive one of two interventions. Control smokers received a list of community smoking cessation resources and experimental subjects received this list plus TTQ. Smoking self-reports and cotinine levels were obtained at baseline, six weeks and nine months. More smokers receiving TTQ had reduced at six weeks post-intervention, while there were no differences in quit or reduction rates at the nine-month follow-up. Students were positive about learning the techniques and their knowledge scores were significantly higher than those of non-participating students.     

Psychosocial predictors of outcome in a worksite smoking cessation program

We examined the relationship of smoking history, motivation, social support, and stress to initial cessation and long-term abstinence in a sample of 402 smokers who participated in a worksite smoking cessation program. Compared to nonquitters, smokers who initially stopped smoking expected less difficulty quitting, had previously abstained for longer periods, and had a higher desire to quit. Long-term abstainers were lighter smokers and had more social support and less stress than relapsers. The differences in the predictors of initial cessation and long-term abstinence support the concept of a staged cessation process. The results suggest that intraindividual factors are particularly important early in the process, whereas environmental factors are more important during the later, maintenance stage. These findings are consistent with a biopsychosocial model of cessation and relapse and support multicomponent interventions.     

National TV smoking cessation program and contest in Finland.

BACKGROUND. In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity. RESULTS: Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001). CONCLUSIONS: The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.