Effect of workplace smoking policies on smoking cessation: results of a longitudinal study

Studies of worksite smoking bans often find that they fail to increase the rate of smoking cessation. To see whether duration of exposure to restrictive policies was an important element, we surveyed workers by phone to examine the effect of being continuously employed at a smokefree worksite for 3 years. Results showed that worksite policy was unrelated to smoking cessation. However, 12% of respondents at smokefree worksites reported that smoking had taken place in their work area, and over 20% reported at least 2 hours of worksite environmental tobacco smoke (ETS) exposure during the prior week. When minimal ETS exposure is used as an indicator of an effectively enforced smoking ban, logistic regression demonstrates that continuous employment at such a worksite strongly predicts smoking cessation. Failure to demonstrate a significant impact of worksite smoking bans on cessation in this and other studies may be due to poor enforcement of smoking policies.     

Gender differences in smoking cessation

Men and women have traditionally consumed cigarettes very differently, demonstrating widely varying patterns of prevalence during the past eight decades. For example, though the prevalence of smoking among men increased dramatically soon after the turn of the century, an analogous though less dramatic increase among women was not observed for another 25-30 years. Similarly, when a dramatic decrease in smoking prevalence among men was observed following the 1964 Surgeon General's Report, a comparable decrease among women was not seen until 15 years later. Such differences in smoking patterns have led to the widespread belief that giving up smoking is more difficult for women than it is for men. This paper reviews various studies which address this issue and suggests areas in which further research is needed.     

吸烟者戒烟意愿及影响因素分析

目的探讨沈阳市吸烟人群有戒烟意愿的人口学特征及影响因素,为有关部门制定有效的控烟措施提供科学依据。方法 2006年4～8月,在沈阳市内五区,采用多阶段分层随机整群抽样的方法 ,按照"街道→社区→家庭→调查对象"四个阶段进行抽样。其中,第一阶段使用按容量比例概率抽样法(PPS)抽取10个街道;第二阶段按PPS法在每个街道内抽取2个社区;第三阶段使用简单随机抽样法在每个社区抽取300户家庭;第四阶段使用简单随机抽样法在300户家庭中抽取100名成年吸烟者作为调查对象;每个居委会至少调查40名吸烟者;最终在沈阳市抽取调查了801名成年吸烟者。结果沈阳市吸烟者中有戒烟意愿者的比例为30.7%;男性有戒烟意愿者的比例(29.8%)远低于女性(46.7%);职业分布中,以国家机关党群组织负责人中有戒烟意愿的比例最高达47.5%,其次为离退休人员36.7%,以专业技术人员有戒烟意愿的比例最低为21.4%。影响因素分析发现:亲人反对、社会舆论、对健康的影响、控烟宣传的力度、健康警示信息的普及、对烟草相关疾病的知晓程度以及对戒烟产品和戒烟服务的接触均会影响吸烟者戒烟意愿的产生。结论通过普及烟草危害的健康教育,提倡亲人积极参与吸烟者戒烟活动,丰富烟草包装健康警示信息,提高控烟宣传力度以及推广戒烟产品和戒烟服务等措施可以很好地提高沈阳市吸烟者戒烟意愿的产生。     

Estimation of average treatment effect with incompletely observed longitudinal data: Application to a smoking cessation study

We study the problem of estimation and inference on the average treatment effect in a smoking cessation trial where an outcome and some auxiliary information were measured longitudinally, and both were subject to missing values. Dynamic generalized linear mixed effects models linking the outcome, the auxiliary information, and the covariates are proposed. The maximum likelihood approach is applied to the estimation and inference on the model parameters. The average treatment effect is estimated by the G‐computation approach, and the sensitivity of the treatment effect estimate to the nonignorable missing data mechanisms is investigated through the local sensitivity analysis approach. The proposed approach can handle missing data that form arbitrary missing patterns over time. We applied the proposed method to the analysis of the smoking cessation trial. Copyright © 2009 John Wiley & Sons, Ltd.     

Continued smoking and smoking cessation among urban young adult women: findings from the Reach for Health longitudinal study

We examined smoking and smoking cessation among 538 young inner-city women who had been followed from early adolescence to young adulthood. Results showed that 14.3% of these young women had smoked in middle school, 26.4% had smoked in high school, and 21.9% had smoked at age 19 or 20 years, when many were rearing children, pregnant, or considering pregnancy. Young women who were raising children were more likely than those who were not to currently smoke or to have smoked in the past. Partner violence victimization was an independent risk factor for continued smoking. If improvements in smoking cessation rates are to be achieved, public health efforts must address factors underlying early and continued smoking.     

Self-reported exposure to policy and environmental influences on smoking cessation and relapse: a 2-year longitudinal population-based study

Although most smokers want to quit, the long-term success rate of quit attempts remains low; research is needed to understand the policy and environmental influences that can increase the success of cessation efforts. This paper uses regression methods to investigate self-reported exposure to policy and environmental influences on quit attempts, maintenance of a quit attempt for at least 6 months, and relapse in a longitudinal population-based sample, the New York Adult Cohort Survey, followed for 12 months (N = 3,261) and 24 months (N = 1,142). When policy or environmental influence variables were assessed independently of other policy or environmental influence variables, many were significant for at least some of the cessation outcomes. In the full models that included a full set of policy or environmental influence variables, many significant associations became nonsignificant. A number of policies may have an influence on multiple cessation outcomes. However, the effect varies by cessation outcome, and statistical significance is influenced by model specification.     

Payroll contracting for smoking cessation: a worksite pilot study

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.     

Mass media and smoking cessation: a critical review.

Evaluations of 40 mass media programs/campaigns designed to influence cigarette smoking were reviewed. Information/motivation programs/campaigns generally produced changes in awareness, knowledge, and attitudes. Extensive national campaigns also produced meaningful behavioral change. Programs/campaigns designed to promote some specific smoking-related action produced mixed results, depending in large part on the type of promotion involved. Mass media cessation clinics were found to be effective, with media plus social support being more effective than viewing plus printed material, and either combination being more effective than viewing alone. It was concluded that mass media health promotion programs can be more effective than many academics may have thought, but that the knowledge necessary to ensure such success is seriously lacking. Research studies, rather than simple evaluations, are needed to improve our knowledge base and build a science of mass media health promotion.     

Impediment profiling for smoking cessation: results of a pilot study

OBJECTIVE: To test the effectiveness of a smoking cessation program based on "impediment profiling," the elucidation of an individual participant's personal barriers, with provision of tailored interventions accordingly. METHODS: A literature search was conducted to identify established impediments to smoking cessation. A long impediment profiler (LIP) was developed from validated survey instruments and used as a screening tool to identify individuals' barriers to quitting. Once barriers were identified, participants were assigned to up to seven interventions. Self-reported smoking cessation was confirmed with measurements of carbon monoxide concentrations in expired air of < or = 10 ppm. RESULTS: Nineteen adults participated in the pilot program. At the year 1 mark, 63.2% of the study population was smoke-free. The mean number of impediments of the study population was 3.5 +/- 1.5. There was a negative association between subjects' quit status and the following impediments: stress (p = .0061), anxiety (p = .0445), and depression (p < .001). No single impediment was predictive of quit status. CONCLUSIONS: Impediment profiling as a basis for tailored smoking cessation intervention is associated with a high quit rate in this initial study, and it appears promising. Long-term follow-up is warranted, as is replication in a larger cohort with a concurrent control group.     

Trends in smoking habits: a longitudinal population study

BACKGROUND: In 1998, the UK government published a White Paper in which it set long-term targets for reducing smoking in the population. This longitudinal study aimed to examine whether progress has been made in achieving these in two adult general practice populations over an 8-year period. METHODS: Postal respiratory questionnaires, based on the European Community Respiratory Health Questionnaire, were sent to all patients registered with two practices in North West England on four occasions between 1993 and 2001. Two analyses were carried out. The first (smaller cohort) included only those subjects answering the question concerning current smoking on all four occasions, the second (larger cohort) those answering at least twice. RESULTS: The smaller cohort included 2403 subjects (19.6% of all respondents). Almost one-quarter reported in all four surveys that they smoked, the highest proportion being in those aged 35-44 years. The proportion of smokers decreased from 34.2% (1993) to 30.3% (2001) (P < 0.001 for trend) and the prevalence of heavy smokers fell from 15.9 to 13.3% (P < 0.001 for trend) over the same period. There were, however, no reductions in those aged <45 years in 1993. These changes were confirmed in the larger cohort which included 7274 subjects (59.3% of respondents). CONCLUSIONS: If smoking-related disease is to be reduced, it is important that adults are targeted for smoking prevention and cessation before they reach middle age. Only when such initiatives show success will smoking prevention among their children become a practical proposition.     

Gender differences among general practitioners in smoking cessation counseling practices

OBJECTIVES: To describe gender differences in smoking cessation counseling practices among general practitioners (GPs), and to investigate the association between training for cessation counseling and counseling practices according to gender. METHODS: Data were collected in two cross-sectional mail surveys conducted in independent random samples of GPs in Montreal, the first in 1998, and the second in 2000. RESULTS: Respondents included 653 GPs (71% of 916 eligible). All indicators of smoking cessation counseling practices were more favorable among female GPs. Higher proportions of female GPs had received training (28% vs. 17%, p=0.002), and were aware of mailed print educational materials related to cessation counseling (81% vs. 57%, p<0.0001). Training among male GPs was associated with higher scores for ascertainment of smoking status (odds ratio (OR) (95% confidence interval)=1.69 (0.97, 2.96)), provision of advice (OR=2.20 (1.23, 3.95)), and provision of adjunct support (OR=2.86 (1.58, 5.16)). Training was not associated with counseling practices among female GPs. CONCLUSIONS: Female GPs may not benefit from formal cessation counseling training to the same extent as male GPs, possibly because they read and integrate the content of (easily available) print educational materials into their clinical practice to a greater extent than male GPs. The gender-specific impact of print educational material and formal training on cessation counseling should be evaluated among GPs.     

Clinical methods in smoking cessation: description and evaluation of a stop smoking clinic.

This study reports the results of the Kaiser-Permanente Stop Smoking Clinic and describes the philosophy and methods employed by the clinic in treating addictive smoking behavior. Of the 1,128 clients who registered for the group program, 57 per cent are abstinent six months after quitting smoking and 47 per cent are abstinent at one year. The clinic methods used are described in detail. They attempt to relate smoking behavior to the larger phenomenon of addiction.     

简短戒烟干预研究的Meta分析

目的 采用Meta分析评价简短戒烟干预的有效性.方法 计算机检索2000年1月至2014年9月中外生物医学数据库(The Cochrane Library、Medline、EMbase、中文期刊全文数据库、万方电子期刊数据库、维普中文科技期刊数据库和中国生物医学文献数据库)中有关简短戒烟干预随机对照试验,采用Revman 5.1软件进行Meta分析.结果 最终纳入9篇文献,随机效应模型合并RR值(95%CI)=1.57(1.01～2.44) .与未进行干预的吸烟者相比,接受了简短戒烟干预的吸烟者,其戒烟的可能性提高了57%.研究对象为孕妇和就诊患者,干预时间≤10 min的亚组更易戒烟,但各亚组分析结果之间的差异均无统计学意义.结论 简短戒烟干预可提高戒烟率,但该结论尚需纳入更多高质量大样本的随机对照试验加以证实.     

The impact of physicians' brief smoking cessation counseling: a MIRNET study

Although many family physicians may discuss smoking cessation with their patients, few do so consistently. A common belief among many physicians is that such efforts will not deter their patients from smoking. Others believe the time commitment required for a successful intervention is excessive. The present study addressed the above issues by examining the effect of a 3- to 5-minute unstructured physician discussion encouraging smoking cessation with family practice patients. Cigarette-smoking patients of two busy family practices in southeast Michigan were randomly assigned to either a control group receiving routine care or an intervention group receiving, in addition to routine care, smoking cessation counseling from their physician. A third comparison group was drawn from smokers in practices not involved in delivering the intervention. Two hundred thirty-eight patients from the intervention group, 178 from the control group, and 47 from the comparison group were followed up with a telephone interview at 6 months. Intervention group patients made significantly more quit attempts than did those in the control group (P less than .001), which was similar to the comparison group. At the 6-month follow-up, 8% of intervention group members, and 4% of both the comparison and control groups reportedly were abstinent from smoking. Among those contacted at the 1-year follow-up, the respective percentages abstinent were 8%, 3%, and 4%. Although these differences in quit rates were not statistically significant, the findings suggest that physicians can positively affect patient smoking cessation. This intervention was feasible in busy family practices, highlighting its generalizability and applicability to other family practice settings in the United States.     

Personality scores and smoking behaviour. A longitudinal study.

The personality scores at 16 years of age of 2753 people, all members of the National Survey of Health and Development, were related, in a follow-up study, to cigarette smoking behaviour in their young adult years. Survey members who recorded high neuroticism scores were found to be more likely to smoke than those with low scores and, among the smokers, deep inhalers formed the most neurotic group. Extraverts were more likely to smoke than introverts, the mean extraversion score being greatest for the male smokers with a high daily consumption of cigarettes. The personality scores were found to have some power in predicting changes in smoking behaviour. Neurotics and extraverts who had not started to smoke by the time of completing the personality inventory at 16 were more likely than the stable and introverted to take up the habit subsequently. Among survey members who were regular smokers at the time of completing the personality inventory the proportion giving up smoking by the time they reached the age of 25 years was related to consumption level recorded at 20 years and the personality scores recorded at 16, stable extraverts among the men being most likely to stop smoking.