American Institute for Preventive Medicine
 

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Smoking Cessation Intervention with White Collar and Blue Collar Employees
Don R. Powell, Ph.D.


Organization Setting
This program was implemented at a Fortune 50 manufacturing company with 300 nationwide locations ranging in size from five to 2,000 employees. The eligible population group consisted of 40,000 employees of whom approximately 8,000 (20%) were smokers. Seventy-five percent of the employees were white-collar workers, and 25% were blue-collar workers.

Problem to Be Solved
Group smoking programs had been conducted more than 100 times over the past 10 years for employees of the corporation. Originally, class sizes were quite large, consisting of 30 to 90 participants. Eventually, classes consisted of only four to five participants. This was attributed to the fact that over the past decade, most of the employees who wished to quit within a class format had attempted to do so. In addition, many of the company's employees worked at small sites where it was not cost-effective to conduct group classes. To reach the employee population that still smoked, a guided self-help smoking cessation program was developed.

Description of Innovation
It has been documented that group smoking cessation interventions have higher success rates than self-help interventions. 1-3 The reason for this is that an instructor can:
  1. take participants through a program step-by-step,
  2. be available to provide expertise and answer questions that may arise, and
  3. provide encouragement and motivation.
A challenge for health promotion practitioners is to develop a new type of self-help approach that is more effective than the traditional self-help methods. To this end, a guided self-help quit smoking program was developed. 4,5

The self-help intervention is a self-administered version of the group program. It contains all of the same booklets, relaxation cassette tape and accessories, along with an instructional tape which teaches participants, step-by-step, how to use the material on their own.

This tape, in effect, takes the place of the instructor. In addition, participants received unlimited access to a toll-free counseling hotline that was staffed by a smoking cessation counselor. The counselor answered questions related both to the techniques in the program or how the caller may be feeling at that point in the quit-smoking process. This "guided self-help" approach was designed to help participants quit on their own in the privacy of their own home, yet still have access to the expertise of an instructor.

The intervention is based on an extensive body of research and teaches stress management, positive reinforcement, attitude changes, food management, environmental support, and relapse prevention techniques.

The following materials are included in the program:

  • Vinyl Album (holds all materials)
  • Urge Zapper
  • Cigarette Pencil
  • 7 Booklets
  • Self-Help Instructional Tape
  • Cigarette Scorecard
  • Cassette Tape
  • Headless Matches
  • Relaxation Cassette Tape
  • Mints
  • Photographs
  • Summary Cards
  • Smokeless Emergency Pack
  • Graduation Diploma
Program Impact
Table I shows the 12-month quit rates. Among the 622 employees who received materials, 138 reported quitting at 12 months, for an overall quit rate of 22%. This compares well to the 5% to 10% commonly reported for self-quit efforts. 6-8 Of the 622 employees, 225 could not be contacted. For the purposes of calculating quit rates, all those not contacted were assumed to still be smoking. If the quit rate were calculated based only on those who were contacted, it would be 35%. Of those contacted, 308 reported that they had used the program, and 89 reported that they had not used the program and had not quit. Among those who had used the program, the quit rate was 45%.

Quit rates among blue-collar employees were comparable to those of all employees as shown in Table 2. This is encouraging because previous research has shown that blue-collar employees usually have lower quit rates. 9

Table 1

Quit Rates for White-Collar and Blue-Collar Employees Combined 12-Month Follow-Up

Category
Total Number of Employees
Number of Nonsmokers
Percent Who Quit
All employees who ordered kits (includes 225 who couldn't be contacted and 89 who didn't use the materials)
622
138
22%*
Employees able to be contacted at follow-up
397
138
35%
Employees contacted at follow-up who actually used kits (397) minus 89 who didn't use materials
308
138
45%

*Assumes all employees who could not be contacted are smokers.

Table 2

Quit Rates for Blue-Collar Employees 12-Month Follow-Up

Category Total Number of Employees Number of Nonsmokers Percent Who Quit
All employees who ordered kits (includes 32 who couldn't be contacted and 9 who didn't use the materials)
94
21
22%*
Employees able to be contacted at follow-up
62
21
34%
Employees contacted at follow-up who actually used kits (94 minus 32 who were unable to be reached)
53
21
40%

*Assumes all employees who could not be contacted are smokers.

Reflection
Many participants attributed their success to the easy-to-follow, step-by-step program approach of the booklets and cassette tapes. In addition, the accessibility to a smoking cessation counselor was cited by participants as contributing to their success. Participation in the program was also quite high as it was easy for employees to obtain the materials. They simply called a toll-free number to have the self-help kit sent to their office or home. An additional benefit of the self-help program was that 26 spouses of smoking employees also reported quitting smoking because they shared the program materials.

At the time of the research study, only Nicorette gum was available as a pharmacological adjunct to the program. 10 Nicotine patches have now been approved by the Food and Drug Administration (FDA), and they will be offered as an option. Since many patients prefer the patches over the gum, it is anticipated they will enhance the program's efficacy. In addition, the participant booklets have been simplified. They are now written at a sixth-grade reading level, with bigger print, more white space, and culturally sensitive illustrations. This will help meet the needs of employees from diverse socioeconomic backgrounds. In addition, a pro-active telephone counseling component has been added to the program. Instead of just waiting for calls to come in, telephone counselors take the initiative and contact participants on a periodic basis to see how they are doing and offer support.

References

  1. U.S. Department of Health and Human Services. Strategies to Control Tobacco Use in the United States. Washington, D.C.: U.S. Department of Health and Human Services Publication Health Service, National Institutes of Health, National Cancer Institute, NIH Publication #92-3316, 1991.
  2. Cohen, S., Lichtenstein, E., Prochaska, J., Rossi, J., Gritz, E., Carr, C., Orleans, C., Schoenbach, V., Biener, L., Abrams, D., DiClemente, C., Curry, S., Marlatt, G., Cummings, K., Emont, S., Giovano, G., Ossip-Klein, D. Debunking myths about self-quitting: Evidence from 10 prospective studies of persons quitting smoking by themselves. American Psychologist, 1989; 44:1355-1365.
  3. Davis, A., Faust, R.,Ordenlich, M. Self-help smoking cessation and maintenance programs: A comparative study with 12-month follow-up by the American Lung Association. American Journal of Public Health, 1984; 74:1212-1217.
  4. Powell, D. Guided Self-Help Smokeless .Farmington Hills, Michigan: American Institute for Preventive Medicine Publishing Company, 1992.
  5. Powell, D. The warm pheasant approach and other prescriptions to help smokers quit. Primary Care and Cancer,1984; 4(6):80.
  6. Powell, D. A ten point practical program to help your smokers quit, Your Patient and Cancer, 1982; 2 (11):87-100.
  7. Cohen, S., Lichtenstein, E., Prochaska, J., Rossi, J., Gritz, E., Carr, C., Orleans, C., Schoenbach, V., Biener, L., Abrams, D., DiClemente, C., Curry, S., Marlatt, G., Cummings, K., Emont, S., Giovano, G., Ossip-Klein, D. Debunking myths about self-quitting: Evidence from 10 prospective studies of persons quitting smoking by themselves. American Psychologist, 1989; 44:1355-1365.
  8. Davis, A., Faust, R., Ordenlich, M. Self-help smoking cessation and maintenance programs: A comparative study with 12-month follow-up by the American Lung Association. American Journal of Public Health, 1984; 74:1212-1217.
  9. U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, DHHS Publication No. (CDC) 89-8411, 1989.
  10. Powell, D. On the use of nicotine gum Primary Care and Cancer, 1984; 4(7):23.
   

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