Elsevier

Addictive Behaviors

Volume 32, Issue 7, July 2007, Pages 1486-1493
Addictive Behaviors

Short communication
Long term success of short smoking cessation seminars supported by occupational health care

https://doi.org/10.1016/j.addbeh.2006.10.002Get rights and content

Abstract

The objective of this longitudinal (3 year) study was to determine predictors of abstinence in 515 employees of a steel plant (28% female, age 18–67 years) after participation in Allen Carr seminars (intensive group counselling in a single session of 6 h). Answers given in computer aided phone interviews were analysed by stepwise and Cox regression. Of 510 responding persons 262 (51.4%) reported continuing abstinence. In a random sample of 61 respondents cotinine concentration in urine was measured, showing high agreement with smoking history. Social support increased abstinence, which was more persistent in males and office workers. Also in female participants the non-smoking spouse was a significant predictor for abstinence while a higher body weight predicted relapse. Relapsed female smokers did not show a sustainable reduction of cigarette consumption. Compared to cessation clinics higher population coverage would be achievable by workplace seminars. Every second smoker motivated to participate seems to be able to quit even without medication and to stay abstinent. Especially in females these seminars should be followed by physical exercise and continued support of gender specific occupational health care.

Introduction

Since cessation rates in the general population have been reported to increase with the introduction of smoke-free workplaces (Burns et al., 2000, Fichtenberg and Glantz, 2002) many countries added workplace interventions to the priorities of tobacco control. Appropriate legislation was still missing when this study was performed in the largest steel company of Austria, which has a long tradition of preventive occupational medicine and decided already in 1999 to offer free seminars for smoking cessation to its workforce, using the services of Easyway® and the method of Carr, 1991, Carr, 1998, Carr, 2002. The aim of this study was to analyse the determinants for successful quitting (Fergusson et al., 2003) over a longer period of time and in a less heterogeneous occupational setting than the only study having evaluated such seminars before (Hutter, Moshammer, & Neuberger, 2006), which are used for smoking cessation at the workplace in many European countries.

Recent reviews concluded that there is not enough evidence yet to know whether group therapy is as effective as individual therapy (Lancaster & Stead, 2005) and that workplace programs for smoking cessation increase cessation in persons already motivated (Smedslund, Fisher, Boles, & Lichtenstein, 2004) and reduce the number of cigarettes smoked during the workday only, with conflicting evidence about whether they reduce overall cigarette consumption by smokers (Moher, Hey, & Lancaster, 2005). These conclusions seem to be based on studies mainly focused on pharmacotherapy. Both population studies (Ferguson, Bauld, Chesterman, & Judge, 2005) and clinical trials (Lancaster & Stead, 2005) using pharmacotherapy reported 1-year abstinence rates around 15% only. In one study the combination of nicotine and bupropion reached success rates of 35.5% compared to placebo (Jorenby et al., 1999), but with counselling sessions of 15 min or less the motivational part did not seem to be of primary importance and was not evaluated separately.

Section snippets

Participants and methods

The method of intervention (intensive group counselling in a single session of 6 h) has been described previously (Hutter et al., 2006): The trainer tells the participants to keep smoking while they listen to him so they can analyse why they do it. He makes the smoker discover that most cigarettes he is not smoking for enjoyment but because of addiction. Instead of going “cold turkey” and feeling deprived, the smoker should feel that he is doing something positive and looking forward to a great

Results

In random samples of 30 smokers and 31 non-smokers according to history the agreement with results from urinary cotinine concentrations was high: The Kappa was 0.9 with a cut-off at 600 ng/ml. Reported number of cigarettes was correlated significantly with urinary cotinine concentrations (r = 0.84). Urinary cotinine concentrations in 5 persons reporting relapse to smoking were found to be below 600 ng/ml, while in 5 persons reporting continuing abstinence they were found above this cut-off.

Discussion

Self selection of highly motivated persons has to be considered as a possible cause for unusually high success rates, however, seminars at the workplace should suffer less from this selection bias than studies on persons seeking medical aid, and they have the advantage of addressing smokers in early motivational stages (Pisinger, Vestbo, Borch-Johnsen, Thomsen, & Jorgensen, 2005), who otherwise would not have consulted a doctor. Unfortunately it was not possible to interview a control group of

Acknowledgements

Both authors declare that they are and have been employed by a medical university, which will not gain or lose financially from the results of this study. They acknowledge support in data collection from H. Csillag, A. Feuerstein, A. Herbst (occupational physicians of voestalpine, guarantor: H. Csillag) and a grant given by the Austrian Society for Occupational Medicine.

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