Vol. 147 No. 3738 (2017)
Smoking cessation in workplace settings: quit rates and determinants in a group behaviour therapy programme
- Yann Hausherr
- Carlos Quinto
- Leticia Grize
- Christian Schindler
- Nicole Probst-Hensch
To capitalise on the opportunities that the smoking ban legislation in Switzerland offers for the prevention of tobacco-related diseases, a smoking cessation programme in a workplace setting was developed and implemented in companies across the language and cultural regions of Switzerland. Our goal was to identify factors associated with relapse into smoking that may be overcome during training sessions or that should be considered for the optimisation of future interventions.
Between 2006 and 2012, 1287 smokers aged 16 to 68 years voluntarily attended smoking cessation training at their workplace. The intervention was based on a cognitive behavioural group therapy combined with individual proactive telephone counselling. The evaluation consisted of three anonymised questionnaires (pre- and postintervention, and 12-month follow-up). In this prospective cohort study, we investigated the association of smoking quit rates with training and participant characteristics, including withdrawal symptoms, by use of multilevel logistic regression analysis with a random intercept for training courses.
The self-reported abstinence rate was 72.4% at the end of the training, and 18.6% 1 year later. The risk of relapse during the training was positively associated with the number of years and daily cigarettes smoked, and negatively with increased appetite, sleeping troubles and satisfaction with learned techniques. Failed abstinence within the first year was associated with younger age, higher numbers of daily smoked cigarettes and unsuccessful recent quit attempts.
Our evaluation suggests that younger and more addicted smokers attending smoking cessation trainings may need additional support to achieve long lasting abstinence rates. Offering smoking cessation training in a workplace setting can achieve reasonable long-term quit rates, but a subset of employees needs additional support at the group or personal level.
Group behaviour therapy could be an effective method to achieve long-term smoking abstinence. The workplace is an important setting to reach and encourage a large number of smokers to participate in a smoking cessation programme, but only few studies investigated its potential. The findings of this study of a modern real-life workplace-based smoking cessation programme endorse the effectiveness and viability of cognitive behavioural group therapy. This group-level intervention at the workplace may be insufficient for young and heavy smokers, as well as women with increased appetite after cessation, who potentially benefit from re-intervention and additional individual level counselling.
- Gmel G, Kuendig H, Notari L, Gmel C, Flury R. Suchtmonitoring Schweiz - Konsum von Tabak in der Schweiz im Jahr 2012. Addiction Monitoring in Switzerland. 2013.
- Junker C. Smoking-attributable mortality in Switzerland. Estimation for the years 1995 to 2007. Federal Statistical Office. 2009.
- Wieser S, Kauer L, Schmidhauser S, et al. Synthesis report – Economic evaluation of prevention measures in Switzerland. Federal Office of Public Health. 2009.
- Wu J, Sin DD. Improved patient outcome with smoking cessation: when is it too late? Int J Chron Obstruct Pulmon Dis. 2011;6:259–67.
- Wenig JR, Erfurt L, Kröger CB, Nowak D. Smoking cessation in groups--who benefits in the long term? Health Educ Res. 2013;28(5):869–78. doi:.https://doi.org/10.1093/her/cyt086
- Song F, Huttunen-Lenz M, Holland R. Effectiveness of complex psycho-educational interventions for smoking relapse prevention: an exploratory meta-analysis. J Public Health (Oxf). 2010;32(3):350–9. doi:.https://doi.org/10.1093/pubmed/fdp109
- Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T ; Agency for Health Care Policy and Research. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. JAMA. 1997;278(21):1759–66. doi:.https://doi.org/10.1001/jama.1997.03550210057039
- Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev. 2005;(2):CD001007.
- Hajek P. Current issues in behavioral and pharmacological approaches to smoking cessation. Addict Behav. 1996;21(6):699–707. doi:.https://doi.org/10.1016/0306-4603(96)00029-9
- Cahill K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev. 2014;2(2):CD003440.
- WHO Framework Convention on Tobacco Control. World Health Organization. 2003. http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf.
- Nichtrauchen kann man lernen. Unternehmen rauchfrei, Lungen Liga. 2012. http://www.unternehmenrauchfrei.ch/fileadmin/user_upload/PDF/Nichtrauchen_kann_man_lernen.pdf.
- Gradl S, Kroeger CB, Floeter S, Piontek D. Effectiveness of a modern smoking cessation programme based on international guidelines. Verhaltensther Verhaltensmed. 2009;30(2):169–85.
- Durham AD, Diethelm P, Cornuz J. Why did Swiss citizens refuse a comprehensive second-hand smoke ban? Swiss Med Wkly. 2014;144:w13983.
- Osler M, Prescott E. Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults. Tob Control. 1998;7(3):262–7. doi:.https://doi.org/10.1136/tc.7.3.262
- Monsó E, Campbell J, Tønnesen P, Gustavsson G, Morera J. Sociodemographic predictors of success in smoking intervention. Tob Control. 2001;10(2):165–9. doi:.https://doi.org/10.1136/tc.10.2.165
- McKee SA, O’Malley SS, Salovey P, Krishnan-Sarin S, Mazure CM. Perceived risks and benefits of smoking cessation: gender-specific predictors of motivation and treatment outcome. Addict Behav. 2005;30(3):423–35. doi:.https://doi.org/10.1016/j.addbeh.2004.05.027
- Borrelli B, Hogan JW, Bock B, Pinto B, Roberts M, Marcus B. Predictors of quitting and dropout among women in a clinic-based smoking cessation program. Psychol Addict Behav. 2002;16(1):22–7. doi:.https://doi.org/10.1037/0893-164X.16.1.22
- Stolz D, Scherr A, Seiffert B, Kuster M, Meyer A, Fagerström KO, et al. Predictors of success for smoking cessation at the workplace: a longitudinal study. Respiration. 2014;87(1):18–25. doi:.https://doi.org/10.1159/000346646
- Matheny KB, Weatherman KE. Predictors of smoking cessation and maintenance. J Clin Psychol. 1998;54(2):223–35. doi:.https://doi.org/10.1002/(SICI)1097-4679(199802)54:2<223::AID-JCLP12>3.0.CO;2-L
- Frikart M, Etienne S, Cornuz J, Zellweger J-P. Five-day plan for smoking cessation using group behaviour therapy. Swiss Med Wkly. 2003;133(3-4):39–43. Available from: https://smw.ch/en/article/doi/smw.2003.10068/
- Meamar R, Etedali F, Sereshti N, Sabour E, Samani MD, Ardakani MR, et al. Predictors of smoking cessation and duration: implication for smoking prevention. Int J Prev Med. 2013;4(Suppl 2):S194–200.
- Boardman T, Catley D, Mayo MS, Ahluwalia JS. Self-efficacy and motivation to quit during participation in a smoking cessation program. Int J Behav Med. 2005;12(4):266–72. doi:.https://doi.org/10.1207/s15327558ijbm1204_7
- Garvey AJ, Bliss RE, Hitchcock JL, Heinold JW, Rosner B. Predictors of smoking relapse among self-quitters: a report from the Normative Aging Study. Addict Behav. 1992;17(4):367–77. doi:.https://doi.org/10.1016/0306-4603(92)90042-T
- Fisher EB, Jr, Bishop DB, Levitt-Gilmour T, Cappello MT, Ashenberg ZS, Newman E. Social support in worksite smoking cessation: qualitative analysis of the EASE project. Am J Health Promot. 1994;9(1):39–47, 75. doi:.https://doi.org/10.4278/0890-1171-9.1.39
- Cahill K, Perera R. Competitions and incentives for smoking cessation. Cochrane Database Syst Rev. 2011;(4):CD004307.
- Alterman AI, Gariti P, Mulvaney F. Short- and long-term smoking cessation for three levels of intensity of behavioral treatment. Psychol Addict Behav. 2001;15(3):261–4. doi:.https://doi.org/10.1037/0893-164X.15.3.261
- Hendricks PS, Delucchi KL, Benowitz NL, Hall SM. Clinical significance of early smoking withdrawal effects and their relationships with nicotine metabolism: preliminary results from a pilot study. Nicotine Tob Res. 2014;16(5):615–20. doi:.https://doi.org/10.1093/ntr/ntt204
- Froom P, Melamed S, Benbassat J. Smoking cessation and weight gain. J Fam Pract. 1998;46(6):460–4.
- Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;5(5):CD009329.
- Abrams DB. The Tobacco Dependence Treatment Handbook: A Guide to Best Practices. New York: Guilford Press; 2003.
- Linehan M. Cognitive Behavioral Therapy of Borderline Personality Disorder. New York: Guilford Press; 1993.
- Hayes SC. Get Out of Your Mind & Into Your Life: The New Acceptance & Commitment Therapy. Oakland: New Harbinger Publications; 2005.
- West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005;100(3):299–303. doi:.https://doi.org/10.1111/j.1360-0443.2004.00995.x
- Fagerstrom KO, Schneider NG. Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. J Behav Med. 1989;12(2):159–82. doi:.https://doi.org/10.1007/BF00846549
- Hughes JR, Hatsukami D. Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatry. 1986;43(3):289–94. doi:.https://doi.org/10.1001/archpsyc.1986.01800030107013
- Fiore MC, Jaen CR, Baker TB, et al., Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med. 2008;35(2):158–76. doi:.https://doi.org/10.1016/j.amepre.2008.04.009