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Littman D, Sherman SE, Troxel AB, Stevens ER. Behavioral Economics and Tobacco Control: Current Practices and Future Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8174. [PMID: 35805833 PMCID: PMC9266334 DOI: 10.3390/ijerph19138174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
Despite considerable progress, smoking remains the leading preventable cause of death in the United States. To address the considerable health and economic burden of tobacco use, the development of improved tobacco control and treatment interventions is critical. By combining elements of economics and psychology, behavioral economics provides a framework for novel solutions to treat smokers who have failed to quit with traditional smoking cessation interventions. The full range of behavioral economic principles, however, have not been widely utilized in the realm of tobacco control and treatment. Given the need for improved tobacco control and treatment, the limited use of other behavioral economic principles represents a substantial missed opportunity. For this reason, we sought to describe the principles of behavioral economics as they relate to tobacco control, highlight potential gaps in the behavioral economics tobacco research literature, and provide examples of potential interventions that use each principle.
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Affiliation(s)
- Dalia Littman
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
| | - Scott E. Sherman
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY 10010, USA
| | - Andrea B. Troxel
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
| | - Elizabeth R. Stevens
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
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Notley C, Gentry S, Livingstone‐Banks J, Bauld L, Perera R, Hartmann‐Boyce J. Incentives for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD004307. [PMID: 31313293 PMCID: PMC6635501 DOI: 10.1002/14651858.cd004307.pub6] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes. OBJECTIVES To determine the long-term effect of incentives and contingency management programmes for smoking cessation. SEARCH METHODS For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018. SELECTION CRITERIA We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community, work-, clinic- or institution-based), and also studies in pregnant smokers. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenzel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations. MAIN RESULTS Thirty-three mixed-population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty-four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long-term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self-deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self-deposits.We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow-up (up to 24 weeks post-partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. AUTHORS' CONCLUSIONS Overall there is high-certainty evidence that incentives improve smoking cessation rates at long-term follow-up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow-up occurs after the withdrawal of incentives. There is also moderate-certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post-partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations.
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Affiliation(s)
- Caitlin Notley
- University of East AngliaNorwich Medical SchoolNorwichUK
| | - Sarah Gentry
- University of East AngliaNorwich Medical SchoolNorwichUK
| | | | - Linda Bauld
- University of EdinburghUsher Institute, College of Medicine and Veterinary MedicineEdinburghUK
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
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Wilkins DJ, Livingstone AG, Levine M. All click, no action? Online action, efficacy perceptions, and prior experience combine to affect future collective action. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2018.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gurmankin AD, Helweg-Larsen M, Armstrong K, Kimmel SE, Volpp KGM. Comparing the Standard Rating Scale and the Magnifier Scale for Assessing Risk Perceptions. Med Decis Making 2016; 25:560-70. [PMID: 16160211 DOI: 10.1177/0272989x05280560] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective. A new risk perception rating scale (“magnifier scale”) was recently developed to reduce elevated perceptions of low-probability health events, but little is known about its performance. The authors tested whether the magnifier scale lowers risk perceptions for low-probability (in 0%–1% magnifying glass section of scale) but not high-probability (>1%) events compared to a standard rating scale (SRS). Method. In studies 1 (n = 463) and 2 (n = 105), undergraduates completed a survey assessing risk perceptions of high- and low-probability events in a randomized 2X 2 design: in study 1 using the magnifier scale or SRS, numeric risk information provided or not, and in study 2 using the magnifier scale or SRS, high- or low-probability event. In study 3, hypertension patients at the Philadelphia Veterans Affairs hospital completed a similar survey (n = 222) assessing risk perceptions of 2 self-relevant high-probability events—heart attack and stroke—with the magnifier scale or the SRS. Results. In study 1, when no risk information was provided, risk perceptions for both high- and low-probability events were significantly lower (P < 0.0001) when using the magnifier scale compared to the SRS, but risk perceptions were no different by scale when risk information was provided (interaction term: P = 0.003). In studies 2 and 3, risk perceptions for the high-probability events were significantly lower using the magnifier scale than the SRS (P = 0.015 and P = 0.014, respectively). Conclusions. The magnifier scale lowered risk perceptions but did so for low- and high-probability events, suggesting that the magnifier scale should not be used for assessments of risk perceptions for high-probability events.
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Affiliation(s)
- Andrea D Gurmankin
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.
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Shea S, Basch CE, Zybert P. Correlates of Internists' Practices in Caring for Patients with Elevated Serum Cholesterol. Am J Health Promot 2016; 4:421-8. [DOI: 10.4278/0890-1171-4.6.421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the relationship between internists personal health practices, health beliefs, and demographic characteristics and their reported practices in caring for patients with elevated serum cholesterol. A questionnaire was mailed to 271 internists (181 respondents) on the medical staff of an urban university hospital. Perceived ability to provide dietary counseling was consistently associated with interventions offered by the internists themselves, including education, counseling, and use of lipid-lowering drugs and with defining elevation of serum cholesterol at a lower value. It was not associated with referral to the dietitian or the Lipid Clinic. There were only weak and inconsistent associations between physician personal health practices, including diet and having a personal cholesterol goal, and any of the physician-reported professional practices examined. These findings strengthen the hypothesis that there is a relationship between physicians' perceived competence and their use of diet counseling and lipid-lowering drugs.
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Emont SL, Cummings KM. Organizational Factors Affecting Participation in a Smoking Cessation Program and Abstinence among 68 Auto Dealerships. Am J Health Promot 2016; 5:107-14. [DOI: 10.4278/0890-1171-5.2.107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of organizational factors on participation rates in a smoking cessation clinic and on one-year quit rates were examined among 68 private sector businesses. Free smoking cessation programs were offered to all smoking employees. Smokers (n = 844) were contacted to determine changes in smoking behavior; managers (n = 68) were also contacted to assess changes in smoking policy implementation over the past year. The participation rate in the clinic was 6.6 percent. Overall, 14.3 percent of smokers reported abstaining from cigarettes for at least one month prior to the one-year follow-up survey. Organization factors predicting clinic participation included having health promotion programs, increased motivation to stop smoking, and greater length of employment. Factors predicting cessation at one year included greater clinic participation rates, larger worksite size, a greater awareness of smoking restrictions, and agreement that passive smoking was dangerous to ones health. The only factor to significantly increase both participation and cessation rates was the presence of smoking policies. Employee, manager, and organizational characteristics can exert independent effects on behavior. Therefore, interventions should be targeted at each of these levels to maximize smoking-related behavior change.
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Cummings KM, Kelly J, Sciandra R, DeLoughry T, Francois F. Impact of a Community-Wide Stop Smoking Contest. Am J Health Promot 2016; 4:429-34. [DOI: 10.4278/0890-1171-4.6.429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper presents the results oj a jollow-up evaluation conducted to assess the impact oj a community-wide stop smoking contest conducted in Buffalo, lVew York in January 1988. The contest challenged smokers to make a pledge to quit jar 30 days to have a chance to win $1,000 cash, a vacation trip, or other prizes. Finalists were randomly selected and chemically tested to verify abstinence. Telephone jollow-up interviews were conducted on a sample oj 411 contestants six weeks and eight months ajter the quit date. A total oj 2,565 smokers enrolled in the contest. Compared to smokers in the general population, contestants were more likely to be jemale, white, under age 40, and smoke 25 or more cigarettes daily. Over 90 percent oj contestants attempted to stop smoking, 51 percent quit jar the 3D-day contest period, and 32 percent were not smoking ajter eight months.
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Abstract
BACKGROUND Material or financial incentives are widely used in an attempt to precipitate or reinforce behaviour change, including smoking cessation. They operate in workplaces, in clinics and hospitals, and to a lesser extent within community programmes. In this third update of our review we now include trials conducted in pregnant women, to reflect the increasing activity and resources now targeting this high-risk group of smokers. OBJECTIVES To determine whether incentives and contingency management programmes lead to higher long-term quit rates. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. The most recent searches were in December 2014, although we also include two trials published in 2015. SELECTION CRITERIA We considered randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. We include studies in a mixed-population setting (e.g. community-, work-, institution-based), and also, for this update, trials in pregnant smokers. DATA COLLECTION AND ANALYSIS One author (KC) extracted data and a second (JH-B) checked them. We contacted study authors for additional data where necessary. The main outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up, and at least six months from the start of the intervention. In the trials of pregnant smokers abstinence was measured at the longest follow-up, and at least to the end of the pregnancy. MAIN RESULTS Twenty-one mixed-population studies met our inclusion criteria, covering more than 8400 participants. Ten studies were set in clinics or health centres, one in Thai villages served by community health workers, two in academic institutions, and the rest in worksites. All but six of the trials were run in the USA. The incentives included lottery tickets or prize draws, cash payments, vouchers for goods and groceries, and in six trials the recovery of money deposited by those taking part. The odds ratio (OR) for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.42 (95% confidence interval (CI) 1.19 to 1.69; 17 trials, [20 comparisons], 7715 participants). Only three studies demonstrated significantly higher quit rates for the incentives group than for the control group at or beyond the six-month assessment: One five-arm USA trial compared rewards- and deposit-based interventions at individual and group level, with incentives available up to USD 800 per quitter, and demonstrated a quit rate in the rewards groups of 8.1% at 12 months, compared with 4.7% in the deposits groups. A direct comparison between the rewards-based and the deposit-based groups found a benefit for the rewards arms, with an OR at 12 months of 1.76 (95% CI 1.22 to 2.53; 2070 participants). Although more people in this trial accepted the rewards programmes than the deposit programmes, the proportion of quitters in each group favoured the deposit-refund programme. Another USA study rewarded both participation and quitting up to USD 750, and achieved sustained quit rates of 9.4% in the incentives group compared with 3.6% for the controls. A deposit-refund trial in Thailand also achieved significantly higher quit rates in the intervention group (44.2%) compared with the control group (18.8%), but uptake was relatively low, at 10.5%. In the remaining trials, there was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that contingent rewards enhanced success rates over fixed payment schedules. We rated the overall quality of the older studies as low, but with later trials (post-2000) more likely to meet current standards of methodology and reporting.Eight of nine trials with usable data in pregnant smokers (seven conducted in the USA and one in the UK) delivered an adjusted OR at longest follow-up (up to 24 weeks post-partum) of 3.60 (95% CI 2.39 to 5.43; 1295 participants, moderate-quality studies) in favour of incentives. Three of the trials demonstrated a clear benefit for contingent rewards; one delivered monthly vouchers to confirmed quitters and to their designated 'significant other supporter', achieving a quit rate in the intervention group of 21.4% at two months post-partum, compared with 5.9% among the controls. Another trial offered a scaled programme of rewards for the percentage of smoking reduction achieved over the course of the 12-week intervention, and achieved an intervention quit rate of 31% at six weeks post-partum, compared with no quitters in the control group. The largest (UK-based) trial provided intervention quitters with up to GBP 400-worth of vouchers, and achieved a quit rate of 15.4% at longest follow-up, compared to the control quit rate of 4%. Four trials confirmed that payments made to reward a successful quit attempt (i.e. contingent), compared to fixed payments for attending the antenatal appointment (non-contingent), resulted in higher quit rates. Front-loading of rewards to counteract early withdrawal symptoms made little difference to quit rates. AUTHORS' CONCLUSIONS Incentives appear to boost cessation rates while they are in place. The two trials recruiting from work sites that achieved sustained success rates beyond the reward schedule concentrated their resources into substantial cash payments for abstinence. Such an approach may only be feasible where independently-funded smoking cessation programmes are already available, and within a relatively affluent and educated population. Deposit-refund trials can suffer from relatively low rates of uptake, but those who do sign up and contribute their own money may achieve higher quit rates than reward-only participants. Incentive schemes conducted among pregnant smokers improved the cessation rates, both at the end-of-pregnancy and post-partum assessments. Current and future research might continue to explore the scale, loading and longevity of possible cash or voucher reward schedules, within a variety of smoking populations.
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Affiliation(s)
- Kate Cahill
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
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Abstract
BACKGROUND Background Material or financial incentives may be used in an attempt to reinforce behaviour change, including smoking cessation. They have been widely used in workplace smoking cessation programmes, and to a lesser extent within community programmes. Public health initiatives in the UK are currently planning to deploy incentive schemes to change unhealthy behaviours. Quit and Win contests are the subject of a companion review. OBJECTIVES To determine whether competitions and incentives lead to higher long-term quit rates. We also set out to examine the relationship between incentives and participation rates. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. Search terms included incentive*, competition*, contest*, reward*, prize*, contingent payment*, deposit contract*. The most recent searches were in November 2010. SELECTION CRITERIA We considered randomized controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. DATA COLLECTION AND ANALYSIS Data were extracted by one author (KC) and checked by the second (RP). We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Where possible we performed meta-analysis using a generic inverse variance model, grouped by timed endpoints, but not pooled across the subgroups. MAIN RESULTS Nineteen studies met our inclusion criteria, covering >4500 participants. Only one study, the largest in our review and covering 878 smokers, demonstrated significantly higher quit rates for the incentives group than for the control group beyond the six-month assessment. This trial referred its participants to local smoking cessation services, and offered substantial cash payments (up to US$750) for prolonged abstinence. In the remaining trials, there was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that contingent rewards enhanced success rates over fixed payment schedules. There is some evidence that recruitment rates can be improved by rewarding participation, which may be expected to deliver higher absolute numbers of successful quitters. Cost effectiveness analysis was not appropriate to this review, since the efficacy of most of the interventions was not demonstrated. AUTHORS' CONCLUSIONS With the exception of one recent trial, incentives and competitions have not been shown to enhance long-term cessation rates. Early success tended to dissipate when the rewards were no longer offered. Rewarding participation and compliance in contests and cessation programmes may have potential to deliver higher absolute numbers of quitters. The one trial that achieved sustained success rates beyond the reward schedule concentrated its resources into substantial cash payments for abstinence rather than into running its own smoking cessation programme. Such an approach may only be feasible where independently-funded smoking cessation programmes are already available. Future research might explore the scale and longevity of possible cash reward schedules, within a variety of smoking populations.
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Affiliation(s)
- Kate Cahill
- Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford, UK, OX3 7LF
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Worksite-based incentives and competitions to reduce tobacco use. A systematic review. Am J Prev Med 2010; 38:S263-74. [PMID: 20117611 DOI: 10.1016/j.amepre.2009.10.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 08/12/2009] [Accepted: 10/27/2009] [Indexed: 11/23/2022]
Abstract
The Guide to Community Preventive Service (Community Guide) methods for systematic reviews were used to evaluate the evidence of effectiveness of worksite-based incentives and competitions to reduce tobacco use among workers. These interventions offer a reward to individuals or to teams of individuals on the basis of participation or success in a specified smoking behavior change (such as abstaining from tobacco use for a period of time). The review team identified a total of 26 published studies, 14 of which met study design and quality of execution criteria for inclusion in the final assessment. Only one study, which did not qualify for review, evaluated the use of incentives when implemented alone. All of the 14 qualifying studies evaluated incentives and competitions when implemented in combination with a variety of additional interventions, such as client education, smoking cessation groups, and telephone cessation support. Of the qualifying studies, 13 evaluated differences in tobacco-use cessation among intervention participants, with a median follow-up period of 12 months. The median change in self-reported tobacco-use cessation was an increase of 4.4 percentage points (a median relative percentage improvement of 67%). The present evidence is insufficient to determine the effectiveness of incentives or competitions, when implemented alone, to reduce tobacco use. However, the qualifying studies provide strong evidence, according to Community Guide rules, that worksite-based incentives and competitions in combination with additional interventions are effective in increasing the number of workers who quit using tobacco. In addition, these multicomponent interventions have the potential to generate positive economic returns over investment when the averted costs of tobacco-associated illnesses are considered. A concurrent systematic review identified four studies with economic evidence. Two of these studies provided evidence of net cost savings to employers when program costs are adjusted for averted healthcare expenses and productivity losses, based on referenced secondary estimates.
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Abstract
BACKGROUND Material or financial incentives may be used in an attempt to reinforce behaviour change, including smoking cessation. They have been widely used in workplace smoking cessation programmes, and to a lesser extent within community programmes. Quit and Win contests are the subject of a companion review. OBJECTIVES To determine whether competitions and incentives lead to higher long-term quit rates. We also set out to examine the relationship between incentives and participation rates. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. Search terms included incentive*, competition*, contest*, reward*, prize*, contingent payment*, deposit contract*. The most recent searches were in December 2007. SELECTION CRITERIA We considered randomized controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. DATA COLLECTION AND ANALYSIS Data were extracted by one author and checked by the second. We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Where possible we performed meta-analysis using a generic inverse variance model, grouped by timed endpoints, but not pooled across the subgroups. MAIN RESULTS Seventeen studies met our inclusion criteria. None of the studies demonstrated significantly higher quit rates for the incentives group than for the control group beyond the six-month assessment. There was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that different types of incentives were more or less effective. There is some evidence that although cessation rates have not been shown to differ significantly, recruitment rates can be improved by rewarding participation, which may be expected to deliver higher absolute numbers of successful quitters. Cost effectiveness analysis is not appropriate to this review, since the efficacy of the intervention has not been demonstrated. AUTHORS' CONCLUSIONS Incentives and competitions have not been shown to enhance long-term cessation rates, with early success tending to dissipate when the rewards are no longer offered. Rewarding participation and compliance in contests and cessation programmes may have more potential to deliver higher absolute numbers of quitters.
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Affiliation(s)
- Kate Cahill
- Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford, UK, OX3 7LF.
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Yzer MC, van den Putte B. Understanding smoking cessation: the role of smokers' quit history. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2006; 20:356-61. [PMID: 16938076 DOI: 10.1037/0893-164x.20.3.356] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many studies have found smokers' quit history to correlate with quitting smoking, but little is known about the psychological processes explaining this relationship. This study uses the integrative model of behavioral prediction to examine how quit history affects quit intention. Data from 3,428 Dutch smokers demonstrate that quit history affects (a) beliefs about quitting and (b) the degree to which self-efficacy predicts quit intention. It seems that a relatively unsuccessful history of prior quit attempts reduces self-efficacy over quitting and strengthens the relationship of self-efficacy with the intention to quit. The results are used to call for more process-oriented research in order to advance our understanding of the relationship between quit history and quit intention.
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Affiliation(s)
- Marco C Yzer
- School of Journalism and Mass Communication, University of Minnesota, 206 Church Street SE, Minneapolis, MN 55455, USA.
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Mak YW, Loke AY, Lam TH, Abdullah AS. Predictors of the participation of smoking parents in a proactive telephone-based smoking cessation program. Addict Behav 2006; 31:1731-43. [PMID: 16448782 DOI: 10.1016/j.addbeh.2005.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Revised: 11/08/2005] [Accepted: 12/19/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to identify the predictors of participation by smoking parents in a proactive telephone-based smoking cessation program. METHODS The smoking parents of young children from a birth cohort were interviewed and invited to take part in a telephone-based smoking cessation program. The characteristics of the parents and the predictors of participation were analyzed by chi-square test and by logistic regression. RESULTS A total of 952 (82.9%) out of the 1149 smoking parents who were interviewed agreed to participate in the smoking cessation program. The analysis showed that the predictors of participation in a pro-active smoking cessation program are being from a middle-income household, being currently employed, having recently had a medical consultation or been hospitalized, being at the stage of contemplating a change in behavior, and perceiving the importance of quitting smoking. CONCLUSIONS Recruitment approaches should be refined according to the identified factors to target those who might decline an invitation to participate in a smoking cessation program.
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Affiliation(s)
- Yim Wah Mak
- Department of Nursing Studies, The University of Hong Kong, Hong Kong, China.
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Gurmankin Levy A, Shea J, Williams SV, Quistberg A, Armstrong K. Measuring perceptions of breast cancer risk. Cancer Epidemiol Biomarkers Prev 2006; 15:1893-8. [PMID: 17035396 DOI: 10.1158/1055-9965.epi-05-0482] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Accurate measurement of people's risk perceptions is important for numerous bodies of research and in clinical practice, but there is no consensus about the best measure. OBJECTIVE This study evaluated three measures of women's breast cancer risk perception by assessing their psychometric and test characteristics. DESIGN A cross-sectional mailed survey to women from a primary care population asked participants to rate their chance of developing breast cancer in their lifetime on a 0% to 100% numerical scale and a verbal scale with five descriptive categories, and to compare their risk to others (seven categories). Six hundred three of 956 women returned the survey (63.1%), and we analyzed surveys from the 566 women without a self-reported personal history of breast or ovarian cancer. RESULTS Scores on the numeric, verbal, and comparative measures were correlated with each other (r > 0.50), worry (r > 0.51), the Gail estimate (r > 0.26), and family history (r > 0.25). The numerical scale had the strongest correlation with annual mammogram (r = 0.19), and its correlation with the Gail estimate was unassociated with participants' sociodemographics. The numerical and comparative measures had the highest sensitivity (0.89-0.90) and specificity (0.99) for identifying women with very high risk perception. The numerical and comparative scale also did well in identifying women with very low risk perception, although the numerical scale had the highest specificity (0.96), whereas the comparative scale had the highest sensitivity (0.89). CONCLUSION Different measures of women's perceptions about breast cancer risk have different strengths and weaknesses. Although the numerical measure did best overall, the optimal measure depends on the goals of the measure (i.e., avoidance of false positives or false negatives).
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Affiliation(s)
- Andrea Gurmankin Levy
- Center for Community Based Research, Dana-Farber Cancer Institute, 44 Binney Street, Smith 253, Boston, MA 02115, USA.
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Abstract
BACKGROUND Material or financial incentives may be used in an attempt to reinforce behaviour change, including smoking cessation. They have been widely used in workplace smoking cessation programmes, and to a lesser extent within community programmes. Quit and Win contests are the subject of a companion review. OBJECTIVES To determine whether competitions and incentives lead to higher long-term quit rates. We also set out to examine the relationship between incentives and participation rates. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE (January 1966 to September 2004), EMBASE (1980 to 2004/8), CINAHL (1982 to 2004/8) and PsycINFO (1872 to 2004/6). Search terms included incentive*, competition*, contest*, reward*, prize*, contingent payment*, deposit contract*. SELECTION CRITERIA We considered randomized controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. DATA COLLECTION AND ANALYSIS Data were extracted by one author and checked by the second. We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking for at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Where possible we performed meta-analysis using a generic inverse variance model, grouped by timed endpoints, but not pooled across the subgroups. MAIN RESULTS Fifteen studies met our inclusion criteria. None of the studies demonstrated significantly higher quit rates for the incentives group than for the control group beyond the six-month assessment. There was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that different types of incentives were more or less effective. There is some evidence that although cessation rates have not been shown to differ significantly, recruitment rates can be improved by rewarding participation, which may be expected to deliver higher absolute numbers of successful quitters. Cost effectiveness analysis is not appropriate to this review, since the efficacy of the intervention has not been demonstrated. AUTHORS' CONCLUSIONS Incentives and competitions do not appear to enhance long-term cessation rates, with early success tending to dissipate when the rewards are no longer offered. Rewarding participation and compliance in contests and cessation programmes may have more potential to deliver higher absolute numbers of quitters.
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Affiliation(s)
- K Hey
- Cochrane Tobacco Addiction Group, Department of Primary Health Care, Old Road Campus, Old Road, Headington, Oxford, UK, OX3 7LF.
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Sussman S, Earleywine M, Wills T, Cody C, Biglan T, Dent CW, Newcomb MD. The motivation, skills, and decision-making model of "drug abuse" prevention. Subst Use Misuse 2004; 39:1971-2016. [PMID: 15587955 DOI: 10.1081/ja-200034769] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This article summarizes the theoretical basis for targeted prevention programs as they apply to different high-risk groups. We explain the advantages and disadvantages of different definitions of risk and discuss strategies for preventing drug use related problems in high-risk youth. Productive prevention programs for many at-risk groups share similar components, including those that address motivation, skills, and decision making. We present key aspects of these three components and link them to theories in clinical psychology, social psychology, sociology, and chemical dependence treatment. Among a total of 29 promising targeted prevention programs, we describe examples of empirically evaluated, intensive interventions that have made a positive impact on the attitudes and behavior of multiple problem youth. Incorporating the perspectives of multiple disciplines appears essential for progress in drug abuse and other problem behavior prevention.
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Affiliation(s)
- Steve Sussman
- Departments of Preventive Medicine and Psychology, Institute for Prevention Research, University of Southern California, Alhambra, California 91803, USA.
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Abstract
This paper summarizes four major conceptions of motivation that have been applied to cigarette smoking cessation. These conceptions are the direction-energy, transtheoretical, intrinsic/extrinsic, and self-regulation models. Constituents of each of these models are suggested. Implications of these theories of motivation for an integrative model of smoking cessation are discussed.
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Affiliation(s)
- Elahe Nezami
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Alhambra, California 91803, USA
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Ahluwalia JS, Richter K, Mayo MS, Ahluwalia HK, Choi WS, Schmelzle KH, Resnicow K. African American smokers interested and eligible for a smoking cessation clinical trial: predictors of not returning for randomization. Ann Epidemiol 2002; 12:206-12. [PMID: 11897179 DOI: 10.1016/s1047-2797(01)00305-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Recruitment is often the rate-limiting step in conducting clinical trials among ethnic minorities. Little is known about participants who consent and enroll into a trial, but do not return for randomization. Why participants fail to return for randomization is largely unknown. METHODS We compared 287 enrolled African American smokers who did not return for randomization, to the 500 who returned and were randomized to participate in a clinical trial for smoking cessation in African Americans. Analyses were conducted to identify variables associated with not returning for randomization. RESULTS Univariate comparisons found the nonrandomized group to be significantly different from those randomized. Logistic regression showed younger age, less readiness to quit, having been proactively recruited, lacking a regular source of health care, believing that they will be smoking in 6 months, less church attendance, and a lower literacy level to be jointly related with not returning for randomization. CONCLUSIONS African American participants who did not return for randomization into a clinical trial were different from those who did. Better understanding of these factors may allow researchers to target recruitment efforts resulting in enhanced accrual in clinical trials and increased efficiency.
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Affiliation(s)
- Jasjit S Ahluwalia
- Department of Preventive Medicine, University of Kansas School of Medicine, Kansas City, KS 66160-7313, USA.
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De Vries H, Mudde AN, Dijkstra A, Willemsen MC. Differential beliefs, perceived social influences, and self-efficacy expectations among smokers in various motivational phases. Prev Med 1998; 27:681-9. [PMID: 9808799 DOI: 10.1006/pmed.1998.0344] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The ASE model, an integration of social psychological models, states that motivational phases and the transition from one phase to another can be predicted by behavioral determinants. The goal of the present study was to replicate the so-called O pattern that was found in earlier Dutch studies. METHODS In four cross-sectional studies (N = 918, N = 354, N = 225, N = 317), smokers filled in a questionnaire based on the ASE model, while the motivational phase question was based on the stage definitions from the Transtheoretical model. RESULTS Precontemplating smokers perceived fewer advantages of quitting than contemplators. Precontemplators encountered less support for quitting than contemplators. Contemplators reported lower self-efficacy expectations than those in preparation, while this group had lower self-efficacy expectations than respondents in action. Ex-smokers in maintenance reported fewer disadvantages of quitting than those in action. CONCLUSIONS Since changes in cognitive determinants are thought to mediate transitions in motivational phases, the results can be used to tailor health education messages to the needs of smokers in the various motivational phases. The results suggest that smokers in precontemplation would benefit most from information about the pros of quitting and from obtaining support for quitting. Smokers in contemplation and preparation may benefit most from self-efficacy-enhancing information.
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Affiliation(s)
- H De Vries
- Department of Health Education and Promotion, Maastricht University, Maastricht, 6200MD, The Netherlands
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Pohl JM, Martinelli A, Antonakos C. Predictors of participation in a smoking cessation intervention group among low-income women. Addict Behav 1998; 23:699-704. [PMID: 9768305 DOI: 10.1016/s0306-4603(98)00017-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The predictors of participation in a smoking cessation group among low-income women were examined. Fifty smokers were recruited from a Midwestern community primary care setting serving an uninsured, underinsured, and Medicaid population. Participants completed a questionnaire before the intervention, and eleven women chose to participate in the 6-week sessions. There were few differences between the control group (nonparticipants) and the intervention group. The intervention group had significantly higher intention-to-quit scores. Logistic regression analysis was used to predict group membership with age, self-efficacy, optimism, social support, nicotine dependence, intention-to-quit, and other smokers in the home as the predictor variables. The only two significant predictors of participation in the cessation intervention were self-efficacy and intention-to-quit smoking. The higher the intention-to-quit score and the lower the self-efficacy score (the belief that one can be successful in not smoking); the more likely these women were to participate in the group intervention. Results are discussed in terms of their clinical relevance as well as future research in the area.
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Affiliation(s)
- J M Pohl
- University of Michigan, School of Nursing, Ann Arbor 48109-0482, USA
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Maibach EW, Davis SW, Ter Maat J, Rivera N. Promoting cancer prevention and screening: the impact of the Cancer Information Service. Part 7. JOURNAL OF HEALTH COMMUNICATION 1998; 3 Suppl:97-108. [PMID: 10977273 DOI: 10.1080/108107398127283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cancer Information Service (CIS) inquiries about cancer prevention and screening are an important opportunity to educate callers about primary or secondary cancer prevention, facilitate their decision-making, and, where appropriate, encourage action. An evaluation was conducted to assess whether these callers' information needs are being satisfied and to determine if the information provided facilitates decisionmaking and subsequent risk reduction actions. A random sample of 2,489 callers was surveyed during a 5-week period, 3 to 6 weeks after their initial call to CIS; prevention or screening was stated as the main reason for calling by 331 respondents. A series of questions was asked regarding level of satisfaction with CIS's performance and how helpful the information provided was in terms of feeling more knowledgeable, making decisions, and taking action. The vast majority of respondents were satisfied with the information received, found it to be helpful, felt more knowledgeable as a result, and would call CIS again with subsequent questions. Although demand characteristics are a possible source of bias, nearly three-quarters of the respondents reported subsequently discussing the information provided with someone else, and almost half sought additional information recommended by CIS. Nearly two-thirds of primary prevention respondents and about half of secondary prevention respondents indicated that they had taken some risk-reducing action subsequent to their interaction with CIS. The CIS is effectively satisfying the information needs of prevention and screening callers; information it is providing is effectively facilitating decisionmaking and stimulating callers to take action.
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Affiliation(s)
- E W Maibach
- Cancer Information Service, Northern California Cancer Center, Union City, USA
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Glasgow RE, McCaul KD, Fisher KJ. Participation in worksite health promotion: a critique of the literature and recommendations for future practice. HEALTH EDUCATION QUARTERLY 1993; 20:391-408. [PMID: 8307762 DOI: 10.1177/109019819302000309] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
One of the major rationales for conducting health promotion/disease prevention activities at the worksite is the potential to reach a high percentage of employees, including many who would otherwise be unlikely to engage in preventive health behaviors. Most studies of worksite health promotion do not report participation data, but among those that do, definitions of participation and participation rates vary dramatically. In general, men and blue-collar employees appear less likely to participate, but little is known about other employee variables related to participation. There have been few studies of worksite characteristics associated with participation and even fewer experimental evaluations of interventions to increase participation. In this paper we review what is known about participation in worksite health promotion programs and recommend procedures for defining participation for different types of programs, for reporting determinants of participation, and for increasing participation. We conclude that participation is both an important process measure and an outcome that should be reported routinely. Participation data have important implications for generalizability of results, feasibility of interventions, and health outcomes.
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Mavis BE, Stachnik TJ, Gibson CA, Stöffelmayr BE. Issues related to participation in worksite health promotion: a preliminary study. Am J Health Promot 1992; 7:53-60. [PMID: 10146799 DOI: 10.4278/0890-1171-7.1.53] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to identify characteristics associated with participation in worksite-based health promotion activities. DESIGN Follow-up interviews were used to identify demographic, attitudinal, and behavioral differences among three employee groups. Reasons employees chose not to participate in health promotion activities were also explored. SETTING All respondents were employed at a large midwestern university and were eligible to participate in free onsite health fairs and health promotion programs. SUBJECTS A stratified random sample of 89 nonparticipants, health fair participants, and behavior change program participants was interviewed. MEASURES The interview was comprised of questions related to demographic information, personal health habits, physical activity, perceived health status, perceived self-efficacy, worksite norms, health promoting lifestyle factors, and knowledge about health promotion activities. RESULTS ANOVA and chi-squared comparisons revealed few group differences. Graduate students and employees with advanced degrees were most likely to take part in health fairs. Behavior change program participants were older, clerical-technical staff members, and women. Faculty members were least likely to participate. A lack of time was the most often cited reason for nonparticipation. CONCLUSIONS The study was retrospective and the analyses limited due to low statistical power. The results suggest that different groups of employees are attracted to different types of health promotion activities.
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Affiliation(s)
- B E Mavis
- Department of Psychiatry, Michigan State University, East Lansing
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Glasgow RE, Hollis JF, Pettigrew L, Foster L, Givi MJ, Morrisette G. Implementing a year-long, worksite-based incentive program for smoking cessation. Am J Health Promot 1991; 5:192-9. [PMID: 10148668 DOI: 10.4278/0890-1171-5.3.192] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There have been few reports of the process of implementing ongoing worksite health promotion programs. This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers. METHODS Issues discussed include: forming a partnership with organizations, design of the multicomponent incentive intervention, program promotion, maintaining participation, and the need to modify program components over time. RESULTS The program produced high participation rates (29% of smokers joined the program) and moderate cessation rates among participants (during the last half of the program, monthly cessation rates averaged 20%). There was marked variability across worksites on both participation and cessation, and qualitative features of organizations associated with outcome are discussed. DISCUSSION The importance of working with employee steering committees to tailor health promotion programs to fit the organization is discussed. The article concludes with recommendations for implementation of similar programs.
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Glynn TJ, Boyd GM, Gruman JC. Essential elements of self-help/minimal intervention strategies for smoking cessation. HEALTH EDUCATION QUARTERLY 1990; 17:329-45. [PMID: 2228634 DOI: 10.1177/109019819001700308] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two decades of research suggest that self-help/minimal intervention strategies for smoking cessation may be the preferred means by which smokers stop and can produce success rates approximating those of more formal programs, at lower cost and with greater access to relevant populations. In order to make the best possible use of these self-help/minimal intervention approaches, the National Cancer Institute (NCI) supported a series of randomized, controlled intervention trials and, in June of 1988, convened an Expert Advisory Panel to address the question "What are the essential elements of self-help/minimal intervention strategies for smoking cessation?". The panel's recommendations were that: (1) Intervention efforts should focus on increasing smokers' motivations to make serious quit attempts; (2) Delivery of programs be broadened to include all smokers; (3) Programs be targeted to stages of cessation and specific populations; (4) All programs include (a) elements focused on health and social consequences of smoking, and (b) strategies and exercises aimed at quitting, maintenance of nonsmoking, relapse prevention, and recycling; (5) Materials and programs be made widely available rather than "fine tuning" existing programs or developing new ones; and (6) Programs make use of specific adjunctive strategies. In this way, a reacceleration of the decline in smoking prevalence may be realized in the 1990s and significantly contribute to the NCI's Year 2000 goals and the Surgeon General's aim of a smoke-free society.
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Affiliation(s)
- T J Glynn
- National Cancer Institute, Bethesda, MD 20892
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Fisher EB, Haire-Joshu D, Morgan GD, Rehberg H, Rost K. Smoking and smoking cessation. THE AMERICAN REVIEW OF RESPIRATORY DISEASE 1990; 142:702-20. [PMID: 2202249 DOI: 10.1164/ajrccm/142.3.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- E B Fisher
- Center for Health Behavior Research, Washington University, St. Louis, MO 63108
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Glasgow RE, Hollis JF, Ary DV, Lando HA. Employee and organizational factors associated with participation in an incentive-based worksite smoking cessation program. J Behav Med 1990; 13:403-18. [PMID: 2246786 DOI: 10.1007/bf00844887] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study investigated employee and worksite characteristics prospectively predictive of participation among 474 smokers in nine different worksites taking part in a year-long incentive-based smoking cessation program. Several different ways of defining participation (e.g., joining versus level of attendance, first 6 months versus entire program) were studied. A consistent pattern of results was observed across two of the participation indices, joining the program and participating in one or more monthly follow-up meetings. Both worksite (number of employees, previous health promotion history, degree of support from management) and employee (gender, motivation, previous quit attempts) variables were predictive of participation. Logistic regression analyses revealed that each set of variables, worksite and employee characteristics, was significantly related to participation after controlling for the effects of the other set. We were less able to predict level of attendance among participants who joined the program. Implications of these findings for future studies of participation in health promotion programs are discussed.
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Sloan RP, Dimberg L, Welkowitz LA, Kristiansen MA. Cessation and relapse in a year-long workplace quit-smoking contest. Prev Med 1990; 19:414-23. [PMID: 2399223 DOI: 10.1016/0091-7435(90)90039-m] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In an attempt to increase the impact of smoking cessation activities, some recent studies have examined the use of contests and competitions. The study reported here evaluates a year-long multiple-lottery quit-smoking contest at Volvo Flygmotor, the Volvo aircraft engine manufacturing company in Trollhattan, Sweden. Lotteries were held at 1, 6, and 12 months after the contest began. By quitting for at least 1 month, enrollees were eligible to win cash prizes. Maintaining nonsmoking status from a previous lottery automatically qualified enrollees for the next one. Smoking status was established by self-report, expired carbon monoxide, and saliva cotinine. Seventy-three employees, representing approximately 10% of the company's smokers, entered the contest during the initial 2-week enrollment period. Point prevalence 1-month and 6-month cessation rates were 64.4 and 49.3%, respectively. Continuous abstinence 6-month and 1-year rates were 45.2 and 32.8% respectively. Psychological, home, work and smoking history variables generally were not related to cessation or relapse.
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Affiliation(s)
- R P Sloan
- Behavioral Medicine Program, Columbia-Presbyterian Medical Center, New York, New York 10032
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Gottlieb NH, Nelson A. A systematic effort to reduce smoking at the worksite. HEALTH EDUCATION QUARTERLY 1990; 17:99-118. [PMID: 2318654 DOI: 10.1177/109019819001700110] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Smoking control is a key element of worksite health promotion. This three-stage study in a large state human services agency included a baseline survey, an assessment of the effects of competition on recruitment to a self-help cessation program, and examination of the outcome of the cessation program. In stage 1, scales for measuring smoking-related attitudes and the social environment were developed and used to study norms for smoking. Regression analysis was used to ascertain correlates of smokers' intentions to quit and to join a self-help program and non-smoker assertiveness. In stage 2, an evaluation using a quasi-experimental design indicated that competition was moderately effective in increasing the recruitment of all employees to the Great American Smoke-Out (70 vs. 17%) and of smokers to a self-help cessation program (28 vs. 6%). In stage 3, the self-reported quit rate at the end of the program was 28% and the biochemically-verified six months' cessation rate was 7%. Efforts are needed to strengthen, using ethical means, the norms for not smoking at the worksite and to increase both the recruitment to and the effectiveness of smoking cessation programs.
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Affiliation(s)
- N H Gottlieb
- Department of Kinesiology and Health Education, University of Texas, Austin 78712
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