Evaluation of a training for managers in using active and personal communication to stimulate employee participation in a workplace smoking cessation program

Development of a Comprehensive Questionnaire Evaluating Knowledge, Attitudes, and Practices Regarding University Student Food Access Resource Use

Background: In Costa Rica, the leading cause of preventable death is smoking. Adults spend one third of their lives at work making the workplace an optimal site for smoking cessation interventions. Therefore, we developed a workplace smoking cessation pilot program among Costa Rican Justice Department government employees based on key Costa Rican values and best practices. Methods: First, focus groups were conducted among exsmokers and smokers. Participants in the focus groups and in the subsequent smoking cessation pilot study were invited to take part in the study through flyers, information sheets, and announcements from the Justice Department. The focus groups revealed that social factors were fundamental to quitting. Therefore, based on these results two programs (14 participants) were conducted consisting of seven sessions encouraging employees to utilize their family and exsmokers. Data were collected before and after the seven sessions on smoking behavior, social influence, and other factors. Findings: Five of 14 (36%) quit smoking. None of the quitters lived with a smoker, as compared with 56% of nonquitters who lived with a smoker. Also, quitters were less likely to have friends (40% vs. 67%) and coworkers (20% vs. 33%) who smoked compared with nonquitters. Conclusion/Application to Practice: Workplace smoking cessation programs should help smokers to increase their social contacts with nonsmokers/exsmokers. Smoking cessation programs should assess not only smoking patterns, but also social contacts, such as family, friends, and coworkers. Based on these assessments, smokers should be encouraged to seek-out nonsmokers/exsmokers to assist them in quitting.

INTRODUCTIONSystematic analyses of workplace smoking cessation programs indicate that efficacy can be enhanced by using incentives. There is variation in the type of incentives used and their effect on participation and efficacy. The aim of our study was to examine whether lowering employee health plan costs (employee contributions, co-pays) encourage employee smokers to participate in workplace smoking cessation.METHODSWe conducted a 2014–2015 prospective cohort study of 415 employee smokers of Loma Linda University Health (LLUH). The employees were offered participation in a workplace smoking cessation program (LLUH BREATHE Initiative) with the incentive of enrollment in an employer-provided health plan that had a 50% lower employee monthly contribution and co-payment relative to the employer-provided health plan for non-participants. Participation rates and variables associated with participation were analyzed.RESULTSIn the LLUH BREATHE cohort, we found a very high rate of participation (72.7%; 95% CI: 69–77%) in workplace smoking cessation that was encouraged by a lower out-of-pocket health plan cost for the participating employee and/or spouse. Participation did, however, vary by gender and spouse, whereby female employee households with a qualifying smoker were more than two times more likely (employee: OR=2.89, 95% CI: 1.59–5.24; or spouse: OR=2.71, 95% CI: 1.47–5.00) to participate in smoking cessation than male employee households. The point prevalence, at four months, of abstinence from smoking among the participants was 48% (95% CI: 42–54%).CONCLUSIONSOur findings indicate that a workplace smoking cessation program that uses a novel reward-based incentive of lower out-of-pocket health plan costs results in a participation rate that is much higher than US norms.

Workplace smoking cessation programs can effectively assist employees to quit smoking. However, little is known about employees' attitudes towards engagement in workplace smoking cessation programs. This study aimed to address the limited understanding of the interaction between employee characteristics and their health beliefs toward engaging in a workplace smoking cessation program. Self-report data was collected from 897 employees of a mining company operating in two remote towns in Australia. The majority of participants were male (73%), the mean age was 36.9 years (SD = 11.5). Chi square tests of independence were used to analyze relationships between employee characteristics and smoking cessation engagement attitudes. Engagement attitudes included: A desire to cease smoking; desire for assistance with the smoking cessation process; and intention to participate in a workplace smoking intervention. The findings from this study indicated that attitudes towards engagement in smoking cessation programs varied for mining employees according to gender, age, perceived severity, perceived self-efficacy, and stage of readiness to change. These findings provide insights that health promotion practitioners may apply to inform the design and marketing of effective workplace smoking cessation programs for similar employees.

Adoption of relational contracting in public sector construction organisations is more difficult than in private sector organisations due to the inherent rigidity of public sector. Therefore, implementation of the relational contracting processes should be treated as an organisational change management process in public sector organisations. The purpose of this paper is to develop a relational contracting conceptual model (RCMM) by integrating success factors for positive change management in public sector organisations. A qualitative research methodology comprising two rounds of expert interviews was used. The first round of interviews was conducted to gauge the present level of relational contracting in public sector construction organisations. The second round of interviews was conducted to validate the relational contracting conceptual model by integrating success factors of change management in public sector organisations. The relational contracting model highlighted the importance of a need to develop a vision for partnering, stakeholder analysis and consensus building among them, empowerment of operational level employees and their participation in plan execution, time bound review meetings of top management on site to show commitment, resolution of disputes and fast decision making along with publication of the performance reports. The paper presents a critical insight on relational processes of public sector construction organisations in India in the context of organisational change management model which has not been the focus in majority of the previous research studies.

Project closure is a core feature of humanitarian action. However, how decisions to end projects are made, and how closure is planned and implemented, has implications for upholding ethical commitments, and can have positive or negative consequences for affected communities, local stakeholders, and humanitarian organizations and their staff. To better understand the ethical dimensions of closing humanitarian projects, we undertook an investigation of national and international humanitarian workers’ experiences.Guided by interpretive description methodology, we conducted an exploratory qualitative study with two rounds of semi-structured interviews. Four national and five international staff of non-governmental organizations with experience of humanitarian health project closure took part. The participants had diverse professional roles and disciplinary backgrounds. All participants took part in the first round of interviews which focused on experiences and perceptions of ethics and project closure. Analysis of these interviews contributed to the development of a draft “ethics guidance note.” Five of the participants took part in the second round of interviews which focused on receiving feedback on the draft guidance note. We used constant comparative techniques and a recursive approach to data collection and analysis. In this article, we draw on both rounds of interviews to present findings related to how participants understood and experienced ethical responsibilities, challenges, and opportunities for humanitarian project closure.We identified six recurrent ethical concerns highlighted by interviewees regarding closure of humanitarian projects: respectfully engaging with partners and stakeholders, planning responsively, communicating transparently, demonstrating care for local communities and staff during project closure, anticipating and acting to minimize harms, and attending to sustainability and project legacy. We present these ethical concerns according to the temporal horizon of humanitarian action, that is, arising across five phases of a project’s timeline: design, implementation, deciding whether to close, implementing closure, and post-closure.This exploratory study contributes to discussions concerning the ethics of project closure by illuminating how they are experienced and understood from the perspectives of national and international humanitarian workers. The interview findings contributed to the development of an ethics guidance note that aims to support project closures that minimize harms and uphold values, while being mindful of the limits of ethical ideals in non-ideal circumstances.

IntroductionTo implement effective conversation aids for early-stage breast cancer surgery, we introduced an online learning collaborative, SHAIR Collaborative, targeting clinical teams who treat these patients. In this qualitative study, we...

BackgroundThe need to reduce smoking rates is a recognised public health policy issue in many countries. The workplace offers a potential context for offering smokers’ programmes and interventions to assist smoking cessation or reduction. A qualitative evidence synthesis of employees’ views about such programmes might explain why some interventions appear effective and others not, and can be used to develop evidence-based interventions for this population and setting.MethodsA qualitative evidence synthesis of primary research exploring employees’ views about workplace interventions to encourage smoking cessation, including both voluntary programmes and passive interventions, such as restrictions or bans. The method used was theory-based “best fit” framework synthesis.ResultsFive relevant theories on workplace smoking cessation were identified and used as the basis for an a priori framework. A comprehensive literature search, including interrogation of eight databases, retrieved 747 unique citations for the review. Fifteen primary research studies of qualitative evidence were found to satisfy the inclusion criteria. The synthesis produced an evidence-based conceptual model explaining employees’ experiences of, and preferences regarding, workplace smoking interventions.ConclusionThe synthesis suggests that workplace interventions should employ a range of different elements if they are to prove effective in reducing smoking among employees. This is because an employee who feels ready and able to change their behaviour has different needs and preferences from an employee who is not at that stage. Only a multi-faceted intervention can satisfy the requirements of all employees.

The effectiveness of a comprehensive program of worksite smoking control, discouragement, and cessation was compared with a program of smoking cessation alone. Two comparable oil refineries served as the research sites. Outcome variables consisted of employee self-reported smoking rate assessed by the use of a smoking questionnaire and unobtrusive observations of smoking behavior before and after the intervention. One company was randomly assigned to the comprehensive program of smoking control, discouragement, and cessation while the other company only received smoking cessation. Humorous antismoking posters emphasizing the benefits of quitting smoking were distributed throughout the first worksite and changed every 2 weeks. Large banners stating "Go SmokeFree" were also placed at all locations to this plant and left up for the duration of the study. Three weeks after the initiation of the smoking discouragement program at one refinery, a group smoking cessation program was begun at both plants. At a 5-month follow-up, participants in the smoking cessation treatment at the plant receiving the comprehensive program achieved a 5-month abstinence rate of 43% in comparison with a rate of 21% at the refinery receiving only smoking cessation.

Cigarette dependence and depressive symptoms as predictors of smoking status at five-year follow-up after a workplace smoking cessation program

INTRODUCTIONRandomized controlled trials have demonstrated the effectiveness of workplace smoking cessation programs. However, with low participation rates reported, it is important to understand the barriers and facilitators for the reach and participation of employees in workplace smoking cessation programs. The objective of the present study is to uncover the needs of employees regarding reach and participation when implementing a workplace program to address smoking cessation.METHODSWe carried out 19 semi-structured qualitative interviews in 2019 based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework with current and former smoking employees of organizations with ≥100 employees in the Netherlands. Some of the interviewees had experience with a cessation program. Data were analyzed using the Framework method.RESULTSThe main barriers according to employees were insufficient promotion of the cessation program, completing the program in the employee’s own time and working night shifts and peak hours. Facilitators included being actively approached to participate by a colleague, positive reactions from colleagues about employee’s participation in the program, providing the program on location and integrating the program as part of the organization’s vitality policy.CONCLUSIONSEffective workplace programs for smoking cessation can stimulate cessation but implementers often experience low participation rates. Our study presents recommendations to improve the recruitment and participation of employees in a workplace smoking cessation program, such as using active communication strategies, training managers to stimulate smoking employees to participate and making the program as accessible as possible by reimbursing time spent and offering the program at the workplace or nearby. Integrating the smoking cessation program into wider company vitality policy will also aid continued provision of the program.

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. 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. 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. 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 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. 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. 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.

e-Cigarette use among individuals who quit smoking more than 1 ago in England is highest among those with lower socioeconomic position and may affect smoking-related health inequalities, depending on whether the devices protect against relapse to tobacco smoking. To assess trends in current e-cigarette use by socioeconomic position among individuals who have quit smoking for at least 1 year, to capture postcessation initiation among those who quit within the past year and did not use an e-cigarette in their most recent quit attempt (representing recent initiation), and to capture postcessation initiation among those who quit smoking before e-cigarettes became popular in 2011 (representing late initiation). This cross-sectional study of 34 442 adults (≥16 years) who formerly smoked used data from the Smoking Toolkit Study (conducted 2014-2019), a nationally representative, monthly, repeated, cross-sectional, household survey of smoking and smoking cessation in England. Data analysis was conducted in December 2019. Socioeconomic position based on occupation. Current self-reported e-cigarette use. Weighted samples consisted of 19 297 individuals who had quit smoking for at least 1 year (mean [SD] age, 59.2 [17.0] years; 9024 [46.8%] women), 904 who quit in the past year and did not use an e-cigarette in their most recent quit attempt (mean [SD] age, 41.6 [17.1] years; 445 [49.3%] women), and 14 241 who quit before 2011 (mean [SD] age, 63.6 [14.6] years; 6619 [46.5%] women). Among those who had quit smoking fot at least 1 year, e-cigarette use increased from 3.3% (95% CI, 2.7%-4.0%) in 2014 to 10.4% (95% CI, 9.2%-11.6%) in 2019 among all socioeconomic groups. Use was more common among those with lower socioeconomic position than those with higher socioeconomic position (odds ratio, 1.59; 95% CI, 1.05-2.40; P = .03). Regarding postcessation initiation of e-cigarettes, among those who quit smoking in the past year and did not use an e-cigarette in their most recent quit attempt, 7.1% (95% CI, 5.9%-9.3%) initiated e-cigarette use after smoking cessation, and there was no clear trend over time or any difference according to socioeconomic position. Among those who quit before 2011, there was an overall increase in use of e-cigarettes (0.8% [95% CI, 0.5%-1.2%] in 2014 to 2.1% [95% CI, 1.4%-2.8%] in 2019), but there were no apparent differences in use across socioeconomic position. In this study, e-cigarette use increased among all participants from 2014 to 2019 but was highest among those with lower socioeconomic position. Continued monitoring of this socioeconomic patterning is important because if e-cigarettes do not confer the public health benefit of protection against relapse to smoking, then equity-negative disadvantages of long-term usage are more likely. Late, but not recent, postcessation initiation of e-cigarettes has increased over time but is not likely to affect smoking-related health inequalities because there were no differences by socioeconomic position.

Smoking and radon cause lung cancer, with smoking being the more significant risk factor. Although programmes to identify UK houses with raised radon levels and to encourage remedial action started in 1990, uptake has been limited and those most at risk, smokers and young families, are not being reached. The risks from smoking and radon are multiplicative. Public health campaigns have reduced smoking prevalence significantly. Since most radon-induced lung cancers occur in smokers, reducing the number of smokers will reduce the number of radon-induced lung cancers. This article considers the impact of reducing smoking prevalence on the effectiveness of radon remediation programmes, combining this with demographic trends and regional variations to assess implications for future public health. Results on cost-effectiveness of smoking cessation and radon remediation programmes were combined with government figures for smoking prevalence to estimate the number of cancers averted and the cost-effectiveness of such programmes, taking into account demographic changes, including increasing life expectancy. Regional variations in smoking prevalence and smoking cessation programmes were reviewed, comparing these to the geographic variation of radon. The continuing impact of smoking cessation programmes in reducing smoking prevalence will reduce the number of radon-induced lung cancers, but with a lag. Smoking cessation programmes are more cost-effective than radon remediation programmes, presenting an additional opportunity to reduce radon risk to smokers. Regional data show no correlation between smoking prevalence and radon levels. Reduced smoking prevalence reduces the effectiveness of radon remediation programmes. This, coupled with limited uptake of radon remediation, suggests that radon remediation programmes should be targeted, and that an integrated public health policy for smoking and radon is appropriate. Lack of correlation between smoking prevalence and radon suggests that local assessment of relative priorities for public health strategies, such as the 'Total Place' initiative, is appropriate.

Although smoking and depression have been related, little importance is given to the impact of depression on outcomes of smoking cessation interventions in the workplace. The aim of this study was to assess the influence of depressive symptoms and a history of depression on abstinence after a workplace smoking cessation intervention, and to explore the roles of gender, nicotine dependence and antidepressants. A retrospective study with employees of Barcelona City Council participating on a voluntary basis. The intervention consisted of a multicomponent approach combined with pharmacological treatment. Depressive symptoms were assessed with the Beck Depression Inventory (BDI), and history of depression was noted in the baseline assessment. Higher scores in BDI were associated with lower rates of abstinence at 3, 6 and 12 months. BDI scores >or= 13 were related to a 1.81x higher likelihood of relapse. This relationship was independent of the effect of dependence severity, of gender and of treatment with antidepressants. In contrast, a history of depression did not influence outcomes. New therapeutic strategies are needed to reduce the impact of employees depressive symptoms in workplace smoking cessation programmes.