Promoting worksite smoking control policies and actions: the Community Intervention Trial for Smoking Cessation (COMMIT) experience. The COMMIT Research Group.

BACKGROUND: As an important aspect of the COMMIT trial, worksite smoking-control consultations and supports were provided to employers in 11 diverse, moderate-sized communities. After a 4-year intervention period (1989-1992), impacts on worksite policies, support resources for smokers, and employee perceptions were assessed in these communities and in 11 matched Comparison communities. METHODS: Data from two surveys are reported here. In each of the 22 COMMIT communities, a sample of worksites within each of four size strata were surveyed to determine worksite policies, activities, and resources regarding smoking. Data from employees were obtained from independent community-wide surveys of community residents. RESULTS: Overall, 44% of the worksites surveyed reported having smoke-free policies, with no differences between Intervention and Comparison communities. Thirty-seven percent of Intervention community work-sites reported offering smoking cessation resources or assistance for employees during the period of the study, compared to 31% of Comparison community worksites (P = 0.04). Employees in Intervention communities, relative to those in Comparison communities, reported greater awareness of stop-smoking resources, but equivalent increases in worksite smoking bans. CONCLUSION: Although the level of worksite smoking-cessation activities was higher in Intervention than in Comparison communities, there remains a substantial need to increase the level of such activities and to integrate such activities with restrictive smoking policies.

Smoking withdrawal symptoms in response to a trauma-related stressor among Vietnam combat veterans with posttraumatic stress disorder.

This study investigated the relationship between a trauma-related stressor and smoking withdrawal symptoms in 25 male Vietnam combat veterans with posttraumatic stress disorder (PTSD) using a within-subjects design. All subjects were smokers. The stressor involved a modified Stroop task, in which the veterans color-named either anxiety-related or neutral control words. Anxiety-related words produced more withdrawal symptoms than neutral control words, including increased craving, negative affect symptoms, somatic symptoms, and lack of alertness.

Smoking in Vietnam combat veterans with post-traumatic stress disorder.

The present study investigated smoking prevalence, smoking motives, demographic variables and psychological symptoms in 124 help-seeking, male Vietnam combat veterans with post-traumatic stress disorder (PTSD). A high percentage of these veterans smoked (60%). Vietnam veterans with PTSD who smoked were more likely than those who did not smoke to report higher levels of PTSD symptoms, depression and trait anxiety. Increased depression was associated with increased automatic smoking. Smokers reported a high frequency of smoking in response to military memories. Implications for smoking interventions, cessation, and relapse prevention efforts are discussed.

Community stop-smoking contests in the COMMIT trial: relationship of participation to costs. Community Intervention trials.

BACKGROUND: This study quantifies resources used to conduct 26 community-wide quit-smoking contests, the percentage of smokers that participated in these contests, and the statistical associations between resource inputs and participation percentages. METHODS: Data collected from the 11 COMMIT intervention communities (adult population range 47,490-185,913) included number of contest participants, contest procedures, and resource inputs. Stepwise regression was used to find the most meaningful association(s) of independent variables with contest participation percentage. RESULTS: Contest participation percentages ranged from 0.27 to 3.11% of smokers (mean = 1.26%). Total cost (COMMIT and community-contributed resources and dollar expenditures) to conduct a contest averaged $24,857 (range $5,751-$74,556), or $78.57 per contest participant. Expenditures in various specific resource categories varied greatly. Total expenditures per smoker in the community (excluding expenditures for prizes) was the independent variable most highly correlated with contest participation percentage, accounting for 63% of the total variability in participation percentages. CONCLUSIONS: The percentage of smoker participation in community-wide stop-smoking contests appears primarily to be a function of total resource expenditures, regardless of the specific types of resources funded. Stop-smoking contests are judged to be quite cost effective. Study strengths and weaknesses are discussed.

Effect of the Johnson & Johnson Live for Life program on employee smoking.

Smoking-cessation programs at the worksite hold the potential to reduce the national prevalence of smoking. This article presents the 2-year results of a broad-spectrum smoking-cessation initiative that was part of the comprehensive Johnson & Johnson LIVE FOR LIFE wellness program. In a quasi-experimental design, four companies offered the complete LIVE FOR LIFE program to their employees, and three comparison companies offered only annual health screen assessments. Smoking status was assessed by self-report and serum thiocyanate at baseline and at a 2-year follow-up. At the LIVE FOR LIFE companies, 22.6% of all smokers quit versus 17.4% of smokers at the health screen only companies. The LIVE FOR LIFE program was particularly effective with smokers at high risk for coronary heart disease: 32% of all high-risk smokers quit at the LIVE FOR LIFE companies versus 12.9% at the health screen only companies. These results demonstrate that a company-wide smoking-cessation initiative can produce significant changes in smoking behavior.

A stage analysis of self-initiated smoking reductions.

Most smoking cessation treatments are predicated on the assumption that the course of smoking reduction is psychologically homogeneous. The present study tested an alternative model incorporating three distinct stages: initial decision, initial control, and maintenance. Three measures (perceived health locus of control, desire to stop, and self-esteem) were used to predict self-initiated smoking reduction in 61 regular smokers. Criterion smoking change measures (one for each stage) were obtained at follow-up. Multiple regression analyses of the criteria showed a different set of predictors were significant for each: desire to stop predicted the decision to reduce smoking, self-esteem predicted initial smoking reduction, and the combination of internal health locus of control beliefs and strong desire to stop predicted successful maintenance of reduction. The differential success across criteria of the predictors shows the value of the stage analysis and suggests the development of smoking treatments varying by stage.

Measurement of smoking: surveys and some recommendations.

A survey of smoking cessation researchers found considerable disagreement in the measurement procedures used to determine treatment outcome. The survey investigated (1) the duration of the measurement interval used to determine abstinence and smoking rate; (2) procedures for classifying people who smoke after treatment but are abstinent at follow-up; and (3) procedures for classifying people who use marijuana or tobacco products other than cigarettes. The marked disagreement among researchers' survey responses was compounded by the failure of their published articles to explain how smoking had been measured and scored. The Discussion identifies long-term abstinence as the most critical problem; its measurement was least consistent procedurally across studies yet most important for comparing them. Recommendations are made for establishing measurement and reporting conventions.

Worksite smoking cessation initiatives: review and recommendations.

Offering health lifestyle change assistance in the workplace represents a major challenge for behavioral scientists and behavior therapists in the 1980's. Business and industry are showing special interest in employee smoking cessation. This paper reviews a wide range of worksite smoking cessation activities and related research. Six types of intervention are discussed: educational campaigns; policies restricting workplace smoking; self-help programs; physical examination and physician advice; incentive programs; and actual smoking cessation services. Existing research is critically reviewed. Practical recommendations for improving and systematically evaluating worksite quit smoking initiatives are presented.

Behavioral approaches to smoking cessation--I. A decade of research progress 1969-79.

This article describes a topical bibliography presented in the subsequent article in this journal, covering the past decade of research into behavioral approaches to smoking cessation. Using multiple searches including Psychological Abstracts, over 300 references were compiled from over 50 psychology, medicine, and related behavioral science journals. All references were comprehensively coded to each of 28 topical areas of interest to behavioral researchers and clinicians. Topics include specific behavioral smoking cessation techniques (e.g. aversive smoking, relaxation techniques, stimulus control), treatment problems (e.g. maintenance problems and procedures, treatment "side-effects") and important research issues (e.g. predictors of treatment success, physiological correlates of smoking behavior, therapist and treatment factors influencing outcome. An index defining each topic and listing by number all articles related to each topic is included with the bibliography. With this index, users with specialized interests can quickly locate all citations concerning a particular topic or combination of topics, Directions for using the bibliography are given along with guidelines for extending and adopting it for personal use.

Behavioral approaches to smoking cessation--II. Topical bibliography 1969-1979.

This topical bibliography covers that past decade of research into behavioral approaches to smoking cessation. Using multiple sources, including Psychological Abstracts, 335 reference were compiled from over 50 psychology, medicine, and related behavioral science journals. All references were comprehensively coded for each of 28 topical area of interest to behavioral researchers and clinicians. Topics include specific behavioral smoking cessation techniques (e.g. aversive smoking, relaxation techniques, stimulus control), treatment problems (e.g. maintenance problems and procedures, physiological correlates of smoking behavior, therapist and treatment factors influencing outcome). An index defining each topical and listing by number all articles related to each topic is included with the bibliography (Tables 1 and 2). With this index, users with specialized interests can quickly locate all citations concerning a particular topic or combination of topics. The preceding article (Orleans et al., 1981) gives guidelines for expanding this bibliography for personal reference use.

Psychosocial effects of cosmetic augmentation mammaplasty.

In a follow-up study, 19 small-busted women who had received a cosmetic augmentation mammaplasty were contrasted with 20 small-busted control wornen and 19 average-busted control women. The augmented women showed much greater happiness with their breast, an improved body image, and more daring and revealing dress. Basic personality traits, self-concept, and the frequency of various activities were unchanged.

Personality characteristics of women seeking breast augmentation. Comparison to small-busted and average-busted controls.

The results of a study, contrasting 28 women seeking cosmetic breast augmentation with 28 small-busted control women and 28 average-busted controls, suggest the average woman desiring surgical breast augmentation is as psychologically stable as other women. She differs from other women only in limited areas--primarily in her negative evaluation of her breasts and her greater emphasis on dress and physical attractiveness.