Community Intervention Trial for Smoking Cessation

COMMIT

Edward Lichtenstein, Lawrence M Wallack, Terry Pechacek

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351845403
• Edition: 1
• Topic: Medicina
• Subtopic: Epidemiologia

The Community Intervention Trial for smoking cessation (COMMIT) is sponsored by the National Cancer Institute and involves eleven pairs of communities in North America. COMMIT emphasizes a partnership between the eleven research institutions and their respective intervention communities in developing the structures needed to implement the intervention protocol. We summarize the epidemiological data and describe the prior community interventions that set the stage for COMMIT, and discuss how COMMIT may inform state-wide tobacco reduction demonstration programs. An overview of the articles that describe the COMMIT intervention and evaluation plan is presented.

PROMOTING SMOKING CONTROL THROUGH WORKSITES IN THE COMMUNITY INTERVENTION TRIAL FOR SMOKING CESSATION (COMMIT)

GLORIAN SORENSEN, PH.D., M.P.H.

University of Massachusetts Medical School, Worcester

RUSSELL E. GLASGOW, PH.D.

Oregon Research Institute, Eugene

KITTY CORBETT, PH.D., M.P.H.

Kaiser Permanente Medical Care Program Oakland, California

For the COM M IT Research Group

ABSTRACT

This article describes the worksite intervention and assessment aspects of the COMMIT project. Following a brief review of the rationale for worksite smoking control efforts and how planning for such activities can be conducted as part of community-based interventions, we describe the COMMIT worksite protocol. All intervention communities conduct specified activities in the areas of smoking policy, motivational and incentive procedures to encourage smoking cessation, and provision of self-help materials and cessation services for employees. Assessment procedures include a computerized process objectives system, surveys of worksites in each of the 22 COMMIT communities, and work related questions on surveys of community residents. Baseline data that have informed the process objectives for the worksite channel are presented, as are examples of how intervention activities have been tailored to different communities.

Although cigarette smoking is on the decline overall within the United States, cessation rates remain low among heavy smokers and among less educated groups [1, 2]. Changes in social norms and community-wide support for nonsmoking may be an effective strategy for promoting cessation among these groups. The Community Intervention Trial for Smoking Cessation (COMMIT) is a community-based intervention project currently being conducted to assess the effectiveness of such community-wide strategies in increasing cessation, especially among heavy smokers [3–6].

This article describes the worksites channel in the COMMIT project. Worksites are an ideal location for promotion and support of smoking cessation efforts, including both programs and policies. Seventy percent of adults between the ages of eighteen and sixty-five are employed [7]; thus worksites provide access to large numbers of community residents who may not be reached through other means, including low income and minority groups [8, 9]. Worksites are increasingly interested in and supportive of health promotion efforts; a recent national survey of a random sample of private sector worksites with fifty or more employees indicated that 65.5 percent of worksites surveyed offered at least one type of health promotion activity [10].

Reviews of the worksite health promotion literature [11, 12], including a recent meta-analysis of worksite smoking cessation studies [13] have concluded that these smoking cessation programs have been efficacious and appear cost-effective [14]. There are several reasons for this. Multiple types of intervention can be offered repeatedly over time in worksites. By such continual contact, smokers at varying stages in the process of change—including those not yet contemplating change as well as those trying to quit—may be motivated to quit and to sustain cessation [15]. This contact may include the promotion of community-wide events or activities sponsored by other agencies. Changes in worksite norms and in the social environment, such as that which may be accomplished through nonsmoking policies, are additional supports for cessation and its maintenance [16].

In this article, we describe the COMMIT project’s methods for planning interventions aimed at worksites, including the process of community analysis and the participation of the Community Board and the Worksites and Organizations Task Force. We also present the intervention protocol, standardized process objectives for this channel and strategies for tailoring the intervention protocol to the specific community. Finally, results from surveys of smokers and nonsmokers in each of the intervention communities conducted early in the program are described, including information on respondents’ opinions about smoking control activities in the workplace.

PLANNING FOR COMMUNITY-BASED INTERVENTIONS

To establish initial knowledge of smoking control related activities in both the intervention and control communities, an extensive community analysis was conducted in all COMMIT communities prior to randomization. Further information to assist with intervention planning was collected in the intervention communities after randomization. For worksites, this community analysis played several important functions. Key community players and major employers were identified, including worksite leaders and providers of smoking cessation programs who were eventually invited to serve on the Community Board or the Worksites and Organizations Task Force. Using a variety of sources, we assessed community services available to worksites and identified gaps in these resources, important for program planning. We also identified “early adopter” worksites that had already made successful changes. The goal was to collect information that would allow us to understand and to compare the intervention and comparison community using nonreactive procedures, including both qualitative and quantitative approaches. Important background information was available from various printed sources, such as listings of worksites and their characteristics (e.g., size, type of industry) from the Chamber of Commerce or a state business census’ newspapers and other public documents reviewing community and business concerns; and annual reports from local businesses. Interviews of community representatives provided more in-depth information. The information collected from these sources was used to tailor the intervention protocol to each of the eleven intervention communities.

The community analysis was also a means to examine the business and labor community’s “culture” and history. For example, we asked: Do worksites have a history of activities or environmental changes supporting smoking cessation or other health behaviors? How extensively have the mass media covered worksite health concerns? Which health issues are of greatest priority to the business-labor community? What other community issues might divert employers’ and workers’ attention and energy away from health concerns? In this way the community analysis provided information on how other issues may compete with smoking control as a priority for this sector of the community. The community analysis was thus an assessment of the capability of worksites in the community to address effectively this public health problem.

Another use of the community analysis was to identify community leaders to serve on the Community Board and its various task forces. The Community Board has been involved in the overall planning of COMMIT efforts in each community; intervention activities have been planned and implemented through the task force specific to a given channel. Roles of the Community Board and its task forces have included the following [17, 18]:

1. catalyst for the support and involvement of community leaders;

2. source of information on ways to tailor the intervention to community needs;

3. liaison with community service providers and service vendors;

4. clearinghouse of information on health information, community resources and effective implementation models of health promotion;

5. coordinator in sponsoring community-wide health promotion activities; and

6. support for on-going program implementation.

The Worksites and Organizations Task Force has included representatives of the business and labor community as well as other organizations, such as churches and fraternal and civic organizations. In this article, we focus on worksites; additional intervention acti...