Quit Evaluation Studies: Volume 7

CHAPTER 2

CBRC and VSHP publication review

Jeremy Cass


Over the past two years, a number of papers which report data relevant to the evaluation of the Victorian Smoking Health Program's (VSHP) activities, and to smoking control in general, have been published or accepted for publication. Some of this work was funded by VSHP and specifically carried out for it, but much of it was independent research conducted by the Centre for Behavioural Research in Cancer.

A great deal of work has been carried out in the area of workplace smoking. Kemp, Hocking, and Borland (1993) reported on the development and evaluation of the total no-smoking policy implemented by Telecom Australia in January 1988. The paper discusses compliance with, and attitudes to, the ban by smoking and non-smoking employees, as well as management issues. The authors conclude with a number of suggestions for an effective implementation of a no-smoking policy, including: the policy should be clear and unambiguous; it should be clearly communicated to those who will be responsible for its implementation; and above all, 'leading by example' is of paramount importance.

The effects of the imposition of workplace smoking bans was also reviewed by Borland, Owen, Hill and Chapman (1994). The researchers explored some of what psychology can offer in understanding and improving regulatory approaches to behaviour change.

A series of papers has been published which demonstrate that total workplace smoking bans are becoming more prevalent and more likely to be preferred by workers. Borland (1992) reported data from 1989 and 1990, and Borland and Mullins (1994) data from 1991 and 1992 on the increasing prevalence of workplace smoking bans in Victoria. The data was collected from household surveys which have asked these questions since 1988 (see Chapter 3 for a description of the surveys). In 1992, 59% of indoor workers reported total workplace smoking bans, more than a three-fold increase from the first survey in 1988. In 1992, data were reported on variability in prevalence of bans as a function of kind of workplace, with workers in hospitals, schools and open-plan offices most likely to report bans. Total workplace smoking bans are now the norm for indoor workers in Victoria.

The past few years have seen a rapid increase in the number of workplaces with smoking restrictions; however, restaurants and cafes have been slower to introduce smokefree dining. As part of the 1993 household survey, Mullins and Borland (in press) found that there was a strong community desire for smokefree dining. They also assessed the proportion of restaurant-goers who want to dine in a smokefree area who make this known when eating out. The data presented indicates that only a small proportion of the population would see a total smoking ban as a disadvantage in a restaurant, with the majority seeing it as an advantage.

As well as workplace bans, CBRC and VSHP have continued their joint research on how to involve general practitioners in smoking cessation programs. Cockburn, Ruth, Silagy, Dobbin, Reid, Scollo and Naccarella (1992) (and Cockburn, 1993) compared three approaches for marketing a quit-smoking intervention kit to general practitioners. They found that doctors receiving the educational facilitator approach were much more likely to report that they found the kit less complicated and to report greater knowledge of how to use the kit. The educational facilitator approach cost $142 per general practitioner compared with $14 for the volunteer courier and $6 for the mailed approach. The advantages of this approach over the other two approaches used did not justify the expenditure required to detail the kit to every Victorian practitioner.

Cockburn and Reid (1993) conducted an evaluation on the usefulness of the QUITZ pack. The QUITZ pack was developed as a self-help resource for smokers making a cessation attempt and has a number of features aimed at overcoming obstacles to quitting in the initial stages of an attempt. It is shaped like a cigarette box and contains a series of trivia cards with facts and figures about smoking, smoking-related conditions and the benefits of quitting. They found that it tended to be rated as useful in a quit effort by those who used it, although a greater proportion of people gave higher ratings to The Can Quit Book and the personal quitting strategy chosen by the person. Their findings led to a decision by VSHP not to market the QUITZ pack. Modified versions of these papers can be found in chapters of Quit Evaluation Studies No. 6, 1990-91.

In another study concerning doctors, Mullins and Borland (1993) examined people's perceptions of doctors' views on smoking, smokers' recall of doctors' advice about smoking, and the relationship between doctors' warnings about smoking and attempts to quit. The data was from the 1990 household survey. They concluded that either doctors are failing to warn many of their patients about smoking or the advice is not being given in a manner that makes it memorable.

In 1993, the VSHP initiated a program encouraging dentists to warn their patients about smoking. As the first step in the development of the program, Mullins (1994) carried out a survey to establish what dentists' current attitudes were towards dealing with smokers, and what the typical practice was when dealing with smokers. She found that there had been a dramatic decrease in the proportion of dentists who smoked in 1993 compared with data from 1977. There had also been a change in the way dentists believed they should deal with their patients, with more dentists encouraging their patients to give up smoking wherever possible.

As well as studies on involving health professionals in smoking cessation programs, Clarke, Hill, Murphy and Borland (1993) studied factors affecting the efficacy of a community-based quit-smoking program, namely the Fresh Start courses. They found that successful quitting at the end of the course and at the 12-month follow-up was positively related to the number of sessions attended and to the perceived likelihood of quitting, and negatively related to initial cigarette consumption.

There is an increasing focus on slip-ups and relapse in research on smoking cessation. Borland (1992) found that feeling bad prior to the slip-up cigarette was associated with reduced recovery from the lapse. By contrast, reporting that the slip-up cigarette made the person feel worse was associated with increased recovery.

Stuart, Borland and McMurray (1994) examined the measures of self-efficacy and health locus of control as predictors of outcomes of a smoking cessation program. Their results indicated that high self-efficacy is inversely related to making attempts to quit, but positively related to the success of attempts. They concluded that the role of health locus of control is complex and needs further investigation.

Different attitudes towards smoking for men and women, the reasons children start smoking, and tobacco and alcohol use among Australian secondary school students have also been addressed. Clarke, White, Beckwith, Borland and Hill (1993) using data collected from household surveys between 1983 and 1989 found both women and men who smoke have essentially similar beliefs about smoking. Therefore, it should be feasible to develop educational campaigns that are broadly applicable to both men and women. They also found that differences in attitudes to smoking between the smoking status categories of never smoker, ex-smoker, and current smoker were greater than the differences between the gender-based categories of male and female. In those cases where there were significant gender differences, these were essentially consistent with a situational explanation of gender-related differences in attitudes, expectations and behaviours rather than reflecting fundamental differences between the sexes.

Conrad, Flay, and Hill (1992) reviewed findings from 27 prospective studies on the onset of cigarette smoking, conducted since 1980. The review confirmed the importance of many well-accepted predictors and raised some questions about others. Expected relationships were strongly supported for socioeconomic status, social bonding variables, social learning variables, refusal skills self-efficacy and broad indicators of self-esteem. From their research the authors suggest that future prospective studies need to be theory-driven, use measures of known reliability and validity, report analyses of scale properties, and use statistical methods appropriate to the hypotheses or theories under study.

Hill, White, Williams and Gardner (1993) investigated prevalence estimates of tobacco smoking and alcohol drinking among Australian secondary students. The prevalence of current smoking was found to increase with age to reach a peak of 25% among 16-year-old boys and 29% among girls aged 15 years. From the age of 13, smoking was more prevalent among girls than boys. Unlike smoking, drinking was slightly more prevalent among boys than girls. They concluded that while the continuing downward trend in smoking and drinking among younger students is encouraging, the results show that there are still large numbers of students who smoke and drink.

Borland (1994) studied reports of occasional smoking among self-described ex-smokers and non-smokers in Victoria as part of the 1990 household survey. He found that occasional cigarette use is common among self-described non-smokers, and there is only a small overlap in the consumption distribution of reported smokers and non-smokers.

References

Borland R. Changes in prevalence of and attitudes to restrictions on smoking in the workplace among indoor workers in the State of Victoria, Australia, 1988-90. Tobacco Control 1992; 1: 19-24.

Borland R. Relationships between mood around slip-up and recovery of abstinence in smoking cessation attempts. International Journal of Addictions 1992; 27: 1079-1086.

Borland R. Population estimates of occasional smoking among self-described smokers and non-smokers in Victoria, Australia. Tobacco Control 1994; 3: 37-40.

Borland R, Mullins R. The increasing prevalence of workplace smoking bans in Victoria. Journal of Occupational Health and Safety 1994; 10: 35-45.

Borland R, Owen N, Hill D, Chapman S. Regulatory innovations, behaviour and health: Implications of research on workplace smoking bans. International Review of Health Psychology 1994; 3: 167-185.

Clarke V, Hill D, Murphy M, Borland R. Factors affecting the efficacy of a community-based quit smoking program. Health Education Research 1993; 8: 537-546.

Clarke V, White V, Beckwith J, Borland R, Hill D. Are attitudes towards smoking different for males and females? Tobacco Control 1993; 2: 201-208.

Cockburn J, Ruth D, Silagy C, Dobbin M, Reid Y, Scollo M, Naccarella L. Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners. British Medical Journal 1992; 304: 691-694.

Cockburn J. Using academic detailing to market a smoking cessation program for general practitioners. Australian Prescriber 1993; 16: 41-43.

Cockburn J, Reid Y. A strategy for evaluating a novel smoking intervention device. Journal of Cancer Education 1993; 8: 71-77.

Conrad K, Flay B, Hill D. Why children start smoking cigarettes: Predictors of onset. British Journal of Addiction 1992; 87: 1711-1724.

Hill DJ, White VM, Williams RM, Gardner GJ. Tobacco and alcohol use among Australian secondary school students in 1990. Medical Journal of Australia 1993; 158: 228-234.

Kemp G, Hocking B, Borland R. Managing the implementation of a no smoking policy. Asia Pacific Journal of Human Resources 1993; 31: 92-99.

Mullins R, Borland R. Doctors' advice to their patients about smoking. Australian Family Physician 1993; 22: 1146-1155.

Mullins R, Borland R. Preference and requests for smokefree dining. Australian Journal of Public Health. In press.

Mullins R. Attitudes and smoking habits of dentists in Victoria: Sixteen years on. Australian Dental Journal 1994; 39: 324-326.

Stuart K, Borland R, McMurray N. Self-efficacy, Health Locus of Control, and smoking cessation. Addictive Behaviours 1994; 19: 1-12.

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