Cahill Et Al-2014-Cochrane Database of Systematic Reviews

Cochrane
Library
Cochrane Database of Systematic Reviews
Workplace interventions for smoking cessation (Review)
Cahill K, Lancaster T
Cahill K, Lancaster T.
Workplace interventions for smoking cessation.
Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003440.
DOI: 10.1002/14651858.CD003440.pub4.
www.cochranelibrary.com

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Trusted evidence.
Informed decisions.
Library Better health. Cochrane Database of Systematic Reviews
TABLE OF CONTENTS
HEADER......................................................................................................................................................................................................... 1
ABSTRACT..................................................................................................................................................................................................... 1
PLAIN LANGUAGE SUMMARY....................................................................................................................................................................... 2
SUMMARY OF FINDINGS.............................................................................................................................................................................. 3
BACKGROUND.............................................................................................................................................................................................. 5
OBJECTIVES.................................................................................................................................................................................................. 5
METHODS..................................................................................................................................................................................................... 5
RESULTS........................................................................................................................................................................................................ 6
Figure 1.................................................................................................................................................................................................. 13
DISCUSSION.................................................................................................................................................................................................. 22
AUTHORS' CONCLUSIONS........................................................................................................................................................................... 23
ACKNOWLEDGEMENTS................................................................................................................................................................................ 24
REFERENCES................................................................................................................................................................................................ 25
CHARACTERISTICS OF STUDIES.................................................................................................................................................................. 36
DATA AND ANALYSES.................................................................................................................................................................................... 91
Analysis 1.1. Comparison 1 Individual Treatments, Outcome 1 Group behavioural therapy (various endpoints).......................... 92
Analysis 1.2. Comparison 1 Individual Treatments, Outcome 2 Individual counselling (various endpoints).................................. 92
Analysis 1.3. Comparison 1 Individual Treatments, Outcome 3 Any self-help intervention (various endpoints)............................ 93
Analysis 1.4. Comparison 1 Individual Treatments, Outcome 4 Pharmacological treatments (various endpoints)........................ 93
Analysis 1.5. Comparison 1 Individual Treatments, Outcome 5 Social support (various endpoints)............................................... 93
Analysis 2.1. Comparison 2 Worksite Treatments, Outcome 1 Environmental support (various endpoints).................................. 94
Analysis 2.2. Comparison 2 Worksite Treatments, Outcome 2 Incentives (various endpoints)........................................................ 94
Analysis 2.3. Comparison 2 Worksite Treatments, Outcome 3 Comprehensive interventions......................................................... 95
Analysis 3.1. Comparison 3 Results of included studies, Outcome 1 Results of included studies................................................... 95
APPENDICES................................................................................................................................................................................................. 101
WHAT'S NEW................................................................................................................................................................................................. 104
HISTORY........................................................................................................................................................................................................ 105
CONTRIBUTIONS OF AUTHORS................................................................................................................................................................... 105
DECLARATIONS OF INTEREST..................................................................................................................................................................... 105
SOURCES OF SUPPORT............................................................................................................................................................................... 105
DIFFERENCES BETWEEN PROTOCOL AND REVIEW.................................................................................................................................... 105
INDEX TERMS............................................................................................................................................................................................... 105
Workplace interventions for smoking cessation (Review) i

Informed decisions.
[Intervention Review]
Workplace interventions for smoking cessation
Kate Cahill1, Tim Lancaster1
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Contact address: Kate Cahill, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter,
Woodstock Road, Oxford, OX2 6GG, UK. kate.cahill@phc.ox.ac.uk.
Editorial group: Cochrane Tobacco Addiction Group.

Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 2, 2014.
Citation: Cahill K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 2.
Art. No.: CD003440. DOI: 10.1002/14651858.CD003440.pub4.
ABSTRACT
Background
The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation.
Objectives
1. To categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help
workers to stop smoking.
2. To collect and evaluate data on costs and cost effectiveness associated with workplace interventions.
Search methods
We searched the Cochrane Tobacco Addiction Group Specialized Register (July 2013), MEDLINE (1966 - July 2013), EMBASE (1985 -
June 2013), and PsycINFO (to June 2013), amongst others. We searched abstracts from international conferences on tobacco and the
bibliographies of identified studies and reviews for additional references.
Selection criteria
We selected interventions conducted in the workplace to promote smoking cessation. We included only randomized and quasi-randomized
controlled trials allocating individuals, workplaces, or companies to intervention or control conditions.
Data collection and analysis

One author extracted information relating to the characteristics and content of all kinds of interventions, participants, outcomes and
methods of the studies, and a second author checked them. For this update we have conducted meta-analyses of the main interventions,
using the generic inverse variance method to generate odds ratios and 95% confidence intervals.
Main results
We include 57 studies (61 comparisons) in this updated review. We found 31 studies of workplace interventions aimed at individual workers,
covering group therapy, individual counselling, self-help materials, nicotine replacement therapy, and social support, and 30 studies
testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials
were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes
(odds ratio (OR) for cessation 1.71, 95% confidence interval (CI) 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96,
95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and
multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants)
all increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective (OR
1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain
Workplace interventions for smoking cessation (Review) 1

Informed decisions.
long-term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive
benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking.
Authors' conclusions
1. We found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking.
These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions
targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace
or elsewhere. Self-help interventions and social support are less effective. Although people taking up these interventions are more likely
to stop, the absolute numbers who quit are low.
2. We failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking,
although this finding was not based on meta-analysed data.
3. There was limited evidence that participation in programmes can be increased by competitions and incentives organized by the
employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long-
term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates.
4. Further research would be valuable in low-income and developing countries, where high rates of smoking prevail and smoke-free
legislation is not widely accepted or enforced.
PLAIN LANGUAGE SUMMARY
Is the workplace an effective setting for helping people to stop smoking
Background
The workplace appears to be a useful setting for helping people to stop smoking. Large groups of smokers are available who can easily
be reached and helped, using proven methods. It is also in the employers’ interests to improve the health of their workforce. Recent
changes introducing anti-smoking laws in many developed countries may have eased the pressure to demonstrate the value of work-
based programmes. The situation in developing countries still requires that such methods be tested and proved in those communities. We
reviewed the evidence about workplace programmes to help employees stop smoking, and any information about their costs and benefits.
Study characteristics
For this updated review (first published in 2003), we searched for randomized and quasi-randomized controlled trials, comparing the
success rates of those in a work-based stop-smoking programme with those not involved in a work-based stop-smoking programme.
The comparison could be between people within a single worksite, or between one or more worksites randomized to a stop-smoking
programme or to no programme (cluster-randomized). The study had to include adults (over 18), and could be in any language and reported
in any format, published or not. It had to report the numbers stopping smoking for at least six months.
Results
We searched for studies in July 2013, and identified ten new trials that fitted our criteria, making a total for this update of 61 comparisons
across 57 included studies. We grouped them into two broad categories: those aimed at helping individual smokers, and those that
targeted the workplace environment as a whole. The first group includes such methods as individual or group counselling, self help,
nicotine replacement therapy (NRT) and other medications, help from workmates or other staff, and helping quitters to stay smoke-
free. The second group includes environmental cues (posters, reminders), financial or material incentives, and comprehensive smoking
cessation or health promotion programmes. The review found that programmes based on group behaviour therapy (eight trials; 1309
participants), on individual counselling (eight trials; 3516 participants), on medications (five trials; 1092 participants), and on several
interventions combined (six trials; 5018 participants) helped people to stop smoking. The chances of stopping smoking using these
methods are about the same in the workplace as they are in other settings. This review found that the following do not help people
to stop smoking when delivered in the workplace: self-help methods, support from friends, family and workmates, relapse prevention
programmes, environmental cues, or comprehensive programmes aimed at changing several high-risk behaviours. Results were mixed for
incentives, with one high-quality trial finding a clear benefit for incentives while the remaining five did not.
Quality of the evidence

Earlier studies tended to be less well-conducted and reported than recent ones. Fewer than one in five studies randomized their study
population by an acceptable method. Two-thirds of the studies checked the accuracy of those who said they had quit by testing their
breath, blood or urine. The results were generally in line with findings from other reviews of those ways of quitting in any setting. The
'Summary of findings' table shows that the trials were generally rated as being of moderate to high quality, further confirming the strength
of our findings. Future research might examine what features of the large incentives trial made it more successful than other trials in that
group. It would also be helpful to have more trials from developing and low-income countries, where smoking rates remain high and anti-
smoking laws are not widely enforced.

SUMMARY OF FINDINGS
Summary of findings for the main comparison. Smoking cessation interventions for the workplace
Library
Cochrane
Smoking cessation interventions for the workplace
Patient or population: Employees who smoke

Settings: Workplaces
Intervention: Smoking cessation interventions
Better health.
Informed decisions.
Trusted evidence.
Outcomes Illustrative comparative risks* (95% CI) Relative effect No of Partici- Quality of the Com-
(95% CI) pants evidence ments
Assumed Corresponding risk (studies) (GRADE)
risk
Control Smoking cessation interven-

tions
Group therapy 51 per 1000 84 per 1000 OR 1.71 1309 ⊕⊕⊕⊝

Follow-up: 6-24 months (54 to 131) (1.05 to 2.80) (8 studies) moderate 1,2,3
Individual counselling 61 per 1000 113 per 1000 OR 1.96 3516 ⊕⊕⊕⊝
Self-help interventions 45 per 1000 52 per 1000 OR 1.16 1906 ⊕⊕⊕⊕

Follow-up: 6-24 months (34 to 79) (0.74 to 1.82) (6 studies) high 2,3
Pharmacological interventions 77 per 1000 142 per 1000 OR 1.98 1092 ⊕⊕⊕⊕ Limiting
Follow-up: 6-24 months (95 to 206) (1.26 to 3.11) (5 studies) high 3,4 to NRT
only (4
studies)
reduced

OR to
1.81
(1.07 to
3.08).
Incentives 73 per 1000 113 per 1000 OR 1.60 1928 ⊕⊕⊕⊝

Follow-up: 6-18 months (82 to 154) (1.12 to 2.3) (5 studies) moderate 3,6
Multiple interventions 63 per 1000 95 per 1000 OR 1.55 5018 ⊕⊕⊕⊝

3
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is
based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;
Library
Cochrane
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.
Better health.
Informed decisions.
Trusted evidence.
11 +outlier (Glasgow 1994); removing this study reduced the OR to 1.62 (0.98 to 2.66).
2Removing self-reported (non-validated) abstinence studies made no significant difference to the results.
3No funnel plot - too few studies.
4Removing trials at high risk of bias made no difference
5Possibility of publication bias
6One trial (Volpp 2009) has 37% of the weight and is the only trial with positive findings. Removing it eliminates the statistical significance (OR 1.16 [0.73 to 1.83]).
7Two non-validated, two partial validation, one 'bogus pipeline' and one CO.

4
Informed decisions.
BACKGROUND Why it is important to do this review

Most adults spend about a third of their day in a workplace During the life of this review (first published ten years ago), smoke-
environment. The workplace is therefore a setting through which free legislation has fundamentally altered working conditions in
large groups of smokers can potentially be reached by health many developed countries. The attention of the tobacco control
promotion (Gruman 1993). community is now shifting to areas where anti-tobacco initiatives
are still in their infancy. We include new studies in this update which
Description of the condition test such approaches in India, Malaysia and China, with varying
levels of success.
It is estimated that in 2007 approximately 60% of Americans were
covered by health insurance plans sponsored through their or their OBJECTIVES
spouse's workplace (DeNaves-Walt 2008). Milani 2009 estimates
that in the US nearly 60% of after-tax profits are spent on corporate The specific objectives of this updated review were:
health benefits, with 80% of such expenses incurred by 10% to 20%
of the workforce. US employers have a vested interest in improving 1. To categorize workplace interventions for smoking cessation
and maintaining the health and performance of their workforce. tested in controlled studies, and to determine the extent to which
they help workers to stop smoking.
National smoke-free policies introduced in the UK in 2006-7 are
complemented by government guidelines on how to implement 2. To collect and evaluate data on costs and cost effectiveness
the policies and how best to assist employees with smoking associated with workplace interventions.
cessation during this process (NICE 2007). Recommendations
include summaries of interventions of proven efficacy, and METHODS
encouragement for employers conducting smoking cessation
programmes within working hours. The cost-effectiveness of such
Criteria for considering studies for this review
implementation has also been tested (NICE 2006). Types of studies
Description of the intervention We include randomized and quasi-randomized controlled trials,

allocating individuals, workplaces or companies to intervention or
Work-based smoking cessation programmes are similar to those control conditions.
deployed in other institutions (e.g. hospitals, colleges, schools) or
in the community. They include behavioural or pharmacological Types of participants
interventions, or a combination of both, and comprehensive health
Adults over 18 years of age, in employment, who smoked.
promotion initiatives, targeting individuals or cohorts of workers.
Proven cessation strategies can be conducted opportunistically on Types of interventions
workplace premises and in working hours.
In earlier versions of this review, we divided the interventions into
How the intervention might work those aimed at helping individual smokers to quit, and those aimed
at the workplace as a whole. Although we still include both types
There are several advantages to the traditional workplace as a of interventions, previous versions of this review also included
setting for smoking cessation: bans and restrictions as interventions aimed at the workplace as
1. It provides access to a large number of people who make up a a whole. These are now covered by a companion review (Callinan
relatively stable population. 2010), and we no longer include them here.
2. It has the potential for higher participation rates than non- We include any workplace interventions aimed at smoking
workplace environments. cessation. These include programmes designed to exclusively
3. It may encourage sustained peer-group support and positive target smoking behaviour or to target multiple lifestyle risk
peer pressure. behaviours. The studies aim mainly to assess the effects
4. It provides a particular opportunity to target young men, who of cessation programmes for individual workers who smoke.
traditionally have low general practitioner consultation rates They test a range of interventions, including individual and
and are thus less likely to benefit from opportunistic health group counselling, self-help materials, pharmacological therapy,
promotion activity in primary care. social and environmental support, incentives, and comprehensive
5. Occupational health staff may be on hand to give professional programmes. They are usually aimed at individuals who seek help
support. rather than at the workforce as a whole. We also include studies that
test relapse prevention interventions in association with worksite-
6. The employee generally is not required to travel to the
based smoking cessation programmes.
programme or to dedicate their own personal time to it.
Types of outcome measures
However, all of these assumptions are based on a model of the
workplace that is rapidly changing. Recent research, included The main outcome was employee smoking behaviour (cessation
in this update, highlights the increasingly transient and volatile rates for programmes and workplace prevalence data), for a
nature of the modern workforce, with younger employees changing minimum of six months. We preferred prolonged or continuous
jobs and locations more frequently than earlier generations (see for abstinence to point prevalence, and biochemically verified
example Mishra 2010; Okechukwu 2009). abstinence to self-report, but did not exclude studies on the basis

Informed decisions.
of their chosen outcomes. We excluded studies with less than six Data synthesis
months follow-up.
For this update, we have pooled data for the main categories
Search methods for identification of studies of intervention, using the generic inverse variance (GIV) method
(derived from the log odds), to produce Mantel-Haenszel odds
We searched the Cochrane Tobacco Addiction Review ratios (ORs), using a fixed-effect model with 95% confidence
Group Specialized Register, which includes studies identified intervals (CIs). We have used the intraclass correlation coefficient
by systematic electronic searches of multiple databases, reported by Martinson 1999 (ICC for percentage quit smoking in
handsearching of specialist journals and conference proceedings, worksite) to obtain an adjusted estimate of the effect size for the
and grey literature (i.e. conference proceedings and unpublished studies that were cluster-randomized. This represents a departure
reports not normally covered by most electronic indexing systems). from the Cochrane Tobacco Addiction Group's preferred analysis
At the time of the search, the Register included the results of method of risk ratios, in order to accommodate the ICC calculations
searches of the Cochrane Central Register of Controlled Trials where necessary.
(CENTRAL), issue 12, 2012; MEDLINE (via OVID) to update 20130607;
EMBASE (via OVID) to week 201324; and PsycINFO (via OVID) to We include a 'Summary of findings for the main comparison' for the
update 20130610. See the Tobacco Addiction Group module in main results.
The Cochrane Library for full search strategies and a list of other
resources searched. See Appendix 1 for the search terms used to We also include a glossary of tobacco-related terms (Appendix 3).
search the Register for this review. These searches include terms
to identify controlled trials. We also conducted ad hoc searches
RESULTS
of MEDLINE, EMBASE and PsycINFO using topic-related keywords
Description of studies
without design limits. These searches were updated on 2nd July
2013. Search terms included 'worksite*' or 'workplace*' as keyword We found 57 studies meeting the inclusion criteria. Ten of these are
or free-text terms, and 'work' or 'occupational health' as keywords. new for this update (Bergstrom 2008; Prochaska 2008; Milani 2009;
We list the search strategies in Appendix 2. The results of these Okechukwu 2009; Volpp 2009; Hishida 2010; Mayer 2010; Mishra
searches were cross-checked against references in the identified 2010; Groeneveld 2011; Noor 2011). Detailed information about
papers and previous reviews and meta-analyses. each is shown in the table Characteristics of included studies. We
assigned the individual studies to one or more of the categories
We also contacted authors of studies for additional information of intervention. Four studies (Omenn 1988; Windsor 1988; Gomel
where necessary. 1993a; Tanaka 2006) contribute to more than one category. For
this update, we identified eight additional studies that did not
Data collection and analysis meet the inclusion criteria, and we also now exclude four trials
Selection of studies that were originally included (Kornitzer 1987; Jeffery 1988; Burling
1989; Burling 2000). This gives a total for this update of 105
One author (KC) prescreened reports for relevance, i.e. studies excluded studies, brief details of which are listed in the table
that might be included, or for useful background, and obtained Characteristics of excluded studies. We also identified two ongoing
full-text copies of candidate studies for inclusion. Both authors studies (NCT01124110 2012; NTR8148 2012), and one Chinese study
then independently assessed them against the inclusion criteria, (Gao 2010) for which we currently have insufficient information to
resolving discrepancies by discussion. We noted reasons for include it.
the non-inclusion of studies, and incorporated those into the
Characteristics of excluded studies table. A number of studies evaluated interventions aimed at the
individual, usually without any attempt to target or modify the
Data extraction and management workplace as a whole. The types of intervention were diverse,
One author (KC) extracted data and a second author (TL) checked including intensive behavioural interventions, self-help materials,
them. Where possible, we extracted data on quit rates using the pharmacological treatments, and social support.
number randomized as the denominator, making the assumption
Other studies included environmental support for not smoking,
that those lost to follow-up (or not reported) continued to smoke.
incentives for not smoking, and multicomponent programmes
Assessment of risk of bias in included studies aimed primarily at smoking cessation, or at improving employees'
general health, including their smoking status.
For this update, we have evaluated all the included studies
(past and new) for risks of bias, using the Cochrane 'Risk of GROUP 1: INTERVENTIONS AIMED AT THE INDIVIDUAL TO
bias' assessment tool (Cochrane Handbook, Chapter 8). We have PROMOTE SMOKING CESSATION
assessed the randomization process (sequence generation and
1. Intensive behavioural interventions: Group counselling
allocation concealment; selection bias), blinding (performance and
detection bias), incomplete outcome reporting (attrition bias), and We found 10 randomized controlled trials that reported 6- to 24-
selective outcome reporting (reporting bias). month quit rates for individuals receiving group-based behavioural
interventions (Glasgow 1984; Frank 1986; Klesges 1987; Omenn
Dealing with missing data 1988; DePaul 1994; Razavi 1999; Schröter 2006; Gunes 2007; Mayer
We contacted authors where possible to fill gaps in the data. 2010; Mishra 2010). Some of these studies compared an intensive
We counted participants lost to follow-up or unaccounted for as intervention, typically including group support meetings, with a
continuing smokers, and where possible included them in the less intensive intervention such as provision of self-help materials,
denominator on an intention-to-treat basis.
Informed decisions.
or with a waiting list control. Some compared variations of group or Relapse Prevention Programme) or to a 'self help only' condition
programmes, or the additional impact of incentives. (American Cancer Society Quitter's Guide). Those not interested in
group support were randomized to a manual-based version of
Three studies evaluated ways to improve the results of group the same Multiple Component Programme or Relapse Prevention
programmes: Programme, or the same Guide. The participation rate was 11%.
This study also contributes data to the self-help group.
• Glasgow 1984 compared three versions of a controlled smoking
programme in 36 employees: abrupt reduction; gradual Schröter 2006 offered a relapse prevention programme in four
reduction; or gradual reduction plus feedback on nicotine German workplaces, compared with a standard behavioural
consumption with one pre- and two post-tests. Smoking programme. Nicotine replacement therapy was also provided if
reduction was defined as an outcome for this study, targeting requested. Sessions rather than individuals were randomized, and
nicotine content (brand smoked), number of cigarettes smoked the programme lasted eight weeks, with follow-up at one year.
daily, and percentage of each cigarette smoked. Participants
could choose either cessation or reduction as their desired Gunes 2007, set in a Turkish textile factory, primarily measured
outcome. The participation rate was not reported, though an 8% movement through stages of change in two matched cohorts
attrition rate was reported. of male smokers. The intervention group received a three-week
• Frank 1986 assigned 63 participants to one of three treatments: behavioural programme based on the American Lung Association's
four hypnotic sessions with a booster; two hypnotic sessions; Seven Steps to a Smoke-Free Life. Smoking status was assessed at
or two hypnotic and two behavioural sessions with a booster. the six-month follow-up.
A follow-up group of 15 later recruits received four hypnotic
sessions and a booster session. The participation rate was not Mishra 2010 is a study set in four Indian call centres, each of
reported. The study lacked a no-treatment control group. which hosted a different level of intervention. The control site
distributed self-help materials to all employees on the hazards
• Klesges 1987 tested the effect of competitions on cessation of tobacco, methods of quitting, and where to go for practical
rates in 136 smokers from eight workplaces. The workplace
help. The first intervention site (which we use in this review)
was the unit of randomization (cluster-randomized) but with
conducted health education sessions for all employees, followed
individuals as the unit of analysis. The participation rate was not
by focus-group discussions for tobacco users in groups of 7 to
reported but was estimated at 28% across all eight participating
10. The second intervention site replicated this but added one-to-
workplaces. The drop-out rate from treatment was 7% overall,
one behavioural therapy, and the third intervention site added the
with no difference across conditions.
offer of bupropion based on needs assessment. The researchers
DePaul 1994) compared three interventions; self-help alone, self- followed up all tobacco users in person or by phone to 12 months.
help with incentive payments for days abstinent, and intensive It is notable that high staff turnover in this population meant that
group support with incentive payments, cognitive behavioural 52.4% of baseline tobacco users had changed jobs after 12 months.
strategies, and maintenance manuals.
2. Intensive behavioural interventions: Individual counselling
Two group-counselling trials (Razavi 1999; Mayer 2010) targeted We found eight studies that investigated individual counselling,
recent ex-smokers, to reinforce abstinence and reduce relapse in most cases given by a physician (Cambien 1981; Li 1984;
rates. Three other trials (Klesges 1987; Omenn 1988: Schröter Gomel 1993a; Kadowaki 2000; Lang 2000), in Terazawa 2001 by
2006) also included a relapse prevention component, alongside a trained nursing staff, in Groeneveld 2011 by either an occupational
cessation intervention. physician or an occupational nurse, and in Windsor 1988 by a
'health educator'.
• Razavi 1999 randomized abstainers (98.6% of those eligible) who
had completed a non-randomized cessation programme, to test Two years post-intervention, Cambien 1981 followed up the first
the efficacy of two relapse prevention programmes. Participants 1292 participants in a cluster-randomized controlled trial, the
were assigned to a psychologist-run support group (PG), or Paris Cardiovascular Risk Factor Prevention Trial, conducted in 160
an ex-smoker-run support group (SG) or a 'no formal support' sections of a civil service administration. They measured the effects
group (NG), and were assessed at 12 months. Participants of physician advice, information leaflets and physical monitoring
in the PG and SG groups attended monthly meetings, where on diet, alcohol and cigarette consumption in young men (25 to 35
cessation support was given, and weight, blood pressure, pulse years of age). We focus here on the 610 participants in the smoking
and concomitant medical problems were monitored. At the cessation components. The intervention participants received
end of nine months, participants completed a Brief Symptoms either three or four tailored counselling sessions, depending on
Inventory and a Life Events Scale. All who were participants at whether their baseline assessment showed them to be at low or
three months were followed up until 12 months post-treatment. at high risk of coronary disease. The control group received only
• Mayer 2010 randomized successful quitters following a smoking baseline and follow-up assessments.
cessation programme in a number of Belgian companies to
either work-based group counselling or to proactive phone Li 1984 studied asbestos-exposed male smokers undergoing
counselling to minimize relapse rates. The cohorts were screening in a mandated programme for naval shipyard workers.
assessed after nine months for long-term relapse-free quit rates. The workers were categorized as having normal or abnormal
pulmonary status on the basis of a chest X-ray and pulmonary
Omenn 1988 recruited smokers at a single workplace. Participants function tests. They were then randomly assigned within
with a preference for a group format were randomized to one of two pulmonary function test categories to receive either a simple
smoking cessation programmes (Multiple Component Programme warning or three to five minutes of behavioural cessation

Informed decisions.
counselling from the physician who gave them the results of their Control subjects received the baseline screening and usual care. All
pulmonary tests. The participation rate is reported as 84.6%. The participants were re-assessed at six and twelve months follow-up.
study did not have a no-treatment control group.
Groeneveld 2011 targeted individuals at elevated risk for cardiac
Windsor 1988 studied the incremental effectiveness of a skills illness in a cohort of Dutch male construction workers. The
training programme with social support enhancement and participants could choose to address either nutrition and physical
monetary incentives to a self-help manual. A health educator activity or smoking cessation, and we focus for this review on
provided training in cessation skills in a structured 20- to 30- the 115 intervention smokers and the 123 control smokers who
minute one-to-one session; one group received this training to attempted to quit smoking. The programme offered three face-
supplement the self-help manual, and another group received both to-face 45- to 60-minute sessions of motivational interviewing
interventions plus monetary incentives. This study also contributes (MI) counselling, and four 15- to 30-minute phone calls with an
data to the incentives group. occupational physician or nurse. All participants also received
brochures on physical activity, healthy eating, smoking, and
Gomel 1993a randomized 28 Sydney (Australia) ambulance stations cardiovascular disease. The relevant outcome was self-reported
to four intervention groups (without a no-treatment control), in an smoking cessation at six and 12 months.
attempt to reduce cardiovascular risk factors. The HRA (Health Risk
Assessment) group received measurements and risk assessments, 3. Self-help interventions
including body mass index, blood pressure, cholesterol, smoking
We found six studies that examined self-help interventions (Omenn
status, percentage of body fat, and aerobic capacity. We focus here
1988; Sutton 1988a; Sutton 1988b; Sutton 1988c; Sutton 1988d;
on the 128 smokers who participated. Those assessed as being at
Hishida 2010). A variety of approaches were tested and included
high risk were referred to their own family physician, but received
short videos (Sutton 1988a; Sutton 1988b; Sutton 1988c; Sutton
no direct support from the intervention programme. The RFE (Risk
1988d), self-help manuals (Omenn 1988), and information about
Factor Education) group received a similar assessment, but were
genotyping (Hishida 2010).
given standard advice, through written and video material. The BC
(Behavioural Counselling) group, after the standard assessment, The Omenn 1988 study is described in the Group Counselling
were offered up to six counselling sessions in risk reduction, section. We consider only the self-help arms for this category.
together with a manual on behaviour change. The fourth group
(BCI, Behavioural Counselling and Incentives) received the same Sutton (Sutton 1988a; Sutton 1988b; Sutton 1988c; Sutton 1988d),
programme as the BC group, together with an incentive scheme in a series of four randomized controlled studies in four UK
which gave individuals the chance to win AUD 40 for achieving companies, evaluated a minimal smoking intervention programme
risk reduction targets at three and six months, plus a prize of based on the use of motivational videotapes. In the videotape
AUD 1000 for the station which achieved the highest percentage studies groups of smokers (n = 603) were randomly assigned to
of successful participants at six-month follow-up. The participation watch one of several different videotapes. They were followed up
rate was 88% (431 participants, including 128 smokers). This study along with non-participants (n = 1015) at three months and again
also contributes data to the incentives group. at one year.
Kadowaki 2000 evaluated the effectiveness of a smoking cessation Hishida 2010 was set in a Tokyo bank, and allocated smokers
intervention in all male smokers in a Japanese radiator to genotyping or to assessment only by alternate months of
manufacturing factory. Participants in the intervention group routine occupational health checks. All smokers received a booklet
received individual counselling by a doctor, and those who indicating that particular genotypes appeared to be at increased
signed a Smoking Cessation Declaration underwent a five-month risk of smoking-related cancers; those in the intervention cohort
intervention. Subjects in the control group received equivalent who agreed to be genotyped received their results three months
delayed intervention after four months. Randomization was by later, without specific cessation advice. All participants were
individual smoker. assessed at 12 months. The primary outcome was movement
through the stages of change, but smoking status by allocated
Lang 2000 compared the effects of a workplace intervention by group and by genotype were also collected.
the occupational physician, offering simple advice on smoking
cessation for five to ten minutes, with a more active strategy of 4. Pharmacological therapy
advice including a quit date and extra support. For both strategies,
the medical team was composed of a physician and whenever Five studies investigated pharmacological therapy in the workplace
possible a nurse, who would reinforce the physician's advice. Both (Sutton 1987; Sutton 1988e; Kornitzer 1995; Rodriguez 2003; Noor
the randomization and the analysis were by workplace. 2011). Seven other included studies (Razavi 1999; Schröter 2006;
Tanaka 2006; Sorensen 2007; Okechukwu 2009; Bergstrom 2008;
Terazawa 2001 randomized 228 smokers presenting for routine Mayer 2010) also included NRT as part of their intervention, but not
occupational health checks in a Japanese factory; 117 were as the component being tested. Mishra 2010 added bupropion to its
allocated to the intervention condition, and 111 to the control. All most intensive intervention arm, but only 10 of the 24 smokers who
participants completed a baseline questionnaire and had carbon were offered bupropion took up the option.
monoxide (CO) and urinary metabolites measured to verify their
level of smoking. Intervention group smokers also received a Kornitzer 1995 evaluated the effects of adding nicotine gum
15- to 20-minute counselling session from a nurse trained in to smokers already using the nicotine patch in a double-blind
cessation methods, and those who were prepared to set a quit date placebo-controlled randomized trial. The effect of the nicotine
received four follow-up phone calls to support their quit attempt. patch against placebo patch in both groups receiving placebo
nicotine gum was also assessed.

Informed decisions.
Sutton 1987 evaluated the effectiveness of a brief treatment for GROUP 2: INTERVENTIONS AIMED AT THE WORKSITE AS A
smoking using nicotine chewing gum in a large retailing company WHOLE
in London, UK. The study was randomized with a two-group pre-
6. Environmental support for not smoking
test/post-test design. In total 270 of 334 cigarette smokers who
expressed interest were invited to take part in the programme, We found three studies that reported environmental or institutional
which consisted of two individual consultations two weeks apart support programmes (Dawley 1991; Erfurt 1991; Hymowitz 1991).
and a prescription for 2 mg Nicorette gum with recommendations Tanaka 2006 also included environmental components, as one
for its use. The remaining 64 smokers constituted a no-intervention part of a complex intervention programme (see Comprehensive
control group. programmes for details).
Sutton 1988e evaluated the effect of offering brief individual Dawley 1991 evaluated a small study of workplace smoking
treatment based on nicotine chewing gum to a randomly chosen control in two comparable oil refineries. One company was
sample in one company (n = 161) still smoking at the three-month randomly assigned to an environmental programme of smoking
follow up to a previous video intervention (Sutton 1988d). The control, discouragement, and cessation, while the other company
treatment course was administered by occupational health nurses received only a smoking cessation programme. Humorous anti-
and consisted of four short consultations over a 12-week period. smoking posters emphasizing the benefits of quitting smoking
were distributed throughout the intervention workplace and were
Rodriguez 2003 delivered a combined intervention of individual changed every two weeks. Three weeks after the initiation of
structured counselling with nicotine patches in an open (non- the smoking discouragement programme at one refinery, a group
blinded) randomized controlled trial conducted in three Spanish smoking cessation programme was begun at both plants. The
worksites. Intervention participants (115 people) were graded by participation rate was not reported.
Fagerstrom score and treated with appropriate levels of nicotine
replacement therapy for up to 12 weeks. Progress, withdrawal Erfurt 1991 compared the effects of four interventions: (1) wellness
symptoms and adverse events were monitored over the 12- screening, (2) wellness screening plus health education, (3) 1 and
month trial period. Control group smokers (103 people) received 2, plus follow-up counselling, and (4) 1, 2 and 3 plus peer support
brief, sporadic and unstructured advice, usually at their annual groups, buddy systems, health promotion classes, and plant-wide
occupational health check. activities.
Noor 2011, set in two Malaysian towns, offered a herbal Hymowitz 1991 evaluated the effect of an enriched environment on
compound (Viva QS) or placebo tablets to male smokers employed the impact of a group quit-smoking programme in six workplaces.
in 11 worksites and attending a mobile smoking cessation Two hundred and fifty-two smokers participated in the group quit
clinic. Participants were contacted by phone at two and four smoking programmes; 131 at the full programme sites (group
weeks, to assess progress and adverse events, and were given plus physician counselling plus workplace health promotion) and
brief counselling. Outcomes were 7-day point prevalence and 121 at the group-only sites (group cessation programme). The
continuous abstinence from weeks 4 to 24, verified by expired CO. participation rate was not reported.
All participants, whether claiming abstinence or not, were checked
face-to-face at 24 weeks. Fifty-four urine samples for cotinine were 7. Incentives
collected at week 24, but not analysed. We found six studies of incentives with comparison groups and
quit rates (Rand 1989; Windsor 1988; Glasgow 1993; Gomel 1993a;
5. Social support for not smoking
Hennrikus 2002; Volpp 2009). A number of other included studies
Two studies evaluated social support as an increment to other (Klesges 1987; DePaul 1989; DePaul 1994; Sutton 1988a to Sutton
cessation strategies (Malott 1984; Glasgow 1986). Social support, in 1988d; Tanaka 2006) used incentives as an aid to cessation or
this context, refers to the support of a 'significant other', for example reduction, but not as the intervention being tested.
a spouse, a workmate or a close friend.
Rand 1989 examined the relative contribution of a contingent
Malott 1984 randomly assigned 24 smokers to controlled smoking payment (up to USD 200) and workplace CO monitoring to the long-
or a controlled smoking plus partner support intervention. Both term maintenance of smoking abstinence. Forty-seven hospital
studies defined smoking reduction as one of their outcomes, employees who had abstained from smoking for five days were
targeting nicotine content (brand smoked), number of cigarettes randomly assigned to one of three follow-up groups: contingent
smoked daily, and percentage of each cigarette smoked. payment and frequent monitoring (n = 17), non-contingent
Participants could choose either cessation or reduction as their payment with frequent monitoring (n = 16), or contingent payment
desired outcome. The participation rate was not reported. with infrequent monitoring (n = 14).
Glasgow 1986 recruited 29 smokers who were assigned to small Windsor 1988 studied the incremental effectiveness of skills
groups and were then randomly allocated to a basic programme training with social support enhancement and monetary incentives
or basic programme plus social support. The participation rate was to a self-help manual. The participants were randomized to four
not reported. groups in a two-by-two factorial pre-test/post-test design. The
monetary incentive was a USD 25 payment to the employee after six
weeks of abstinence. An additional USD 25 incentive was awarded
at the end of six months abstinence.
Glasgow 1993 evaluated the impact of a year-long incentive-

based workplace cessation programme (the HIP program).
Informed decisions.
Nineteen workplaces were randomized to incentive or no-incentive In DePaul 1989, the basic design was as for DePaul 1987, but
conditions. Smokers were paid USD 10 each time they were enhanced with monthly booster sessions, and with successful
confirmed abstinent by CO validation at monthly meetings over the quitters and up to five of their family and co-workers entered in a
year-long programme. In addition, each month at each workplace lottery at the end of the intervention period and at one-year follow-
abstinent smokers were also eligible to win a lottery prize (which up.
ranged from USD 5 to USD 20) and grand prize lotteries during
the final month of the programme. All identified smokers in Sorensen 1993 examined the effectiveness of a multi-component
the workplace were considered as participants for the study, smoking cessation programme. The three-month intervention
whether or not they participated in the intervention. Analyses included consultation for employers on the adoption of a non-
were conducted at both the workplace and individual level and smoking policy (90-minute consultation), training for nonsmokers
using both self-reported and biochemically validated cessation as (a one-hour class) to provide assistance to smokers attempting
endpoints. There was a participation rate of 23% in the incentive to quit, and cessation classes for smokers (three one-hour
group. behavioural cessation classes). Eight workplaces were randomized
to two groups (intervention/no intervention) with one and two
Gomel 1993a, in a cluster-randomized study of 28 Australian post-tests. Although the workplace was the unit of randomization,
ambulance stations, included an incentives component in its four- analyses were conducted using the individual as the unit of
way comparison study to reduce cardiovascular risk factors. This analysis. The participation rate was reported as 12% of smokers and
trial is described above, under the individual counselling section. 3.7% of nonsmokers. The attrition rate was not reported. No data
were available for individual smoking cessation.
The SUCCESS Project (Hennrikus 2002) compared three
programme options (telephone counselling, group sessions, or a A Dutch study (Willemsen 1998) compared a comprehensive
choice of either), each offered with and without incentives for smoking cessation intervention of self-help manuals, group
recruitment and cessation. Four workplaces were assigned to each courses, a mass media campaign, and smoking policies with a
of the six options, and were surveyed at baseline, and again at 12 minimal intervention of self-help manuals only. Eight workplaces
and 24 months. Incentive site smokers were paid for signing up to (four matched pairs) participated in the study. The 'bogus pipeline'
a programme (USD 10), for completing it (USD 20) and for 30 days procedure was used to improve the validity of self reports of
abstinence (USD 20). Successful quitters were entered into a prize smoking status. This means that subjects are informed that their
draw, to win up to USD 500. A sample of quitters at 24 months were self reports can be biochemically verified, although the test is
also paid USD 25 if they supplied saliva for cotinine measurement. not necessarily performed. Respondents who claimed they were
nonsmokers at the 14-month follow-up were asked to co-operate
Volpp 2009, set in a multinational company in the US, with biochemical validation of their smoking status.
randomized smokers to information about local smoking cessation
services versus the same information combined with stepped A Japanese study (Shimizu 1999), available only as an abstract,
financial rewards for completing a smoking cessation course examined the effectiveness of a multicomponent smoking
and for sustained cessation. Up to USD 750 were available to cessation programme (intensive education, group lectures and
each intervention smoker for long-term (12-month) cessation individual counselling) compared to a waiting-list control group of
biochemically confirmed. Participants were also rewarded for smokers. The participation rate was not reported.
completing a smoking cessation course, for complying with
assessments and for supplying confirmatory samples. The primary The HIPOP-OHP Study (Tanaka 2006) was a Japanese
outcome was validated abstinence at 12 or 18 months (depending multicomponent intervention to reduce cardiovascular risk factors,
on earlier success). Assessments were conducted and rewards including smoking, in six intervention sites matched to six control
given some months after completion of the cessation programme. sites. The study concentrated mostly on blue-collar workers. The
six-week cessation programme was offered five times over 36
8. Comprehensive programmes months, and included information brochures on stages of change,
four counselling sessions and NRT if requested. It was integrated
We classify these trials into two groups:
with an intra-site publicity campaign (posters, newsletters, web
(a) Programmes which used a combination of types of intervention
site), designation of smoking areas, and an award for successful
to support the primary aim of the trial, i.e. to quit smoking.
abstainers. Participants were assessed at 12, 24, and 36 months.
(b) Programmes which used a mix of interventions to reduce a
The participation rate was 9% of smokers across the six sites.
number of different high-risk behaviours, including smoking.
Okechukwu 2009 targeted apprentices in the US building trades,
a) Multiple intervention smoking cessation programmes
with a four-month multi-pronged programme based on group
We found seven trials which have smoking cessation as their counselling, supplemented by free NRT, self-help materials and
primary or only outcome, but use a combination of interventions environmental cues (posters, support materials). The smoking
to address it (DePaul 1987; Willemsen 1998; DePaul 1989; Sorensen cessation component was integrated with training in work-related
1993; Shimizu 1999; Tanaka 2006; Okechukwu 2009). toxic hazards. The outcome was self-reported abstinence at least
six months from the end of the intervention.
DePaul 1987 randomized workplaces to self-help materials in
conjunction with televised cessation programmes versus the same b) Multiple-outcome comprehensive workplace programmes
materials and programmes plus group or individual counselling at
Thirteen studies evaluated multiple-outcome workplace
the workplace.
programmes, i.e. targeting several health indicators, including
smoking, for risk reduction (Kornitzer 1980; Shi 1992; Glasgow
1995; Sorensen 1996; Sorensen 1998; Emmons 1999; Nilsson 2001;
Informed decisions.
Campbell 2002; Sorensen 2002; Sorensen 2007; Bergstrom 2008; habits, integrated health promotion and health protection through
Prochaska 2008; Milani 2009). joint worker-management participation in programme planning
and implementation, consultation on workplace changes, and
In the Belgian Heart Disease Prevention Project, Kornitzer 1980 educational programmes targeting health behaviour change,
cluster-randomized 30 paired Belgian factories to intervention or including smoking cessation. This study particularly addressed
control conditions, with all male workers aged 40 to 59 eligible differences in behaviour change between white-collar and blue-
to take part. All intervention participants were screened for collar workers.
cardiovascular risk factors (blood pressure, serum cholesterol,
weight, smoking and physical activity), and were given written Another study within the Working Well Trial was the Working
advice to reduce their risks. The screening results were also passed Healthy Project (Emmons 1999). The Brown University study
on to participants' family and workplace doctors. The two deciles centre developed an extended programme within its 26 worksites
with the highest risk score were ranked as the high risk group, (reduced eventually to 22), similar in aims and scope to the
and additionally received six-monthly physician advice and testing. parent trial but including physical activity as a target objective,
At the environmental level, anti-smoking posters were regularly and following a cohort rather than assessment by cross-sectional
displayed, and each intervention factory held a conference on the surveys. The control sites received a minimal self-help programme
dangers of tobacco use. A five per cent sample of the intervention of two smoking cessation courses and one each of nutrition and
group were re-assessed annually. In the 15 control factories a exercise, for those sites that wished to implement them.
random 10% sample were fully assessed at baseline, and then
followed throughout the trial. Within that group a 20% high- A Swedish study (Nilsson 2001) reported the effects of a long-term
risk group was identified and compared throughout with their comprehensive programme of lifestyle interventions, including
intervention counterparts. The participation rate was 83.7% (n = smoking cessation, to reduce risk factors for cardiovascular
16,230). disease. This randomized controlled trial for at-risk public sector
employees also targeted body mass index, diastolic blood
The HealthWise Stepped Intervention Study (Shi 1992) allocated pressure, heart rate, low-density lipoprotein and cholesterol. The
nine North Californian worksites belonging to Pacific Gas & Electric intervention group received individual counselling as well as 16
to four intervention levels. The seven sites allocated to levels 1 annual group sessions, using lectures, discussions, videos and
to 3 were randomly assigned, while the two smallest sites were outdoor activities; the control group received standard oral and
allocated to Intervention level 4, in order to minimize the running written advice about cardiovascular risk reduction at the beginning
costs of the trial. The trial lacked a no-treatment control site. The of the trial, and nothing subsequently. Smoking point prevalence
interventions ranged incrementally from Health Risk Assessments was assessed at 12- and at 18-months follow-up.
(HRAs) at the start and finish of the trial with a bimonthly health
newsletter at Level 1, through the addition of a Health Resource The Health Works for Women trial (Campbell 2002) developed
Centre and self-care books at Level 2 sites, behavioural workshops a two-pronged approach to helping rural blue-collar women
and a social support team at Level 3, to an environmental smoking workers to improve their diet and physical activity levels, and
policy and a case management programme for the high-risk group to stop smoking. The programme was a combination of tailored
(the 15% with the highest overall risk score) at Level 4. Outcomes 'magazines' at baseline and at six months, personalized for
were measured by cross-sectional HRAs at baseline and at two- the characteristics and preferences of each participant, and
year follow-up, and included smoking, drinking and speeding. The social support at work from volunteer 'natural helpers'. The
participation rate was 69% at baseline and 48% at follow-up. smoking intervention was incompletely delivered, however, as no
lay helpers were willing to be trained to deliver the personal
The 'Take Heart' study (Glasgow 1995) evaluated the short-term support. The control group received a minimal intervention (one
effects of a low-intensity heart disease risk reduction programme, personalized magazine) at six months, with no offer of social
targeting smoking, dietary intake and cholesterol. Twenty-six support. Randomization was by worksite. The participation rate
workplaces with between 125 and 750 employees were randomly was 73% at baseline.
assigned to early or delayed intervention. Early intervention
consisted of an 18-month multi-faceted programme that featured Based on the WellWorks Study, WellWorks-2 (Sorensen 2002) was
an employee steering committee and a menu approach to a block-randomized controlled trial of 15 workplaces, all handling
intervention activities tailored to each site. hazardous chemicals. The intervention and aims of the study were
very similar to the original WellWorks Project, being primarily
The Working Well Trial (Sorensen 1996) used a randomized health promotion and protection, but follow-up was only to six
matched-pair design, with the workplace as the unit of assignment months. Like its parent project, WellWorks-2 targeted differences
and analysis in 108 workplaces, with an average of 316 workers between white- and blue-collar workers, and concentrated on
per site. The intervention targeted individuals and the workplace smoking and nutrition; an additional outcome of interest in this
environment, and included dietary habits (all four study centres) study was changes in perceived hazard exposure.
as well as smoking (three of the four centres). Each centre also
addressed one additional risk factor; these included occupational The Tools for Health study (Sorensen 2007) targeted American
exposure to carcinogens, exercise, cancer screening, and smokeless construction workers, on the basis that they represented a transient
tobacco. population who tended not to benefit from workplace occupational
health provision. Six hundred and seventy-four workers, contacted
Nested within the Working Well Trial, and based at the through their trade union, completed a baseline survey on their
Massachusets study centre, was the WellWorks Study (Sorensen smoking and their consumption of fruit and vegetables. The
1998), a randomized matched-pair trial in 24 workplaces. The intervention consisted of tailored phone-based counselling (up
two-year intervention, aimed at changing dietary and smoking to four calls over three months), mailed tailored feedback, six
Informed decisions.
targeted mailings of educational materials, and NRT for those intervention (HRI)) on four risk factors (inactivity, BMI, stress and
who requested it. At six months, 582 participants (including 188 smoking) in a worksite sample. We focus here on the smoking
smokers) completed the follow-up survey, giving an attrition rate of interventions, and compare the HRI-alone arm with the HRI plus
13.6%. motivational interviewing arm. The outcome was progression
through the stages of change, but also reported six-month quit
Another Swedish study (Bergstrom 2008) allocated four companies rates, although without end-of-study denominators.
in the paper, steel and truck manufacturing industries to a 3½-
year comprehensive lifestyle programme to reduce risks of COPD, Milani 2009 was a six-month comprehensive cardiovascular risk
asthma and cardiovascular disease, and to target neck and back reduction programme in New Orleans, USA, targeting nutrition,
pain, alcohol, and absenteeism. The whole programme was offered smoking, and physical activity in employees and their spouses.
three times over the course of the study. 'High-risk' individuals The basis for inclusion was coverage by employer-sponsored
were offered inpatient rehabilitation courses based on behavioural healthcare insurance. Smoking was addressed in the intervention
approaches, while those deemed to be at moderate risk were given site by referral to a group counselling programme for smoking
smoking cessation information and the offer of NRT by medical cessation. Participants who achieved milestones were rewarded
staff at the occupational health service. A 'reference' company with extra vacation days and "other job-related perks". Outcomes
acted as the control. Evaluation became problematic, as individual were assessed at one year, including any cost savings to the
companies often set up their own health promotion activities, company.
including 'stop smoking' support groups.
Risk of bias in included studies
Prochaska 2008 aimed to compare the effect of three approaches
(motivational interviewing, an online transtheoretical model A summary of the 'Risk of bias' assessments is given in Figure 1.
(Prochange Lifestyle Management Programs), and a health risk

Informed decisions.
Figure 1. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Empty cells are for multiple studies within a single study report.

Informed decisions.
Figure 1. (Continued)

Informed decisions.
Figure 1. (Continued)
Some randomized studies aim to intervene with the workplace six-month quit rates, but without the relevant denominators.
as a whole. They use a cluster-randomized design, allocating Okechukwu 2009 warned that there may have been contamination
entire workplaces to conditions. Such studies should be analysed between intervention and control cohorts, since randomization
at the level of the cluster rather than the individual. When was by the union training base but apprentices from different bases
workplaces are the unit of allocation, but results are presented for could sometimes have worked together on the same worksites.
individual quitters, the assumption that outcomes are independent Hishida 2010 reported that unexpectedly high cessation rates in the
is violated, since people in the same site may be more like one control group may have been associated with concurrent health
another than expected by chance. If the analysis ignores the promotion legislation to prevent passive smoking in the workplace.
clustering, the confidence intervals are likely to be too narrow
(Bland 1997). The effect is greater if there are a small number Two Japanese studies (Shimizu 1999; Terazawa 2001) are included
of large clusters. Cluster-randomized studies with individual on the basis of data derived from the abstracts alone.
outcomes also present problems related to the choice of an
The 'gold standard' outcome for smoking cessation studies is
appropriate denominator. The number of smokers who attend
biochemical validation of self-reported cessation (i.e. testing of
group meetings or use self-help materials is considerably smaller
saliva, blood, urine samples or exhaled breath for evidence of
than the total number of smokers in a workplace. In cluster-
recent smoking). This generally results in lower rates of cessation,
randomized studies the denominator chosen for the analysis may
due not only to people misreporting their smoking, but also to
be all smokers, smokers who express interest in treatment, or
relapsing, or refusing to provide samples for other reasons. Using
those who attend sessions. If the intervention involves individual
validation may not change the relative effect of the intervention,
cessation treatment, then trials focus on the outcome in the
since similar levels of misreporting are likely to be seen in the
group of attenders. If the intervention includes other changes
control condition as well, unless no intervention at all is provided
to the workplace environment, for example the introduction of
to the control. Of the 55 studies in which intervention was
restrictions on smoking, it is reasonable to assess the impact on the
provided to individuals, 41 (66%) used some form or combination
smoking workforce as a whole.
of biochemical verification procedures for at least one follow-up
Eleven of the included studies (19%) reported randomization point. These included butt counts, carbon monoxide ((CO) in 47%
procedures in sufficient detail to be rated as adequate for their of the included studies), salivary thiocyanate and urinary, blood or
attempts to control selection bias. The majority of included salivary cotinine.
studies (67%) either did not describe how randomization was
In assessing the potential impact of workplace interventions it
performed or reported in insufficient detail to determine whether
is important to know the proportion of smokers who can be
a satisfactory attempt to control selection bias had been made.
recruited to different types of intervention, whilst recognizing that
Eight studies (14%) either failed to randomize appropriately or
some barriers to recruitment to trials may not be relevant to
did not use a randomized trial design at all. In two studies
real settings. In some of the studies included here the use of a
(Sutton 1987; Sutton 1988e) a few control group subjects were
workplace population would appear to have been largely a matter
allowed to move into the intervention group. One study (Li 1984)
of convenience for ease of recruitment. These studies have typically
modified its randomization procedure partway through the study
not reported on the proportion of the smoking workforce who
and was also obliged to reconstitute its experimental and control
participated. Where studies have calculated the participation rate
groups to accommodate physicians who did not comply with
we have recorded this in the Characteristics of included studies
the protocol; Shi 1992 and Gomel 1993a allocated smaller or
table. The participation rates in the studies included here ranged
fewer worksites to the most expensive interventions in order to
from 9% to 88%.
keep trial costs down. Gomel 1993a also reported some level of
contamination between conditions as staff moved from station GROUP 1: INTERVENTIONS AIMED AT THE INDIVIDUAL TO
to station. Schröter 2006 compromised the distinction between PROMOTE SMOKING CESSATION
the experimental and control group interventions, by applying
'rescue' relapse prevention techniques to members of the standard 1. Intensive behavioural interventions: GROUPS
behavioural group when necessary. Prochaska 2008 reported

Informed decisions.
Only two of this group of 10 trials described the method Three of the four studies in this group employed a clustered design,
of randomization in sufficient detail to exclude the possibility with Tanaka 2006 allocating sites non-randomly to intervention or
of allocation bias: in Omenn 1988 allocation was based on control in a matched-pair design. Two of the cluster-randomized
randomized assignment lists, while Razavi 1999 used random trials (Dawley 1991; Hymowitz 1991) analysed by individual, while
numbers concealed by a label. Four studies (Klesges 1987; DePaul the third (Erfurt 1991) used the workplace as the unit of analysis.
1994; Mayer 2010; Mishra 2010) used cluster randomization, and There was no biochemical validation of self-reported cessation in
Gunes 2007 assembled matched cohorts of intervention and Erfurt 1991 or Tanaka 2006. Dawley 1991 reported validation by
control participants, based on shifts worked, i.e. quasi-cluster- urinary cotinine and Hymowitz 1991 by expired air CO.
randomized. All of the trials except Schröter 2006, and Gunes 2007
used biochemical validation of self-reported smoking status. Two 7. Incentives
studies (Omenn 1988; DePaul 1994) used saliva cotinine, one study
(Frank 1986) used saliva thiocyanate and one (Klesges 1987) used Details of Gomel 1993a are reported under the Individual
both saliva thiocyanate and expired air carbon monoxide. Two Counselling heading.
studies (Glasgow 1984; Mishra 2010) used expired air CO alone, Windsor 1988 described randomization using a computer-
and two studies (Razavi 1999; Mayer 2010) used a combination of generated assignment system in numbered envelopes. Glasgow
expired CO and urinary cotinine. 1993 was described as cluster-randomized with both the workplace
and the individual used as the units of analysis. Rand 1989 gave
2. Intensive behavioural interventions: INDIVIDUAL no details of randomization. The SUCCESS Project (Hennrikus 2002)
COUNSELLING was described as a 3x2 factorial study, with workplaces randomly
assigned to the six treatment options, but stratified by gender
Only two of the eight studies in this group (Kadowaki and education level. No details of randomization were offered.
2000; Groeneveld 2011) adequately described the method of Volpp 2009 randomized in permuted blocks of four, stratified by
randomization. Three trials (Cambien 1981; Gomel 1993a; Lang site, income and level of smoking (more or less than 40 per day).
2000) used cluster randomization. Five studies used CO assessment Assignments were concealed in this trial until after allocation, but
for validation of self-reported cessation, with Lang 2000 using not thereafter. All six studies reported biochemical validation, using
partial validation, as several workplace physicians had no access to saliva thiocyanate (Windsor 1988; Hennrikus 2002; Volpp 2009),
a carbon monoxide monitor. Gomel 1993a used serum cotinine to serum cotinine (Gomel 1993a), urine if on NRT (Volpp 2009), or
validate smoking status at all assessment points, and Windsor 1988 carbon monoxide (Rand 1989) and carbon monoxide plus cotinine
used salivary cotinine testing. Only Groeneveld 2011 relied upon (Glasgow 1993).
self report, without any biochemical validation.
8. Comprehensive approach
3. Self-help interventions
No details of randomization were given, apart from Okechukwu
Among this group of six studies, none described the method of
2009, who used a random number generator. Bergstrom 2008,
randomization. All except Hishida 2010 validated their cessation
Tanaka 2006 and Willemsen 1998 allocated the worksites non-
rates, the Sutton studies with expired air CO, and Omenn 1988 with
randomly to intervention or control status. Fourteen of the 20
salivary cotinine.
studies employed a cluster-randomized design, while Nilsson 2001
4. Pharmacological therapy aggregated its participants from four public sector workplaces
within the same district. Non-validated self-reported smoking
Three studies described adequate randomization procedures, for cessation was recorded in 14 studies, partial or complete saliva
a placebo-controlled double-blind trial (Kornitzer 1995; Noor cotinine validation in two studies (DePaul 1987; DePaul 1989),
2011) and an open-label randomized controlled trial (Rodriguez and CO in Shimizu 1999 and Campbell 2002. Sorensen 1993 at
2003). The remaining two studies allowed movement between the six months and Willemsen 1998 at four months collected saliva
intervention and control groups (Sutton 1987; Sutton 1988e). All cotinines, but did not test them (the 'bogus pipeline' principle).
five studies validated self reports of cessation, using expired air CO Willemsen 1998 did, however, collect and test cotinine samples for
to verify smoking status. Noor 2011 collected end-of-trial cotinine 52% of self-reported quitters at the 14-month follow-up.
samples from all participants, whether abstinent or not, but failed
to analyse the urine samples because of technical problems at the Effects of interventions
laboratory. See: Summary of findings for the main comparison Smoking
cessation interventions for the workplace
5. Social support for not smoking
Smoking cessation/reduction
Neither study (Malott 1984; Glasgow 1986) gave randomization
details or participation rates. Self-reported cessation was validated For this update, we have conducted meta-analyses of the
in both studies using expired air CO and quantity of cigarette butts. main classes of intervention. Where there was more than one
The Glasgow study also monitored saliva cotinine. intervention arm, we have compared the control group (minimal
or no intervention) with the next simplest treatment. Although
GROUP 2: INTERVENTIONS AIMED AT THE WORKPLACE AS A this may occasionally underestimate the trial's true efficacy over
WHOLE: multiple interventions, we avoid the risks of overstating the effect
of the treatment or of tipping a result into significance by forcing
a binary comparison that does not reflect the true findings of the
trial. Studies treated selectively in this way include DePaul 1994,

Informed decisions.
Erfurt 1991, Glasgow 1984, Kornitzer 1995, Omenn 1988, Rand 1989, achieved 12-month validated quit rates of 16% for the multiple
Razavi 1999, Sutton 1988a, Sutton 1988b, Sutton 1988c, Sutton component arm, 18% for the relapse prevention arm and 8% for the
1988d, Windsor 1988, Prochaska 2008 and Mishra 2010. Analysable minimal treatment arm (NS).
data were not available for Hennrikus 2002 (incentives, Analysis
2.2), for Sorensen 1993 (multiple intervention programmes for In DePaul 1994 at 12 months, the self-help participants achieved a
smoking cessation; Analysis 2.3) or for 10 of the 13 comprehensive sustained abstinence rate of 5.1%, the incentives participants 11%,
programme trials targeting multiple risk factors (therefore not and the group participants 31.2% (P < 0.01).
meta-analysed).
Schröter 2006 found that participants in the standard behavioural
We have also produced a Results table (Analysis 3.1), which gives (SB) programme were more successful than those who received
details of types of participants, follow-up, smoking outcomes and relapse prevention (RP) support (21.1% continuously abstinent at
validation of cessation. 12 months versus 12.2%). They speculated that this unexpected
finding might be attributable to the emphasis in the RP group
GROUP I: INTERVENTIONS AIMED AT THE INDIVIDUAL TO on the likelihood of failure, but also noted that SB participants
PROMOTE SMOKING CESSATION had received relapse prevention 'rescue' support when necessary,
which may have compromised the separation between the two
1. Intensive behavioural intervention: GROUP COUNSELLING
interventions.
Eight trials (1309 participants) of worksite-based group behavioural
therapy interventions for smoking cessation demonstrated a Gunes 2007 reported a non-significant difference in the six-month
benefit for the counselling programmes, with an odds ratio (OR) of quit rate between the intervention and control groups (6% versus
1.71 (95% confidence interval (CI) 1.05 to 2.80; Analysis 1.1.1). There 2%, P = 0.14). The primary outcome of interest for this study was
was no statistical heterogeneity (I2 = 0%). movement through stages of change, and for this measure the
intervention group achieved significantly lower numbers in 'pre-
Within this category, two trials of relapse prevention using contemplation' and higher numbers in the 'preparation' stages at
group-based therapy (484 participants) found no benefit for the six months, but this did not translate into higher quit rates within
programmes: OR 1.15 (95% CI 0.80 to 1.65); Analysis 1.1.2. the time scale of the trial.
Glasgow 1984 showed that at six months one-third of participants Mishra 2010 demonstrated a benefit for counselling and focus
in the gradual condition were abstinent compared to no groups over self-help materials alone at 12 months, with an
participants in the abrupt condition. However, in this small intervention quit rate of 20% compared to 6% in the control group
sample the result was not statistically significant. This study also (P = 0.03). The two incrementally more intensive arms (+ individual
targeted smoking reduction as a valid outcome, and 47% of counselling, and + bupropion if wished) achieved similar results,
participants stated that they wished to reduce their consumption. with 12-month quit rates of 19% (P = 0.06) and 20% (P = 0.03)
Reducers were found to have been successful for each of the respectively.
target behaviours as they addressed them, without compensatory
increases in the other two behaviours. Achieved reductions were For the two relapse prevention studies, Mayer 2010 did not detect
statistically significant (P values from 0.001 to < 0.02). Mean an advantage at nine months for the proactive phone counselling
reduction in nicotine content was 50%, in percentage of each (57.5% remained quit) over the worksite-based group programme
cigarette smoked 34% and in number of cigarettes smoked (61.7% remained quit, P = 0.552). Predictors of higher abstinence
28%. Carbon monoxide (CO) levels were 28% lower on average, included a lower BSI-GSI score, lower levels of urinary cotinine, and
suggesting that participants were not compensating for the having to pay EUR 50 for the programme.
behavioural changes. All but one participant improved on at least
two measures, and 46% on all four variables. At six-month follow- The Belgian relapse prevention study (Razavi 1999) found
up, reducers maintained all the changes except for percentage of differences between psychologist-supported quitters (43.7% still
the cigarette smoked, with both abrupt and gradual plus feedback abstinent at 12 months), ex-smoker-supported quitters (37.5%)
participants relapsing on this measure (P < 0.05). and no formal support quitters (35.5%), but these did not reach
statistical significance.
Frank 1986, testing combinations of behavioural support and
2. Intensive behavioural interventions: INDIVIDUAL COUNSELLING
hypnotic sessions, showed no long-term differences between any
treatment variants. Eight trials (3516 participants) of worksite-based individual
counselling interventions demonstrated a benefit for the
Klesges 1987, testing both a relapse prevention component and counselling programmes, with an OR of 1.96 (95% CI 1.51 to 2.54;
a competition in a factorial design, failed to detect evidence for Analysis 1.2). There was minimal statistical heterogeneity (I2 = 24%).
a long-term benefit of either. At the immediate post-test, the
competition intervention resulted in higher quit rates (39% versus Cambien 1981 found that at two-year follow up 21.4% (65/304) of
16%, P < 0.004) but these differences were minimal at six months smokers in the intervention group had quit, compared with 13.4%
(12% versus 11%, NS). The six-month differences for relapse (41/306) in the control group. Although the descriptive forest plot
prevention were in the expected direction but not statistically suggests that this result was statistically significant, the authors
significant (15% versus 8%), although the competition appeared to report that it was not. The result does not take account of the 195
increase short-term quit rates. participants lost to follow-up, and the authors observe that those
lost to follow-up from the intervention group were significantly
Omenn 1988 showed non-significant trends towards higher quit heavier smokers than the follow-up attenders (P < 0.01) or the
rates for groups than for self-help controls. The three Group arms control participants.

Informed decisions.
Li 1984 found that at 11 months smokers given behavioural (23.7% versus 19.5%; P = 0.45). The intervention was more
counselling from a physician were more likely to remain abstinent successful in older participants (> 45 years) at both time points.
(8.4%) than those with a minimal warning (3.6%, P < 0.05).
Prolonged abstinence rates did not differ between participants with 3. Self-help programmes
abnormal lung function tests (3.7%) and normal lung function tests Six trials (1906 participants) of worksite-based self-help
(5.9%). interventions demonstrated no clear benefit for the self-help
programmes, with an OR of 1.16 (95% CI 0.74 to 1.82; Analysis 1.3).
Windsor 1988: As the two incentive arms of the trial did not There was no statistical heterogeneity (I2 = 0%).
detect any significant benefit for the payment schemes, the authors
collapsed the incentive and no-incentive groups together in the Omenn 1988, discussed earlier in the group counselling section,
analysis to test the efficacy of adding counselling and social support reported that the self-help arms achieved 12-month validated
to self-help materials. This comparison yielded a cessation rate cessation rates of 9% for the multiple component arm, 11% for the
of 5.8% (11/190) at 12 months for the combined self-help groups, relapse prevention arm, and 6% for the minimal treatment arm
compared with 14.4% (27/188) for the self help with counselling and (NS).
social support combined groups (P < 0.001).
Video studies
Gomel 1993a did not find significant differences in continuous The four studies of minimal video interventions with control groups
abstinence rates between any of the four groups (HRA, RFE, BC and (Sutton 1988a; Sutton 1988b; Sutton 1988c; Sutton 1988d) failed
BCI) at six or 12 months. However, when the authors pooled the to detect a difference in validated abstinence rates between the
HRA group with RFE (n = 68 smokers) and BC group with BCI (n = video groups, although the second study (Sutton 1988b) detected a
60 smokers) to test the efficacy of the counselling component, they difference between the video groups and the non-participant group
detected statistically significant differences in abstinence rates. (P < 0.05). This study, however, included younger smokers who
At six months, the combined HRA/RFE group had a continuous smoked more heavily than participants in the other three studies.
abstinence rate of 1%, compared with 10% for the BC/BCI pooled Another finding of the first of the studies (Sutton 1988a) was of more
group (Fisher's Exact Test P = 0.05); 12-month rates were 0% and smokers trying to stop in the intervention group than in the control
7% respectively (P = 0.05). The authors report that contamination group (P < 0.05), but in that study the 'control' video concerned
between the intervention groups and low participation rates seatbelts, whereas the 'control' videos in the other three studies all
among the RFE stations meant that the effect size of the whole trial related in some way to tobacco.
may have been compromised.
Genotyping information studies
Kadowaki 2000 found cessation rates of 12.9% and 3.1% in the
intervention and control groups respectively (P = 0.003). Among Hishida 2010 found a higher quit rate among the controls (baseline
those who succeeded in quitting 48.6% maintained cessation at information, plus observation only, 8.0%) at 12 months than in the
18-month follow-up. Overall the cessation rate was 8.4% after 22 intervention group (baseline information, then genotyped, 5.8%;
months and the prevalence of male smokers had decreased from P = 0.34). Although the authors offer concurrent anti-smoking
62.9 to 56.7% (P = 0.038). legislation as a possible confounder to account for this, it is not
clear why that would have impacted the control group more
Lang 2000 found point prevalence quit rates of 18.4% in the heavily than the intervention group. Comparisons by genotype also
intensive group compared to 13.5% in the minimal intervention detected no significant differences, with quit rates of 5.6% and 7.1%
group at one year (P = 0.03). Self-reported sustained cessation of six in the LS and SS (high-risk) groups respectively versus 4.9% (P =
months and more was reported in 6.1% of the intervention group 0.723) in the LL (low-risk) group.
compared with 4.6% of the comparison group (P = 0.26).
4. Pharmacological therapy
Terazawa 2001 detected a point prevalence cessation rate of
11.1% (13/117) at 12 months in the intervention group, compared Five trials (1092 participants) of worksite-based pharmacological
with 1.8% (2/111) in the control group. Twelve-month continuous interventions demonstrated a benefit for the treatment
abstinence rates were 6.8% (8/117) and 0.9% (1/111) respectively programmes, with an OR of 1.98 (95% CI 1.26 to 3.11; Analysis 1.4).
(Fisher's Exact 2-tailed Test P = 0.04 [our calculation]). Only 25 of the There was mild statistical heterogeneity (I2 = 19%).
117 counselled smokers in the intervention group agreed to make Sutton 1987 reported one-year continuous abstinence rates of 12%
a quit attempt and would therefore have received the four follow- among those allocated to nicotine gum and 2% among the control
up phone calls. group (no P value given). If an intention-to-treat analysis (i.e. based
The HIPOP-OHP study (Tanaka 2006) detected a steady rise in quit on all randomized participants) is performed on these data, the quit
rates in both the intervention and control worksites over the 36- rate drops to 7.8% for the intervention group at 12 months.
month assessment period. They report final quit rates of 12.1% in Sutton 1988e reported validated one-year abstinence rates of 22%
the intervention sites versus 9.4% for the controls (P = 0.021), but in those receiving nicotine gum compared with 2% in the control
this is based only on those who responded at both baseline and group (P < 0.001). An intention-to-treat analysis of these data would
at final follow-up. An intention-to-treat analysis yields quit rates of yield an intervention quit rate of 10.1% (8/79). The more rigorous
8.9% and 7.0% respectively (P = 0.046 [our calculation]). 'complete' abstinence rates (i.e. no smoking of any kind up to
Groeneveld 2011 found that a statistically significant benefit at follow-up assessment) are 6.3% (5/79) for the intervention group
six months (31.3% versus 13.4%) was not sustained to 12 months and 2.4% (2/82) for the controls.

Informed decisions.
In Kornitzer 1995 the three treatment groups (Group 1: active GROUP 2: INTERVENTIONS AIMED AT THE WORKSITE AS A WHOLE
nicotine patch and active gum; Group 2: active nicotine patch and
placebo gum; Group 3: placebo patch and placebo gum) achieved
12-month abstinence rates in Group 1, 2 and 3 of 18.1%, 12.7% and Four trials (3851 participants) of worksite-based environmental
13.3% respectively (P = 0.19). ORs comparing Groups 1 and 2 at 12 support demonstrated no benefit for the environmental
months (OR 1.47, CI 0.76 to 2.78, P = 0.125), and comparing Groups programmes, with an OR of 1.00 (95% CI 0.60 to 1.65; Analysis 2.1).
2 and 3 (OR 0.96, no further details) were not significant. Time to There was no statistical heterogeneity (I2 = 0%).
relapse was longer in Group 1 compared with the other two groups
(P = 0.04). In Dawley 1991 at five months the abstinence rate at the
environmental intervention site was twice that of the cessation-
Rodriguez 2003 detected a 12-month CO-validated continuous only site (43% versus 21%, no P value given).
abstinence rate of 20.2% (23/114) in the intervention group,
compared with 8.7% (9/103) among the controls. This gave an OR of Erfurt 1991 compared the effects of four interventions: (1) wellness
2.58 (95% CI 1.13 to 5.90, P = 0.025). These results are based on an screening; (2) wellness screening plus health education; (3) as
intention-to-treat analysis, except for one death in the intervention 2, plus follow-up counselling; and (4) as 3, plus peer support
group. groups, buddy systems, health promotion classes, and plant-wide
activities. In each group there was a reduction in the prevalence
Noor 2011 found a higher rate of continuous abstinence (weeks of smoking over three years, and the smoking prevalence at
4 to 24) in the intervention than in the control group; 25.3% three years was lower for interventions 3 and 4 compared with
versus 12.5%, P = 0.04. Although point prevalence abstinence was interventions 1 and 2 (P < 0.01), although this difference depended
biochemically validated, the continuous abstinence rates were not. on combining the 1985 smokers with the then ex-smokers.
Interventions 3 and 4 recorded slightly higher quit rates (20.3% and
5. Social support for not smoking 18.9% respectively) than interventions 1 and 2 (17.1% and 17.6%
Two trials (53 participants) of worksite-based social support respectively) among employees who were smoking at baseline, but
interventions demonstrated no benefit for the programmes, with the difference was not statistically significant, and may have been
an OR of 0.69 (95% CI 0.18 to 2.62; Analysis 1.5). There was no compromised by differences in baseline.
statistical heterogeneity (I2 = 0%).
Hymowitz 1991 failed to detect an effect of environmental support.
Two studies of social support (Malott 1984; Glasgow 1986) found Twelve-month quit rates were 22% for physician counselling and
no difference with the addition of this component to a basic group support alone, and 18% for the same support with an
programme of group counselling and support. Both studies also 'enriched milieu'.
defined smoking reduction as an outcome of interest, in which
Tanaka 2006 found that quit rates in both groups rose steadily
participants could choose to attempt either complete cessation or
over 36 months of follow-up. Six-month sustained abstinence at
reduction of smoking. In the earlier study (Malott 1984) the authors
36 months (ITT analysis) was 8.9% for the intervention sites versus
note that among non-abstainers, at six months follow-up the
7.0% for the controls (P = 0.0467).
Controlled Smoking (CS) Group daily consumption of nicotine was
0.52 mg compared with Controlled Smoking + Partner Support (CS 7. Incentives
+PS) Group's consumption of 0.45 mg. Average number of cigarettes
per day at six months follow-up was CS:21.5, compared with CS Five trials (1928 participants) of worksite-based incentive
+PS: 20.1. In both conditions, participants relapsed on number of interventions demonstrated a benefit for payment or reward
cigarettes smoked (P < 0.05). In addition, CS participants relapsed schedules, with an OR of 1.60 (95% CI 1.12 to 2.30; Analysis 2.2).
on nicotine content (P < 0.05), and CS+PS relapsed on percentage There was moderate statistical heterogeneity (I2 = 43%). Hennrikus
of cigarette smoked (P < 0.01). Neither group relapsed on CO levels, 2002 did not contribute any analysable data to this comparison.
and non-abstinent smokers in both groups were smoking less at
Our analysis of the incentives trials demonstrates a benefit for
follow-up than they had been before treatment.
rewards programmes over the control condition. However, a single
In Glasgow 1986 no differences in outcome were detected between study (Volpp 2009) contributed 37% of the weight and all of
the two groups of reducers (Basic Programme [BP] and Basic the statistical significance to this analysis; removing these data
Programme + Social Support [BP+SS]). Both groups at six months reduced the OR to 1.16 (95% CI 0.73 to 1.83). But despite this
had achieved reductions in nicotine (BP: 0.90 to 0.49; BP+SS: 0.78 cautionary note, we observe that Volpp 2009 was the only study
to 0.49, P < 0.05 for both). Number of cigarettes per day was to conduct assessments and deliver rewards considerably after
reduced in both groups (BP: 20.5 to 18.3; BP+SS: 27.7 to 24.4), the cessation programmes, when success rates might have been
but was statistically significantly higher than at immediate post- expected to have dissipated. This was a large study conducted and
test. The same pattern applied to percentage of each cigarette reported to high standards, and delivering robust findings.
smoked, although the BP+SS group six-month rate was still lower
Windsor 1988 failed to detect an effect of monetary incentives on
(P < 0.05) than pre-test levels (BP: 83.3 to 74.8; BP+SS: 89.0 to
quit rates, with 6/95 achieving continuous cessation in the self-
81.2). Carbon monoxide levels followed the same pattern, while
help group at 12 months compared with 5/95 in the self help
saliva thiocyanate levels were higher at six-month follow-up than
plus incentives group. The corresponding rates for the counselling
at baseline. As with cessation, this study offered no evidence that
groups were 18/94 and 9/94. If anything, the incentive component
social support enhanced sustained reduction.
appeared to have a negative impact.

Informed decisions.
Rand 1989 found that contingent payments delayed but did not Sorensen 1993 (not included in the meta-analysis) demonstrated
necessarily prevent relapse to smoking. The study failed to detect that at six-month follow-up, 12% of smokers in the intervention
an effect on relapse of monitoring and feedback of CO rates. group reported quitting, compared to 9% in the control group (P <
0.05), with cessation predicted by co-worker requests not to smoke.
Glasgow 1993 failed to detect a difference between incentive
and no-incentive conditions across 19 workplaces. There were no A small study (Shimizu 1999) of a multicomponent programme
statistically significant differences in self-reported cessation rates including group and individual counselling did not detect a
at one year (12.9% for incentives versus 12% for control) or at two statistically significant difference, with quit rates of 19% in the
years (18% for incentives versus 15.5% for control). intervention group and 7% in the control group.
The SUCCESS Project (Hennrikus 2002; not included in the meta- Tanaka 2006 detected a six-month sustained abstinence rate at
analysis) found that programme recruitment was higher in the 36 months of 8.9% (self-reported) for the intervention sites versus
incentive sites (22% vs 12%, P = 0.0054), but that this did not 7.0% for the control sites (P = 0.0467). Quit rates in both groups rose
translate to higher cessation rates. Although the authors suggest steadily over the three-year course of outcome measurement.
that telephone counselling appeared to be at least as effective
as group programmes, the two types of support seem to have Okechukwu 2009 found that a significantly higher one-month quit
been offered at different levels of intensity, with drop-outs from rate in the intervention group had dissipated to a non-significant
group programmes not followed up, while telephone counsellors difference by six months, at 9% versus 7.2% (P = 0.48). These results
routinely made ten contact attempts per session plus messages or were not biochemically validated, in order to avoid any perceived
letters to their participants. association with 'drug-testing', and because such tests might have
been confounded by work-related toxins.
Gomel 1993a failed to detect an effect of either individual or group
incentives. Rewards appeared to have no effect, or possibly a (b) Comprehensive interventions targeting several risk factors,
including smoking
negative impact, with 3/30 smokers continuously abstinent at 12
months in the BC (counselling only) group compared with 1/30 in Since only three trials (Glasgow 1995; Prochaska 2008; Milani 2009;
the BCI (counselling plus incentives) group, but this difference did 383 participants) of the 13 (> 78,000 participants) in this group
not achieve statistical significance. Other outcomes for this trial are offered data for meta-analysis, we decided against pooling these
covered under the Individual Counselling heading. findings, as they are likely to be unrepresentative and misleading.
We report the results here narratively, and in the Results Table
Volpp 2009 detected a statistically significant benefit of incentives Analysis 3.1.
over control conditions, with 15- or 18-month prolonged
abstinence rates of 9.4% versus 3.6% (P = 0.0008) respectively. Kornitzer 1980 detected a decline in smoking prevalence of 18.7% in
the high-risk intervention group at two-year follow-up, compared
The effectiveness of incentives and competitions as an aid to with a 12.2% drop in the high-risk control group (P < 0.05). A five
smoking cessation in any setting is covered in another Cochrane per cent sample of all the intervention participants demonstrated a
review (Cahill 2011). prevalence decline of 12.5% over two years, which was very close to
8. Comprehensive programmes
the 10% sample control group's decline of 12.6% (non-significant).
The authors speculate that the lack of face-to-face counselling
(a) Multiple interventions for smoking cessation: (available only to the high-risk intervention group) may have been
Six trials (5018 participants) demonstrated a benefit for a significant factor in the failure of the anti-smoking campaign.
comprehensive programmes aimed at smoking cessation, with Stepwise multiple discriminant function analysis among the high-
an OR of 1.55 (95% CI 1.13 to 2.13; Analysis 2.3.1). There was risk groups identified fewer cigarettes smoked at baseline, more
some heterogeneity (I2 = 30%). Sorensen 1993 did not contribute previous quit attempts and the residential area of the country as
analysable data to this comparison. significant predictors of quitting among the intervention group,
and higher education and more previous quit attempts among
The initial De Paul study (DePaul 1987) achieved 12-month the controls. The significant differences between intervention
sustained cessation rates of 6% for the group participants versus and control high-risk groups gradually disappeared over the
2% for the self-help participants (NS), with both arms achieving subsequent four years of the study, due to a combination of less
a 19% point prevalence rate. It reported a non-significant trend intensive intervention activity and a spontaneous rise in the control
towards higher quit rates for groups than for self-help controls. group's quit rate in line with secular trends.
Willemsen 1998 failed to detect an effect of a comprehensive The HealthWise Stepped Intervention Study (Shi 1992) noted a
programme. The six-month sustained abstinence rates were 8% in decline in smoking prevalence at two-year follow-up in all four
the comprehensive workplaces and 7% in the minimal-treatment intervention levels (nine worksites). Smoking reduced in Level 1
workplaces. Among the medium to heavy smokers, prolonged sites by 34%, from 18% to 12%, in Level 2 sites by 18%, from 17% to
abstinence rates were 9% for the comprehensive programme and 14%, in Level 3 sites by 35%, from 24% to 15%, and in Level 4 sites by
4% for the minimal programme. 44%, from 14% to 8%. All differences were statistically significant at
P < 0.01 level, except for the Level 2 decline which was significant at
At 12 months, point prevalence for the group participants in DePaul the 0.1 level. Outcomes were measured by cross-sectional surveys
1989 was 26%, compared with 16% for non-group participants (P < rather than cohort analysis, with relatively low participation rates
0.06), with sustained abstinence rates of 11% and 3% respectively of 69% at baseline and 48% at follow-up.
(P < 0.05).

Informed decisions.
The 'Take Heart' study (Glasgow 1995) reported that the early and Sorensen 2007 detected a significant increase in the six-month quit
delayed intervention groups did not differ on changes in smoking rate in the intervention group compared with the controls (19%
rates, dietary intake or cholesterol levels. Despite documented versus 8%, P = 0.03). This analysis was restricted to the 188 smokers
implementation of the intervention, there were no short-term who completed both the baseline and follow-up surveys, although
improvements beyond secular trends also observed in control the authors reported that an intention-to-treat (ITT) analysis also
workplaces. Glasgow 1997 (an excluded study) also reported the found a statistically significant benefit of the intervention. The ITT
results of 'Take Heart II' which was non-randomized but with data were 19 quitters from 125 baseline smokers in the intervention
a matched quasi-experimental study design similar to the first group (15%), compared with 7 quitters from 106 baseline smokers
'Take Heart' trial, plus updated menu and added guidance for in the control group (7%, P = 0.04).
employee steering committees and implementation. The authors
reported that there were no statistically significant differences in Bergstrom 2008 evaluated a 3½-year comprehensive programme
smoking prevalence and smoking cessation between intervention at ten time points, including smoking cessation support by the
and control workplaces. occupational health services for those assessed as being at
moderate risk, and referral to inpatient rehabilitation or inpatient
The Working Well Trial (Sorensen 1996) reported a non-significant smoking cessation for those at high risk. All four intervention
1.53% difference between intervention and control workplaces in companies showed a decline in smoking prevalence compared
six-month smoking cessation rates. Smoking prevalence declined with the reference (control) company; Companies 1, 2 and 4
in intervention sites (from 24.5% to 21.2%) and in control sites (from demonstrated a statistically significant decline (-0.60 (P < 0.05),
25.8% to 21.8%) (NS). -0.92 (P < 0.01) and -0.45 (P < 0.05) respectively), while the decline
in Company 3 (-0.09) was non-significant. Sensitivity analyses
The WellWorks Study (Sorensen 1998) nested within the Working to assess white- and blue-collar workers separately found no
Well Trial, was a randomized controlled trial, with similar aims meaningful differences between the subgroups.
to its parent trial, but combining health promotion and health
protection interventions, and also targeting outcome differences The primary outcome for Prochaska 2008 was movement through
by job category. Six-month smoking abstinence rates were 15% the stages of change in response to three workplace interventions
in the intervention workplaces, and 9% in the control workplaces targeting inactivity, BMI, stress and smoking. The comparison of
(P = 0.123). We have not used the first analyses for this study, health risk intervention (HRI) alone versus HRI + motivational
published in 1996, since these did not include results from the interviewing (MI) for smoking cessation indicated a non-significant
control workplaces. benefit for the MI arm, with an abstinence rate at six months
of 34.6% versus 16.7%. The third arm (HRI + transtheoretical
At three-year follow-up, the Working Healthy Project (Emmons model) achieved a rate of 21.1%. We were unable to establish the
1999) did not detect significant differences between either the distribution of the 101 reported to be 'at criterion' at six months (i.e.
seven-day point prevalence quit rates (intervention 25.6% versus deemed to be in the action stage, which for smoking was defined as
control 21.8%) or the six-month continuous abstinence quit rates achieving point prevalence abstinence). We have therefore applied
(intervention 8.0% versus control 8.1%). an intention-to-treat principle, using the baseline smokers as the
denominators for our assessment of success rates.
The Swedish trial of cardiovascular risk reduction (Nilsson 2001)
detected a decline in smoking prevalence in the intervention group In a personal communication, Milani 2009 reported six-month point
from 65% to 37% at 12 months, compared with a non-significant prevalence cessation rates of 18.2% (6/33) for the intervention
decline in the control group from 65% to 63%. Prevalence at 18 group, and 0% (0/31) for the control group (P = 0.08). The primary
months was 40% for the intervention group and 59% for the control outcome for this trial was cost savings to the employer of a
group, and this difference influenced the decrease in the mean risk systematic health promotion programme for their insured work
score from 10.3 (standard deviation (SD) 1.5) to 9.0 (SD 2.2, P = force.
0.042).
Economic analysis
The intervention arm of the Health Works for Women trial
(Campbell 2002) had a higher smoking prevalence at baseline There is limited literature on the costs of implementing workplace
(30%) than the control arm (22%), but only 9% of the intervention smoking control programmes. Only six of the studies identified
participants (26% of the current smokers) chose to concentrate for this review (Windsor 1988; DePaul 1989; Erfurt 1991; DePaul
their efforts on quitting. Both groups reduced their prevalence rate 1994; Tanaka 2006; Milani 2009) reported cost data. All except the
by about 3% at 18-month follow-up. The intervention for smokers Japanese HIPOP-OHP study were conducted in the USA.
was incomplete, as no lay helpers were willing to be trained to
Windsor 1988 found that material costs to deliver the programme
support the smokers trying to quit. It is therefore not possible
plus lost employee time to participate produced a total programme
to draw any meaningful inferences from the lack of a detectable
cost of approximately USD 50 per employee. The cost to implement
difference between the two arms of the trial.
the programme for combined groups 1 (brief advice and self-help
The WellWorks-2 Trial (Sorensen 2002) did not detect a significant materials) and 3 (as 1 with monetary awards) was approximately
difference in point prevalence rates at six months between USD 9500 (USD 50 x 190 per combined intervention group). The
intervention and control workplaces (reductions of 4.1% and 1.6% estimated savings to the University for Groups 1 and 3 with a
respectively). Cohort analysis failed to detect an effect in overall 5.8% quit rate (9 employee quitters at USD 1000) was about
quit rates between intervention (11.3%) and control workplaces USD 9000. From a cost-to-benefit ratio perspective the estimated
(7.5%, OR 1.57, P = 0.17). savings observed from combined groups 2 (as 1 with self help,
further counselling, buddy selection and contract) and 4 (as 2 with

Informed decisions.
monetary rewards for cessation) was the same as for groups 1 and declined in the intervention group to an average of USD 1539 per
3 (USD 9500). The observed quit rate of 15% (27 employee quitters participant (P = 0.002), compared with USD 2522 per participant
at USD 1000) produced an estimated saving of approximately USD in the control group (P = NS). The authors report that "For every
27,000. The researchers suggested that reducing the estimated dollar invested in worksite intervention, $6 was realized in health
savings by 50% (for example, USD 500 per employee per year care savings".
instead of USD 1000) still led to estimated savings of USD 13,500,
40% above the estimated cost of USD 9500. The cost-to-benefit ratio Absenteeism
for the most effective methods (groups 2 and 4) was approximately One study of a comprehensive lifestyle intervention (Nilsson 2001)
2 to 1. reported on mean number of sick days over the last four months of
the first year of the trial. Mean sick days taken by the intervention
DePaul 1989 showed that in the Group condition (media, self-help
group fell from 6.0 to 2.9 (P = 0.03), while the mean sick days taken
manuals, groups and incentives) 44 participants had quit at the
by the control group for that period rose from 4.5 to 7.4 (P = 0.04).
12-month follow-up and for the Non-group condition 26 had quit
However, smoking was only one of several behaviours targeted in
smoking. Incentives and supplies cost approximately USD 21,000
this trial, and the contribution of reduced smoking prevalence to
for the Group intervention, so each Group quitter cost USD 477.
absentee rates could not be separately estimated.
Supplies for the Non-group cost about USD 2000, so each quitter
cost USD 77. DISCUSSION
Erfurt 1991 found that the annual direct cost per employee for
Workplace interventions are heterogeneous. Although the
post-screening interventions was USD 2.97 for site 1 (control site),
workplace may offer particular opportunities for recruitment to
USD 17.68 for site 2 (health education), USD 30.96 for site 3 (health
programmes, many of the interventions tested in workplace
education plus follow-up counselling), and USD 38.31 for site 4
studies are not specific to this setting. This is particularly true of
(health education, follow-up counselling plus plant organization
interventions aimed at helping individuals to stop smoking. The
for health promotion). For engaging employees into treatment or
effects of smoke-free policies and restrictions within the workplace
programme participation, sites 3 and 4 were approximately 10
are covered in a companion review (Callinan 2010).
times more cost-effective than site 2. Also, for reducing risks and
relapse prevention, sites 3 and 4 were five to six times more cost- Summary of main results
effective than site 2. At sites 3 and 4 the total direct cost per
percentage of risks reduced and relapse prevented was less than This updated review (latest search July 2013) identified 57
one dollar (USD 0.67 and USD 0.74, respectively) per employee per randomized or quasi-randomized trials (61 comparisons), with
year. later trials tending to be of higher quality for both conduct
and reporting. We report the main findings in the 'Summary of
The last of the DePaul studies, DePaul 1994, summarized the cost findings for the main comparison'. Ten trials of group behavioural
implications of all three De Paul studies. The total cost for each therapy (1793 participants), eight trials of individual counselling
intervention was Self-help USD 4717, Incentives USD 6992 and (3516 participants), five trials of pharmacological interventions
Group USD 26,867. Costs per quitter (12-month point prevalence (1092 participants) and six trials of multiple interventions
to continuous quit rate) were Self-help USD 225 - 1179, Incentives targeting smoking cessation (5018 participants) all found clear
USD 250 - 699 and Group USD 455 - 790. The cost of the programme evidence in support of such worksite-based programmes. Work-
offered to the public (50,000 self-help manuals and newspaper based incentives programmes (five trials, 1928 participants) also
supplements) was USD 62,500. If 5% to 15% of the recipients of self- demonstrated benefits, but this analysis was dominated by one
help materials could quit smoking, the cost would range from USD large trial with positive findings that were not sustained when
8 to USD 25 per quitter. With the television series costing about USD it was removed from the calculation. Self-help interventions,
20,000, if only 5% of smokers who watched it managed to quit, the social support programmes, relapse prevention programmes and
cost per quitter would be USD 3. environmental cues did not demonstrate significant benefits when
offered in the workplace. Although we identified 13 studies of
The HIPOP-OHP Study (Tanaka 2006) calculated that the comprehensive intervention programmes for multiple risk factors
intervention delivered 36.3 additional quitters, in a period when including smoking, we were unable to extract sufficient data for
intervention and control sites all reported a steady rise in the meta-analysis. Although there is a strong theoretical rationale for
cessation rate. Based on materials and opportunity costs, each approaches that integrate smoking cessation with comprehensive
quitter was estimated to have cost JPY 70,080 (95% CI JPY 32,800 health promotion and protection programmes in the workplace,
to JPY 532,200). This converts to USD 707 at November 2013 rates. formal studies of such approaches have failed to show that they
The authors report that this is comparable with the cost per quitter significantly decrease overall prevalence of smoking.
in companies with a smoke-free policy (USD 799), and lower than
the cost of a smoker who quits without NRT through primary care In addition to effectiveness, it is clearly important for employers
or smoking specialist services (USD 2100 to 7900). to consider the economic aspects of introducing smoking
programmes in their workplaces. These issues are infrequently
Milani 2009 presents the findings of their trial as an illustration addressed in the studies included in this review, and those
to the employer of potential savings from an effective healthcare studies which do discuss the economic implications are difficult
intervention in the workplace. They comment that in the US nearly to compare. The absolute figures quoted vary across time and
60% of after-tax profits are spent on corporate health benefits, with across countries, and the methods of calculating costs differ
80% of such expenses incurred by 10% to 20% of the workforce. from one study to the next. Some studies calculate a cost per
Before the intervention, total medical claim costs averaged USD quitter from among the smokers only, while others use the entire
2981 per participant, but in the 12 months after the intervention
Informed decisions.
workforce as the denominator. These approaches also take no 1.88; 119 trials, Stead 2012; RR converted to OR), compared with
account of smokers who are not enrolled in the programme, but the pharmacological interventions OR in this review of 1.98 (95%
who are nonetheless reached and affected by the programme's CI 1.26 to 3.11); the same analysis restricted only to NRT trials
publicity, or by friends and family who participate. Given that the delivered an OR of 1.81 (95% CI 1.07 to 3.08). Self-help interventions
quitters among them may have been influenced by the presence conducted in the workplace generally did not deliver enhanced
of the programme, they might reasonably be counted among the rates of smoking cessation (OR 1.16; 95% CI 0.74 to 1.82), which
programme's successes. Furthermore, it is inappropriate to base again is consistent with the findings of the Cochrane self-help
the calculations simply on the programme costs, without reference review (OR 1.08; 95% CI 0.98 to 1.19; 32 studies; Lancaster 2005b,
to other direct costs such as occupied space that could have been RR converted to OR).
used differently, donated or discounted time and resources, and
avoidance of future healthcare expenditure on continuing smokers. A particular attraction of the workplace is that it provides a route
Some studies risk an over-simplified approach to the analysis, of access for communicating about smoking and offering help
calculating the costs per quitter in the intervention group without to stop. However, participation rates are often low. A number
reference to the costs per quitter in the control or pre-policy group. of studies considered methods for increasing participation. This
The intervention costs should be reckoned as incremental to those review found limited evidence that participation in programmes
incurred by the control group, which can be seen as demonstrating can be increased by competitions and incentives organized by
the background or placebo rate. the employer (see also Cahill 2011). One limitation of the existing
evidence is that most studies were conducted in stable workplace
Overall completeness and applicability of evidence settings which are becoming less common, as workers are
increasingly mobile (for example, in the construction and transport
In this third update of our review, we are confident that rigorous industries) or on short-term contracts (as in many modern service
ad hoc and routine searching have ensured that we have identified industries). The assumption that the workplace is a good place for
the key research to inform the review question. Previous iterations recruitment is only valid for certain types of workplace.
have been dominated by US-based trials, through a combination
of funding resources and the material interests of employers who AUTHORS' CONCLUSIONS
usually cover health insurance costs for their staff. It is notable that
for this update we have been able to include a few recent trials set Implications for practice
in developing countries; this arena is likely to become increasingly
important as the big tobacco companies shift their focus to these 1. We found strong evidence that some interventions directed
areas, while smoking rates in high-income countries stabilise or towards individual smokers increase the likelihood of quitting
decline. smoking. These include both individual and group counselling,
pharmacological treatment, and multiple interventions to increase
Agreements and disagreements with other studies or smoking cessation. All these interventions show similar effects
reviews whether offered in the workplace or elsewhere. Self-help
interventions, relapse prevention and social support are less
In drawing conclusions about the effectiveness of these effective. Although people taking up these interventions are more
interventions we have placed the findings of the workplace studies likely to stop, the absolute numbers who quit are low.
in the context of what is known from systematic reviews that
include non-workplace studies. Although the results of some of 2. We failed to detect an effect of comprehensive programmes
the individual studies considered in this review have inconclusive targeting multiple risk factors in reducing the prevalence of
findings, most are consistent with the findings from other smoking; however, this conclusion is based upon a narrative rather
systematic reviews. On this basis, we conclude that there is strong than a meta-analytical synthesis.
evidence for an effect of group therapy, of individual counselling,
of pharmacological treatments, and of multiple interventions 3. There was limited evidence that smoking cessation can
for smoking cessation. The Cochrane review of group behaviour be increased by competitions and incentives organized by the
therapy (Stead 2005) showed that such programmes increase employer, although one trial demonstrated a sustained effect of
the likelihood of quitting, approximately doubling the odds of financial rewards for attending a smoking cessation course and for
quitting (odds ratio (OR) 2.20, 95% confidence interval (CI) 1.72 long-term quitting.
to 2.81 compared with other formats; 13 studies; risk ratio (RR)
converted to OR). This compares with the OR in this review for 4. The potential advantage of the workplace is that more people
the group behavioural studies of 1.71 (95% CI 1.05 to 2.80). Only can be reached and participation in cessation attempts is thereby
one included study (DePaul 1994) is common to that review and increased. However, participation rates are usually low even within
the relevant comparison in this update, making the two bodies workplaces.
of evidence relatively independent of each other. The Cochrane
review of individual counselling (Lancaster 2005a) identified 18 Implications for research
trials in workplaces and other settings, with only one study 1. A particular finding of this review is the sparsity of data on
(Windsor 1988) in common with this review. The OR for successful economic aspects of workplace cessation programmes. Future
smoking cessation in the individual counselling review was 1.53 studies should include measurement of direct and indirect
(95% CI 1.31 to 1.80; RR converted to OR), compared with the costs, and if possible, economically relevant outcomes such as
individual counselling OR in this review of 1.96 (95% CI 1.51 to absenteeism and productivity.
2.54). Pharmacological interventions (predominantly NRT) were
also successful when mediated through the workplace, which was
compatible with results in other settings (OR 1.78; 95% CI 1.68 to
Informed decisions.
2. Further research is needed to establish which components of the Briggs for advice on the economic aspects, and Stephen Sutton,
largest trial of incentives (Volpp 2009) contributed to its enhanced peer reviewers from the Department of Health, and Malgorzata Bala
success rates. for comments and suggestions.
3. Further research would be valuable in low-income and We thank Glorian Sorensen for supplying additional data for the
developing countries, where high rates of smoking still prevail and 2008 updated version of the review.
smoke-free legislation is not widely accepted or enforced.
For the current update, we thank Gunnar Bergström, Dal Lae
ACKNOWLEDGEMENTS Chin, Marco Mario Farrario, Annice Kim, Lydia Makrides, Brian
Martinson, Soeren Mattke, Gauravi Mishra, Richard Milani, Weeza
Michael Moher was the contact author on the original review and
Noor, Cassandra Okechukwu and Lisa Quintiliani for providing
2005 update, and was a co-author on the 2008 update.
articles or additional information, or both. We also thank Eleonora
We would like to thank Angela Harden for advice in the planning
Fulcini and Yaling Yang for translations of Italian and Chinese
stage of the review, Rafael Perera for statistical support, Lindsay
articles.
Stead for search strategies and for editorial guidance, Andrew

Informed decisions.
REFERENCES
References to studies included in this review smoking cessation program. Amercian Journal of Community
Psychology 1994;22(2):257-71. [MEDLINE: 1995067774]
Bergstrom 2008 {published data only}
Bergström G, Björklund C, Fried I, Lispers J, Nathell N, DePaul 1994 {published data only}
Hermansson U, et al. A comprehensive workplace intervention * Jason LA, McMahon SD, Salina D, Hedeker D, Stockton M,
and its outcome with regard to lifestyle, health and sick leave: Dunson K, et al. Assessing a smoking cessation intervention
the AHA study. Work 2008;31(2):167-80. involving groups, incentives, and self-help manuals. Behavior
Therapy 1995;26(1):393-408.
Cambien 1981 {published data only}
Cambien F, Richard JL, Ducimetiere P, Warnet JM, Kahn J. The Jason LA, Salina D, McMahon SD, Hedeker D, Stockton M.
Paris Cardiovascular Risk Factor Prevention Trial: Effects of two A worksite smoking intervention: A 2 year assessment of
years of intervention in a population of young men. Journal of groups, incentives and self-help. Health Education Research
Epidemiology and Community Health 1981;35:91-7. 1997;12(1):129-38.
Campbell 2002 {published data only} McMahon SD, Jason LA, Salina D. Stress, coping, and appraisal
* Campbell MK, Tessaro I, DeVellis B, Benedict S, Kelsey K, in a smoking cessation intervention. Anxiety, Stress and Coping
Belton L, et al. Effects of a tailored health promotion program 1994;7(2):161-71.
for female blue-collar workers: Health Works for Women.
Emmons 1999 {published data only}
Preventive Medicine 2002;34(3):313-23.
Emmons KM, Linnan LA, Shadel WG, Marcus B, Abrams DB.
Tessaro I, Campbell MK, Benedict S, Kelsey K, Heisler- The Working Healthy Project: a worksite health-promotion
MacKinnon J, Belton L, et al. Developing a worksite health trial targeting physical activity, diet, and smoking. Journal of
promotion intervention: Health Works for Women. American Occupational and Environmental Medicine 1999;41(7):545-55.
Journal of Health Behavior 1998;22(6):434-42.
Erfurt 1991 {published data only}
Tessaro I, Taylor S, Belton L, Campbell MK, Benedict S, Kelsey K, Erfurt JC, Foote A, Heirich MA. The cost-effectiveness of work-
et al. Adapting a natural (lay) helpers model of change for site wellness programs for hypertension control, weight loss,
worksite health promotion for women. Health Education and smoking cessation. Journal of Occupational Medicine
Research 2000;15(5):603-14. 1991;33(9):962-70.
Dawley 1991 {published data only} * Erfurt JC, Foote A, Heirich MA. Worksite wellness programs:
Dawley HH, Dawley LT, Correa P, Fleischer B. A comprehensive Incremental comparison of screening and referral alone, health
worksite smoking control, discouragement, and cessation education, follow-up counselling, and plant organization.
program. International Journal of Addiction 1991;26(6):685-696. American Journal of Health Promotion 1991;5(6):438-48.
DePaul 1987 {published data only} Gregg W, Foote A, Erfurt JC, Heirich MA. Worksite follow-up
Flay BR, Gruder CL, Warnecke RB, Jason LA, Peterson P. and engagement strategies for initiating health risk behavior
One year follow-up of the Chicago televised smoking changes. Health Education Quarterly 1990;17(4):455-78.
cessation program. American Journal of Public Health
Frank 1986 {published data only}
1989;79(10):1377-80. [MEDLINE: 1989390780]
Frank RG, Umlauf RL, Wonderlich SA, Ashkanazi GS. Hypnosis
* Jason LA, Gruder CL, Buckenberger L, Lesowitz T, and behavioral treatment in a worksite smoking cessation
Belgredan J, Flay BR, et al. A 12-month follow-up of a worksite program. Addictive Behaviors 1986;11(1):59-62.
smoking cessation intervention. Health Education Research
1987;2(3):185-94. Glasgow 1984 {published data only}
Glasgow RE, Klesges RC, Godding PR, Vasey MW, O'Neill HK.
Jason LA, Gruder CL, Martino S, Flay BR. Work site group Evaluation of a worksite-controlled smoking program. Journal
meetings and the effectiveness of a televised smoking cessation of Consulting and Clinical Psychology 1984;52(1):137-8.
intervention. American Journal of Community Psychology
1987;15(1):57-72. [MEDLINE: 1987267430] Glasgow 1986 {published data only}
Glasgow RE, Klesges RC, O'Neill HK. Programming social
DePaul 1989 {published data only}
support for smoking modification: an extension and replication.
* Jason LA, Lesowitz T, Michaels M, Blitz C, Victors L, Dean L, Addictive Behaviors 1986;11:453-457.
et al. A Worksite Smoking Cessation Intervention Involving
the Media and Incentives. American Journal of Community Glasgow 1993 {published data only}
Psychology 1989;17(6):785-99. [MEDLINE: 199261661] * Glasgow RE, Hollis JF, Ary DV, Boles SM. Results of a year-
long incentives-based worksite smoking-cessation program.
Salina D, Jason LA, Hedeker D, Kaufman J, Lesondak L,
Addictive Behaviors 1993;18(4):455-64.
McMahon SD, et al. A follow-up of a media-based, worksite

Informed decisions.
Glasgow RE, Hollis JF, Ary DV, Lando HA. Employee and Martinson BC. Intraclass correlation for measures from a
organizational factors associated with participation in an worksite health promotion study: estimates, correlates,
incentive-based worksite smoking cessation program. Journal and applications. American Journal of Health Promotion
of Behavioral Medicine 1990;13(4):403-18. 2000;14(4):271.
Glasgow RE, Hollis JF, Pettigrew L, Foster L, Givi MJ, Martinson BC, Murray DM, Jeffery RW, Hennrikus DJ. Intraclass
Morrisette G. Implementing a year-long worksite-based correlation for measures from a worksite health promotion
incentive program for smoking cessation. American Journal of study: Estimates, correlates, and applications. American Journal
Health Promotion 1991;5(3):192-9. of Health Promotion 1999;13(6):347-57.
Glasgow 1995 {published data only} Hishida 2010 {published data only}
* Glasgow RE, Terborg JR, Hollis JF, Severson HH, Boles SM. Hishida A, Terazawa T, Mamiya T, Ito H, Matsuo K, Tajima K, et
Take Heart: Results from the initial phase of a work-site wellness al. Efficacy of genotype notification to Japanese smokers on
program. American Journal of Public Health 1995;85(2):209-16. smoking cessation-an intervention study at workplace. Cancer
Epidemiology 2010;34(1):96-100.
Glasgow RE, Terborg JR, Hollis JF, Severson HH, Fisher KJ,
Boles SM, et al. Modifying dietary and tobacco use patterns in Hymowitz 1991 {published data only}
the worksite: the Take Heart Project. Health Education Quarterly Hymowitz N, Campbell K, Feuerman M. Long-term smoking
1994;21(1):69-82. intervention at the worksite: effects of quit- smoking groups
and an "enriched milieu" on smoking cessation in adult white-
Gomel 1993a {published data only}
collar employees. Health Psychology 1991;10(5):366-9.
Gomel M, Oldenburg B, Simpson JM, Chilvers M, Owen N.
Composite cardiovascular risk outcomes of a work-site Kadowaki 2000 {published data only}
intervention trial. American Journal of Public Health Kadowaki T, Kanda H, Watanabe M, Okayama A, Miyamatsu N,
1997;87(4):673-6. Okamura T, et al. Are comprehensive environmental changes as
effective as health education for smoking cessation?. Tobacco
* Gomel M, Oldenburg B, Simpson JM, Owen N. Work-site
Control 2006;15(1):26-9.
cardiovascular risk reduction: a randomized trial of health risk
assessment, education, counseling, and incentives. American * Kadowaki T, Watanabe M, Okayama A, Hishida K, Ueshima H.
Journal of Public Health 1993;83(9):1231-8. Effectiveness of smoking-cessation intervention in all
of the smokers at a worksite in Japan. Industrial Health
Groeneveld 2011 {published data only}
2000;38(4):396-403.
* Groeneveld IF, Proper KI, Van der Beek AJ, Hildebrandt VH,
Van Mechelen W. Short and long term effects of a lifestyle Klesges 1987 {published data only}
intervention for construction workers at risk for cardiovascular Klesges R, Glasgow RE, Klesges L, Morray K, Quale R.
disease: a randomized controlled trial. BMC Public Health Competition and relapse prevention training in worksite
2011;11:836. [DOI: 10.1186/1471-2458-11-836] smoking modification. Health Education Research
1987;2(1):5-14.
Groeneveld IF, Proper KI, Van der Beek AJ, Van Duivenbooden C,
Van Mechelen W. Design of a RCT evaluation the (cost-) Kornitzer 1980 {published data only}
effectiveness of a lifestyle intervention for male construction
De Backer G, Kornitzer M, Dramaix M, Kittel F, Thilly C, Graffar M,
workers for cardiovascular disease; the health under
et al. The Belgian Heart Disease Prevention Project: 10-year
construction study. BMC Public Health 2008;8:1.
mortality follow-up. European Heart Journal 1988;9(3):238-42.
Groeneveld IF, Proper KI, Van der Beek AJ, Van Mechelen W.
De Backer G, Kornitzer M, Thilly C, Depoorter AM. The Belgian
Sustained body weight reduction by an individual-based
multifactor preventive trial in CVD (I): design and methodology.
lifestyle intervention for workers in the construction industry
Hart Bulletin 1977;8:143-6.
at risk for cardiovascular disease: Results of a randomized
controlled trial. Preventive Medicine 2010;51(3-4):240-6. Kornitzer M. The Belgian Heart Disease Prevention Project:
a model of multifactorial prevention [Le projet Belge de
Gunes 2007 {published data only}
prevention des affections cardiovasculaires: un modele de
Gunes G, Ilgar M, Karaoglu L. The effectiveness of an education prevention multifactorielle]. Bulletin et Memoires de l'Academie
program on stages of smoking behavior for workers at a factory Royale de Medecine de Belgique 1989;144(1-2):101-9.
in Turkey. Industrial Health 2007;45(2):232-6.
Kornitzer M, De Backer G, Dramaix M. The Belgian Heart Disease
Hennrikus 2002 {published data only} Prevention Project: modification of the coronary risk profile in
* Hennrikus DJ, Jeffery RW, Lando HA, Murray DM, Brelje K, an industrial population. Circulation 1980;61(1):18-25.
Davidann B, et al. The SUCCESS project: the effect of program
format and incentives on participation and cessation in Kornitzer M, Dramaix M, De Backer G, Thilly C. The Belgian
worksite smoking cessation programs. American Journal of multifactor preventive trial in CVD (III): smoking habits and
Public Health 2002;92(2):274-9. sociobiological variables. Hart Bulletin 1978;1:7-13.

Informed decisions.
* Kornitzer M, Dramaix M, Kittel F, De Backer G. The Belgian Nilsson 2001 {published data only}
Heart Disease Prevention Project: changes in smoking Nilsson PM, Klasson E-B, Nyberg P. Lifestyle intervention at the
habits after two years of intervention. Preventive Medicine worksite - reduction of cardiovascular factors in a randomized
1980;9(4):496-503. study. Scandinavian Journal of Work and Environmental Health
2001;27(1):57-62.
Kornitzer M, Dramaix M, Thilly C, De Backer G, Kittel F, Graffar M,
et al. Belgian Heart Disease Prevention Project: incidence and Noor 2011 {published data only}
mortality results. The Lancet 1983;321(8333):1066-70.
Noor ZM, Aris MAM, Mohamed MHN, Draman S, Bux SH. Safety
Kornitzer M, Rose G. WHO European Collaborative Trial of and efficacy of Viva QS® for smoking cessation among industrial
multifactorial prevention of coronary heart disease. Preventive workers in Kerteh and Kuantan, Malaysia. International Medical
Medicine 1985;14(3):272-8. Journal 2011;18(3):188-93.
Rustin R-M, Kittel F, Dramaix M, Kornitzer M, De Backer G. Okechukwu 2009 {published data only}
Smoking habits and psycho-socio-biological factors. Journal of Chin DL, Hong O, Gillen M, Bates MN, Okechukwu CA. Heavy and
Psychosomatic Research 1978;22(2):89-99. light/moderate smoking among building trades construction
workers. Public Health Nursing 2012;30(2):128-39.
Kornitzer 1995 {published data only}
Kornitzer M, Boutsen M, Dramaix M, Thijs J, Gustavsson G. Chin DL, Hong O, Gillen M, Bates MN, Okechukwu CA.
Combined use of nicotine patch and gum in smoking cessation: Occupational factors and smoking cessation among
a placebo-controlled clinical-trial. Preventive Medicine unionized building trades workers. Workplace Health & Safety
1995;24(1):41-7. 2012;60(10):445-52.
Lang 2000 {published data only} Okechukwu CA, Krieger N, Chen J, Sorensen G, Li Y, Barbeau EM.
The association of workplace hazards and smoking in a U.S.
Lang T, Nicaud V, Slama K, Hirsch A, Imbernon E, Goldberg M,
multiethnic working-class population. Public Health Reports
et al. Smoking cessation at the workplace. Results of a
2010;125(2):225-33.
randomised controlled intervention study. Worksite physicians
from the AIREL group. Journal of Epidemiology and Community * Okechukwu CA, Krieger N, Sorensen G, Li Y, Barbeau EM.
Health 2000;54(5):349-54. MassBuilt: effectiveness of an apprenticeship site-based
smoking cessation interention for unionized building trade
Li 1984 {published data only}
workers. Cancer Causes and Control 2009;20(6):887-94.
Li VC, Kim YJ, Ewart CK, Terry PB, Cuthie JC, Wood J,
et al. Effects of physician counseling on the smoking Okechukwu CA, Krieger N, Sorensen G, Li Y, Barbeau EM.
behavior of asbestos-exposed workers. Preventive Medicine Testing hypothesized psychosocial mediators: Lessons learned
1984;13(5):462-76. in the MassBUILT study. Health Education and Behavior
2011;38(4):404-11.
Malott 1984 {published data only}
Malott JM, Glasgow RE, O'Neill HK, Klesges RC. Co-worker social Okechukwu CA, Nguyen K, Hickman NJ. Partner smoking
support in a worksite smoking control program. Journal of characteristics: Association with smoking and quitting among
Applied Behavior Analysis 1984;17(4):485-495. blue-collar apprentices. American Journal of Industrial Medicine
2010;53(11):1102-8.
Mayer 2010 {published data only}
Omenn 1988 {published data only}
Mayer C, Vandecasteele H, Bodo M, Primo C, Slachmuylder JL,
Kaufman L, et al. smoking relapse prevention programs Curry S, Thompson B, Sexton M, Omenn GS. Psychosocial
and factors that predict abstinence: a controlled study predictors of outcome in a worksite smoking cessation
comparing the efficacy of workplace group counselling and program. American Journal of Preventive Medicine 1989;5(1):2-7.
proactive phone counselling. Journal of Smoking Cessation
* Omenn GS, Thompson B, Sexton MJ, Hessol N, Breitenstein B,
2010;5(1):83-94.
Curry SJ, et al. A randomized comparison of worksite-sponsored
Milani 2009 {published data only} smoking cessation programs. American Journal of Preventive
Medicine 1988;4(5):261-7.
Milani RV, Lavie CJ. Impact of worksite wellness intervention on
cardiac risk factors and one-year health care costs. American Thompson B, Omenn G, Sexton M, Breitenstein B, Hessol N,
Journal of Cardiology 2009;104(10):1389-92. Curry S, et al. Worksite smoking cessation: a test of two
programs. Progress in Clinical and Biological Research
Mishra 2010 {published data only}
1987;248:93-100.
Mishra GA, Majmudar PV, Gupta SD, Rane PS, Hardikar NM,
Shastri SS. Call centre employees and tobacco dependence: Prochaska 2008 {published data only}
making a difference. Indian Journal of Cancer 2010;47 Suppl Butterworth S, Linden A, McClay W, Leo M. The effect
1:43-52. of motivational interviewing-based health coaching on
employees' physical and metal health status. Journal of
Occupational Health Psychology 2006;11(4):358-65.

Informed decisions.
* Prochaska JO, Butterworth S, Redding CA, Burden V, Perrin, Callaghan RC, Herzog TA. The relation between processes-of-
N, Leo M, et al. Initial efficacy of MI, TTM tailoring and HRI's with change and stages-transition in smoking behavior: a two-year
multiple behaviors for employee health promotion. Preventive longitudinal study of the Transtheoretical Model. Addictive
Medicine 2008;46(3):226-31. Behaviors 2006;31(8):1331-45.
Rand 1989 {published data only} Emmons KM, Marcus BH, Linnan L, Rossi JS, Abrams DB.
Rand CS, Stitzer ML, Bigelow GE, Mead AM. The effects of Mechanisms in multiple risk factor interventions: smoking,
contingent payment and frequent workplace monitoring on physical activity, and dietary fat intake among manufacturing
smoking abstinence. Addictive Behaviors 1989;14(2):121-8. workers. Working Well Research Group. Preventive Medicine
1994;23(4):481-9.
Razavi 1999 {published data only}
Emmons KM, Thompson B, McLerran D, Sorensen G,
Razavi D, Vandecasteele H, Primo C, Bodo M, Debrier F,
Linnan L, Basen-Engquist K, et al. The relationship
Verbist H, et al. Maintaining abstinence from cigarette smoking:
between organizational characteristics and the adoption of
effectiveness of group counselling and factors predicting
workplace smoking policies. Health Education and Behavior
outcome. European Journal of Cancer 1999;35(8):1238-1247.
2000;27(4):483-501.
Rodriguez 2003 {published data only (unpublished sought but not
Sorensen G, Thompson B, Basen-Engquist K, Abrams D,
used)}
Kuniyuki A, DiClemente C, et al. Durability, dissemination, and
Guallar-Castillon P, Lafuente Urdinguio P, Garteizaurrekoa institutionalization of worksite tobacco control programs:
Dublang P, Sainz Martinez O, Diez Azcarate JI, Foj Aleman M, et Results from the Working Well trial. International Journal of
al. Probability of success in tobacco quitting during the course Behavioural Medicine 1998;5(4):335-51.
of two simple medical interventions [Probabilidad de exito
en el abandono del tabaco en el curso de dos intervenciones * Sorensen G, Thompson B, Glanz K, Feng Z, Kinne S,
sencillas para dejar de fumar]. Revista Espanol de Salud Publica DiClemente C, et al. Work site-based cancer prevention: primary
2003;77(1):117-24. results from the Working Well Trial. American Journal of Public
Health 1996;86(7):939-47.
* Rodriguez-Artalejo F, Lafuente Urdinguio P, Guallar-
Castillon P, Garteizaurrekoa Dublang P, Sainz Martinez O, Diez Wetter DW, Cofta-Gunn L, Fouladi RT, Irvin JE, Daza P, Mazas C,
Azcarate JI, et al. One year effectiveness of an individualised et al. Understanding the associations among education,
smoking cessation intervention at the workplace: a randomised employment characteristics, and smoking. Addictive Behaviors
controlled trial. Occupational Environmental Medicine 2005;30(5):905-14.
2003;60(3):358-63.
Wetter DW, McClure JB, De Moor C, Cofta-Gunn L, Cummings S,
Schröter 2006 {published data only} Cinciripini PM, et al. Concomitant use of cigarettes and
Schröter M, Collins SE, Frittrang T, Buchkremer G, Batra A. smokeless tobacco: prevalence, correlates, and predictors of
Randomized controlled trial of relapse prevention and a tobacco cessation. Preventive Medicine 2002;34(6):638-48.
standard behavioral intervention with adult smokers. Addictive
Sorensen 1998 {published data only}
Behaviors 2006;31:1259-64.
Sorensen G, Himmelstein J, Hunt M, Youngstrom R, Hebert J,
Shi 1992 {published data only} Hammond S, et al. A model for worksite cancer prevention:
Shi L. The impact of increasing intensity of health promotion integration of health protection and health promotion in the
intervention on risk reduction. Evaluation and the Health WellWorks Project. American Journal of Health Promotion
Professions 1992;15(4):3-25. 1995;10(1):55-62.
Shimizu 1999 {published data only} Sorensen G, Stoddard A, Hammond SK, Hebert JR, Avrunin JS,
Ockene JK. Double jeopardy: job and personal risks for
Shimizu J, Kita Y, Kai K, Okayama A, Choudhury SR, cratfspersons and laborers. American Journal of Health
Kawashima J, et al. Randomized controlled trial for smoking Promotion 1996;10(5):355-63.
cessation among city office employees. Nippon Koshu Eisei
Zasshi 1999;46(1):3-13. * Sorensen G, Stoddard A, Hunt MK, Hebert JR, Ockene JK,
Avrunin JS, et al. The effects of a health promotion-health
Sorensen 1993 {published data only} protection intervention on behavior change: the WellWorks
Sorensen G, Lando HA, Pechacek TF. Promoting smoking study. American Journal of Public Health 1998;88(11):1685-90.
cessation at the workplace. Results of a randomized controlled
intervention study. Journal of Occupational Medicine Sorensen G, Stoddard A, Ockene JK, Hunt MK, Youngstrom R.
1993;35(2):121-126. Worker participation in an integrated health promotion/health
protection program: Results from the WellWorks Project. Health
Sorensen 1996 {published data only} Education Quarterly 1996;23(2):191-203.
Biener L, Glanz K, McLerran D, Sorensen G, Thompson B,
BasenEngquist K, et al. Impact of the Working Well Trial on the Sorensen 2002 {published data only}
worksite smoking and nutrition environment. Health Education Hunt MK, Lederman R, Stoddard AM, LaMontagne AD,
Behavior 1999;26(4):478-94. McLellan D, Combe C, et al. Process evaluation of an integrated

Informed decisions.
health promotion/occupational health model in WellWorks-2. Sutton 1988e {published data only}
Health Education and Behavior 2005;32(1):10-26. Sutton S, Hallett R. Smoking intervention in the workplace
using videotapes and nicotine chewing gum. Preventive
Sorensen G, Stoddard AM, LaMontagne AD, Emmons K,
Medicine 1988;17(1):48-59.
Hunt MK, Youngstrom R, et al. A comprehensive worksite
cancer prevention intervention: behavior change results from Tanaka 2006 {published data only}
a randomized controlled trial (United States). Journal of Public
Naito M, Nakayama T, Okamura T, Miura K, Yanagita M, Fujieda Y,
Health Policy 2003;24(1):5-25.
et al. HIPOP-OHP Research Group. Effect of a 4-year workplace-
* Sorensen G, Stoddard AM, LaMontagne AD, Emmons K, based physical activity intervention program on the blood
Hunt MK, Youngstrom R, et al. A comprehensive worksite lipid profiles of participating employees: the high-risk and
cancer prevention intervention: behavior change results from a population strategy for occupational health promotion (HIPOP-
randomized controlled trial (United States). Cancer Causes and OHP) study. Atherosclerosis 2008;197(2):784-90.
Control 2002;13(6):493-502.
Okamura T, Tanaka T, Babazono A, Yoshita K, Chiba N,
Sorensen 2007 {published data only} Takebayashi T, et al. The High-risk and Population Strategy
for Occupational Health Promotion (HIPOP-OHP) study: study
Harley AE, Devine CM, Beard B, Stoddard AM, Hunt MK,
design and cardiovascular risk factors at the baseline survey.
Sorensen G. Multiple health behavior changes in a cancer
Journal of Human Hypertension 2004;18(7):475-85.
prevention intervention for construction workers, 2001-2003.
Preventing Chronic Disease 2010;7(3):A55. Okamura T, Tanaka T, Takebayashi T, Nakagawa H, Yamato H,
Yoshita K, et al. Methodlogical issues for a large-scale
Hunt MK, Harley AE, Stoddard AM, Lederman RI, MacArthur MJ,
intervention trial of lifestyle modification: interim assessment
Sorensen G. Elements of external validity for tools for health:
of the High-Risk and Population Starategy for Occupational
an intervention for construction laborers. American Journal of
Health Promotion (HIPOP-OHP) Study. Environmental Health
Health Promotion 2010;24(5):e11-20.
and Preventive Medicine 2004;9(4):137-43.
Sorensen G, Barbeau EM. Integrating occupational health,
* Tanaka H, Yamato H, Tanaka T, Kadowaki T, Okamura T,
safety and worksite health promotion: opportunities for
Nakamura M. Effectiveness of a low-intensity intra-worksite
research and practice. Medicina del Lavoro 2006;97(2):240-57.
intervention on smoking cessation in Japanese employees: a
* Sorensen G, Barbeau EM, Stoddard AM, Hunt MK, Goldman R, three-year intervention trial. Journal of Occupational Health
Smith A, et al. Tools for health: the efficacy of a tailored 2006;48(3):175-82.
intervention targeted for construction laborers. Cancer Causes
Terazawa 2001 {published data only}
and Control 2007;18(1):51-9. [DOI: 10.1007/s10552-006-0076-9]
Terazawa T, Mamiya T, Masui S, Nakamura M. [The effect
Sutton 1987 {published data only} os smoking cessation counselling at health checkup] [in
Sutton S, Hallett R. Randomized trial of brief individual Japanese]. Sangyo Eiseigaku Zasshi 2001;43(6):207-13.
treatment for smoking using nicotine gum in a workplace
Volpp 2009 {published data only}
setting. American Journal of Public Health 1987;77(9):1210-1.
Kim A, Kamyab K, Zhu J, Volpp K. Why are financial incentives
Sutton 1988a {published data only} not effective at influencing some smokers to quit? Results of
Hallet R, Sutton SR. Predicting participation and outcome a process evaluation of a worksite trial assessing the efficacy
in four workplace smoking intervention programs. Health of financial incentives for smoking cessation. Journal of
Education Research 1987;2:257-66. Occupational and Environmental Medicine 2011;53(1):62-7.
* Sutton S, Hallett R. Smoking intervention in the workplace Kim AE, Towers A, Renaud J, Zhu J, Shea JA, Galvin R, et al.
using videotapes and nicotine chewing gum. Preventive Application of the RE-AIM framework to evaluate the impact of
Medicine 1988;17(1):48-59. a worksite-based financial incentive intervention for smoking
cessation. Journal of Occupational and Environmental Medicine
Sutton 1988b {published data only} 2012;54(5):610-4.
Sutton S, Hallett R. Smoking intervention in the workplace
Volpp KG, Das A. Comparative effectiveness - thinking beyond
medication A versus medication B. New England Journal of
Medicine 1988;17(1):48-59.
Medicine 2009;361(4):331-3.
Sutton 1988c {published data only}
* Volpp KG, Troxel AB, Pauly MV, Glick HA, Puig A, Asch DA,
Sutton S, Hallett R. Smoking intervention in the workplace et al. A randomized controlled trial of financial incentives
using videotapes and nicotine chewing gum. Preventive for smoking cessation. New England Journal of Medicine
Medicine 1988;17(1):48-59. 2009;360(7):699-709.
Sutton 1988d {published data only}
Sutton S, Hallett R. Smoking intervention in the workplace
Medicine 1988;17(1):48-59.
Informed decisions.
Willemsen 1998 {published data only} Brenner 1994 {published data only}
Willemsen M, De Vries H, Van Breukelen G, Genders R. Long- Brenner H, Fleischle B. Smoking regulations at the workplace
term effectiveness of two Dutch worksite smoking cessation and smoking behaviour: a study from Southern Germany.
programs. Health Education and Behavior 1998;25(4):418-35. Preventive Medicine 1994;23(2):230-4.
Windsor 1988 {published data only} Brigham 1994 {published data only}
Windsor RA, Lowe JB. Behavioral impact and cost analysis of Brigham J, Gross J, Stitzer ML, Felch LJ. Effects of a restricted
a worksite self-help smoking cessation program. Progress in worksite smoking policy on employees who smoke. American
Clinical and Biological Research 1989;293:231-42. Journal of Public Health 1994;84(5):773-8.
* Windsor RA, Lowe JB, Bartlett EE. The effectiveness of a Broder 1993 {published data only}
worksite self-help smoking cessation program: a randomized Broder I, Pilger C, Corey P. Environment and well-being before
trial. Journal of Behavioral Medicine 1988;11(4):407-21. and following smoking ban in office buildings. Canadian Journal
of Public Health 1993;84(4):254-8.
References to studies excluded from this review Bunger 2003 {published data only}
Addley 2001 {published data only} Bunger J, Lanzerath I, Ruhnau P, Görlitz A, Fischer C, Kott J,
Addley K, McQuillan P, Ruddle M. Creating healthy workplaces et al. [Company health plan: Evaluation of interventions
in Northern Ireland: evaluation of a lifestyle and physical for the reduction of cardiovascular risks] of cardiovascular
activity assessment programme. Occupational Medicine risks Operational demand for health: Evaluation from
2001;51(7):439-49. interventions to the lowering of cardiovascular risks
[Operational demand for health: Evaluation of interventions
Armitage 2007 {published data only} for the reduction of cardiovascular risks] [Betriebliche
Armitage CJ. Efficacy of a brief worksite intervention to reduce Gesundheitsforderung: Evaluation von Interventionen zur
smoking: the role of behavioral and implementation intentions. Senkung kardiovascularer Risiken [in German]]. Arbeitsmedizin
Journal of Occupational Health Psychology 2007;12(4):376-90. Sozialmedizin Umweltmedizin 2003;8:421-5.
Baile 1991 {published data only} Burling 1989 {published data only}
Baile WF, Gibertini M, Ulschak F, Snow-Antle S, Hann D. Burling TA, Marotta J, Gonzalez R, Moltzen JO, Eng AM,
Impact of a hospital smoking ban: changes in tobacco use and Schmidt GA, et al. Computerized smoking cessation program
employee attitudes. Addictive Behaviors 1991;16(6):419-426. for the worksite: treatment outcome and feasibility. Journal of
Consulting and Clinical Psychology 1989;57(5):619-22.
Barbeau 2006 {published data only}
Burling 1994 {published data only}
Barbeau EM, Li Y, Calderon P, Hartman C, Quinn M, Markkanen P,
et al. Results of a union-based smoking cessation intervention Burling TA, Seidner AL, Gaither DE. A computer-directed
for apprentice iron workers (United States). Cancer Causes and program for smoking cessation treatment. Journal of Substance
Control 2006;17(1):53-61. Abuse 1994;6(4):427-31.
Bertera 1990 {published data only} Burling 2000 {published data only}
Bertera RL, Oehl LK, Telepchak JM. Self-help versus group Burling AS, Burling TA. A work in progress: Effectiveness of a
approaches to smoking cessation in the workplace: eighteen comprehensive internet-delivered interactive multimedia stop
month follow-up and cost analysis. American Journal of Health smoking program. Presented at the 34th Annual Convention of
Promotion 1990;4(3):187-92. the Association for the Advancement of Behavior Therapy, New
Orleans, LA, November 2000.
Borland 1991b {published data only}
Busch 2005 {published data only}
Borland R, Owen N, Hill D, Schofield P. Predicting attempts
and sustained cessation of smoking after the introduction of Busch M. Comparison of two programmes to help apprentices
workplace smoking bans. Health Psychology 1991;10(5):336-42. of a large corporation stop smoking. Arbeitsmedizin
Sozialmedizin Umweltmedizin 2005;40:70-3.
Borland 1995 {published data only}
Campbell 2000 {published data only}
Borland R, Owen N. Need to smoke in the context of workplace
smoking bans. Preventive Medicine 1995;24:59-60. Campbell MK, Tessaro I, DeVellis B, Benedict S, Kelsey K,
Belton L, et al. Tailoring and targeting a worksite health
Brenner 1992 {published data only} promotion program to address multiple health behaviors
among blue-collar women. American Journal of Health
Brenner H, Mielck A. Smoking prohibition in the workplace
Promotion 2000;14(5):306-13.
and smoking cessation in the Federal Republic of Germany.
Preventive Medicine 1992;21(2):252-61. Choi 2007 {published data only}
Choi KS, Lee CH, Kim SY, Choi TS, Ryu SH. Effect of nicotine
patches on craving in a workplace smoking cessation program.
European Neuropsychopharmacology. 2007; Vol. 17:S561-S562.

Informed decisions.
Conrad 1996 {published data only} Farrelly 1999 {published data only}
Conrad KM, Campbell RT, Edington D, Faust HS, Vilnius D. The Farrelly MC, Evans WN, Sfekas AE. The impact of workplace
worksite environment as a cue to smoking reduction. Research smoking bans: results from a national survey. Tobacco Control
in Nursing and Health 1996;19(1):21-31. 1999;8(3):272-7.
Cooreman 1997 {published data only} Fine 2004 {published data only}
Cooreman J, Mesbah H, Leynaert B, Segala C, Pretet S. Fine A, Ward M, Burr M, Tudor-Smith C, Kingdon A. Health
Evaluation of the impact of a smoking ban in a large Paris promotion in small workplaces - a feasibility study. Health
hospital. Semaine des Hopitaux 1997;73:317-23. Education Journal 2004;63:334-46.
Cornfeld 2002 {published data only} Franchin 2011 {published data only}
Cornfeld MJ, Schnoll RA, Tofani SH, Babb JS, Miller SM, Franchin D, Antonioli L, Cremaschini M, Moretti R, Rocca G,
Henigan-Peel T, et al. Implementation of a comprehensive Prestipino A, et al. Workplace health promotion: description
cancer control program at the worksite: year one summary and preliminary results of ASL of Bergamo integrated
report. Journal of Occupational and Environmental Medicine [Promuovera la salute in azienda: descrizione e primi risultati
2002;44(5):398-406. di un intervento interdisciplinare dell'ASL di Bergamo].
Giornale Italiano di Medicina del Lavoro e Ergonomia 2011;33(2
Dalsey 2009 {published data only} Suppl):51-6.
Dalsey E, Park HS. Implication of organizational health
policy on organizational attraction. Health Communication Glasgow 1997 {published data only}
2009;24(1):71-81. Glasgow RE, Cummings KM, Hyland A. Relationship of worksite
smoking policy to changes in employee tobacco use: findings
Daughton 1992 {published data only} from COMMIT. Community Intervention Trial for Smoking
Daughton DM, Andrews CE, Orona CP, Patil KD, Rennard SI. Total Cessation. Tobacco Control 1997;6(Suppl 2):209-16.
indoor smoking ban and smoker behaviour. Preventive Medicine
1992;21(5):670-6. Gomel 1993b {published data only}
Gomel M, Oldenburg B, Lemon J, Owen N, Westbrook F. Pilot-
Dawley 1984 {published data only} study of the effects of a workplace smoking ban on indices of
Dawley HH, Fleischer BJ, Dawley LT. Smoking cessation with smoking, cigarette craving, stress and other health behaviors.
hospital employees: an example of worksite smoking cessation. Psychology and Health 1993;8(4):223-9.
International Journal of the Addictions 1984;19(3):327-34.
Gottlieb 1990a {published data only}
Dawley 1993 {published data only} Gottlieb NH, Nelson A. A systematic effort to reduce smoking at
Dawley LT, Dawley HH, Glasgow RE, Rice J, Correa P. Worksite the worksite. Health Education Quarterly 1990;17(1):99-118.
smoking control, discouragement, and cessation. International
Journal of the Addictions 1993;28(8):719-33. Graham 2007 {published data only}
Graham AL, Cobb NK, Raymond L, Sill S, Young J. Effectiveness
Eisner 1998 {published data only} of an internet-based worksite smoking cessation intervention at
Eisner MD, Smith AK, Blanc PD. Bartenders' respiratory health 12 months. Journal of Occupational and Environmental Medicine
after establishment of smoke-free bars and taverns. JAMA 2007;49(8):821-8.
1998;280(22):1909-14.
Gritz 1988 {published data only}
Emont 1992 {published data only} Gritz ER, Marcus AC, Berman BA, Read LL, Kanim LEA, Reeder SJ.
Emont SL, Cummings KM. Using a low-cost, prize-drawing Evaluation of a worksite self-help smoking cessation program
incentive to improve recruitment rate at a work-site for registered nurses. American Journal of Health Promotion
smoking cessation clinic. Journal of Occupational Medicine 1988;3(2):26-35.
1992;34(8):771-4.
Hagimoto 2007 {published data only}
Eriksen 2005 {published data only} Hagimoto A, Masui S, Nakamura M, Bai Y, Oshima A. Effects of
Eriksen W. Work factors and smoking cessation in nurses' aides: skill level on individual behavioral counselling for smoking
a prospective cohort study. BMC Public Health 2005;5:142. cessation. Nippon Koshu Eisei Zasshi (Japanese Journal of Public
Health) 2007;54(8):486-95.
Etter 1999 {published data only}
Etter JF, Ronchi A, Perneger T. Short-term impact of a university- Hailstone 2005 {published data only}
based smoke-free campaign. Journal of Epidemiology and Hailstone S, Wyndham A, Mitchell E. Delivering smoking
Community Health 1999;53(11):710-5. cessation information in the workplace using Quit Online. New
South Wales Public Health Bulletin 2005;16(1-2):18-22.
Farkas 1999 {published data only}
Farkas AJ, Gilpin EA, Distefan JM, Pierce JP. The effects of
household and workplace smoking restrictions on quitting
behaviours. Tobacco Control 1999;8(3):261-5.
Informed decisions.
He 1997 {published data only} International Archives of Occupational and Environmental Health
He D, Berg JE, Høstmark AT. Effects of acupuncture on smoking 2006;79(1):42-8.
cessation or reduction for motivated smokers. Preventive
Hwang 2012 {published data only}
Medicine 1997;26(2):208-214.
Hwang GS, Jung HS, Yi Y, Yoon C, Choi JW. Smoking cessation
Heloma 2001 {published data only} intervention using stepwise exercise incentives for male
Heloma A, Jaakkola MS, Kahkonen E, Reijula K. The short-term workers in the workplace. Asia-Pacific Journal of Public Health
impact of national smoke-free workplace legislation on passive 2012;24(1):82-90.
smoking and tobacco use. American Journal of Public Health
Izuno 1990 {published data only}
2001;91(9):1416-8.
Izuno T, Yoshida K, Shimada N, Muto T. An epidemiological
Helyer 1998 {published data only} study of health behavior and health consciousness in smoking
Helyer AJ, Brehm WT, Gentry NO, Pittman TA. Effectiveness of behavior modification. Nihon Koshu Eisei Zasshi (Japanese
a worksite smoking cessation program in the military. Program Journal of Public Health) 1990;37(5):308-14.
evaluation. American Association of Occupational Health Nurses
Jason 1990 {published data only}
Journal 1998;46(5):238-45.
Jason LA, Jayaraj S, Blitz CC, Michaels MH, Klett LE. Incentives
Hope 1999 {published data only} and competition in a worksite smoking cessation intervention.
Hope A, Kelleher C, O'Connor M. Lifestyle and cancer: the American Journal of Public Health 1990;80(2):205-6.
relative effects of a workplace health promotion program across
Jeffery 1988 {published data only}
gender and social class. American Journal of Health Promotion
1999;13(6):315-8. Jeffery RW, Pheley AM, Forster JL, Kramer FM, Snell MK. Payroll
contracting for smoking cessation: a worksite pilot study.
Hotta 2007 {published data only} American Journal of Preventive Medicine 1988;4(2):83-6.
Hotta K, Kinumi K, Naito K, Kuroki K, Sakane H, Imai A, et al.
Kadowaki 2004 {published data only}
An intensive group therapy programme for smoking cessation
using nicotine patches and internet mailing support in a Kadowaki T, Okamura T, Funakoshi T, Okayama A, Kanda H,
university setting. International Journal of Clinical Practice Miyamatsu N, et al. Effectiveness of annual interventions
2007;61(12):1997-2001. for smoking cessation in an occupational setting in Japan.
Environmental Health and Preventive Medicine 2004;9(4):161-4.
Hudzinski 1994 {published data only}
Kinne 1993 {published data only}
Hudzinski LG, Sirois PA. Changes in smoking behavior and body
weight after implementation of a non smoking policy in the Kinne S, Kristal AR, White E, Hunt J. Worksite smoking policies:
workplace. Southern Medical Journal 1994;87(3):322-7. their population impact in Washington State. American Journal
of Public Health 1993;83(7):1031-3.
Humerfelt 1998 {published data only}
Klesges 1986 {published data only}
Humerfelt S, Eide GE, Kvale G, Aaro LE, Gulsvik. Effectiveness
of postal smoking cessation advice: a randomized controlled Klesges RC, Vasey MM, Glasgow RE. A worksite smoking
trial in young men with reduced FEV1 and asbestos exposure. modification competition: potential for public health impact.
European Respiratory Journal 1998;11(2):284-90. American Journal of Public Health 1986;76(2):198-200.
Hunt 2003a {published data only} Koffman 1998 {published data only}
* Hunt MK, Fagan P, Lederman R, Stoddard A, Frazier L, Girod K, Koffman DM, Lee JW, Hopp JW, Emont SL. The impact of
et al. Feasibility of implementing intervention methods in an including incentives and competitions in a workplace smoking
adolescent worksite tobacco control study. Tobacco Control cessation program on quit rates. American Journal of Health
2003;12 Suppl 4:IV40-5. Promotion 1998;13(2):105-10.
Sorensen G, Fagan P, Hunt MK, Stoddard AM, Girod K, Kornitzer 1987 {published data only}
Eisenberg M, et al. Changing channels for tobacco control with Kornitzer M, Kittel F, Dramaix M, Bourdoux P. A double blind
youth: developing an intervention for working teens. Health study of 2 mg versus 4 mg nicotine-gum in an industrial setting.
Education Research 2004;19(3):250-60. Journal of Psychosomatic Research 1987;31(2):171-6.
Hunt 2003b {published data only} Kunitsuka 2002 {published data only}
Hunt MK, Stoddard AM, Barbeau E, Goldman R, Wallace L, Kunitsuka K, Yamatsu K, Adachi Y. A correspondence behavioral
Gutheil C, et al. Cancer prevention for working class, approach for 6 lifestyle's improvements in a workplace.
multiethnic populations through small businesses: the healthy Nippon Koshu Eisei Zasshi (Japanese Journal of Public Health)
directions study. Cancer Causes and Control 2003;14(8):749-60. 2002;49(6):525-34.
Hutter 2006 {published data only} Longo 1996 {published data only}
Hutter HP, Moshammer H, Neuberger M. Smoking cessation Longo DR, Brownson RC, Johnson JC, Hewett JE, Kruse RL,
at the workplace: 1 year success of short seminars. Novotny TE, et al. Hospital smoking bans and employee

Informed decisions.
smoking behavior: results of a national survey. JAMA Nerín 2002 {published data only}
1996;275(16):1252-7. Nerín I, Guillén D, Más A, Nuviala JA, Hernandez MJ. [Evaluation
of a workplace anti-smoking program at a company with
Longo 2001 {published data only}
640 employees] (Spanish). Archivos de Bronchoneumologia
Longo DR, Johnson JC, Kruse RL, Brownson RC, Hewett JE. 2002;38:267-71.
A prospective investigation of the impact of smoking
bans on tobacco cessation and relapse. Tobacco Control Nerín 2005 {published data only}
2001;10(3):267-72. Nerín I, Crucelaegui A, Más A, Villalba JA, Guillén D, Gracia A.
Results of a comprehensive workplace program for the
Lowe 1987 {published data only}
prevention and treatment of smoking addiction. Archivos de
Lowe JB, Windsor RA, Post KL. Effectiveness of impersonal Bronconeumologia 2005;41(4):197-201.
versus interpersonal methods to recruit employees into
a worksite quit smoking program. Addictive Behaviors O'Connell 2006 {published data only}
1987;12(3):281-4. O'Connell M, Comerford BP, Wall HK, Yanchou-Njike V,
Faridi Z, Katz DL. Impediment profiling for smoking cessation:
Maheu 1989 {published data only}
application in the workplace. American Journal of Health
Maheu MM, Gevirtz RN, Sallis JF, Schneider NG. Competition/ Promotion 2006;21(2):97-100.
cooperation in worksite smoking cessation using nicotine gum.
Preventive Medicine 1989;18(6):867-76. Offord 1992 {published data only}
Offord KP, Hurt RD, Berge KG, Frusti DK, Schmidt L. Effects of the
Makrides 2008 {published data only}
implementation of a smoke-free policy in a media center. Chest
Makrides L, Dagenais GR, Chockalingam A, LeLorier J, 1992;102(5):1531-6.
Kishchuk N, Richard J, et al. Evaluation of a workplace health
program to reduce coronary risk factors. Clinical Governance Olive 1996 {published data only}
2008;13(2):95-105. Olive KE, Ballard JA. Changes in employee smoking behavior
after implementation of restrictive smoking policies. Southern
Matson-Koffman 1998 {published data only}
Medical Journal 1996;89(7):699-706.
Matson-Koffman D, Lee JW, Hopp JW, Emont SL. The impact of
including incentives and competition in a workplace smoking Olsen 1990 {published data only}
cessation program on quit rates. American Journal of Health Olsen GW, Shellenberger RJ, Lacey SE, Fishbeck WA, Bond GG. A
Promotion 1998;13(2):105-11. smoking cessation incentive program for chemical employees:
design and evaluation. American Journal of Preventive Medicine
McMahon 2001 {published data only}
1990;6(4):200-7.
McMahon SD, King C, Mautz B, Jason LA, Rossi JS, Redding CA.
Worksite interventions: a methodological exploration and Olsen 1991 {published data only}
pilot study promoting behavior change. Journal of Primary Olsen GW, Lacey SE, Sprafka JM, Arceneaux TG, Potts TA,
Prevention 2001;22(2):103-19. Kravat BA, et al. A 5-year evaluation of a smoking incentive
program for chemical employees. Preventive Medicine
McMahon 2002 {published data only}
1991;20(6):774-84.
McMahon A, Kelleher CC, Helly G, Duffy E. Evaluation of a
workplace cardiovascular health promotion programme Ong 2005 {published data only}
in the Republic of Ireland. Health Promotion International Ong MK, Glantz SA. Free nicotine replacement therapy
2002;17(4):297-308. programs vs implementing smoke-free workplaces: a cost-
effectiveness comparison. American Journal of Public Health
Musich 2003 {published data only}
2005;95(6):969-75.
Musich S, McDonald T, Hirschland D, Edington DW. Examination
of risk status transitions among active employees in a Park 2007 {published data only}
comprehensive worksite health promotion program. Journal of Park MK, Kang KS, Kim NY. Effects of a smoking cessation
Occupational and Environmental Medicine 2003;45(4):393-9. program on amount of smoking and nicotine dependence and
self-efficacy of smoking cessation for smoking workers. Taehan
Muto 1998 {published data only}
Kanhoe Hakhoe Chi 2007;37(7):1073-9.
Muto T, Nakamura M, Oshima A. Evaluation of a smoking
cessation program implemented in the workplace. Industrial Patten 1995 {published data only}
Health 1998;36(4):369-71. Patten CA, Gilpin E, Cavin SW, Pierce JP. Workplace smoking
policy and changes in smoking behaviour in California: a
Nepps 1984 {published data only}
suggested association. Tobacco Control 1995;4(1):36-41.
Nepps MM. A minimal contact smoking cessation program at
the worksite. Addictive Behaviors 1984;9(3):291-4. Pegus 2002 {published data only}
Pegus C, Bazzarre TL, Brown JS, Menzin J. Effect of the Heart At
Work program on awareness of risk factors, self-efficacy, and

Informed decisions.
health behaviors. Journal of Occupational and Environmental among motor freight workers: results of the gear up for health
Medicine 2002;44(3):228-36. study. Cancer Causes & Control 2010;21(12):2113-22.
Prior 2005 {published data only} Stoddard 2005 {published data only}
Prior JO, Van Melle G, Crisinel A, Burnand B, Cornuz J, Darioli R. Stoddard AM, Fagan P, Sorensen G, Hunt MK, Frazier L, Girod K.
Evaluation of a multicomponent worksite health promotion Reducing cigarette smoking among working adolescents:
program for cardiovascular risk factors - correcting for the results from the SMART study. Cancer Causes & Control
regression towards the mean effect. Preventive Medicine 2005;16(10):1159-64.
2005;40(3):259-67.
Stoddard 2008 {published data only}
Richmond 1985 {published data only} Stoddard JL, Augustson EM, Moser RP. Effect of adding
Richmond RL, Webster IW. A smoking cessation programme a virtual community (bulletin board) to smokefree.gov:
for use in general practice. The Medical Journal of Australia randomized controlled trial. Journla of Medical Internet
1985;142(3):190-4. Research 2008;10(5):e53.
Rosenstock 1986 {published data only} Sun 2009 {published data only}
Rosenstock IM, Stergachis A, Heaney C. Evaluation of a smoking Sun HQ, Guo S, Chen DF, Jiang ZN, Liu Y, Di XL, et al. Family
prohibition policy in a health maintenance organization. support and employment as predictors of smoking cessation
American Journal of Public Health 1986;76(8):1014-5. success: a randomized, double-blind, placebo-controlled trial
of nicotine sublingual tablets in Chinese smokers. American
Roto 1987 {published data only} Journal of Drug and Alcohol Abuse 2009;35(3):183-8.
Roto P, Ojala A, Sundman K, Jokinen K, Peltomakl R. Nicotine
gum and withdrawal from smoking. Suomen Laakarllehtl Terry 2010 {published data only}
1987;36:3445-8. Terry PE, Fowles JB, Harvey L. Employee engagement factors
that affect enrollment compared with retention in two coaching
Ryan 2002 {published data only} programs--The ACTIVATE study. Population Health Management
Ryan PJ, Forster NJD, Holder D. Evaluation of a worksite 2010;13(3):115-22.
smoking-cessation program. Journal of Occupational and
Environmental Medicine 2002; Vol. 44, issue 8:703-4. Ullén 2002 {published data only}
Ullén H, Höijer Y, Ainetdin T, Tillgren P. Focusing management in
Schlegel 1983 {published data only} implementing a smoking ban in a university hospital in Sweden.
Schlegel RP, Manske SR, Shannon ME. Butt out! Evaluation of European Journal of Cancer Prevention 2002;11(2):165-70.
the Canadian Armed Forces smoking cessation program. In:
Forbes WF, Frecker RC, Nostbakken DJ editor(s). Proceedings Waage 1997 {published data only}
of the Fifth World Conference on Smoking and Health. Pntario: Waage HP, Vatten LJ, Opedal E, Hilt B. Smoking intervention
Canadian Council on Smoking and Health, 1983. in subjects at risk of asbestos-related lung cancer. American
Journal of Industrial Medicine 1997;31(6):705-12.
Scott 1986 {published data only}
Scott RR, Prue DM, Denier CA, King AC. Worksite smoking Wakefield 1996 {published data only}
intervention with nursing professionals: Long-term outcome Wakefield M, Roberts L, Owen N. Trends in prevalence and
and relapse assessment. Journal of Consulting and Clinical acceptance of workplace smoking bans among indoor workers
Psychology 1986;54(6):809-13. in South Australia. Tobacco Control 1996;5(3):205-8.
Shipley 1988 {published data only} Whitney 1994 {published data only}
Shipley RH, Orleans CT, Wilbur CS, Piserchia PV, McFadden DW. Whitney E, Harris N. A progress report on an ongoing smoking
Effect of the Johnson & Johnson Live for Life program on cessation initiative as part of a major wellness program. Health
employee smoking. Preventive Medicine 1988;17(1):25-34. Values 1994;18(1):84-90.
Sloan 1990 {published data only} Wilbur 1986 {published data only}
Sloan RP, Dimberg L, Welkowitz LA, Kristiansen MA. Cessation Wilbur CS, Hartwell TD, Piserchia PV. The Johnson & Johnson
and relapse in a workplace quit-smoking contest. Preventive LIVE FOR LIFE program: Its organization and evaluation plan. In:
Medicine 1990;19(4):414-23. Cataldo MF, Coates TJ editor(s). Health and Industry. New York:
John Wiley & Sons, 1986:338-50.
Sorensen 1991 {published data only}
Sorensen G, Rigotti N, Rosen A, Pinney J, Prible R. Effects of a Willemsen 1995 {published data only}
worksite non-smoking policy: evidence for increased cessation. Willemsen MC, De Vries H. Evaluation of a smoking cessation
American Journal of Public Health 1991;81(2):202-4. intervention for Dutch employees consisting of self
help methods and a group programme. Tobacco Control
Sorensen 2010 {published data only} 1995;4(4):351-4.
Sorensen G, Stoddard A, Quintiliani L, Ebbeling C, Nagler E,
Yang M, et al. Tobacco use cessation and weight management

Informed decisions.
Willemsen 1999 {published data only} Additional references

Willemsen MC, De Vries H, Oldenburg B, Van Breukelen G. Bland 1997
Impact of a comprehensive worksite smoking cessation
Bland JM, Kerry SM. Statistics notes: Trials randomised in
programme on employees who do not take part in cessation
clusters. BMJ 1997;315(7108):600.
activities. Psychology and Health 1999;14(5):887-95.
Cahill 2011
Woodruff 1993 {published data only}
Cahill K, Perera R. Competitions and incentives for smoking
Woodruff TJ, Rosbrook B, Pierce J, Glantz SA. Lower levels of
cessation. Cochrane Database of Systematic Reviews 2011, Issue
cigarette consumption found in smoke-free workplaces in
4. [DOI: 10.1002/14651858.CD004307.pub4]
California. Archives of Internal Medicine 1993;153(12):1485-93.
Callinan 2010
References to studies awaiting assessment Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative
smoking bans for reducing secondhand smoke exposure,
Gao 2010 {published data only} smoking prevalence and tobacco consumption. Cochrane
Gao J, Zheng P, Gao J, Fu H. Application of theory organizational Database of Systematic Reviews 2010, Issue 4. [DOI:
change for smoking cessation in workplace. We Sheng Yan Jiu 10.1002/14651858.CD005992.pub2]
(Journal of Hygiene) 2010;39(6):705-8.
Cochrane Handbook
Higgins JPT, Green S (editors). Cochrane Handbook of
References to ongoing studies Systematic Reviews of Interventions Version 5.1.0 (updated
NCT01124110 2012 {published data only} March 2011). The Cochrane Collaboration, 2011. Available from
cochrane-handbook.org.
Duffy SA, Ronis DL, Richardson C, Waltje AH, Ewing LA,
Noonan D, et al. Protocol of a randomized controlled trial of the DeNaves-Walt 2008
Tobacco Tactics website for operating engineers. BMC Public
DeNaves-Walt C, Proctor BD, Smith JC. Income, Poverty
Health 2012; Vol. 12:335.
and Health Insurance Coverage in the United States 2007.
* NCT01124110. Tobacco Tactics website for operating www.census.gov/prod/2007pubs/p60-233.pdf (accessed 18
engineers (BCBSM-OE). clinicaltrials.gov/show/NCT01124110 November 2013).
(accessed 12 November 2013).
Gruman 1993
NTR8148 2012 {published data only} Gruman J, Lynn W. Worksite and community intervention for
Laan EK, Kraaijenhagen RA, Peek N, Busschers WB, tobacco control. In: Orleans CT, Slade J editor(s). Nicotine
Deutekom M, Bossuyt P, et al. Effectiveness of a web-based Addiction: Principles and Management. New York: Oxford
health risk assessment with individually-tailored feedback University Press, 1993:396-411.
on lifestyle behaviour: study protocol. BMC Public Health
Lancaster 2005a
2012;12:200. [NTR8148]
Lancaster T, Stead LF. Individual behavioural counselling for
* NTR8148. Web-based health risk assessment. Dutch trial smoking cessation. Cochrane Database of Systematic Reviews
register NTR8148 (accessed 12 November 2013). 2005, Issue 2. [DOI: 10.1002/14651858.CD001292.pub2]
Simpson 2000 {published data only} Lancaster 2005b

Dobbins TA, Simpson JM, Oldenburg B. Who comes to a Lancaster T, Stead LF. Self-help interventions for smoking
workplace health risk assessment?. International Journal of cessation. Cochrane Database of Systematic Reviews 2005, Issue
Behavioural Medicine 1998;5:323-34. 3. [DOI: 10.1002/14651858.CD001118.pub2]
Harris D, Vita P, Oldenburg B, Owen N. Socio-behavioural and Martinson 1999

environmental approaches to worksite health promotion: Martinson BC, Murray DM, Jeffery RW, Hennrikus DJ. Intraclass
the intervention of the Australian National Workplace Health correlation for measures from a worksite health promotion
Project. Health Promotion Journal of Australia 1999;9:49-54. study: estimates, correlates, and applications. American Journal
of Health Promotion 1999;13(6):347-57.
Oldenburg B, Sallis JF, Harris D, Owen N. Checklist of Health
promotion Environments at Worksites (CHEW): development NICE 2006
and measurement characteristics. American Journal of Health
York Health Economics Consortium. A rapid review of
Promotion 2002;16(5):288-99.
the cost-effectiveness of workplace policies for smoking
* Simpson JM, Oldenburg B, Owen N, Harris D, Dobbins T, cessation in England. www.nice.nhs.uk/nicemedia/pdf/
Salmon A, et al. The Australian National Workplace Health SmokingCessationEconomicsNon-NHSFullReview.pdf (accessed
Project: Design and baseline findings. Preventive Medicine May 22nd 2008) 2006.
2000;31(3):249-60.

Informed decisions.
NICE 2007 References to other published versions of this review

National Institute for Health and Clinical Excellence. Workplace Cahill 2008b
health promotion: how to help employees to stop smoking.
Cahill K, Moher M, Lancaster T. Workplace interventions for
www.nice.org.uk/nicemedia/pdf/PHI005guidance.pdf (accessed
smoking cessation. Cochrane Database of Systematic Reviews
23rd May 2008) 2007.
2008, Issue 4. [DOI: 10.1002/14651858.CD003440.pub3]
Stead 2005
Moher 2003
Stead LF, Lancaster T. Group behaviour therapy programmes for
Moher M, Hey K, Lancaster T. Workplace interventions for
2005, Issue 2. [DOI: 10.1002/14651858.CD001007.pub2]
2003, Issue 2. [DOI: 10.1002/14651858.CD003440]
Stead 2012
Moher 2005
Stead LF, Perera R, Bullen, C Mant D, Hartmann-Boyce J,
Moher M, Hey K, Lancaster T. Workplace interventions for
Cahill K, et al. Nicotine replacement therapy for smoking
cessation. Cochrane Database of Systematic Reviews 2012, Issue
2005, Issue 2. [DOI: 10.1002/14651858.CD003440.pub2]
11. [DOI: 10.1002/14651858.CD000146.pub4]
* Indicates the major publication for the study
CHARACTERISTICS OF STUDIES
Characteristics of included studies [ordered by study ID]
Bergstrom 2008
Methods Country: Sweden
Setting: 4 intervention sites (2 paper mills, 1 steelworks, 1 truck manufacturer), 1 'reference' [control]
site (4 paper industry companies associated with one of the paper mills).
Design: Prospective multicentre cohort study, run from 2000 - 2003
Participants 741 workers at the reference site, 387 at Company 1, 541 at Company 2, 1144 at Company 3, 2045 at
Company 4. Baseline smoking prevalence at each was 13.3%, 16.2%, 27.1%, 20.5% and 21.3% respec-
tively. Mean 12% women; mean age 41.3
Interventions 1. Intervention: Personal feedback provided after screening; smokers assessed at moderate or high
risk got individual and group counselling, and NRT. High-risk smokers were offered full-time behaviour-
al rehab programmes for 2 or 4 weeks. Some companies self-initiated self-help SC groups. The whole
screening/feedback/intervention cycle was offered 3 times over the course of the study.
2. Control: In 2001 (yr 2), employees completed a questionnaire on the pyschosocial work environment,
and received tailored feedback. No other interention.
Population measures taken 10 times over 4 years.
Outcomes Lifestyle (smoking and exercise), health-related quality of life, sick leave.
Smoking prevalence at each time point, recorded by OHS, who also did spirometry and PEF, to year 4,
probably based on self-reported PPA.
Type of intervention 8. COMPREHENSIVE
Notes New for 2014 update. This is the AHA study (Arbete och Hälsa inom process och verkstadsindustrin
[Work and health in the processing and engineering industries]), funded by AFA Insurance.
Additional smoking data supplied by the author.
Risk of bias
Bias Authors' judgement Support for judgement

Informed decisions.
Bergstrom 2008 (Continued)
Random sequence genera- High risk Not randomized; reference sites had more white-collar workers (34%) than the
tion (selection bias) interventions sites (26%, 25%, 16%, 14%)
Allocation concealment Unclear risk N/A

(selection bias)
Blinding of outcome as- Unclear risk Not stated

sessment (detection bias)
All outcomes
Incomplete outcome data High risk Time between feedback and referral shorter at Companies 1 & 2 than at 3 & 4.
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Company 4 had very low response rates throughout
porting bias)
Cambien 1981
Methods Country: France
Recruitment: Worksite volunteers in 160 sections of an administrative organization.
Design: Randomized controlled trial. Randomization method not described
Participants 3336 men aged 25 - 35 at baseline. 424 classified as at high risk of coronary disease, 868 at low risk. 304
intervention / 306 control smokers.
Mean cpd 8.9 intervention, 10.0 control
Interventions 1. High-risk intervention participants recalled at 6m, 12m, 24m, low-risk at 12m, 24m. All intervention
participants measured blood sample, weight, BP, no. of cpd. Given tailored advice on diet, alcohol and
smoking at each visit.
2. Controls received no counselling or measurement between baseline and follow-up
Outcomes Abstinence/reduction at 2 yrs.

At 2yrs 568 (86%) of intervention group returned, and 529 (84%) of control group.
Validation: Blood CO
Type of intervention 2. Intensive behavioural: INDIVIDUAL COUNSELLING
Notes This trial was added to the 2005 update.

95 intervention participants lost to follow up were heavier smokers (+ 4.4 cpd) vs 100 control partici-
pants lost to follow-up (+ 0.4 cpd).
Risk of bias
Random sequence genera- Unclear risk Not stated

tion (selection bias)
Allocation concealment Unclear risk "Sections were randomly assigned"

(selection bias)

All outcomes

Informed decisions.
Cambien 1981 (Continued)
Incomplete outcome data Low risk Rates reported

(attrition bias)
All outcomes
Selective reporting (re- Low risk Expected outcomes reported

porting bias)
Campbell 2002
Methods Country: USA
Recruitment: 10 small manufacturing companies in NC.
Design: Cluster RCT, no details of randomization
Participants 859 blue-collar women at baseline (73% of eligible). 538 completed programme to 18m. 53% aged 40 or
younger, 58% African American. Mean BMI 29. 30% I group, 22% C group smoked.
Interventions 1. Intervention: computer-tailored 'magazine' with dietary, exercise, smoking advice, at baseline
and 6m, plus social support at work from trained helpers in participants' chosen activity. N.B. No lay
helpers offered smoking support.
2. Delayed intervention (control): One computer-tailored 'magazine at 6m, no social support.
Outcomes Abstinence at 18m: self-reported, no biochemical validation.

Natural (lay) helpers declined training in smoking cessation, so this arm of the intervention was not
available to participants trying to quit.
Risk of bias

Allocation concealment Unclear risk "Four worksites were randomized to the intervention group and 5 to the de-
(selection bias) layed intervention group"

All outcomes
Incomplete outcome data Unclear risk Only the 62.6% who completed all 3 surveys were analysed
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Very little information on smoking cessation
porting bias)
Dawley 1991

Informed decisions.
Dawley 1991 (Continued)

Recruitment: worksite volunteers in 2 comparable oil refineries in Southern Louisiana
Design: cluster-RCT, no details of randomization method
Participants 30 smokers (14 at intervention site and 16 at comparison site)

76% male
Av. age: 39, av. cpd 21
Participation rate: not reported
Interventions 1. Intervention: comprehensive programme of smoking control, discouragement, cinnamon sticks as

cigarette substitutes, and smoking cessation
2. Control: smoking cessation alone
Outcomes Self-reported smoking cessation at 5m with urinary cotinine validation
Type of intervention 6. ENVIRONMENTAL SUPPORT
Notes Introduction includes lengthy discussion of economic and health costs of smoking
Risk of bias

Allocation concealment Unclear risk "One refinery was randomly assigned"

(selection bias)

All outcomes
Incomplete outcome data Unclear risk No losses reported

(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Nothing stated

porting bias)
DePaul 1987
Recruitment: Employees at 43 worksites, recruited prior to a 3w television smoking cessation pro-
gramme.
Design: Cluster-randomization by worksite, matched for size
Participants 233 smokers in 21 group discussion worksites, 192 in 22 non-group work sites.
Groups led by trained employees
Interventions All participants were given self-help manuals by company co-ordinators and instructed to view the
televized segments
1. Twice-weekly group meetings
2. Self help alone
Outcomes Abstinence at 12m (multiple PP)

Informed decisions.
DePaul 1987 (Continued)

Partial validation by salivary cotinine or family/colleague report
Notes
Risk of bias

Allocation concealment Unclear risk "Forty-three cooperating worksites were randomly assigned ..."
(selection bias)

All outcomes
Incomplete outcome data Low risk Attrition rates @ 12m reported (7.7% G, 8.3% NG)
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Percentages only reported, not raw numbers
porting bias)
DePaul 1989
Recruitment: Employees at 38 worksites, recruited prior to a 3w television smoking cessation pro-
gramme.
Design: Cluster-randomization by worksite
Participants 419 smokers who participated in the worksite programmes, 206 Group, 213 No-Group conditions.
Interventions 1. 6 x twice-weekly group meetings to coincide with the 3w television series, then monthly meetings for
a year. Abstinent smokers and 5 of their family and 5 co-workers entered for a lottery at the final group
meeting and 12m follow-up.
2. Self-help manuals only
Outcomes Abstinence from end of programme to 24m

Validation by saliva cotinine and co-worker or relative confirmation.
Notes This study featured monthly booster sessions and monetary incentives for abstainers, as a develop-
ment of the design of the first De Paul study
Risk of bias

Informed decisions.

Allocation concealment Unclear risk "a randomly selected half" got the Group discussions. No further information
(selection bias)

All outcomes
Incomplete outcome data Low risk At 12m, 5.3% G and 8.4% NG lost
(attrition bias)
All outcomes
Selective reporting (re- Low risk All expected outcomes reported

porting bias)
DePaul 1994
Setting: 61 worksites
Participants 844 smokers recruited; 289 Self Help (SH), 281 Incentives (I), 283 Group (G).
Av. age 38, Av cpd 21
72% women in SH, 58% women in I, 59% women in G
Participation rate: 58% in SH, 59% in I, 55% in G
Interventions Worksite interventions timed to coincide with a mass media intervention consisting of a week-long
smoking cessation series on TV, and a complementary newspaper supplement.
SH: Self-help manual (ALA Freedom from Smoking in 20 days)
I: Self-help manual and incentive payment of USD 1 for each day abstinent up to USD175
G: 6 group meetings over 3w followed by 14 booster meetings over 6m. Incentive payments. Handouts
from same S-H manual. Maintenance manual (ALA A Lifetime of Freedom from Smoking)
Outcomes Sustained abstinence at 12m

Validation: CO < 9ppm. Saliva cotinine at 6m only
Type of intervention 1. Intensive behavioural: GROUPS
Notes Discussion section includes some cost-benefit analysis.
Risk of bias

Allocation concealment Unclear risk "matched according to size and type, and then randomly assigned..."
(selection bias)

All outcomes

Informed decisions.
Incomplete outcome data Low risk 5 companies dropped out between pretest and 6m. ITT analysis used for indi-
(attrition bias) viduals.
All outcomes

porting bias)
Emmons 1999
Setting: 26 worksites in RI and SE Mass (Brown University-based).
Only 22 sites completed the trial.
Design: randomized matched pair, following a cohort over 3 yrs. Randomization process not described.
Participants 22 worksites, and 2055 participants who completed all surveys. No demographic differences between
intervention and control groups. Smoking prevalence 28% across both groups.
Interventions 1. Intervention sites: As with Working Well Trial (Sorensen 1996), but including physical activity; a com-
bination of individual and environmental programmes, including space, showers, equipment and dis-
counted membership of fitness facilities.
2. Control sites: Minimal care: Could offer 2 S-H smoking cessation programmes and 1 each on nutri-
tion and physical activity.
Outcomes Self-reported abstinence at 3 yrs for 6m prior to assessment, and 7-day PP.
No biochemical validation used.
Secondary outcome: movement through stages of change.

This is the Working Healthy Project, nested within the Working Well trial.
Risk of bias

Allocation concealment Unclear risk "random assignment of worksites within pairs"

(selection bias)

All outcomes
Incomplete outcome data Unclear risk Not stated

(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Not stated

porting bias)

Informed decisions.
Erfurt 1991
Setting: 4 General Motors worksites, Michigan
Participants Random sample of 400-500 employees screened at baseline and followed up 3 yrs later.
Predominantly male, white, blue collar.
41-45% smoked at baseline, but in the rescreened sample only 41% in site 3 and 36% in site 4 smoked
at baseline
Interventions Smoking, high blood pressure & obesity targetted.

1 worksite was allocated to each of 4 conditions:
1. Wellness screening; identify risks & referral
2. As 1. + media, programme sign-up campaigns and classes
3. As 1. + media, program sign-up campaigns, menu of interventions including guided self-help, group
or individual counselling + follow up
4. As 3 + follow-up counselling + Plant Organization including peer support, aimed at reducing relapse.
All sites initiated no smoking areas during the period.
Outcomes Self-reported smoking status
Notes Quit rates were calculated by combining 1985 smokers and ex-smokers (i.e. at risk of relapse) as the de-
nominator. If the calculation is based only on current smokers at 1985 compared with 1988 quitters,
the results do not reach statistical significance.
Reduced prevalence at all 4 sites coincided with the setting-up of restrictive policies in each site.
Risk of bias

Allocation concealment Unclear risk "The plants were randomly assigned"

(selection bias)

All outcomes
Incomplete outcome data Unclear risk ITT analysis (all employees screened, whether or not they participated in inter-
(attrition bias) vention).
All outcomes
Selective reporting (re- High risk Some confounding of denominators by inclusion of ex-smokers
porting bias)
Frank 1986
Recruitment: University of Missouri employees
Evaluation: determine the effects of various amounts of hypnosis and hypnosis plus behavioural ses-
sions
Design: RCT, no details of randomization method

Informed decisions.
Frank 1986 (Continued)
Participants 63 smokers
Women: 62%
Median education: 16 yrs
Median income: USD 27,000
Interventions In the initial study, 48 subjects of the total (N = 63) used, were assigned to one of three treatments:
1. 4 hypnotherapy (HYP) sessions + booster
2. 2 HYP sessions
3. 2 HYP + 2 behavioural sessions + booster.
A follow-up group was later recruited composed of 15 participants who received 4 HYP + booster with
less time between sessions.
Outcomes Self-reported cessation at 3m and 6m, with saliva thiocyanate confirmation at 3m only.
Notes
Risk of bias

Allocation concealment Unclear risk "Subjects from the initial sample were blocked on high and low median in
(selection bias) pack years ... and scores on the Creative Imagery Scale and were then random-
ly assigned"

All outcomes
Incomplete outcome data Unclear risk Losses of 17% at 3m and 25% at 6m (distribution not reported).
(attrition bias)
All outcomes
Selective reporting (re- Low risk All expected outcomes covered

porting bias)
Glasgow 1984
Methods Country:USA
Recruitment: telephone company employees
Participants 36 employees and spouses

69% women. Av. age: 37
Smoked: average of 18 yrs and on average 30 cpd
Interventions Group therapy

Informed decisions.
Glasgow 1984 (Continued)

3 groups: 1. abrupt reduction 2. gradual reduction 3. gradual reduction with feedback pre- and 2 post-
tests; 7 weekly meetings with goals of 50% reduction per week in abrupt group; 25% per week in grad-
ual group; 25% per week with graphs of daily nicotine intake for gradual/feedback group.
Outcomes Self report of smoking status and consumption at 6m, with CO validation and cigarette butt weight.
Notes Analyses were conducted on non-abstinent participants at end of treatment, to assess reduction effica-
cy.
Outcomes included changes in nicotine content (brand smoked), amount of cigarette smoked, and
number of cigarettes smoked.
Risk of bias

Allocation concealment Unclear risk "Subjects were randomly assigned..."

(selection bias)

All outcomes
Incomplete outcome data Low risk Losses at 6 months reported (4 abrupt; 0 gradual; 1 gradual + feedback)
(attrition bias)
All outcomes

porting bias)
Glasgow 1986
Methods Country:USA
Recruitment: VA hospital, savings and loan association, and a health insurance agency employee vol-
unteers
Design: RCT, no details of randomization procedure
Participants 29 adult cigarette smokers

69% women. Av. age 33.5
Average 25 cpd
Fagerstrom score 5.7, indicating moderate levels of tobacco dependence.
Interventions 1. Basic program (BP): 6 weekly group meetings - focused on making reductions in the no. of cpd and
reductions in nicotine content. Midway through the programme participants given the option of either
complete cessation or reducing the percentage of each cigarette smoked.
2. BP + social support (SS): the same treatment as the BP group; in addition, each BP+SS participant
selected a partner who provided support and encouragement during non-work hours.
Outcomes Self reports, examination and weighing of saved cigarette. Butts and 2 biochemical measures of smok-
ing exposure, CO and saliva thiocyanate.

Informed decisions.
Type of intervention 5. SOCIAL SUPPORT
Notes Outcomes included changes in nicotine content (brand smoked), amount of cigarette smoked, and
number of cigarettes smoked. The influence of social support, or lack of it, was also assessed.
Risk of bias

Allocation concealment Unclear risk Participants assigned, and then "Groups were then randomly assigned"
(selection bias)

All outcomes
Incomplete outcome data Unclear risk 7% losses reported

(attrition bias)
All outcomes

porting bias)
Glasgow 1993
Recruitment: 19 worksites in Oregon.
Design: Cluster-randomized RCT
Participants Worksites from 140 - 600 employees. Smoking prevalence of 21 - 22%; Av age 40 - 41. 63% women. 474
in Incentives (I) Group, 623 in No incentives (NI) Group
Interventions Company steering groups ran the programmes

1. I Group members were paid USD 10 for each verified abstinent month, up to 10m, + monthly and
end-of-programme lotteries. There was also a buddy scheme, with cash prizes to helpers.
2. NI Group operated their normal company policy, which usually restricted but didn't ban smoking
Outcomes Cessation rates at 12m and 2 yrs, verified by CO and salivary cotinine
Type of intervention 7. INCENTIVES
Notes Analysis was at both worksite and individual level.
Risk of bias

Allocation concealment Unclear risk "worksites were stratified on number of employees and estimated smoking
(selection bias) prevalence... and then randomized"

Informed decisions.

All outcomes
Incomplete outcome data Unclear risk Losses to follow-up (22% at 1 yr and 30% at 2 yrs) not included in the analyses
(attrition bias) but 99% of current employees at 1 yr and 97% at 2 yrs contacted.
All outcomes
Selective reporting (re- Unclear risk All expected outcomes reported

porting bias)
Glasgow 1995
Setting: 26 worksites in Oregon
Design: Cluster-randomized trial
Participants 26 heterogeneous worksites in Oregon with between 125 and 750 employees - an average of 247.
Participation rate: at baseline, early intervention rate was 38% and delayed intervention 58%.
At 2-yr follow-up, early intervention rate was 40% and delayed intervention was 57%
Interventions Take Heart Project, focusing on diet and smoking

Early intervention (multifaceted programme consisting of employee steering committee and a menu
approach to conducting key intervention activities tailored to each site) vs delayed but similar inter-
vention
Outcomes Self-reported smoking cessation
Notes This is the Take Heart worksite wellness program. Other outcomes included dietary intake and choles-
terol levels
Risk of bias

Allocation concealment Unclear risk "matched on (1) type of industry ..., (2) number of employees..., and (3) a com-
(selection bias) posite variable... The resulting matched pairs were then randomly assigned"

All outcomes
Incomplete outcome data Unclear risk Not collected

(attrition bias)
All outcomes
Selective reporting (re- Unclear risk % of smokers by cross-sectional surveys

porting bias)

Informed decisions.
Gomel 1993a
Methods Country: Australia
Setting: 28 Sydney ambulance stations
Design: Cluster-randomized RCT. method of randomization not described.
Participants 431 participants (88%) in 28 stations. av age 32 yrs. 128 smokers, mean cpd 17.9.
Interventions 1. Health Risk Assessment (HRA): (10 stations, 40 smokers): Measurement of BMI, % body fat, BP, cho-
lesterol, smoking status, aerobic capacity. Feedback given, with high-risk people referred to family GP.
This minimal 30-minute intervention was the control group.
2. Risk Factor Education (RFE): (8 stations, 28 smokers): Same measures as HRA, + advice through man-
ual and videos in a 50-minute session.
3. Behavioural Counselling (BC): (6 stations, 30 smokers). Same as RFE group, + up to 6 counselling ses-
sions (averaged 3) over 10w, + staged change manual.
4. Behavioural Counselling + Incentives (BCI): (4 stations, 30 smokers).
As RFE, + manual and goal-setting and follow-up counselling (average 2 hrs). Also lottery draw for AUD
40 voucher if interim targets achieved, and final prize of AUD1000 for highest achieving station at 6m.
Outcomes Baseline, 3, 6 and 12m assessments.

PP abstinence at 12m, validated by serum cotinine.
Type of intervention 2. Intensive behavioural: INDIVIDUAL COUNSELLING / INCENTIVES

Fewer stations and participants were allocated to the more intensive interventions (BC and BCI) be-
cause of cost. Some contamination between conditions reported.
Risk of bias

Allocation concealment Unclear risk "Work sites were randomly allocated"; fewer stations (6/28 for BC, and 4/28 for
(selection bias) BC+I) were allocated to the BC groups, to reduce costs.

All outcomes
Incomplete outcome data Low risk ITT analyses performed. Losses reported for 3-, 6- and 12-month assessments.
(attrition bias)
All outcomes
Selective reporting (re- High risk Outcomes combined across groups; %s only. Staff moved between conditions
porting bias) throughout the study. "movement and transition of individuals between the
different ambulance stations did occur", but no further details.
Groeneveld 2011
Methods Country: Netherlands
Setting: All OHSs that perform Periodic Health Screenings (every 4 years to under-40s, every 2 years to
over-40s) in the construction industry.

Informed decisions.
Groeneveld 2011 (Continued)

Design: RCT, conducted Jan 2007 - Feb 2008
Participants 816 blue- and white-collar workers at > 400 companies at risk of CVD. 115 intervention and 123 control
were the smoker cohorts. Mean age 47
Interventions All OH physicians and nurses could apply to become lifestyle counsellors. All participants got brochures
on physical activity, healthy eating, smoking and CVD.
1. Intervention 6-m counselling course, based on MI, 3 x 45 - 60-min face-to-face and 4 15 - 30-min
phone sessions; Pts could focus on diet + (physical activity OR smoking).
2. Control: 'usual care', i.e. brief oral or written advice about their risk profile, based on screening re-
sults.
Outcomes Questionnaires at 6 and 12m.
Notes New for 2014 update. Study was funded by Stichting Arvouw
Risk of bias
Random sequence genera- Low risk "using Random Allocation Software (Version 1.0)", but prestratified by blue- or
tion (selection bias) white-collar status.
Allocation concealment High risk Probably not (unblinded)

(selection bias)
Blinding of outcome as- Low risk Yes. "The investigator who performed the analysis was blinded to the group al-
sessment (detection bias) location".
All outcomes
Incomplete outcome data High risk Analyses included only those with complete data (baseline, 6m, 12m) and had
(attrition bias) attended at least 5 sessions. Final denominator in analyses was 80/115 and
All outcomes 82/123.

porting bias)
Gunes 2007
Methods Country: Turkey
Setting: Textile factory in Malatya
Design: matched controlled study, followed up at 6m
Participants 200 workers (425 smokers completed baseline questionnaire); 100 in each group, matched on age, edu-
cation, working periods and amount smoked. Intervention and control groups worked different shifts.
All male workforce, mean age 29.3, 81.7% married, 44.5% attended high school. Prevalence 65.9%
smokers, 6.8% ex-smokers.
Interventions 3-wk 7-step programme, based on stages of change model, and ALA programme.
Outcomes Primary outcome was movement through stages of change, but 6m cessation rate also reported. PPA
self-report, no verification.

Informed decisions.
Gunes 2007 (Continued)
Notes Reported as no attrition or losses to follow-up.

New for 2008 update.
Risk of bias
Random sequence genera- Unclear risk Not applicable.

Allocation concealment High risk Not randomised; 100 intervention versus 100 matched controls. Selection
(selection bias) process not explained.
Blinding of outcome as- Unclear risk Not stated.

All outcomes
Incomplete outcome data High risk Nothing reported; implication that there were no losses.
(attrition bias)
All outcomes
Selective reporting (re- High risk Insufficient information.

porting bias)
Hennrikus 2002
Setting: 24 worksites in and around St Paul. No overlap with the Healthy Worker Project.
Design: Randomized 2 x 3 factorial design, with smokers followed up at 12m and 24m.
85.5% responded to 12m survey, and 81.7% to 24m survey.
Participants 2402 smokers on 24 sites, 4 sites randomized to each of the 6 conditions. There were significant differ-
ences in demographic characteristics between sites.
Smoking prevalence ranged from 10.7% to 37.2%.
Interventions The 3 programme formats were group counselling, telephone counselling or a choice of group or
phone.
The programmes were then offered with and without incentives (=6).
The incentive site smokers received USD10 for signing up to a programme, and USD 20 for near or full
completion. They were also offered USD 20 for 30 days cessation, and were then entered into a prize
draw for a USD 500 cash prize.
Outcomes Rates of recruitment to the programmes, and 7-day smoking PP at 12m and 24m follow-up.
Validation was by self report, confirmed by family member or friend.
A sample of 188 quitters at 24m were asked to supply a saliva sample (128 complied).
Winners of the prize draw could only claim their prizes by verifying abstinence with salivary cotinine.
Notes This is the SUCCESS Project.

Significant differences between worksites meant that several covariates had to be controlled for in the
analyses.
Other outcomes included comparing quit rates of registrants for the programmes with non-registrants

Informed decisions.
Hennrikus 2002 (Continued)
Risk of bias
Random sequence genera- Unclear risk Not stated.

Allocation concealment Unclear risk "Four worksites were randomly assigned to each of the six intervention con-
(selection bias) ditions. Randomization was stratified by gender and education of the work-
force".

All outcomes
Incomplete outcome data Low risk Level of non-responders reported.

(attrition bias)
All outcomes
Selective reporting (re- Low risk All expected outcomes reported.

porting bias)
Hishida 2010
Methods Country: Japan
Setting: Nagoya branch of Tokyo-Mitsubishi Bank
Design: Quasi-randomized controlled trial, conducted July 2002 - December 2002
Participants Smokers identified at annual health check. 257/286 intervention smokers agreed to be genotyped and
included; 100% of control smokers (276) agreed to participate. No sig baseline diffs, nor between the
257 genotyped and the 29 who refused.
Interventions 1. Intervention: Genotyped and classified for L-myc, modifying smoking-related disease risks. At 3m,
genotype reports distributed, and any questions answered. No strong messages to quit.
2. Control: No intervention, follow-up at 12m.
All pts got a 8-page booklet on smoking and genetic polymorphisms; Stage of change established by
baseline and 12m questionnaires.
Outcomes Smoking status and stage of change by group, and by L-myc genotype at 12m.
Type of intervention 3. SELF-HELP
Notes New for 2014 update. Trial funded by a grant-in-aid for Cancer Research from the Japanese Ministry of
Health, Labour and Welfare.
Risk of bias
Random sequence genera- Unclear risk Not randomized; Alternate allocation by month to intervention (August, Octo-
tion (selection bias) ber, December) and control (July, September, November). No obviously raised
risks.

Informed decisions.
Hishida 2010 (Continued)
Allocation concealment Unclear risk N/A

(selection bias)
Blinding of outcome as- Low risk Assessor blinded. "Blood samples were numbered ... but the name of partici-
sessment (detection bias) pants was not attached".
All outcomes
Incomplete outcome data Low risk Losses reported at 12m (Int: 16%, Cont: 11%). ITT analysis also included (with
(attrition bias) refusers).
All outcomes
Selective reporting (re- Unclear risk None noted.

porting bias)
Hymowitz 1991
Setting: 6 white-collar worksites. No worksite had a formal no-smoking policy or ongoing smoking ces-
sation activities.
Participants 6 worksites ranging in size from 950 to 3300 employees. 25% smoking prevalence.
252 employees aged 21 and older participated, representing only a small proportion of the total num-
ber of smokers at each worksite.
62% women. Av. age 42.3
> 60% White
Interventions 1. Full programme (I): volunteers participated in a 5w training programme for quit-smoking group lead-
ers, and received additional training, support, and how-to manuals to carry out a protocol for health
education and sitewide intervention activities, as well as for the implementation of worksite smoking
policies.
2. Group-only (C): volunteers participated in the training programme for group leaders, but did not car-
ry out the protocols for health education and smoking policies.
Outcomes Self-reported cessation at 12m

Validation: expired air CO
Notes Unit of randomization was worksite but unit of analysis was the individual.
Risk of bias

Allocation concealment Unclear risk "Six worksites were assigned randomly"

(selection bias)

All outcomes

Informed decisions.
Hymowitz 1991 (Continued)
Incomplete outcome data Low risk Drop-outs fully reported

(attrition bias)
All outcomes
Selective reporting (re- Unclear risk All expected outomes reported

porting bias)
Kadowaki 2000
Setting: single factory, 542 employees
Design: RCT, allocation by random number
Participants 263 male smokers

Av. age 34, av cpd 19
Interventions 1. Physician advice, CO feedback, cessation contract, self-help materials. follow-up over 5m. Smoking
Cessation Marathon during month 4.
2. Delayed intervention control
Outcomes Abstinence for > 1m at 5m

(also 12m follow-up but by then control group also treated)
Validation: CO < 9ppm, plus urine test at 12m
Notes All male smokers (62.9%) were entered compulsorily into the trial. Female smokers (3.4%) were not in-
cluded.
Other outcomes included smoking reduction, willingness to quit and predictors of success.
Risk of bias
Random sequence genera- Low risk "using a random number-generating software".

Allocation concealment Unclear risk Not stated.

(selection bias)

All outcomes
Incomplete outcome data Unclear risk 6% failed to complete final questionnaire.

(attrition bias)
All outcomes

porting bias)

Informed decisions.
Klesges 1987
Recruitment: Employees from 4 worksites in Fargo, North Dakota and 4 in Eugene, Oregon
Design: Cluster-(worksite) randomization but individuals the unit of analysis. Two (competition/no-
competition) by two (relapse prevention training/no relapse prevention training) factorial design
Participants Participants: 136 smokers from 8 worksites. Site size ranged from 50 - 380
Av. age: 38. av cpd: 28
Smoked: average 19 years
Participation rate: not reported - estimated 28% across all sites
Interventions Evaluates the incremental effectiveness of competition and relapse prevention training in the context
of a multicomponent cessation programme.
Multicomponent cognitive behavioural programme for 6 weekly sessions; within-site competition with
weekly feedback on a visible barometer and monetary prizes at programme completion and at 6m; re-
lapse prevention booster sessions were held at 1m and 2m intervals following the programme.
Outcomes Cessation at 6m.

Validation: CO and saliva thiocyanate.
Notes The competition incentive was conducted within each intervention worksite, rather than between the
worksites.
Other outcomes included relapse prevention, smoking reduction, nicotine levels (brands), % of ciga-
rette smoked.
Risk of bias

Allocation concealment Unclear risk "The four worksites in each community were randomly assigned..." [2 compe-
(selection bias) tition/no competition, 2 relapse prevention/no replapse prevention at each of
2 sites].

All outcomes
Incomplete outcome data Unclear risk 7% attrition by end of treatment, and 10% by 6m.
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk All expected outcomes reported.

porting bias)
Kornitzer 1980
Methods Country: Belgium
Setting: 30 factories
Design: Cluster-randomized matched pair design RCT. Randomization method not described.
Participants Participants: 16,230 men aged 40 - 59 (83.7% of eligible men).

Informed decisions.
Kornitzer 1980 (Continued)
Interventions 1. Intervention: All screened for height, weight, cholesterol, smoking, BP, ECG, personality and psy-
chological testing. Top 20% at risk counted as the 'high risk' group, who received 6-monthly individual
physician counselling. Complete cessation was encouraged, but pipes or cigars allowed if necessary.
Advice booklet also supplied. All smokers of 5 or more cpd received written advice to quit. Environmen-
tal components included anti-smoking posters and a factory conference on dangers of tobacco.
2. Control: a 10% sample screened at baseline were followed up; the 20% of this sample with the high-
est risk score were also identified as the control 'high risk' subset, to be analyzed separately. The 'De-
sign and Methodology' paper reports that all eligible men in the control factories all received an ECG,
but this is not mentioned in later reports.
Outcomes 7-day PP at 2 yrs follow up.

5% sample of intervention group (327 men) were tested, + all of the original high-risk group (1268). The
10% random sample control subjects were reviewed after 2 yrs, including the 20% high risk subgroup
(202 men). Self report only, without biochemical verification.
Abstinence was defined as someone smoking at baseline who had been abstinent for at least the week
before the 2-year assessment.

This is the Belgian Heart Disease Prevention Project
Risk of bias

Allocation concealment Unclear risk Factories matched for size and industry, and "within each pair one is randomly
(selection bias) allocated to intervention".

All outcomes
Incomplete outcome data High risk Results based on all high-risk smokers + 5% of total sample, versus 10% of
(attrition bias) control group. At 2yrs 28.5% of high-risk group lost; at 10 years 0.66% lost
All outcomes overall.
Selective reporting (re- Unclear risk Not stated; pipes and cigars allowed "if a substitute was needed".
porting bias)
Kornitzer 1995
Recruitment: Worksite
Design: RCT, computer-generated list.
Participants 374 volunteers

men and women, age > 20 yrs. No. of cigarettes: > 10 day for > 3 years.
Interventions 1.Active patch and active gum (2mg as required).

2.Active patch and placebo gum.
3.Placebo patch and placebo gum.
High level of adjunct support.

Informed decisions.
Kornitzer 1995 (Continued)
Outcomes Sustained abstinence at 12m.

Validation: baseline salivary cotinine, and expired CO < 10 ppm at each follow-up.
Type of intervention 4. PHARMACOLOGICAL
Notes Other outcomes included dermatological and systemic adverse effects, and time to relapse.
Risk of bias
Random sequence genera- Low risk "a randomized list generated by a computer program".
Allocation concealment Low risk "Subjects were allocated a number and a treatment plan".
(selection bias)
Blinding of outcome as- Low risk Participants and investigators blinded, packaging blinded.
All outcomes
Incomplete outcome data Unclear risk ITT analysis; losses not reported.
(attrition bias)
All outcomes
Selective reporting (re- Low risk All expected outcomes.

porting bias)
Lang 2000
Methods Country: France
Setting: Annual health check in one large gas and electric company
Design: Cluster-randomization by site physician, physician as unit of analysis
Participants 28 site physicians covering 1269 smokers and 2614 nonsmokers

Av. age: 38, 82% male
Av cpd: 14
Interventions 1. A: Low intensity [control] intervention: Physician advice 5 - 10 mins incl. leaflets
2. B: High intensity [intervention]: as 1. plus quit date, moral contract, follow-up phone call, and 2nd
visit
Outcomes Abstinence (self-reported) for at least 6m at 1-yr follow-up

Validation: CO measurement in subgroup
Notes Other outcomes included BMI and depression score.
Risk of bias
Random sequence genera- Unclear risk Not stated; the scientific committee selected one unit from the list supplied by
tion (selection bias) each physician.

Informed decisions.
Lang 2000 (Continued)
Allocation concealment Unclear risk "one unit per physician was randomly selected".
(selection bias)

All outcomes
Incomplete outcome data Low risk ITT analysis. Full report of those lost to follow-up, with reasons.
(attrition bias)
All outcomes

porting bias)
Li 1984
Setting: naval shipyard.
Recruitment: Smokers identified at worksite screening (unselected).
Design: RCT, no details of method
Participants 871 male asbestos-exposed smokers

Av cpd: 24 - 26
Interventions 1.Advice from occupational physician; minimal warning, results of pulmonary function tests, leaflets
2. As group 1 plus behavioural counselling
Outcomes Sustained abstinence at 11m.

Validation: expired CO.
Notes Other outcomes included stratification by lung function, reduction by continuing smokers, predictors
of successful quitting and characteristics of smokers refusing to participate in the study.
Randomization ratio (method not explained) changed halfway through the study from 3:1 to 1:1.
The study found wide variation in implementation of the study procedure by physicians.
Risk of bias

Allocation concealment High risk Allocation ratio changed at 3m from 3:1 to 1:1; also only 215/359 experimental
(selection bias) group received the counselling, while 361/220 got minimal advice [3 deleted
because advising physician NK]. Groups had to be "reconstituted".

All outcomes
Incomplete outcome data High risk 24% lost at 3m (assessments changed from at-work to at-home); 14% lost at
(attrition bias) 11m follow-up.

Informed decisions.
Li 1984 (Continued)
All outcomes
Selective reporting (re- Unclear risk Expected outcomes reported.

porting bias)
Malott 1984
Setting: volunteers from telephone company (8) and a medical clinic (16)
Participants 24 participants av age 34, had smoked for an average of 16 years, and av cpd 24.
Average score on the Fagerstrom NTQ 6.0
Interventions Group therapy

1. controlled smoking
2. controlled smoking plus partner support
Outcomes Self-monitoring records, laboratory analyses of spent cigarette butts, and CO at 6m
Type of intervention 5. SOCIAL SUPPORT
Notes Other outcomes included nicotine levels (brand smoked), smoking reduction, CO levels in continuing
smokers and % of cigarette smoked.
Risk of bias

Allocation concealment Unclear risk "groups were then randomly assigned".

(selection bias)

All outcomes
Incomplete outcome data Low risk One lost to follow-up (moved away).
(attrition bias)
All outcomes
Selective reporting (re- Low risk All expected outcmes reported.

porting bias)
Mayer 2010
Recruitment: Successful abstainers from a smoking cessation programme.

Design: Cluster-RCT in 42 companies (industry not specified). Conducted from December 1993 - June
1997.

Informed decisions.
Mayer 2010 (Continued)
Participants 275 self-reported abstainers, mean age 40, 75% male, allocated to proactive phone counselling (141)
or to worksite-based group counselling (134) for relapse prevention. Each pt paid EUR 50 to participate
(14.5% were paid for by their employers).
Interventions 1. PPC [proactive phone counselling]: 10 sessions, 2 in first month and then monthly; 5 calls over 7 days
to recruit; sessions lasted a minimum of 10 minutes.
2. WGC [workplace group counselling]: 10 sessions, in a work-based room, either during or after work-
time; each session lasted 90 minutes, with 5 - 10 participants.
All sessions addressed potential lapses, high-risk situations, strategies and compensatory behaviours.
Outcomes 4-week CA at session 11 (12m after quit date), checked by CO < 10 ppm and urinary cotinine < 317 ng/
ml.
Notes
Risk of bias
Random sequence genera- Unclear risk "Workplace randomization was based on using a single sequence of random
tion (selection bias) assignments produced by a computer program".
Comment: Not clear exactly what was done, or why it could not be subverted.

(selection bias)

All outcomes
Incomplete outcome data Low risk Drop-outs reported, with reasons.

(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Expected outcomes reported.

porting bias)
Milani 2009
Setting: 2 worksites (1 company); type of industry not reported.
Participants Employees + spouses with health insurance through a single employer-sponsored provider. 185 inter-
vention site (33 smokers), 154 control site (31 smokers).
Interventions 1. Intervention: 6m programme of CV-risk reduction counselling (nutrition, smoking, physical activity).
Smoking covered by "referrals to group smoking cessation programs".
2. Control: "usual care"

Informed decisions.
Milani 2009 (Continued)
Outcomes Smoking prevalence at 6m; costs at 12m.
Notes New for 2014 update. Author provided additional information.

Funding sorce not stated, but trialists run a company (Oschner Health System) that sells these services
to local workforces.
Risk of bias
Random sequence genera- Unclear risk Not reported.

Allocation concealment Unclear risk Not reported.

(selection bias)

All outcomes
Incomplete outcome data Low risk 3 dropped out of intervention group, none from control group.
(attrition bias)
All outcomes
Selective reporting (re- High risk Smoking results acquired from author, not from study report.
porting bias) Some contamination possible between sites (may not have affected smoking
subgroups).
Mishra 2010
Methods Country: India
Setting: 4 Business Process Outsourcing (call centre) sites in Mumbai
Design: 4-arm cluster-randomized trial, each arm around 200 employees; 12-m programme spread over
18 months study duration.
Participants All 992 employees invited, and 646 participated. 267 (41.3%) were tobacco users (the denominator for
the trial). BPO 1 (control) had highest prevalence (56.7%), BPO3 the lowest (22.2%). N of tobacco users
was BPO1: 63; BPO2: 87; BPO3: 43; BPO4: 74. BPO3 was admin-based, while the others were public-con-
tact call centres.
Interventions BPO1 (control): Pamphlets to all employees on hazards of tobacco, how to quit.
BPO2: Active health education sessions (slide show, for anyone) + focus groups of 7 - 10 smoking em-
ployees; these became support groups for quitters and quit-attempters.
BPO3: As BPO2, + individual counselling.
BPO4: As BPO3, + optional bupropion based on individual needs assessment (offered to 24 but only 10
used it).
Regular follow-up every 2 - 3 months, final assessment at 12m.
Outcomes Sustained cessation for 6m, verified by "smoke-check" CO monitor, expired CO < 6 ppm; reduction.
Comparison used was 1 (controls) versus 2 (groups).

Informed decisions.
Mishra 2010 (Continued)
Notes New for 2014 update.

Funding was by Intramural grants from the Tata Memorial Hospital.
Risk of bias
Random sequence genera- Unclear risk "Each of the 4 BPO units was randomly assigned using lottery methods".

(selection bias)

All outcomes
Incomplete outcome data Low risk 52.4% of tobacco users by 12m had changed jobs; follow-up and counselling
(attrition bias) conducted by phone for those who had left. 1% not traced.
All outcomes
Selective reporting (re- Unclear risk None noted.

porting bias)
Nilsson 2001
Methods Country: Sweden
Recruitment: 4 public sector worksites (568 employees) in Helsinborg.
Design: RCT
Randomization: method of allocation not stated.
Participants Of 128 at-risk workers invited, 60/65 randomized to the intervention group attended for baseline as-
sessment, and 53/63 from the control group.
Mean age was 49.7, 61% women.
Interventions 1. Intervention group received 16 group sessions a year, as well as individual counselling by a nurse.
Sessions included lectures, discussions, video sessions and outdoor activities.
2. Control group received standard written and oral advice about cardiovascular risk factors at the
start of the intervention, and nothing thereafter.
Outcomes PP at 12m and 18m. No biochemical validation.
Notes Smoking was only one of several risk factors targeted, including BMI, BP, heart rate, low-density
lipoprotein and cholesterol.
Group sessions were held in working hours but away from the worksites.
Risk of bias

Informed decisions.
Nilsson 2001 (Continued)

Allocation concealment Unclear risk "The persons ... were randomized".

(selection bias)

All outcomes
Incomplete outcome data Low risk Drop-outs fully reported.

(attrition bias)
All outcomes

porting bias)
Noor 2011
Methods Country: Kerteh and Kuantan, Malaysia
Setting: 11 industrial workplaces (type not stated) in two towns (not cluster-randomized)
Design: RCT, conducted from April to October 2008
Participants Male smokers (FTND > 4) invited from those attending mobile SC clinic; 48% between 31 and 45 yrs of
age, baseline FTND mean 50% 7 - 10.
Interventions 1. Viva QS: (77) a "herbal medication" "twelve herbs mainly found in Korea and China".
2. Control: (78) placebo tablets.
All pts asked to set TQD (day 8), and given 24-wk supply of tablets. All pts phoned at wks 2 and 4, giv-
en 5 - 10 mins counselling. At wk 12 all had face-to-face session of brief counselling and smoking status
checked with CO testing; those not available were phoned.
Final assessment at wk 24, with bio-confirmation (CO < 8 ppm, cotinine). Any lost or unconfirmed
counted as smokers.
Outcomes 7-day PPA, CA wks 4 - 12. CO validated at wks 12 and 24. Cotinine validation (50 ng/ml) for all pts,
whether self-reporting abstinence or not. Adverse events.
Notes New for 2014 update; publication supplied by the author.
Funding was by Viva and Revival Productions Sdn Bhd
Risk of bias
Random sequence genera- Low risk "The manufacturer was responsible for the randomization".

Informed decisions.
Noor 2011 (Continued)
Allocation concealment Low risk "the medication packs were numbered from 1 to 155"; "Subjects were as-
(selection bias) signed to a specific treatment number based on the provided randomization
code".
Blinding of outcome as- Low risk "There was no difference between placebo and Viva QS in appearance, color,
sessment (detection bias) and shape of the capsules, and were packaged in identical blister packages
All outcomes and boxes. Viva QS used was from the same production batch. The administra-
tion of the capsules was conducted on a double-blind basis i.e. all subjects and
researchers had no information on who received Viva QS or placebo".
Incomplete outcome data Unclear risk 1 intervention and 3 placebo pts excluded because lost to follow-up at base-
(attrition bias) line; but denominators used were -2 int and -6 controls. 29 validated results as
All outcomes wk 12, versus 111 self-reported.
Selective reporting (re- High risk Validated outcomes reported for 7-day PPA, but not for CA. 54 urine samples
porting bias) collected but not analysed (lab problem).
Okechukwu 2009
Methods Country: USA (Massachussets)
Setting: 10 unionised building sites (4 intervention, 6 control)
Design: RCT (cluster-randomised), conducted 2004 - 2007.
Participants 624 (251 smokers) intervention trainees, 560 (239 smokers) control trainees completed all three surveys
= working cohort. Mean age 28, 95% male, smoking prevalence 41%.
Interventions 4-month programme, conducted in work time.
1. Intervention:
(a) Toxics and tobacco curriculum; 2 x 1-hour modules on work-related hazards added to smoking
risks.
(b) Group-based SC counselling: 8-week course on MI principles at each site; 3 - 12 people per group.
(c) Free NRT patches to any intervention smoker, regardless of other interactions.
(d) DIY quit kits; self-help materials, including SC guide.
(e) Environmental cues: posters, support materials.
Those who attended got early release from classes, and meals. Those who completed 7/8 sessions en-
tered into cash raffle. Survey completers got a USD 10 store voucher.
2. Control:
Assessment only, at 3 time points, but received full programme after study end.
Outcomes Smoking status (PA) at 1m, 6m. 7-day PPA at 1m. Not biochemically verified (to avoid 'drug-testing' as-
sociation). Also smoking reduction, number of quit attempts. Time 3 (6m) slipped to 8m for 1 site and
9m for another.
Notes New for 2014 update; additional information supplied by the author.
This is the MassBuilt study.

Informed decisions.
Okechukwu 2009 (Continued)

Funded by grant 1R01 DP000097-01, National Institutes of Occupational Safety and Health;
Risk of bias
Random sequence genera- Low risk "The statistician (YL) for the study separated the group into two groups of
tion (selection bias) large and small sites then he used random number generator to manually ran-
domize the sites into intervention and control groups" (personal communica-
tion from the author).

(selection bias)
Blinding of outcome as- Low risk "We used different sets of research personnel for th intervention and data col-
sessment (detection bias) lection" (personal communication from the author).
All outcomes
Incomplete outcome data Low risk Only those that completed all 3 surveys were used. But ITT and cross-sectional
(attrition bias) sensitivity analyses showed no differences in findings.
All outcomes
Selective reporting (re- Unclear risk Site was unit of randomization, while individual was unit of analysis.
porting bias)
Might have been contamination between intervention and control on building
sites.
Omenn 1988
Recruitment: Single worksite (13,000 workers, 9 employers)
Randomization: by nurses at aid stations using randomized assignment lists generated by research
centre, within preference for format.
Participants 159 smokers (av. age 43, 66% male, av.cpd 25) with preference for group programme or no preference.
243 smokers with a preference for self help randomized to 3 different S-H programmes
Groups lead by instructors trained in both programmes.
Participation rate: 11%
Interventions Group therapy preference:

1. Multiple Component programme. 3 sessions over 3w
2. Relapse Prevention programme. 6 sessions over 6w
3. Minimal Treatment programme. Self-help materials only. American Cancer Society's 22 page 'Quit-
ter's Guide' 7-day plan.
S-H preference:
Same 3 programmes, all in manual form, with no group meetings.
Outcomes Abstinence at 12m (single PP)

Validation: saliva cotinine <= 35ng/ml
Type of intervention 1. Intensive behavioural: GROUPS / SELF HELP
Notes Group programmes were held away from worksite in non-work hours.
50% random sample of continuing smokers supplied salivary samples
Risk of bias

Informed decisions.
Omenn 1988 (Continued)
Random sequence genera- Low risk "randomized assignments that had previously been generated at the research
tion (selection bias) center"
Allocation concealment Low risk Smokers could choose self-help or group format and were then randomized
(selection bias) within that. Randomization was by nurses trained in this procedure. "Our sys-
tem ... indicated that the nurses successfully followed the protocol".

All outcomes
Incomplete outcome data Unclear risk Failed to complete course: MCP 24%, RRP 58%, MTP-group 69%, MTP-self 60%.
(attrition bias) ITT analyses conducted.
All outcomes

porting bias)
Prochaska 2008
Methods Country: Oregon, USA
Setting: Medical University

Study design: RCT
Participants 1400 employees, randomized to health risk assessment intervention (HRI: 464; 48 smokers), HRI + MI
counselling (433; 40 smokers) or HRI + interactive TTM programme (TTM: 503; 48 smokers). Study tar-
geted 4 risk-reduction programmes: stress, exercise, weight control and smoking. 11% M, mean age 41,
mean CPD N/S.
Interventions Intervention 1: MI: HRA + 3 x phone or face-to-face MI sessions, to move along SoC and reduce risky be-
haviour.
Intervention 2: TTM: HRA + online TTM programme (Pro-Change Lifestyle Management Program); 4
programmes over 6m; recommended 3 sessions of each course.
Control: Health risk assessment (HRA) only. SoC assessed for each risk, and identified single best step
to remedy.
Outcomes 'Reaching criterion' at 6m, i.e. PPA (no longer at risk) for smokers.
Validation: None.
Notes New for 2014 update; No 6m denominators reported, but 101/136 smokers reported to have completed
(Table 3). No reply from authors.
Funded by CDC grant 1 RO1 DP000103.
Risk of bias
Random sequence genera- Unclear risk "randomly assigned".


Informed decisions.
Prochaska 2008 (Continued)

(selection bias)

All outcomes
Incomplete outcome data Unclear risk 35 smokers lost by 6m; distribution not reported. We conducted ITT analysis.
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Not stated.

porting bias)
Rand 1989
Recruitment: Smoking volunteers employed at Francis Scott Key Medical Center, Baltimore.
Design: RCT, no randomization detail
Participants 47 subjects who completed 5 days verified abstinence.
Interventions 1.Contingent payment for continued abstinence + frequent monitoring (n = 17)

2. Non-contingent payment for abstinence + frequent monitoring (n = 16)
3. Non-contingent payment, infrequent monitoring (n = 14).
Outcomes Quit rate at 6m, confirmed by CO validation.
Notes Subjects had received a minimal cessation programme, i.e. a 15-minute talk and a booklet, with no
skills training in cessation or relapse prevention.
Risk of bias

Allocation concealment Unclear risk "randomly assigned".

(selection bias)

All outcomes
Incomplete outcome data Low risk Losses reported.

(attrition bias)
All outcomes

porting bias)

Informed decisions.
Razavi 1999
Recruitment: workplace volunteers in 32 companies.
Design: Open-label cessation phase, then RCT for relapse prevention, using random numbers and
blinded list
Participants 344 quitters, abstinent for at least 1m at end of 3m X 7 cessation programme including group therapy
and NRT.
38% women, av age 39.
Interventions 1. Relapse Prevention (RP). 10 sessions inc group discussion and role play led by professional counsel-
lor.
2. RP. 10 sessions of group discussion led by former smokers.
3. No RP
Outcomes Abstinence for 9m from start of RP programme.

Validation by expired CO < 10 ppm and urinary cotinine ≤ 317 ug/ml.(Rates for CO and self report alone
also reported; higher than for doubly validated rates)
Notes All participants for this study had achieved abstinence after a 3m group and NRT programme. This is a
relapse prevention study, rather than cessation.
Other outcomes include predictors of sustained abstinence, weight gain.
Risk of bias
Random sequence genera- Low risk Randomization by company; "a printed randomisation list".
Allocation concealment Low risk RP phase: "Randomisation was performed by using a provided list of random
(selection bias) number (hidden by a label) to assign the follow-up regime."

All outcomes
Incomplete outcome data Unclear risk ITT analysis; drop-outs not reported.
(attrition bias)
All outcomes

porting bias)
Rodriguez 2003
Methods Country: Spain
Setting: 1 transport company (mostly bus drivers) and 2 electrical utility worksites (mostly clerical) in
Bilbao.
Design: Open RCT, with randomization by sealed opaque envelopes and computer-generated random
lists

Informed decisions.
Rodriguez 2003 (Continued)
Participants 218 participants randomized to intervention (115) and control (103). All had physical check up, Fager-
strom NTQ, lab tests and ECG at baseline
Interventions 1. Intervention: 5 - 8 mins structured individual counselling on smoking cessation at baseline by occu-
pational physician, + further contacts at 2 days, 15 days and 3m. Grade I (Fagerstrom score < 5) coun-
selling only. Grade II (Fagerstrom score 5 - 7) 8 wks x 14 mg nicotine patches. Grade III (Fagerstrom
score > 7) 4 wks x 21 mg, 4 wks x 14 mg, 4 wks x 7 mg. Lower grade interventions could be upgraded if
necessary. Participants kept records of progress, withdrawal symptoms, adverse events; weight and to-
bacco consumption were checked at specified intervals.
2. Control: minimal (30 - 60 secs) sporadic unstructured advice, usually at annual medical check up.
Outcomes Continuous abstinence (7-day PP at each assessment) at 12m.

Validated at each assessment by expired CO ≤ 10 ppm.

Secondary outcomes were: change in tobacco withdrawal symptoms, and weight changes.
Risk of bias
Random sequence genera- Low risk "The randomisation list was simple, computer generated, and independent for
tion (selection bias) each study centre".
Allocation concealment Low risk "a sealed opaque envelope".

(selection bias)
Blinding of outcome as- High risk "The trial was open" (i.e. unblinded).
All outcomes
Incomplete outcome data Low risk Minimal losses to follow-up (1 lung ca death).
(attrition bias)
All outcomes

porting bias)
Schröter 2006
Methods Country: Germany
Setting: 4 worksites
Design: RCT, sessions allocated randomly to standard behavioural (SB) or relapse prevention (RP) pro-
grammes.
Participants 79 workers, mean age 40, 58% men, mean cpd 24, mean FTND score 5.
Interventions 6 x 90-min sessions over 8 wks, group counselling + NRT if wanted. First 2 sessions same, then:
1. SB: psycho-educational, self monitoring, environmental cue control, problem-solving, behavioural

control strategies, operant conditioning, social support.
2. RP: functional analysis of high-risk situations, planning for them, coping strategies, self monitoring,
noting triggers.

Informed decisions.
Schröter 2006 (Continued)
Outcomes Self-reported CA and PPA at 1m and 12m.
Notes 12m non-responders were phoned for smoking status.

SB participants were given 'rescue' RP training when necessary, so separation of interventions not
guaranteed.
Risk of bias

Allocation concealment Unclear risk "Researchers randomized the sessions".

(selection bias)
Blinding of outcome as- High risk Performance bias: Relapsers in the standard behavioural group were given
sessment (detection bias) "rescue" RP when necessary (numbers not reported).
All outcomes
Incomplete outcome data High risk 45/79 did not provide full follow-up data.
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk %s only, not raw data.

porting bias)
Shi 1992
Methods Country:USA
Setting: 9 Pacific Gas and Electric (PG&E) worksites, allocated to 4 levels of intervention.
Design: Quasi-experimental, random assignment of worksites. Sites were blinded to other intervention
conditions.
Participants 2887 workers across 9 sites at baseline HRA survey (69% of eligibles). At 2-yr follow-up 1998 (48%) were
surveyed. Cross-sectional, not cohort surveys.
> 40% of participants were manual workers, 25 - 31% clerical, 15 - 21% managerial and 12 - 16% techni-
cal staff.. 74 - 79% male, > 70% aged 30 - 49.
Interventions 1. (3 sites, 1372 participants): HRA (height, weight, smoking, BP, cholesterol, HDL levels) at start and
end of programme, + a bi-monthly health newsletter (counts as control group).
2. (2 sites, 1083 participants): As 1, + health resources centre and free self-care booklets.
3. (2 sites, 1016 participants) As 2, + behaviour change workshops and a divisional HealthWise social
support team.
4. (2 sites, 693 participants): As 3, + case management programme for high-risk participants (the 15%
with the highest risk scores) and an environmental policy (space, smoking policies, incentives, health
fairs)
Outcomes Smoking prevalence at 2-yr follow-up in all 4 intervention groups. Self report 'current smoker' at HRA;
no biochemical confirmation.

Informed decisions.
Shi 1992 (Continued)

This is the HealthWise Stepped Intervention Study (HSIS). Level 4 sites were preselected by PG&E man-
agement (non-random) and were significantly smaller than the other levels, reflecting the expense of
the Level 4 interventions
Risk of bias

Allocation concealment High risk "divisions were then randomly assigned"; Level 4 companies preselected by
(selection bias) PG&E as small and cheaper to administer.

All outcomes
Incomplete outcome data Unclear risk Drop-outs recorded as % reduced, but not consistent cohort.
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Quit rates not available, as results reported as prevalence surveys.
porting bias)
Shimizu 1999
Setting: Omihachiman city office
Design: RCT
Participants 53 volunteer smokers
Interventions 1. Intervention group received intensive education (i.e. the effect of smoking on health, the beneficial
aspects of quitting smoking, how to stop smoking and how to deal with the withdrawal symptoms) for
5m, group lectures (twice) and individual counselling (3 times).
2. Control group had no special treatment for 1st 5m
Outcomes Self-reported and validated using expired air CO concentration.
Notes Other outcomes included predictors of cessation success.

Data were derived from abstract only
Risk of bias

Allocation concealment Unclear risk Not stated

(selection bias)

Informed decisions.
Shimizu 1999 (Continued)

All outcomes

(attrition bias)
All outcomes

porting bias)
Sorensen 1993
Setting: 8 worksites in Bloomington, Minnesota
Design: Cluster-randomized trial.
Participants Intervention worksites (I): 1885 workers

Comparison sites (C): 1479 workers. 39% smoked at baseline in I and 31% in C worksites
Participation rate: 12% of smokers (range 8 - 29% by site); 3.7% of nonsmokers participated in classes
to assist quitters.
Interventions The 3m intervention included consultation for employers on the adoption of a non-smoking policy,
training for nonsmokers to provide assistance to smokers attempting to quit, and cessation classes for
smokers
Outcomes Quit rate, self-reported (an attempt was made to collect saliva samples for analysis for cotinine). Base-
line survey of all employees was conducted 9m before intervention, companies then randomized, then
3m intervention period, 1m and 6m after the completion of intervention.
Evaluation period: 6m
Notes Analyses were by individuals for some outcomes, although randomization was by worksite.
The study area had been an intervention site for the Minnesota Heart Health Program, and outcomes
may not be generalizable.
Other outcomes included nonsmokers' support for quit attempts, co-worker requests not to smoke,
co-workers' non-smoking, number of quit attempts.
Risk of bias

Allocation concealment Unclear risk "randomly assigned", "randomized to treatment and control conditions".
(selection bias)

All outcomes
Incomplete outcome data Unclear risk Not reported

(attrition bias)

Informed decisions.
Sorensen 1993 (Continued)

All outcomes
Selective reporting (re- Unclear risk Not clear

porting bias)
Sorensen 1996
Setting: 108 worksites in 16 US states
Design: Randomized matched-pair trial, using cross-sectional surveys at baseline and 2-yr follow-up
Participants 108 worksites with over 28,000 employees ( 49 - 1700 workers per site). Participation rate 72%, Av age
41, 77% men, 92% white.
Only 3 of the 4 study centres (84 sites) measured changes in smoking, as the 4th centre sites (Florida)
had smoking bans already in place.
Interventions Each workplace had an employee as co-ordinator, and an employee advisory board.
1) Individual core interventions: Process included a kickoff event, interactive activities, posters and
brochures, self assessments, self-help materials, campaigns and contests, and direct education
through classes and groups.
2) Environmental core interventions:
Consultation on smoking policy, changes in cafeteria and vending machine food, and additional nutri-
tional education.
Control sites had results of employee survey, and in some cases an optional minimal intervention of
posters and newsletters.
Outcomes Self-reported smoking cessation, without biochemical validation. 6m abstinence at follow-up, smoking
prevalence.
Notes This is the Working Well Trial.

Randomization and analysis were both based on worksite.
Other outcomes were dietary fat reduction, fibre intake and fruit and vegetable consumption.
Some control sites had minimal interventions such as posters and brochures.
The Working Well trial generated a nested cohort study, the WellWorks Trial, which examined dietary
and smoking changes stratified by job type at the Massachusets worksites. See Sorensen 1998.
Risk of bias

Allocation concealment Unclear risk "work sites were stratified, matched into pairs, and randomly assigned within
(selection bias) pairs"

All outcomes
Incomplete outcome data High risk No baseline prevalence data, so losses not calculable
(attrition bias)
All outcomes

Informed decisions.
Selective reporting (re- Unclear risk Insufficient data to derive quit rates
porting bias)
Sorensen 1998
Setting: 24 mainly manufacturing worksites in Massachusets, randomized into 12 pairs, and all thought
to be using known or suspected carcinogens.
Randomization was by worksite, but analysis was by individual. Analysis in this paper was co-
hort-based
Participants 5914 (61%) of sampled employees responded at baseline, and 5406 (62%) at 2-yr follow-up.
The cohort who responded to both surveys was 2658 employees (699 smokers and recent quitters).
Interventions 3 elements of intervention:

1) Joint worker-management programme planning and implementation
2) Consultation by project staff with management on environmental changes, inc tobacco control poli-
cies, healthy foods, occupational hazard reduction
3) Health education programs targeting individual behaviours in the risk factor areas.
Outcomes Self-reported abstinence for 6m before final survey.

No biochemical validation
Notes The WellWorks Study is a nested component of the Working Well trial (Sorensen 1996), but, unlike that
trial, attempted to integrate health promotion and health protection interventions, and is therefore as-
sessed separately.
Other outcomes included fat, fibre and fruit and vegetable consumption, and differences between
blue- and white-collar workers in all outcomes.
Risk of bias

Allocation concealment Unclear risk "worksites were matched into 12 pairs... One work site in each pair was then
(selection bias) randomly assigned"

All outcomes
Incomplete outcome data Unclear risk No report of losses

(attrition bias)
All outcomes
Selective reporting (re- Low risk Expected outcomes reported

porting bias)

Informed decisions.
Sorensen 2002
Setting: 15 manufacturing sites, probably handling hazardous chemicals, in Massachusetts.
Design: RCT, randomized by worksite, but analysed by individual employee.
Participants 9019 employees (80%) across 15 sites. Mean workforce size 741 employees. Responders in the control
groups were younger, more likely to be women, less educated, less likely to be white, and less likely to
be hourly-paid rather than salaried.
Interventions 1. Control [8 sites] had Health Promotion (HP) intervention, i.e. consultation to management on tobac-
co control policies, catering and cafeteria policies, and programmes aimed at individuals, including self
assessment with feedback, self-help activities, contests, demonstrations and displays, opportunities to
try behaviours and goals, and group discussions.
2. Experimental Group [7 sites] (HP/OHS = health promotion with occupational health and safety) had
the same elements as the Control sites, plus management recommendations to reduce occupation-
al hazard exposure. For individuals, occupational health and safety training was added to the tobacco
and nutritional elements of the control programme.
Outcomes Quit rates (PP) at 6m, reported by cross-sectional survey and for the smoking cohort.
Self report only, no biochemical validation
Notes This is the Wellworks-2 Trial, targeting particularly blue collar workers. Analyses were cross-sectional
and cohort.
Other primary outcomes were nutrition and perceived exposure to occupational hazards.
Risk of bias
Random sequence genera- Low risk "Worksites were randomly assigned by the study biostatistician using a
tion (selection bias) process conducted independently from the intervention team"
Allocation concealment Low risk "Worksites were randomized within blocks..."

(selection bias)

All outcomes
Incomplete outcome data Low risk Drop-outs reported, and separated from the "embedded cohort" who replied
(attrition bias) to all surveys
All outcomes

porting bias)
Sorensen 2007
Setting: Phone-based and mailed info, targeted at members of LIUNA (construction workers union).
Design: RCT, no details given

Informed decisions.
Participants 674 workers (354 intervention and 320 control*) completed baseline survey, and 582 (188 smokers [=
current or quit within last 6m]) at 6m follow-up. 94% men, mean age 40, smoking prevalence I:45%,
C:40%.
Interventions 3m programme to increase fruit & veg consumption and quit smoking.
Intervention: (i) Phone-based counselling, up to 4 calls in 3m.
(ii) Mailed tailored feedback. (iii) 6 mailings of targeted info. (iv) NRT if requested.
Control: Nothing during programme, but all targeted written info at study end.
Outcomes Self-reported 7-day PPA at 6m, no verification.

Increased fruit & veg consumption.
Notes Tools for Health programme; specifically targeted blue-collar workers.

* data supplied by authors
Risk of bias

Allocation concealment Unclear risk "survey respondents agreeing to participate were randomly assigned to one of
(selection bias) two conditions"

All outcomes
Incomplete outcome data Unclear risk 92 lost to follow-up

(attrition bias)
All outcomes

porting bias)
Sutton 1987
Methods Country: UK
Recruitment: Worksite primary care clinic in UK retail company (employees 3253)
Participants 270 participants invited out of 334 who expressed an interest

Av age: 34, 70% women
av cpd 15.5
Interventions 1. Nicotine gum (2 mg) at least 4 boxes, duration not stated. (172 people)
2. Non-intervention control group (no placebo) of 64 continuing smokers
Low level of support
Outcomes Sustained abstinence at 12m; Validation: expired CO

Informed decisions.
Sutton 1987 (Continued)
Notes Slight contamination of intervention group, as 4 control group members were moved at their own re-
quest into the intervention group.
Risk of bias
Random sequence genera- High risk 4 controls moved at their own request into intervention group
Allocation concealment High risk "a randomly selected 270 were sent a personal invitation"; the remaining 64
(selection bias) who had expressed an interest became the control group

All outcomes
Incomplete outcome data High risk Losses reported, but not by group
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Absolute numbers unclear

porting bias)
Sutton 1988a
Methods Country: UK
Setting: Company A with occupational health programme near London
Design: RCT: cessation motivation vs seat belt video groups
Participants 77 in videotape conditions (33 for smoking video, 44 for seatbelts video), 55 non-participant smokers
(no-treatment control group).
Interventions Trial was described to company as a 'health information programme', and was open to all employees,
whether or not they smoked.
1. 25-minute video 'Dying for a Fag' (DFF) plus a cessation booklet, the Health Education Council's 'The
smoker's guide to non-smoking'
2. 25-minute video on seatbelt use, + a leaflet about seatbelts
3. Smokers who chose not to participate - no videos or information
Outcomes Self-reported PP smoking cessation at 3m and 1yr with CO validation < 10 ppm
Notes Although all 4 trials (a-d) are of similar design, and are reported in a single paper, we have treated them
here as 4 separate RCTs.
Cash incentives were offered at baseline and at 12m follow-up to boost questionnaire response rates.
The authors also present a 4-study pooled analysis, which failed to detect signficant differences in ces-
sation rates.
Risk of bias

Informed decisions.
Sutton 1988a (Continued)
Random sequence genera- Unclear risk See below

Allocation concealment Unclear risk "Sessions were randomly assigned to videotapes"

(selection bias)

All outcomes
Incomplete outcome data Low risk % of drop-outs reported, and ITT analysis performed
(attrition bias)
All outcomes

porting bias)
Sutton 1988b
Methods Country: UK
Setting: Company B with occupational health programme near London
Design: RCT: cessation motivation vs cessation motivation plus confidence boosting vs political as-
pects of tobacco video groups
Participants 150 in videotape conditions (46, 50 and 54 in the 3 groups), + 374 non-participant smokers
Interventions Trial was described to company as a 'smoking education programme', and was open only to smokers.
2. DFF with additional sequence to boost the confidence of those making a quit attempt (DFF+C)
3. 'Licence to Kill', on the political aspects of smoking (LTK).
Notes Cash incentives were offered at baseline and at 12m follow-up to boost questionnaire response rates.
The authors also present a 4-study pooled analysis, which failed to detect significant differences in ces-
sation rates.
Although the cessation rates appear to be significantly better in this study than in the other 3, the au-
thors point out that follow-up was around New Year, when many people try and stop anyway, and may
also have been influenced by the concurrent BBC series 'So you want to stop smoking'
Risk of bias
Random sequence genera- Unclear risk See Sutton 1988a

Sutton 1988c
Methods Country: UK
Informed decisions.
Sutton 1988c (Continued)

Setting: Company C with occupational health programme near London
Design: RCT : cessation motivation vs cessation motivation minus a gory sequence vs. advertising as-
pects of tobacco videotapes groups
Participants 197 in videotape conditions (56, 67 and 74 in the 3 groups) + 226 non-participant smokers
2. DFF with graphic 'shock' sequence about diseased lungs edited out, to lower fear element (DFF-G)
3. 'The Tobacco War', on the advertising aspects of smoking (TW).
Notes Cash incentives were offered at 12m follow-up to boost questionnaire response rate.
There were no differences between the video and non-participant groups in long-term abstinence .
sation rates.
Risk of bias

Sutton 1988d
Methods Country: UK
Setting: Company D with occupational health programme near London
Design: RCT: cessation motivation vs another cessation motivation vs advertising aspects of tobacco
videotapes groups
Participants 179 in videotape conditions (62, 59 and 58 in 3 groups) + 360 non-participant smokers
2. "Smoker's Luck", on a continuing smoker suffering from advanced smoking-related disease (SL)
3. 'The Tobacco War', on the advertising aspects of smoking (TW).
Notes There were no differences between the video and non-participants groups in long-term abstinence.
Cash incentives were offered at baseline and at 12-month follow-up to boost questionnaire response
rates.
sation rates.
Risk of bias

Informed decisions.
Sutton 1988d (Continued)

Sutton 1988e
Methods Country: UK
Recruitment: Worksite primary care clinic (employees 3253)
Participants 161 adult smokers who were still smoking after 3m of a videotape smoking cessation programme. Av
cpd 15 - 19
Interventions 1. Nicotine gum (2 mg) for up to 12w

2. Non-intervention control group (no placebo).
Low level of support
Outcomes Validated long-term abstinence at 12m

Validation: expired CO
Notes Participants are the non-quitters at 3m from Sutton 1988d

5/82 control subjects asked for and received treatment. One was a long-term abstainer, and is classed
as a control group success.
Risk of bias

Allocation concealment High risk "randomly divided into two groups", but 5 control subjects requested treat-
(selection bias) ment.

All outcomes
Incomplete outcome data Low risk No losses to follow-up

(attrition bias)
All outcomes

porting bias)
Tanaka 2006
Setting: 12 companies (500 - 1000 employees each)
Design: Matched pairs controlled study (randomization intended but not feasible).

Informed decisions.
Tanaka 2006 (Continued)
Participants Int/Cont: 1382/1736 current smokers, 94%/97.4% men, 92.9%/95.7% blue-collar workers, 66.1%/61.5%
smoke > 20 cpd. Significant differences between groups on age, gender, occupation type, cpd, con-
trolled for in analysis.
71.6%/73.2% in precontemplation; 35.1%/34.5% had made at least one previous quit attempt.
Interventions Intervention: 1. Posters, newsletters, website, advertising the cessation campaign and stages of change
model.
2. Worksite smoking cessation programme, conducted by worksite nurse using research team materi-
als, giving (a) 5 brochures on stages of change, (b) 4 counselling sessions + NRT if requested, (c) award
to winner among abstainers. 6-wk programme, run 5 times over 36m.
3. Advice re secondhand smoke, and designation of smoking areas.
4. Regular site visits by member of research team.
Control: Standard annual health checks.
Participation rate was 9% across all sites.
Outcomes Sustained 6m abstinence at 12m, 24m, 36m, not biochemically verified.

Movement through stages of change, cost-benefit analysis.
Notes New for 2008 update (previously an excluded study)
Risk of bias
Random sequence genera- Unclear risk N/A

Allocation concealment High risk Not randomized (opposition from the companies)
(selection bias)

All outcomes
Incomplete outcome data Unclear risk Drop-out rates reported (26.4% over 3 years)
(attrition bias)
All outcomes

porting bias)
Terazawa 2001
Setting: Occupational health clinic
Design: RCT; details of randomization not described
Participants 228 smokers, randomized to intervention (117) or control (111). Average age 39, av cpd 23; 50% had
made previous quit attempts.
Interventions Baseline questionnaire during routine health check up, with CO and urinary metabolites measured and
reported back.
1. Intervention: Stage-matched counselling (15 - 20 mins) by trained nurses, + 4 follow-up phone calls
for those prepared to set a quit date.

Informed decisions.
Terazawa 2001 (Continued)

2. Control: baseline questionnaire and usual care.
Outcomes Continuous abstinence at 6m and 12m. Validated by CO ?
Notes This trial was added to the 2005 update

25 smokers in the intervention group set a quit date and received the follow-up calls.
Data were derived from abstract only
Risk of bias

Allocation concealment Unclear risk Not stated

(selection bias)

All outcomes

(attrition bias)
All outcomes

porting bias)
Volpp 2009
Setting: Multiple worksites of General Electric Energy Company
Study design: RCT
Participants 878 smokers, randomized to Int (436) or control (442). Av age 45, 65% men, av 20 cpd, 25% high school
or lower, 65% income > 500% of poverty level. Motivation to quit not required. No sig baseline diffs be-
tween groups on any demographic variables.
Interventions All pts given information on local community-based SC services, + received standard employee bene-
fits, e.g. physician visits, SC pharmacotherapies. All received USD 20 per telephone interview at base-
line and at 3 follow-ups, plus USD 25 per confirmatory sample returned.
Int: Told they would receive USD 100 for completing an SC course, USD 250 for confirmed abstinence at
6m, and USD 400 for confirmed sustained additional 6m abstinence.
Outcomes Prolonged abstinence at 9 or 12m. Those not abstinent at 3m were retested at 6m, and followed from
then if abstinent. All abstinent at both follow-ups were assessed again 6m later, i.e. at 15 or 18m.
9 - 12m endpoint used in 6m MA, and 15 - 18m endpoint in 12m MA.
Validation: Cotinine by saliva or urine
Notes New for 2014 update;

Informed decisions.
Volpp 2009 (Continued)

Funded by CDC grants RO1 DP000100-01 and RO1 DP001168-01, and Pennsylvania Department of
Health.
Risk of bias
Random sequence genera- Low risk "performed in permuted blocks of four", stratified by level of smoking (+/- 2
tion (selection bias) packs per day), income and worksite.
Allocation concealment Low risk "assignments were concealed until all eligible criteria had been entered"
(selection bias)
Blinding of outcome as- High risk "blinding could not be maintained ... because of the nature of the interven-
sessment (detection bias) tion"
All outcomes
Incomplete outcome data Unclear risk Drop-outs and losses fully reported
(attrition bias)
All outcomes

porting bias)
Willemsen 1998
Methods Country: Holland
Setting: 4 worksites (chemical, telecommunication, public transport and local government) and 4 oth-
er similar worksites
Design: cluster-randomized trial
Participants 279 employees at intervention sites and 234 employees at comparison sites
Average age: 41 years
75% men
Interventions 1. Comprehensive programme (self-help manuals, group courses, a mass media campaign, smoking
policies and a 2nd-yr programme)
2. Minimal intervention (self-help manuals only).
Outcomes Self-reported smoking cessation and saliva cotinine estimation
Notes Analysis of light vs heavy smokers suggests greater efficacy among heavy smokers (P values not given).
Other outcomes included relapse rates, the effectiveness of a 2nd-yr programme.
Risk of bias
Random sequence genera- High risk N/A

Allocation concealment High risk Worksites self-selected involvement

(selection bias)

Informed decisions.
Willemsen 1998 (Continued)

All outcomes
Incomplete outcome data Unclear risk Losses reported for SC group course participation, and ITT analysis done
(attrition bias)
All outcomes
Selective reporting (re- Unclear risk Some expected outcomes reported

porting bias)
Windsor 1988
Recruitment: University of Alabama employees volunteering for a quit smoking programme
Design: randomized 2 x 2 factorial trial
Participants 378 smokers

Av. age 37, av cpd 23 - 27
Therapist: health visitor
Interventions All groups received a 10-minute session of brief advice

1.+ S-H manuals (n = 95)
2. +S-H and another session of counselling (20 - 30 mins) with skills training, buddy selection and a
contract (n = 94)
3. as 1, with monetary awards for cessation (n = 95)
4. as 2, with monetary rewards for cessation (n = 94)
Outcomes Abstinence at 1 yr (sustained at 6w, 6m & 1 yr)

Validation: saliva thiocyanate < 100 ng/ml at all follow-ups
Type of intervention 2. INDIVIDUAL COUNSELLING/ INCENTIVES
Notes Other outcomes included some cost-benefit analysis, including efficacy of incentives..
Risk of bias
Random sequence genera- Low risk "a computer-generated assignment system"... before the baseline interview
Allocation concealment Low risk "400 employee group assessment labels were placed in separately sealed en-
(selection bias) velopes"; "the next sequentially numbered envelope".

All outcomes
Incomplete outcome data Low risk Losses to follow-up reported; 7 quitters from Groups 2&4 lost to follow-up and
(attrition bias) counted as smokers
All outcomes
Selective reporting (re- Unclear risk Groups pooled and not reported separately
porting bias)

Informed decisions.
ALA: American Lung Association

av: average
BMI: body mass index
BP: blood pressure
CO: carbon monoxide
cpd: cigarettes per day
ETS: environmental tobacco smoke
FTND: Fagerström Test for Nicotine Dependence
h: hour
HDL: high density lipids
HRA: health risk assessment
inc: Including
I: intervention; C: control
m: month
MI: motivational interviewing
NRT: nicotine replacement therapy
NTQ: nicotine tolerance questionnaire
PEF: peak expiratory flow
PPA: point prevalence abstinence
ppm: parts per million
RCT: randomized controlled trial
SC: smoking cessation
SoC: stage of change
S-H: self help
vs: versus
w: week
yr: year (s)
Characteristics of excluded studies [ordered by study ID]
Study Reason for exclusion
Addley 2001 Observational study, no control worksites. Smoking was one of a number of lifestyle changes sur-
veyed over a 3-year period, by a follow-up postal survey 6 months after assessment.
Armitage 2007 RCT for smoking reduction; 2m duration

Baile 1991 Follow-up only 4 months. Evaluated the impact of a hospital smoking ban with no report of cessa-
tion programmes.
Barbeau 2006 Pre/post study, no control group, assessment at 5m

Bertera 1990 Non-randomized. Evaluated the relative efficacy and cost effectiveness of a stop smoking clinic ver-
sus self-help kit in the workplace
Borland 1991b Examined predictors of smoking cessation attempts not cessation rates after the introduction of
workplace smoking bans.
Borland 1995 One group post-test only. Surveyed smokers 2 years after a total workplace ban.
Brenner 1992 Population-based survey, to assess the effects of workplace smoking bans and cessation rates, ex-
pressed as a quit ratio
Brenner 1994 One group, post-test only. Evaluated smoking regulations at the workplace and smoking behaviour
in Southern Germany.

Informed decisions.
Brigham 1994 Follow-up for only 4 weeks. Examined the effects of a restricted worksite smoking policy on em-
ployees who smoke.
Broder 1993 Pre- and post-ban surveys on 3 buildings (137 workers), to assess air quality and physical symp-
toms of ETS. Prevalence was not a primary outcome, but was reported as unchanged between the
2 surveys
Bunger 2003 Description of a cardiovascular risk reduction intervention in a power plant; no control or compari-
son site
Burling 1989 Trial of nicotine fading + self-help materials versus self-help materials alone; originally an included
study, but classified as excluded for 2014 update.
Burling 1994 Descriptive report of a computer-directed programme for smoking cessation treatment. Previous
reported outcome data from a minimal intervention and intensive stop smoking treatment are pre-
sented.
Burling 2000 Trial of ALA self-help programme versus an internet-based self-help programme; originally an in-
cluded study, but classified as excluded for 2014 update.
Busch 2005 Observational study of 2 German factory interventions.

Campbell 2000 Cross-sectional survey of 859 women in 9 North Carolina worksites, to assess health behaviours,
risks and desire to change behaviour. A population-based survey, with no control group or inter-
vention.
Choi 2007 6-wk RCT of patches for reducing craving.

Conrad 1996 Non-randomized. Evaluated exposure to a worksite health-promoting environment as an aid to

smoking cessation.
Cooreman 1997 Eight years had elapsed between surveys. Evaluated the impact of a smoking ban in a large Paris
hospital
Cornfeld 2002 Large cohort study, not a controlled intervention trial
Dalsey 2009 Survey response to implementation of a smoke-free policy. New for 2014.
Daughton 1992 One group, no pre-test. Evaluated the effect of a smoking ban with partially subsidised cessation
programmes.
Dawley 1984 Non-randomized. Evaluation of a smoking cessation treatment programme of 10 x 1-hour sessions.
Dawley 1993 Follow-up for only 4 months. A programme of smoking control in one company versus a smoking
cessation class in a second company.
Eisner 1998 Outcome not smoking cessation but bartenders' respiratory health. Evaluated the respiratory
health of bartenders before and after legislative prohibition of smoking in all bars and taverns by
the state of California.
Emont 1992 Outcome not smoking cessation. Evaluated the effectiveness of incentives as an aid to recruitment.
Eriksen 2005 Survey of Norwegian nurses' smoking


Informed decisions.
Etter 1999 Follow-up for only 4 months. Evaluated short-term impact of a University-based smoke-free cam-
paign.
Farkas 1999 Non-workplace for part of study. Evaluated the association of household and workplace smoking
restrictions with quit attempts, 6-month cessation and light smoking.
Farrelly 1999 Cross-sectional not pre-post-test. Estimated the impact of workplace smoking restrictions on the
prevalence and intensity of smoking among all indoor workers.
Fine 2004 Comparison of CHD risk factor interventions and musculo-skeletal interventions in Welsh work-
places. Outcome was acceptability and feasibility in small workplace.
Franchin 2011 2 workplace health promotion programmes, with a 'quit & win' contest as the tested intervention.
New for 2014.
Glasgow 1997 Data from a population-based survey of adult smokers who completed surveys in 1988 and 1993,
as part of the COMMIT trial.
Gomel 1993b Follow-up for only 6 weeks. Examined the short-term effects of a workplace smoking ban on in-
dices of smoking, cigarette craving, stress and other health behaviours in 24 employees.
Gottlieb 1990a Non-randomized. 3-stage study included a baseline survey, an assessment of the effects of compe-
tition on recruitment to a self-help cessation programme and examination of the outcome of the
cessation programme.
Graham 2007 Observational study, no control group

Gritz 1988 Non-randomized. Evaluation of a self-help smoking cessation programme for registered nurses.
Hagimoto 2007 Assessment of counsellors' skills and success rates in 6 Japanese worksites.
Hailstone 2005 Evaluation, no control group.

He 1997 Follow-up for only 3 weeks. Examined the effects of acupuncture on smoking cessation or reduc-
tion for motivated smokers.
Heloma 2001 9 Finnish worksites surveyed before and after legislation to restrict ETS; not a controlled trial
Helyer 1998 Non-randomized. Evaluated the effectiveness of a worksite smoking cessation programme in the
military.
Hope 1999 Non-randomized study, with no control or comparison group, and short follow-up (timing not stat-
ed). Surveyed 5 workplaces before and after a 1-year health promotion campaign, targeting mul-
tiple health behaviours, including smoking. Primarily interested in gender and social class differ-
ences
Hotta 2007 Evaluation study, no control group.

Hudzinski 1994 Outcome was daily cigarette consumption, cessation rate not reported. Study was designed to as-
sess changes in employee health, particularly weight gain and CO levels, and smoking behaviour.

Informed decisions.
Humerfelt 1998 Community-based, not workplace. Evaluated the effects of postal smoking cessation advice in
smokers with asbestos exposure and /or reduced forced expiratory volume in 1 second.
Hunt 2003a The SMART study; RCT, targeting employed adolescents rather than adults.
Hunt 2003b Healthy Directions - Small Businesses study; RCT, but smoking cessation was not the target inter-
vention, and was offered in both intervention and control sites (= 24).
Hutter 2006 Evaluation of Allen Carr programme; no control group.

Hwang 2012 Observational Korean study of a step-wise workplace cessation programme. New for 2014.
Izuno 1990 Non-randomized. Examined the factors critical to behaviour modification with respect to smoking
cessation at worksites.
Jason 1990 Non-randomized. A cessation programme with incentives and competition offered in 1 company,
compared to a control company.
Jeffery 1988 Trial of cessation versus reduction or cessation; originally an included study, but classified as ex-
cluded for 2014 update.
Kadowaki 2004 10-year Japanese programme of annual small-scale smoking cessation interventions; assessed at
2 months, but primary outcome was overall prevalence after 10 years. Controlled trial, but not ran-
domized.
Kinne 1993 Population-based telephone survey of 1228 employed adults to assess impact of worksite smoking
policies.
Klesges 1986 Non-randomized. A smoking cessation programme offered in 5 companies, with and without com-
petitions for participation and cessation.
Koffman 1998 Not a randomized study, as one of the 3 participating worksites refused to be randomized.
Kornitzer 1987 Testing variable doses of NRT, without a non-cessation control group.
Originally an included study, but counted as excluded for 2014 update.
Kunitsuka 2002 Survey of post-intervention multiple lifestyle changes, including number of cigarettes smoked. No
control group used.
Longo 1996 Not pre-post-test evaluation but post-ban quit ratio. Examined the impact of workplace smoking
bans on smoking behaviour of employees.
Longo 2001 Not pre-post-test. Examined the long-term impact of workplace smoking bans on employee smok-
ing cessation and relapse.
Lowe 1987 Cessation was not an outcome of interest. Evaluated method of contact (phone vs letter) as an aid
to recruitment.
Maheu 1989 Non-randomized. 2 worksites offered a multicomponent behavioural programme with nicotine
gum. Additional competition in 1 site.
Makrides 2008 RCT of a comprehensive worksite intervention, reporting smoking reduction; author contacted, but
cessation rates not available. New for 2014.

Informed decisions.
Matson-Koffman 1998 Non-randomized. Evaluated the effectiveness of a multicomponent smoking cessation programme
supplemented by incentives and team competitions.
McMahon 2001 Small non-randomized pilot study, based on stages of change model, to compare expert systems,
group support and self-help manuals.
McMahon 2002 Happy Heart at Work programme; 10-yr evaluation, without a control group
Musich 2003 Survey of changes in risks among GM employees; not a controlled trial
Muto 1998 Non-randomized. Evaluated the effectiveness of a smoking cessation programme known as
'Smoke Busters'.
Nepps 1984 Non-randomized. Evaluation of a minimal contact smoking cessation programme at the worksite.
Nerín 2002 Evaluation of an anti-smoking programme, without a comparison worksite
Nerín 2005 Evaluation study, no control group.

O'Connell 2006 Evaluation study, no control group.

New for 2008 update
Offord 1992 One group, post-test only. Evaluated the effect of a smoking ban, with no-cost nicotine dependence
treatment.
Olive 1996 One hospital had pre-test data. Evaluated changes in employee smoking behaviour after imple-
mentation of restrictive smoking policies.
Olsen 1990 Non-randomized. Evaluation of a smoking cessation incentive programme for Dow chemical em-
ployees in the USA.
Olsen 1991 Non-randomized. A 5-year evaluation of a smoking cessation incentive programme for chemical
employees.
Ong 2005 Cost effectiveness rather than efficacy evaluation.

Park 2007 Korean controlled before-and-after study; probably too short (5-day programme); no further infor-
mation from authors. New for 2014
Patten 1995 Population-based telephone survey of 1844 Californian adult indoor workers, to assess changes in
smoking status and cigarette consumption, related to whether or not their workplace was smoke-
free, and for how long the ban had been in place..
Pegus 2002 The Heart At Work programme. Smoking prevalence was measured, but was not an intervention
outcome
Prior 2005 Cohort study, no comparison worksite.

Richmond 1985 Non-workplace setting. A smoking cessation programme for use in general practice
Rosenstock 1986 Post-test only. Evaluated a non-smoking policy in a health maintenance organization

Informed decisions.
Roto 1987 Non-workplace setting for half of the participants. Evaluated nicotine gum and advice versus ad-
vice only for smoking cessation.
Ryan 2002 594 employees at a UK pharmaceutical company (GSK) attempted to quit with bupropion, and
were followed up at 6 months. Not an RCT.
Schlegel 1983 Non-randomized. Evaluation of 'BUTT OUT' , a quit smoking programme developed specifically for
the Canadian Armed Forces.
Scott 1986 Non-randomized. Nurses in different units offered cessation treatment or a waiting list control. 29
participants.
Shipley 1988 Non-randomized. Determined the effect of a smoking cessation programme compared with health
screening on employee smoking.
Sloan 1990 Non-randomized. Evaluated cessation and relapse in a year-long workplace quit-smoking contest.
Sorensen 1991 One group post-test only . Evaluated the impact of a restrictive smoking policy with free onsite
smoking cessation classes.
Sorensen 2010 Not randomized, pre-test/post-test. New for 2014.
Stoddard 2005 RCT of teenagers (aged 15 - 17) working part-time, many still in school.
New for 2008 update
Stoddard 2008 RCT of supplementing an online smoking cessation service with a 'bulletin board'. New for 2014.
Sun 2009 Not set in a workplace, though testing employment as a predictor of successful cessation. New for
2014.
Terry 2010 Study of enrolment and retention rates in a comprehensive worksite health promotion pro-
gramme. New for 2014.
Ullén 2002 Evaluation of a Swedish hospital smoking ban, but without a comparison worksite.
Waage 1997 Non-randomized. Smoking intervention based on risk communication in subjects at risk of as-
bestos-related lung cancer.
Wakefield 1996 Did not report smoking cessation rate. Compared the reported prevalence and acceptance of bans
on smoking among indoor workers in South Australia.
Whitney 1994 One group, post-test only. Determined the impact of a smoking cessation programme using NRT as
part of a larger wellness programme.
Wilbur 1986 Comprehensive health promotion intervention, but not a randomized trial.
Willemsen 1995 Non-randomized. Evaluated a smoking cessation intervention for Dutch employees consisting of
self-help methods and a group programme.
Willemsen 1999 Non-randomized. Examined the impact of a comprehensive worksite smoking cessation pro-
gramme on employees who do not take part in cessation activities.
Woodruff 1993 Results of the 1990 California Tobacco Survey; 11,704 working adults responded. Aim was to assess
relationship of worksite policy (or its absence) to smoking status, controlling for demographic fac-
tors

Informed decisions.
Characteristics of studies awaiting assessment [ordered by study ID]
Gao 2010
Methods RCT in 2 Shanghai workplaces; 2008 - 2009
Participants 233 intervention 246 control; mean age 34.7 and 31.1.
Interventions Tobacco control programme based on theory of organizational change.
Outcomes Smoking prevalence, cpd, willingness to accept colleague support, knowledge about smoking and
harms; cessation at 6m, cotinine-confirmed.
Notes No response from authors re smoking cessation rates (denominators),
Characteristics of ongoing studies [ordered by study ID]
NCT01124110 2012
Trial name or title Tobacco Tactics website, worksite-based
Methods RCT, pilot study.
Participants 184 blue-collar operating engineers.
Interventions Tobacco Tactics website vs 1-800-QUIT-NOW telephone support programme, + NRT + coun-
selling.
Outcomes 6m cessation rates, cotinine-validated.
Starting date
Contact information bump@mich.edu
Notes
NTR8148 2012
Trial name or title Web-based health risk assessment
Methods Cluster-randomized controlled trial
Participants
Interventions Individually-tailored feedback to baseline questionnaire; targeting 5 indicators: physical activity,

nutrition, smoking behaviour, alcohol consumption, signs of burnout.
Outcomes 6m performance on sum of all 5 indicators.
Starting date
Contact information

Informed decisions.
NTR8148 2012 (Continued)
Notes Funded by ZonMw project number 200310006
Simpson 2000
Trial name or title Australian National Workplace Health Project
Methods Cluster-randomized trial, 20 worksites, 2x2 factorial design
Participants Employees in participating worksites. 2498 completed baseline survey, 2082 completed health risk
appraisal
Interventions Socio-behavioural and environmental intervention, for physical activity, healthy eating, smoking
and alcohol
Outcomes Behaviour change at 1 and 2 yrs
Starting date NK
Contact information judy.simpson@sydney.edu.au
Notes Included in 2005 update; no further info for 2008 update, or for 2014 update
DATA AND ANALYSES
Comparison 1. Individual Treatments
Outcome or subgroup title No. of No. of Statistical method Effect size

studies partici-
pants
1 Group behavioural therapy (various 10 Odds Ratio (Fixed, 95% CI) Subtotals only
endpoints)
1.1 Cessation 8 1309 Odds Ratio (Fixed, 95% CI) 1.71 [1.05, 2.80]
1.2 Relapse prevention 2 484 Odds Ratio (Fixed, 95% CI) 1.15 [0.80, 1.65]
2 Individual counselling (various end- 8 3516 Odds Ratio (Fixed, 95% CI) 1.96 [1.51, 2.54]
points)
3 Any self-help intervention (various end- 6 1906 Odds Ratio (Fixed, 95% CI) 1.16 [0.74, 1.82]
points)
4 Pharmacological treatments (various 5 1092 Odds Ratio (Fixed, 95% CI) 1.98 [1.26, 3.11]
endpoints)
5 Social support (various endpoints) 2 53 Odds Ratio (Fixed, 95% CI) 0.69 [0.18, 2.62]

Informed decisions.
Analysis 1.1. Comparison 1 Individual Treatments, Outcome 1 Group behavioural therapy (various endpoints).
Study or subgroup Programme No pro- log[Odds Odds Ratio Weight Odds Ratio
gramme Ratio]
N N (SE) IV, Fixed, 95% CI IV, Fixed, 95% CI
1.1.1 Cessation
Glasgow 1984 12 13 2.7 (1.554) 2.61% 14.29[0.68,300.32]
Frank 1986 45 20 0.4 (0.728) 11.88% 1.42[0.34,5.92]
Klesges 1987 66 61 0.1 (0.592) 17.97% 1.06[0.33,3.4]
Omenn 1988 51 51 0.8 (0.649) 14.95% 2.19[0.61,7.82]
DePaul 1994 281 280 0.9 (0.635) 15.62% 2.55[0.73,8.84]
Schröter 2006 41 38 -0.7 (0.628) 15.98% 0.52[0.15,1.78]
Gunes 2007 100 100 1.1 (0.827) 9.21% 3.13[0.62,15.85]
Mishra 2010 87 63 1.3 (0.732) 11.78% 3.58[0.85,15.02]
Subtotal (95% CI) 100% 1.71[1.05,2.8]
Heterogeneity: Tau2=0; Chi2=8.26, df=7(P=0.31); I2=15.24%
Test for overall effect: Z=2.14(P=0.03)
1.1.2 Relapse prevention

Razavi 1999 88 121 0.1 (0.288) 41.83% 1.09[0.62,1.92]
Mayer 2010 134 141 0.2 (0.245) 58.17% 1.19[0.74,1.92]
Subtotal (95% CI) 100% 1.15[0.8,1.65]
Heterogeneity: Tau2=0; Chi2=0.05, df=1(P=0.82); I2=0%
Test for subgroup differences: Chi2=1.63, df=1 (P=0.2), I2=38.59%
Favours no programme 0.005 0.1 1 10 200 Favours programme
Analysis 1.2. Comparison 1 Individual Treatments, Outcome 2 Individual counselling (various endpoints).
gramme Ratio]
Cambien 1981 304 306 0.6 (0.218) 37.27% 1.76[1.15,2.7]
Li 1984 215 361 0.9 (0.376) 12.52% 2.45[1.17,5.12]
Windsor 1988 188 190 1 (0.374) 12.62% 2.73[1.31,5.68]
Gomel 1993a 60 68 2.4 (1.499) 0.79% 10.91[0.58,206.1]
Lang 2000 591 504 0.3 (0.324) 16.88% 1.36[0.72,2.56]
Kadowaki 2000 132 131 1.5 (0.571) 5.41% 4.69[1.53,14.37]
Terazawa 2001 117 111 2.1 (1.07) 1.54% 8.07[0.99,65.71]
Groeneveld 2011 115 123 0.3 (0.369) 12.97% 1.32[0.64,2.72]
Total (95% CI) 100% 1.96[1.51,2.54]

Test for overall effect: Z=5.05(P<0.0001)

Informed decisions.
Analysis 1.3. Comparison 1 Individual Treatments, Outcome 3 Any self-help intervention (various endpoints).
gramme Ratio]
Sutton 1988b 46 374 1.1 (0.542) 18.12% 2.92[1.01,8.45]
Omenn 1988 76 85 0.3 (0.58) 15.84% 1.34[0.43,4.17]
Sutton 1988a 33 55 0.1 (0.936) 6.07% 1.12[0.18,7.02]
Sutton 1988d 62 360 0.1 (0.78) 8.75% 1.06[0.23,4.89]
Sutton 1988c 56 226 0.5 (0.85) 7.37% 1.64[0.31,8.67]
Hishida 2010 257 276 -0.3 (0.348) 43.86% 0.72[0.36,1.42]
Total (95% CI) 100% 1.16[0.74,1.82]

Analysis 1.4. Comparison 1 Individual Treatments, Outcome 4 Pharmacological treatments (various endpoints).
gramme Ratio]
Sutton 1987 270 64 1.7 (1.034) 4.99% 5.31[0.7,40.27]
Sutton 1988e 79 82 1 (0.851) 7.35% 2.7[0.51,14.33]
Kornitzer 1995 150 75 -0.1 (0.422) 29.99% 0.94[0.41,2.15]
Rodriguez 2003 114 103 1 (0.42) 30.26% 2.64[1.16,6.01]
Noor 2011 77 78 0.9 (0.441) 27.41% 2.51[1.06,5.96]
Total (95% CI) 100% 1.98[1.26,3.11]

Test for overall effect: Z=2.96(P=0)
Analysis 1.5. Comparison 1 Individual Treatments, Outcome 5 Social support (various endpoints).
gramme Ratio]
Malott 1984 12 12 -0.5 (1.025) 44.21% 0.6[0.08,4.47]
Glasgow 1986 16 13 -0.3 (0.913) 55.79% 0.77[0.13,4.61]
Total (95% CI) 100% 0.69[0.18,2.62]


Informed decisions.
Comparison 2. Worksite Treatments
Outcome or subgroup title No. of No. of Statistical method Effect size

studies partici-
pants
1 Environmental support (various end- 4 3851 Odds Ratio (Fixed, 95% CI) 1.00 [0.60, 1.65]
points)
2 Incentives (various endpoints) 5 1928 Odds Ratio (Fixed, 95% CI) 1.60 [1.12, 2.30]
3 Comprehensive interventions 6 5018 Odds Ratio (Fixed, 95% CI) 1.55 [1.13, 2.13]
Analysis 2.1. Comparison 2 Worksite Treatments, Outcome 1 Environmental support (various endpoints).
gramme Ratio]
Erfurt 1991 223 228 0 (0.456) 31.61% 1.03[0.42,2.51]
Hymowitz 1991 131 121 -0.3 (0.379) 45.76% 0.74[0.35,1.56]
Dawley 1991 16 14 1 (0.881) 8.48% 2.85[0.51,16.03]
Tanaka 2006 1382 1736 0.3 (0.682) 14.15% 1.3[0.34,4.96]
Total (95% CI) 100% 1[0.6,1.65]

Analysis 2.2. Comparison 2 Worksite Treatments, Outcome 2 Incentives (various endpoints).

gramme Ratio]
Windsor 1988 95 95 -0.2 (0.627) 8.67% 0.82[0.24,2.8]
Rand 1989 16 14 1 (1.663) 1.23% 2.81[0.11,73.15]
Gomel 1993a 30 30 -1.2 (1.221) 2.28% 0.31[0.03,3.4]
Glasgow 1993 344 426 0.2 (0.26) 50.51% 1.28[0.77,2.13]
Volpp 2009 436 442 1 (0.302) 37.3% 2.76[1.53,4.99]
Total (95% CI) 100% 1.6[1.12,2.3]


Informed decisions.
Analysis 2.3. Comparison 2 Worksite Treatments, Outcome 3 Comprehensive interventions.

gramme Ratio]
DePaul 1987 233 192 1.1 (0.6) 7.28% 3[0.93,9.74]
DePaul 1989 206 213 1.4 (0.496) 10.65% 4.13[1.56,10.91]
Okechukwu 2009 251 239 0.2 (0.414) 15.32% 1.24[0.55,2.78]
Shimizu 1999 26 27 1.1 (0.889) 3.32% 2.98[0.52,17.01]
Tanaka 2006 1382 1736 0.3 (0.257) 39.6% 1.3[0.79,2.16]
Willemsen 1998 279 234 0.1 (0.331) 23.84% 1.16[0.61,2.22]
Total (95% CI) 100% 1.55[1.13,2.13]

Comparison 3. Results of included studies
Outcome or subgroup title No. of No. of partici- Statistical method Effect size
studies pants
1 Results of included studies Other data No numeric data
Analysis 3.1. Comparison 3 Results of included studies, Outcome 1 Results of included studies.
Results of included studies
Study Baseline/follow-up Smoking outcome Validated ?
Bergstrom 2008 About 881 smokers across 4 companies No MA data, but logistic regression re- No indication of validation (all long-
risk-assessed and given SC classes and sults over 10 timepoints for 3½ years. term data collected by post or phone)
NRT; about 98 controls assessed only Significant reductions in gradient rela-
tive to controls in Companies 1 (-0.6), 2
(-0.92) and 4 (-0.45), not in Company 3
(-0.09).
Cambien 1981 304 intervention smokers recalled at 2 21.4% of intervention smokers quit, vs Validation by blood CO levels
yrs, and 306 control smokers. 195 par- 13.4% of control smokers. Point preva-
ticipants lost to follow up, proportion of lence at 2 yrs, not a significant differ-
smokers not reported ence
Campbell 2002 538 women in 9 worksites (4 exp, 5 con- No raw data given for smoking, but Self-report on all outcomes, no bio-
trol) completed all surveys (282 I, 256 C) prevalence went down by around 3% in chemical validation
to 18m. both groups. No significant differences,
and no p values.
Dawley 1991 2 US oil refineries randomized to eenv- 7/16 smokers in the comprehensive Self report only, no biochemical valida-
iornmental anti-smoking campaign + programme site had quit at 5m, versus tion
SC programme, versus SC programme 3/14 at the SC only site.
alone.
DePaul 1987 425 smokers in 43 corporations, ran- 6% vs 2% continuously abstinent (NS), Partial validation by salivary cotinine,
domised to group support programmes 19% in both groups were abstinent at with family and colleague report
or self-help alone programmes 12 months point prevalence.
Attrition rate was 8% in both groups Companies were the unit of analysis,
similar results found using individual as
unit of analysis.
(See also Cochrane Review 'Self-help
interventions for smoking cessation')
DePaul 1989 419 smokers in 38 worksites, ran- At the company level of analysis the 12 Partial validation by salivary cotinine,
domised to experimental programme month point prevalence quit rates were with family and colleague report
(206) and comparison programme Group 26% vs No Group 16% (p<0.06);
(213). The attrition rate was 17% for continuous abstinence rates were 11%
Group worksites and 29% for Non (Group) vs 3% (No Group) (p<0.05).
Group worksite participants, so correct-

Informed decisions.

ing the data for attrition would increase Reported rates were not based on In-
the apparent efficacy of the Group con- tention to Treat, but on participation
dition. in the programmes. Correcting for attri-
tion would increase the efficacy of the
Group programme.
At 24 months, 30% of the Group smok-
ers were abstinent, comnpared with
19.5% of Non-Group smokers (no p val-
ue).
DePaul 1994 844 smokers in 61 worksites, ran- 12 month quit rates for sustained absti- Validation by salivary cotinine at 6
domised to Self-help [SH] (289), In- nence were 5.1% (n=79) SH, 11% (n=91) months, and CO<9ppm at 12 months
centives [I] (281) or Group support [G] I, 31.2% (n=109) G (p<0.01). An Inten-
(283). tion to Treat analysis, taking account of
12 month attrition rates were 52.5% in attrition, would further favour the inter-
SH, 47.2% in I, and 37.5% in G. vention groups.
Emmons 1999 2055 workers (28% smokers) complet- At 3 yr final follow up, 8.0% of the inter- Self-report, with no biochemical valida-
ed all surveys from 22 worksites, and vention smokers had quit for 6m, and tion
constituted the cohort. 8.1% of the control smokers. 25.6% and
21.8% respectively claimed 7-day PP.
Differences were non-significant
Erfurt 1991 Four sites were assessed at baseline; Participation was affected by the inter- Self-report only, not biochemically val-
Site 1 had 1096 smokers (45%), Site 2 vention: 5% in Site 1, 9% in Site 2, 53% idated
598 (44%), Site 3 844 (41%) and Site 4 in Site 3 and 58% in Site 4.
834 (44%). Possible bias due to different baseline
At 3 year follow-up Site 4 had been sig- characteristics of people rescreened
nificantly restructured. in site 3 & 4 limit interpretation of fol-
low-up smoking prevalences: 41.6%,
40.6%, 36.1%, 31.0%
All sites had significant relative re-
ductions in smoking: 7.8% (p<0.01),
10.6% (p<0.01), 11.7% (p<0.001), 13.2%
(p<0.001).
Of those smoking in 1985 who were re-
screened in 1988, 17.1% at Site 1 had
quit, 17.6% at Site 2, 20.3% at Site 3 and
18.9% at Site 4 (NS).
Frank 1986 48 smokers initially randomised to No difference between the groups for Salivary cotinine measured at 3
three groups, with varying levels of hyp- smoking cessation 6 months after treat- months, but self-report only at 6
nosis, booster and self-management ment, regardless of the frequency, months
training. A 4th group (15 smokers) was length between sessions, or addition
later recruited, with Group 2 interven- of behavioural methods. Quit rate was
tions applied more intensively. 20% for all groups, based on Intention
Attrition rate of 6% across the initial 3 to Treat.
groups at end of treatment, 17% at 3 Intensive intervention produced ini-
months and 25% at 6 month follow-up. tially higher quit rates (60% at end of
treatment), but this reverted to 20% by
6 months
(See also Cochrane Review 'Hypnother-
apy for smoking cessation')
Glasgow 1984 36 employees, randomised to abrupt At 6 months up to one third in the grad- CO<10 ppm at 6 months, weighing of
reduction (13), gradual reduction (12) ual condition were abstinent compared cigarette butts
and gradual reduction + feedback (11). to no subjects in the abrupt condition
Attrition at 6 months was respectively (NS).
4, 0 and 1. Intention to Treat analysis showed that
the gradual reduction programme was
more successful than the abrupt reduc-
tion (p<0.05)
Glasgow 1986 29 employees randomised to Basic Pro- Consistent with previous findings, sup- Self report, weighing of cigarette butts,
gramme (13) or Basic Programme + So- portive social interactions were not re- CO monitoring and salivary thiocyanate
cial Support (16). lated to treatment outcome.3/13 in the
Attrition 7% at end of treatment, and a Basic Programme had quit at 6 months,
further 7% at 6 months and 3/16 in the Basic + Social Support
Group (NS).
(See also Cochrane review 'Enhancing
partner support to improve smoking
cessation').
Glasgow 1993 19 worksites, random allocation to In- At 2 year follow-up 49/344 (14%) were CO monitoring and salivary cotinine
centive programme (474 smokers) or abstinent in the Incentives group, and
No Incentive programme (623 smok- 49/426 (12%) in the No incentives group
ers).

Informed decisions.

Attrition rates at 1 year were 19% (I) (NS). Intention to Treat analysis would
and 24% (no I), and at 2 years were 27% give more conservative quit rates
and 32% respectively
Glasgow 1995 26 worksites, randomised to early or Comprehensive programme; a 26% rate Self report, not biochemically validated
delayed interventions. 1222 employ- of cessation was noted across both lon-
ees were followed up at all assessment gitudinal cohort groups (NS), and a 30%
points to 2 years. years. rate across both cross-sectional groups
(NS). No significant differences were
seen between the 2 types of interven-
tion
Gomel 1993a 28 ambulance stations randomized to No significant differences between Serum cotinine validation used.
4 levels of risk reduction intervention. HRA and RFE groups at any follow-up
128 baseline smokers followed for 1 yr point, nor between BC and BCI groups.
HRA and RFE groups (68 smokers) were
pooled and compared with 60 smokers
in pooled BC and BCI groups. Continu-
ous abstinence rates at 6m were 1% for
HRA+RFE and 10% for BC+BCI (Fisher's
Exact Test P = 0.05); 12m rates were 0%
and 7% (P = 0.05).
Groeneveld 2011 115 intervention smokers got MI + PPA at 6 and 12m. Study used as de- No biochemical validation
phone counselling, and 123 controls re- nominators only those with complete
ceived 'usual care'. follow-up data, who had attended at
least 5 sessions. On this basis, 6m quit
rates were (I) 31.2%, (C) 13.4%, and
12m (I) 23.75, (C) 19.5. Our ITT analysis
gives 6m: (I) 21.7%, (C) 8.9%: 12m: (I)
16.5%, (C) 13%.
Gunes 2007 200 smokers randomized to 7-step be- Main outcome was movement through Probably no validation (not mentioned)
havioural programme or no interven- stages of change. Smoking cessation at
tion, followed for 6m 6m was (I): 6/100, (C) 2/100.
Hennrikus 2002 24 worksites, randomised to 6 pro- 407 (17%) smokers signed up to pro- Self-report, validated by family mem-
grammes, 4 worksites in each programmes. 15.4% at 12 months and ber or friend.
gramme. 2402 smokers were surveyed 19.4% at 24 months reported them- A sample of quitters were asked to sup-
at baseline and at 12 and 24 months. selves as non-smokers. ply saliva, and were paid $25 if they
85.5% response rate at 12 months, and Recruitment was significantly high- complied.
81.7% at 24. er in the incentive sites (22% vs 12% Winners of cessation prize draws had
p=0.0054), but did not translate into to supply a valid saliva sample.
higher cessation rates.
Quit rates were consistently higher
among programme registrants than
among non-registrants, but the differ-
ential was greater in the non-incentive
sites (15%) than in the incentive ones
(6.7%), consistent with incentives at-
tracting smokers less motivated to quit.
Hishida 2010 257 smokers genotyped, given self-help At 12m, 15/257 intervention smokers Self report only, not verified.
booklet; 276 controls assessment only. had quit, versus 22/276 control smok-
ers. Intervention smokers at genetically
higher risk of smoking-related cancers
(5.6% and 7.1%) did not perform differ-
ently from the low-risk smokers (4.9%,
P = 0.723). Possible confounding by leg-
islation preventing passive smoking.
Hymowitz 1991 Six worksites randomised to Full Pro- At 12 months, 23/131 (18%) in the Full Self-report and expired CO < 8 ppm.
gramme or Group-only interventions. Programme arm had quit, while 27/121
Participation was 50% in the Full Pro- (22%) in the Group-only arm had quit
gramme sites, and 44% at Group-only (NS).
(NS).
193/252 smokers who began the quit
programme completed it.
Randomisation was by worksite, but
analysis was by individual.
Kadowaki 2000 263 male employees randomised to in- Quit rates 17/132 (Intervention), Expired CO<9 ppm at baseline, 5
tervention (132) or control (131). 4/131 (Control) at 5-month follow-up months and 12 months, and a urine test
No attrition, as inclusion was compul- (p=0.003). Male smoking decreased at 12 months
sory. from 62.9% to 56.7% (p=0.04).
Delayed intervention in the control
group lead to 13% quit rate (16/123)
Klesges 1987 8 Oregon worksites (127 participating At 6m, 15/127 had quit; Competition CO < 10 ppm and saliva thiocyanate
smokers), randomized to group behav- sites 12%, no-competition 11%.
ioural intervention, + either a 2x2 com-

Informed decisions.

petition component or a 2x2 relapse
prevention component
Kornitzer 1980 30 Belgian factories (16,230 men) ran- High risk intervention group (n = 1268) Self report only, no biochemical valida-
domized to intervention (risk assess- reduced prevalence by 18.7% (84.5% tion.
ment, physician and written advice) or to 68.7%), and high risk control group
control (assessment only). tested at 2 (n = 202) reduced by 12.2% (80.8% to
yrs. 70.9%). P < 0.05.
Random sample comparison: 5% of
intervention group (n = 327) reduced
by 12.5%, compared with 10% control
sample (n = 800) reduced by 12.6% (ns).
Kornitzer 1995 374 employees randomised to Group At 12 months, abstinence in Group 1 Salivary cotinine at baseline, and ex-
1(149, active patch + active gum), was 18.1% (NS), in Group 2 12.7% (NS) pired CO<10 ppm at subsequent checks
Group 2(150, active patch + placebo and in Group 3 13.3% (NS). Time to re-
gum) or Group 3 (75, placebo patch + lapse was significantly longer in Group
placebo gum) 1 compared with the other 2 groups
(p=0.04).
Lang 2000 30 worksite physicians (1095 smokers) 2 physicians dropped out post ran- Self-report, with CO<7 ppm valida-
were randomised to Group A (504, sim- domisation. tion on a subset of 231 subjects whose
ple advice) or Group B (591, advice + 3.4% of baseline non-smokers in each physicians had access to a CO monitor.
support and 'contract'). group were smokers at 1 year fol-
low-up.
The sustained abstinence rate at 6
months or more (A: 4.6%; B: 6.1%) was
non-significant using the physician as
the unit as analysis.
At 12 months, Group A had a quit rate
of 13.5%, and Group B a rate of 18.4%
(p=0.03)
Li 1984 871 employee smokers, randomised Counselled workers had an 8.4% ab- Expired CO<10 ppm at 11 months fol-
to Group 1 (simple warning) or Group stinence rate at 11 months, compared low-up in all quitters, and in a random
2(brief physician advice), stratified by with 3.6% in the control group (p<0.05). sample of 379 continuing smokers
normal/abnormal lung function. Feedback on abnormal lung func-
After fine tuning, at 3 months 215 tion was not significantly related to in-
workers received counselling, while 361 creased rates of quitting
received simple warning and 3 were ex-
cluded.
Attrition was 30%.
Malott 1984 24 employees randomised to controlled Few differences were observed be- Self-monitoring, butt counts, expired
smoking Group (1) or controlled smok- tween controlled smoking and con- CO levels
ing + partner support Group (2). trolled smoking plus partner support
Attrition 4% at 6 months conditions either during treatment or
at the 6-month follow-up. 25% of Group
1, and 17% of Group 2 were abstinent at
6 months (NS).
(See Cochrane review 'Enhancing part-
ner support to improve smoking cessa-
tion').
Mayer 2010 275 abstainers randomized by compa- No significant differences at 9m: Phone 4-wk CA assessed by CO < 10 ppm, and
ny to proactive phone counselling (134) counselling 57.5% and group coun- by urinary cotinine ≤ 317 ng/ml.
or to worksite-based group counselling selling 61.7% remained abstinent (P =
(141) for relapse prevention. 0.552).
Milani 2009 Two sites chosen; 33 intervention 6/33 intervention smokers quit at 6m, Not stated, but probably unvalidated.
smokers received comprehensive CV versus 0/31 controls. Cost effectiveness
risk programme, including referral to analysis reported.
SC programme, and 31 controls.
Mishra 2010 Tobacco users in 4 call centres (63 con- 6m PA at 12m rates were 4/63 (con- CO monitor < 6ppm.
trol, 204 intervention) received increas- trols), 17/87 BPO2 (HE sessions + fo-
ing levels of support and bupropion; cus groups), 8/43 BPO3 (as BPO2 + in-
controls got self-help leaflets. 99% re- dividual counselling), and 15/74 BPO4
ceived long-term counselling. (as BPO3 + bupropion offered); high
turnover (52.4%) but only 1% lost to fol-
low-up.
Nilsson 2001 113 workers randomised to interven- Baseline prevalence for both groups Self-report, not biochemically validated
tion (65) or control (63). was 65%. At 12 months the interven-
Attrition at 12 months was 32% for the tion group point prevalence rate was
intervention group, and 24% for the 37%, and the control group 63%. At 18
control group. At 18 months the respec- months, the rates were 40% (of 43) and
tive attrition rates were 34% and 27%. 59% (of 46) respectively. This difference
influenced the decrease in mean risk
score from 10.3 to 9.0 after 18 months
in the intervention group (P = 0.042)

Informed decisions.

Noor 2011 77 male intervention smokers random- At wk 24 all pts had face-to-face meet- All pts cotinine- (< 50 ng/ml) and CO- (<
ized to 24 wks of Viva QS tablets + brief ing at workplace for smoking status. 8 ppm) tested at 24 wks, whether claim-
counselling; 78 male control smokers Intervention 20-wk CA quit rate 19/75, ing abstinence or not. 54 24-wk urine
randomized to placebo tablets. Attrti- controls 9/72. Similar AEs (sore throat: samples not analysed, so only CO reli-
tion was 1 intervention and 3 controls I 28.8%, C 36.6%; dry mouth: I 17.8%, C able.
at start of study. 16.9%).
Okechukwu 2009 251 intervention smokers (4 sites) and At 6m, 22/245 intervention and 17/235 Not verified (fear of 'drug-testing, + pos-
239 control smokers (6 sites) had 4m controls had PA quit. 2/10 sites had de- sibility of industrial toxin contamina-
programme of counselling, self help, layed assessment (8m and 9m). tion).
NRT and environmental cues. Attri-
tion at 6m post-programme was I 2%, C
1.7%.
Omenn 1988 402 employee smokers randomised Self-reported quit rates similar across Salivary cotinine at 12 months < 35 ng/
within their preference for group all three group preference conditions ml
or self-help programmes, to 3 pro- but more missing saliva samples in self-
grammes, MCP (1), RPP (2) or MTP (3). help so validated rates lower.
7% attrition rate at 12 months. All self-help programmes similar.
Results: Group 1 8/51, Group 2 10/57,
Group 3 4/51 (NS)
SH1 7/76, SH2 9/82, SH3 6/85 (NS)
Prochaska 2008 48 smokers randomized to the HRI PPA at 6m ("at criteria") was estimat- Not stated, but probably no validation.
group, 40 to the MI group, and 48 to the ed at 8/48 for HRI alone, 14/40 for HRI
TTM group. Attrition was 25.7% at 6m + MMI, 10/48 for HRI + TTM; 6m denom-
(distribution NK) inators not reported (no reply from au-
thors), so we have applied 6m quit rates
to baseline smoking rates.
Rand 1989 47 employees randomised to contin- Contingent payment combined with Expired CO monitoring <12 ppm
gent payment/frequent CO monitor- frequent CO monitoring delayed but
ing group (17), non-contingent pay- did not ultimately prevent participant
ment/frequent CO monitoring (16), relapse to smoking by the end of the six
non-contingent payment/ infrequent month follow-up. Contingent payment
monitoring (14). group had CO value at or less than 11
4 participants failed to abstain for 5 ppm significantly longer than the oth-
days, and were excluded before ran- er two groups (p=0.03). CO monitoring
domisation. alone had no effect on abstinence.
At 6 months 11 more participants had At six months, only 2 subjects ( 1con-
dropped out. Analyses were Intention tingent, 1 non-contingent) had
to Treat at randomisation. achieved sustained abstinence.
Razavi 1999 344 post-cessation abstainers ran- 12 months abstinence rates were Expired CO and urinary cotinine. Un-
domised to psychologist support (135), 59/135 (43.7%) in the PG group; 33/88 validated self-report (higher) were also
ex-smoker support (88), or no formal (37.5%) in the SG group; 43/121 (35.5%) given.
support (121), in no support group (NS).
Rodriguez 2003 218 smokers randomized to counselling 12 months continuous abstinence rates Expired CO <+ 10 ppm
+ NRT (115) or minimal sporadic advice were 23/114 (20.2%) for the interven-
(103) in 3 Bilabao (Spain) worksites tion group, vs 9/103 (8.7%) in the con-
trol group (P = 0.025).
NNT was 9 people treated for 3mss to
produce 1 quitter
Schröter 2006 38 smokers assigned to standard be- 12m continuous abstinence rates were Self-reported, no biochemical valida-
havioural (SB) programme, 41 to re- 8/38 (21.1%) for SB, and 5/41 (12.2%) tion
lapse prevention (RP) programme. for RP.
Assessed at 12m for continuous and PP
abstinence
Shi 1992 2887 workers (533 smokers) across 9 2 yr cross-sectional survey of 1998 Self-reported PP at HRA, not biochemi-
Californian sites, partially randomized workers (250 smokers); Prevalence de- cally validated
to 4 intervention levels. No non-inter- clined by 34% from 18% to 12% in Lev-
vention control group el 1 (p < 0.1); by 18% from 17% to 14%
in Level 2 (p < 0.1); by 35% from 24% to
15% in level 3 (p < 0.01); by 44% from
14% to 8% in Level 4 (p < 0.01)
Shimizu 1999 53 volunteer employee smokers, ran- After the 5 months of intervention, Expired CO monitoring
domised to intervention and control smoking cessation rate in the interven-
groups. tion group (19.2%) tended to be higher
than that in the control group (7.4%),
(NS).
Control group was given same pro-
gramme after the 5 months for the in-
tervention group. At six months after
both groups were treated, overall ces-
sation rate was 24.5%, and at one year
was 13.2%.

Informed decisions.

Sorensen 1993 Eight worksites, randomised to inter- Analysis of all smokers, not just partici- Self-report only.
vention (1885 workers) or comparison pants. Baseline and follow-up salivary co-
(1479 workers). At the 6-month follow-up, 12% of tinines obtained for 52% of base-
At baseline, 9 months before interven- smokers in the intervention group re- line smokers. These data were not
tion, 34% of respondents were current ported quitting, compared with 8.8% in analysed.
smokers (I:39%;C:31%) the control group (p<0.05), controlling
Six-month data were on only 7 of the for age, sex & occupation.
8 sites, because of ownership changes
at the 8th. Six-month survey was of all
smokers then employed, = 66% of origi-
nally surveyed employees.
Analyses were by individual, while ran-
domisation was by worksite.
Sorensen 1996 108 matched worksites (>28,000 work- Worksite was the unit of allocation and Self-reported, no biochemical valida-
ers), randomised to intervention or analysis. Baseline smoking data were tion
control conditions, though Florida cen- not reported in detail.
ter sites did not target smoking, leaving There was a difference of 1.53% (NS) in
smoking outcomes available in only 84 the 6-month quit rates between inter-
worksites. vention and control sites, and a reduc-
tion in prevalence from 24.5% to 21.2%
(I), and from 25.8% to 21.8% (C), a dif-
ference between the 2 groups of 0.66%
(NS).
Sorensen 1998 Cohort analysis (2658 employees) of PP abstinence for the 6 months prior Self-reported, no biochemical valida-
a randomised controlled study of 12 to 2-year follow-up was 15% for inter- tion
matched pairs of worksites. vention group and 9% for control group
Worksite was unit of allocation, but (p=0.123)
analysis was by individual. Blue-collar cessation rates for the 2
groups were 18% (I) and 9% (C), while
the white-collar workers achieved high-
er rates in the control than in the in-
tervention group; office worker rates
were 2.5% (I) vs 5.1% (C), and professip-
nal/managerial rates were 14.2% (I) vs
18.6% (C).
Sorensen 2002 Cross-sectional analysis (9019 at base- At six months, point prevalence in the Self-reported, no biochemical valida-
line [80%] and 7327 [65%] ) at six HP/OHS sites fell from 20.4% to 16.3%, tion
months follow-up, plus cohort analysis and in the HP sites from 18.6% to 17%.
of 5156 employees who responded to In the embedded cohort (825 smokers)
both surveys (embedded cohort of 436 at 6m, the HP/OHS quit rate was 11.3%,
smokers). compared with the HP rate of 7.5%
Worksite was unit of allocation, but (OR=1.57, p=0.17). Within the cohort,
analysis was by individual. blue-collar quit rates more than dou-
bled in the HP/OHS sites (11.8%) com-
pared with the HP sites (5.9%, p=0.04)
Sorensen 2007 Baseline participants 674 workers, (354 7-day self-reported PPA at 6m: Int: Self-reported, no biochemical valida-
Int/ 320 Cont). 19/101 (19%), Cont: 7/87 (8%) (P=0.03). tion
188 smokers (101 Int, 87 Cont) com- ITT analysis Int: 19/125 , Cont: 7/106, P
pleted baseline and 6m surveys = 0.04.
Sutton 1987 270/334 interested smokers invited to 12% (20/172) of those who attended Expired CO<11 ppm
nicotine gum cessation programme; the intervention course were abstinent
the uninvited 64 represented a control at 12 months, compared with 1% (1/98)
group. 172 (64%) of invitees attended of those who did not accept the invi-
the 1st consultation, 163 the 2nd. tation, and 2% (1/64) of the control
One-year follow-up rate was 99% (9% group; p values not given.
by phone).
Sutton 1988a Video programme (smoking, plus seat- Abstinence rates (DFF: 3%, SB [con- Expired CO<11 ppm.
belt advice) was offered to all employ- trol] 0%) were not significantly differ-
ees. 77 employees were randomised to ent from each other at 12 months fol-
DFF video (33) or seatbelt (44=control) low-up, There was no significant differ-
videos. ence in validated abstinence between
the video groups and the non-partici-
pant group.
Sutton 1988b 150 employees (smokers only) partic- Abstinence rates (DFF: 11%, DFF+C 8%, Expired CO<11 ppm.
ipated. 46 watched the DFF video, 50 LTK [control] 9%) were higher than in
watched a confidence-boosting version the other 3 studies, but not significantly
of the DFF video, and 54 (control group) different from each other
watched LTK video. at 12 months follow-up. But there was
a significant difference in abstinence
rates between participant groups and
the non-participant group (4%, p<0.05).

Informed decisions.

Sutton 1988c 197 employees (smokers only) partic- Abstinence rates (DFF: 4%, DFF-G 3%, Expired CO<11 ppm.
ipated. 56 watched the DFF video, 67 TW [control] 4%) were not significantly
watched a less gory version of the DFF different from each other.
video, and 74 (control group) watched at 12 months follow-up. There was no
the TW video. significant difference in abstinence
Non-responder smokers at baseline rates between the video groups and the
had higher smoking prevalence (45%) non-participant group.
than responders (29%), suggesting
some response bias.
Sutton 1988d 179 employees (smokers only) par- Abstinence rates (DFF: 3%, SL 2%, Tw Expired CO<11 ppm.
ticipated. 62 watched the DFF video, [control] 5%) were not significantly dif-
59 watched SL video, and 58 (control ferent from each other at 12 months
group) watched TW video. follow-up. There was no significant dif-
Non-responder smokers at baseline ference in validated abstinence artes
had higher smoking prevalence (34%) between the video groups and the non-
than responders (22%), suggesting participant group.
some response bias.
Sutton 1988e Fourth study (D) of the video studies 22% (7/32) of attenders in the inter- Expired CO<11 ppm.
groups provided a nested RCT. 161 convention group were abstinent at 12
tinuing smokers at 3-month follow-up months, compared with 2% (1/47) of
were randomised to intervention (79) or the non-attending invitees, and com-
control (82). pared with 2% (2/82)of the control
40.5% response rate, attending at least group (p<0.001).
one consultation. 16% of intervention group achieved
'complete' sustained abstinence at 12
months, vs 2% control group (p<0.01).
Tanaka 2006 Six intervention sites matched to 6 con- 6m sustained abstinence at 36m ITT No biochemical confirmation
trol sites; Of 1017 intervention smokers analysis was 8.9% (123/1382) interven-
who completed baseline and 36m fol- tion vs 7.0% (121/1736) control (P =
low-up, 125 participated in cessation 0.0467). Quit rates in both groups rose
campaign, and 79 accepted counselling steadily over 36m.
+ NRT.
Terazawa 2001 228 smokers randomized to interven- PP 11.1% (13/117) in the intervention Probably validated by expired CO
tion (117) or control (111). 25 smokers group at 12m, compared with 1.8%
in the intervention group made a sup- (2/111) controls. Continuous absti-
ported quit attempt nence 6.8% (8/117) intervention, com-
pared with 0.9% (1/111) controls. Fish-
er's Exact test 2-tailed P = 0.04
Volpp 2009 878 smokers randomized to interven- At 15m or 18m 41/436 intervention and Confirmed by cotinine in saliva or urine.
tion (436) or control (442); all got infor- 16/442 control had quit (PA).
mation about local SC programmes,
and intervention also got stepped re-
wards for cessation efforts and goals.
Attrition (losses + withdrawals) by 18m
was 29% intervention and 24% con-
trols.
Willemsen 1998 Four intervention worksites matched Overall sustained abstinence quit rates Self-report, plus baseline Fagerstrom
to 4 control sites (minimal self-help), at 6 months were 8% (9% for heavy score.
giving 498 smokers who completed smokers) in the comprehensive group, At 4-month follow-up, 'bogus pipeline'
baseline survey and enrolled in pro- and 7% (4% for heavy smokers) in the procedure was used, and at 14 months
grammes. minimal group (no p values given) salivary cotinines were collected from
41/79 quitters
Windsor 1988 387 smokers randomly assigned to four As monetary incentives made no differ- Baseline salivary cotinine, and fol-
groups, in a 2x2 factorial pre-/post-test ence, groups 1&3 were compared with low-up salivas at 6 weeks, 6 months
design. 2&4. Sustained abstinence at 1 year and 1 year.
37 were lost to follow-up, and were was 5.8% (11/190) in the self-help only
counted as continuing smokers groups, and 14.4% (27/188) in the self-
help + counselling groups (p<0.001).
APPENDICES
Appendix 1. Search Strategy for Register

Strategy for Tobacco Addiction Group Specialised Register
via Cochrane Register of Studies (CRS)
#1 workplace*:TI,AB,KY,XKY,MH,EMT
#2 worksite*:TI,AB,KY,XKY,MH,EMT

Informed decisions.
#3 work:KY,XKY,MH,EMT
#4 occupational health:KY,XKY,MH,EMT
#5 #1 OR #2 OR #3 OR #4
(KY, XKY, MH & EMT are keyword fields)
Appendix 2. Search strategies for electronic databases

Strategies used for update in 2013
Strategy for EMBASE
1. health behavior/
2. health promotion/
3. health education/
4. prevention/ or primary prevention/
5. mass screening/
6. 1 or 2 or 3 or 4 or 5
7. workplace/
8. (smok* or tobacco).mp.
9. 6 and 7 and 8
10. limit 9 to exclude medline journals
11. ("2008" or "2009" or "2010" or "2011" or "2012" or "2013").yr.
12. 10 and 11
Strategy for MEDLINE
1. exp Health Behavior/

2. exp Health Education/
3. Health Promotion/
4. Healthy People Programs/
5. exp Primary Prevention/
6. 1 or 2 or 3 or 4 or 5
7. Work/
8. Workplace/
9. Occupational Health/
10. 7 or 8 or 9
12. 6 and 10 and 11
13. ("2008" or "2009" or "2010" or "2011" or "2012" or "2013").yr.
14. 12 and 13
Strategy for PsycINFO
1. health behavior/
2. health promotion/
3. health education/
4. health care psychology/
5. prevention/ or preventive medicine/
6. health screening/
7. 1 or 2 or 3 or 4 or 5 or 6
8. occupational health/
9. workplace*.tw.
10. 8 or 9
12. ("2008" or "2009" or "2010" or "2011" or "2012" or "2013").yr.
13. 7 and 10 and 11 and 12
Appendix 3. Glossary of tobacco-related terms
Term Definition

Informed decisions.
(Continued)
Abstinence A period of being quit, i.e. stopping the use of cigarettes or other tobacco products, May be defined
in various ways; see also:
point prevalence abstinence; prolonged abstinence; continuous/sustained abstinence
Biochemical verification Also called 'biochemical validation' or 'biochemical confirmation':

A procedure for checking a tobacco user's report that he or she has not smoked or used tobacco. It
can be measured by testing levels of nicotine or cotinine or other chemicals in blood, urine, or sali-
va, or by measuring levels of carbon monoxide in exhaled breath or in blood.
Bupropion A pharmaceutical drug originally developed as an antidepressant, but now also licensed for smok-
ing cessation; trade names Zyban, Wellbutrin (when prescribed as an antidepressant)
Carbon monoxide (CO) A colourless, odourless highly poisonous gas found in tobacco smoke and in the lungs of people
who have recently smoked, or (in smaller amounts) in people who have been exposed to tobacco
smoke. May be used for biochemical verification of abstinence.
Cessation Also called 'quitting'

The goal of treatment to help people achieve abstinence from smoking or other tobacco use, also
used to describe the process of changing the behaviour
Continuous abstinence Also called 'sustained abstinence'

A measure of cessation often used in clinical trials involving avoidance of all tobacco use since the
quit day until the time the assessment is made. The definition occasionally allows for lapses. This is
the most rigorous measure of abstinence
'Cold Turkey' Quitting abruptly, and/or quitting without behavioural or pharmaceutical support.
Craving A very intense urge or desire [to smoke].

See: Shiffman et al 'Recommendations for the assessment of tobacco craving and withdrawal in
smoking cessation trials'
Nicotine & Tobacco Research 2004: 6(4): 599-614
Dopamine A neurotransmitter in the brain which regulates mood, attention, pleasure, reward, motivation and
movement
Efficacy Also called 'treatment effect' or 'effect size':

The difference in outcome between the experimental and control groups
Harm reduction Strategies to reduce harm caused by continued tobacco/nicotine use, such as reducing the number
of cigarettes smoked, or switching to different brands or products, e.g. potentially reduced expo-
sure products (PREPs), smokeless tobacco.
Lapse/slip Terms sometimes used for a return to tobacco use after a period of abstinence. A lapse or slip
might be defined as a puff or two on a cigarette. This may proceed to relapse, or abstinence may be
regained. Some definitions of continuous, sustained or prolonged abstinence require complete ab-
stinence, but some allow for a limited number or duration of slips. People who lapse are very likely
to relapse, but some treatments may have their effect by helping people recover from a lapse.
nAChR [neural nicotinic acetylcholine receptors]: Areas in the brain which are thought to respond to nico-
tine, forming the basis of nicotine addiction by stimulating the overflow of dopamine
Nicotine An alkaloid derived from tobacco, responsible for the psychoactive and addictive effects of smok-
ing.
Nicotine Replacement Therapy A smoking cessation treatment in which nicotine from tobacco is replaced for a limited period by
(NRT) pharmaceutical nicotine. This reduces the craving and withdrawal experienced during the initial
period of abstinence while users are learning to be tobacco-free The nicotine dose can be taken
through the skin, using patches, by inhaling a spray, or by mouth using gum or lozenges.

Informed decisions.
(Continued)
Outcome Often used to describe the result being measured in trials that is of relevance to the review. For ex-
ample smoking cessation is the outcome used in reviews of ways to help smokers quit. The exact
outcome in terms of the definition of abstinence and the length of time that has elapsed since the
quit attempt was made may vary from trial to trial.
Pharmacotherapy A treatment using pharmaceutical drugs, e.g. NRT, bupropion
Point prevalence abstinence A measure of cessation based on behaviour at a particular point in time, or during a relatively brief
(PPA) specified period, e.g. 24 hours, 7 days. It may include a mixture of recent and long-term quitters. cf.
prolonged abstinence, continuous abstinence
Prolonged abstinence A measure of cessation which typically allows a 'grace period' following the quit date (usually of
about two weeks), to allow for slips/lapses during the first few days when the effect of treatment
may still be emerging.
See: Hughes et al 'Measures of abstinence in clinical trials: issues and recommendations'; Nicotine
& Tobacco Research, 2003: 5 (1); 13-25
Relapse A return to regular smoking after a period of abstinence
Secondhand smoke Also called passive smoking or environmental tobacco smoke [ETS]
A mixture of smoke exhaled by smokers and smoke released from smouldering cigarettes, cigars,
pipes, bidis, etc. The smoke mixture contains gases and particulates, including nicotine, carcino-
gens and toxins.
Self-efficacy The belief that one will be able to change one's behaviour, e.g. to quit smoking
SPC [Summary of Product Advice from the manufacturers of a drug, agreed with the relevant licensing authority, to enable
Characteristics] health professionals to prescribe and use the treatment safely and effectively.
Tapering A gradual decrease in dose at the end of treatment, as an alternative to abruptly stopping treat-
ment
Titration A technique of dosing at low levels at the beginning of treatment, and gradually increasing to full
dose over a few days, to allow the body to get used to the drug. It is designed to limit side effects.
Withdrawal A variety of behavioural, affective, cognitive and physiological symptoms, usually transient, which
occur after use of an addictive drug is reduced or stopped.
See: Shiffman et al 'Recommendations for the assessment of tobacco craving and withdrawal in
smoking cessation trials'
Nicotine & Tobacco Research 2004: 6(4): 599-614
WHAT'S NEW
Date Event Description
25 October 2013 New citation required but conclusions 10 new trials added to Included studies, and 8 to Excluded stud-
have not changed ies, with 2 new ongoing and 1 awaiting classification. Four previ-
ously included trials now excluded. 'Risk of bias' tables and fig-
ure generated for all included studies. We include meta-analyses
of the main categories, which quantify and consolidate our pre-
vious findings.
25 October 2013 New search has been performed New searches run and incorporated.

Informed decisions.
HISTORY
Protocol first published: Issue 1, 2002
Review first published: Issue 2, 2003
Date Event Description
22 May 2008 New search has been performed Four new included studies added (behavioural interventions).
Review restructured to exclude bans and restrictions, which are
now covered in a separate review.
Forest plots changed from OR to RR.
16 May 2008 New citation required but conclusions Order and names of authors amended.
have not changed
23 April 2008 Amended Converted to new review format.
19 February 2005 New citation required and conclusions Substantive amendment

have changed
CONTRIBUTIONS OF AUTHORS
KC and TL extracted and checked the data for the current update (2014).
KC produced full 'Risk of bias' tables for all included studies.
KC conducted meta-analyses.
KC wrote the update, with editorial input from TL.
DECLARATIONS OF INTEREST
None known
SOURCES OF SUPPORT
Internal sources
• Department of Primary Health Care, Oxford University, UK.
• National School for Health Research School for Primary Care Research, UK.
External sources
• NHS Research & Development Programme, UK.
DIFFERENCES BETWEEN PROTOCOL AND REVIEW

For the 2014 update, we have constructed meta-analyses for the main categories of intervention. We also now include 'Risk of bias' tables
with a summary figure (Figure 1), and a 'Summary of findings for the main comparison'.
INDEX TERMS
Medical Subject Headings (MeSH)

*Smoking Prevention; *Workplace; Counseling; Psychotherapy, Group; Randomized Controlled Trials as Topic; Smoking Cessation
[*methods]; Social Support; Tobacco Use Cessation Devices
MeSH check words

Humans


Cahill Et Al-2014-Cochrane Database of Systematic Reviews

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cahill Et Al-2014-Cochrane Database of Systematic Reviews

Uploaded by

Copyright:

Available Formats

Cochrane

Workplace interventions for smoking cessation (Review)

Workplace interventions for smoking cessation (Review)

Workplace interventions for smoking cessation (Review) i

Workplace interventions for smoking cessation

Kate Cahill1, Tim Lancaster1

1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Editorial group: Cochrane Tobacco Addiction Group.

Data collection and analysis

Workplace interventions for smoking cessation (Review) 1

PLAIN LANGUAGE SUMMARY

Is the workplace an effective setting for helping people to stop smoking

Quality of the evidence

Workplace interventions for smoking cessation (Review) 2

Patient or population: Employees who smoke

Control Smoking cessation interven-

Group therapy 51 per 1000 84 per 1000 OR 1.71 1309 ⊕⊕⊕⊝

Self-help interventions 45 per 1000 52 per 1000 OR 1.16 1906 ⊕⊕⊕⊕

Cochrane Database of Systematic Reviews

Incentives 73 per 1000 113 per 1000 OR 1.60 1928 ⊕⊕⊕⊝

Multiple interventions 63 per 1000 95 per 1000 OR 1.55 5018 ⊕⊕⊕⊝

Cochrane Database of Systematic Reviews

BACKGROUND Why it is important to do this review

Description of the intervention We include randomized and quasi-randomized controlled trials,

Workplace interventions for smoking cessation (Review) 5

Workplace interventions for smoking cessation (Review) 7

Workplace interventions for smoking cessation (Review) 8

Glasgow 1993 evaluated the impact of a year-long incentive-

Workplace interventions for smoking cessation (Review) 12

Workplace interventions for smoking cessation (Review) 13

Workplace interventions for smoking cessation (Review) 14

Workplace interventions for smoking cessation (Review) 15

Workplace interventions for smoking cessation (Review) 16

Workplace interventions for smoking cessation (Review) 17

Workplace interventions for smoking cessation (Review) 18

Workplace interventions for smoking cessation (Review) 19

Workplace interventions for smoking cessation (Review) 20

Workplace interventions for smoking cessation (Review) 21

Workplace interventions for smoking cessation (Review) 24

Workplace interventions for smoking cessation (Review) 25

Workplace interventions for smoking cessation (Review) 26

Workplace interventions for smoking cessation (Review) 27

Workplace interventions for smoking cessation (Review) 28

Workplace interventions for smoking cessation (Review) 30

Workplace interventions for smoking cessation (Review) 32

Workplace interventions for smoking cessation (Review) 33

Workplace interventions for smoking cessation (Review) 34

Willemsen 1999 {published data only} Additional references

Simpson 2000 {published data only} Lancaster 2005b

Harris D, Vita P, Oldenburg B, Owen N. Socio-behavioural and Martinson 1999

Workplace interventions for smoking cessation (Review) 35

NICE 2007 References to other published versions of this review

* Indicates the major publication for the study

Characteristics of included studies [ordered by study ID]

Design: Prospective multicentre cohort study, run from 2000 - 2003

Population measures taken 10 times over 4 years.

Type of intervention 8. COMPREHENSIVE

Bias Authors' judgement Support for judgement

Workplace interventions for smoking cessation (Review) 36

Bergstrom 2008 (Continued)

Allocation concealment Unclear risk N/A

Blinding of outcome as- Unclear risk Not stated

Outcomes Abstinence/reduction at 2 yrs.