Moher M, Hey K, Lancaster T
Depts of Primary Health Care and Public Health, University of Oxford, Institute of Health Sciences, Old Road, Headington, OXFORD, UK, OX3 7LF.
Cochrane Database Syst Rev. 2003(2):CD003440. doi: 10.1002/14651858.CD003440.
The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation.
To categorise workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking or to reduce tobacco consumption.
We searched the Tobacco Addiction Review Group trials register in November 2002, Medline (1966 - November 2002), EMBASE (1985 - November 2002) and PsycINFO (to November 2002). We searched abstracts from international conferences on tobacco and we checked the bibliographies of identified studies and reviews for additional references.
We categorised interventions into two groups: a) Interventions aimed at the individual to promote smoking cessation and b) interventions aimed at the workplace as a whole. We applied different inclusion criteria for the different types of study. For interventions aimed at helping individuals to stop smoking, we included only randomised controlled trials allocating individuals, workplaces or companies to intervention or control conditions. For studies of smoking restrictions and bans in the workplace, we also included controlled trials with baseline and post-intervention outcomes and interrupted times series studies.
Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one reviewer and checked by two others. Because of heterogeneity in the design and content of the included studies, we did not attempt formal meta-analysis, and evaluated the studies using qualitative narrative synthesis.
Workplace interventions aimed at helping individuals to stop smoking included nine studies of group therapy, three studies of individual counselling, eight studies of self-help materials and four studies of nicotine replacement therapy. The results were consistent with those found in other settings. Group programmes, individual counselling and nicotine replacement therapy increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective. Workplace interventions aimed at the workforce as a whole included 13 studies of tobacco bans, two studies of social support, four studies of environmental support, four studies of incentives, six studies of comprehensive (multi-component) programmes and two studies of competitions and recruitment. Tobacco bans decreased cigarette consumption during the working day but their effect on total consumption was less certain. We failed to detect an increase in quit rates from adding social and environmental support to these programmes. There was a lack of evidence that comprehensive programmes reduced the prevalence of smoking. Competitions and incentives increased attempts to stop smoking, though there was less evidence that they increased the rate of actual quitting.
REVIEWER'S CONCLUSIONS: We found 1. Strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include advice from a health professional, individual and group counselling and pharmacological treatment to overcome nicotine addiction. Self-help interventions are less effective. All these interventions are effective whether offered in the workplace or elsewhere. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low. 2. Limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer. 3. Consistent evidence that workplace tobacco policies and bans can decrease cigarette consumption during the working day by smokers and exposure of non-smoking employees to environmental tobacco smoke at work, but conflicting evidence about whether they decrease prevalence of smoking or overall consumption of tobacco by smokers. 4. A lack of evidence that comprehensive approaches reduce the prevalence of smoking, despite the strong theoretical rationale for their use. 5. A lack of evidence about the cost-effectiveness of workplace programmes.
工作场所具有作为一种途径的潜力，通过它可以接触到大量人群以鼓励戒烟。
对在对照研究中测试的工作场所戒烟干预措施进行分类，并确定这些措施在多大程度上帮助员工戒烟或减少烟草消费。
我们于2002年11月检索了烟草成瘾综述小组试验注册库、Medline（1966年 - 2002年11月）、EMBASE（1985年 - 2002年11月）和PsycINFO（至2002年11月）。我们检索了关于烟草的国际会议摘要，并检查了已识别研究和综述的参考文献目录以获取更多参考文献。
我们将干预措施分为两组：a）旨在促进个体戒烟的干预措施和b）旨在整个工作场所的干预措施。对于不同类型的研究，我们应用了不同的纳入标准。对于旨在帮助个体戒烟的干预措施，我们仅纳入将个体、工作场所或公司分配到干预或对照条件的随机对照试验。对于工作场所吸烟限制和禁令的研究，我们还纳入了具有基线和干预后结果的对照试验以及中断时间序列研究。
一位审阅者提取了与各类干预措施的特征和内容、参与者、结果及研究方法相关的信息，并由另外两人进行核对。由于纳入研究的设计和内容存在异质性，我们未尝试进行正式的荟萃分析，而是采用定性叙述性综合方法对研究进行评估。
旨在帮助个体戒烟的工作场所干预措施包括9项团体治疗研究、3项个体咨询研究、8项自助材料研究和4项尼古丁替代疗法研究。结果与在其他环境中发现的结果一致。与不治疗或最小干预对照相比，团体项目、个体咨询和尼古丁替代疗法提高了戒烟率。自助材料效果较差。旨在整个员工群体的工作场所干预措施包括13项烟草禁令研究、2项社会支持研究、4项环境支持研究、4项激励措施研究、6项综合（多成分）项目研究以及2项竞赛和招募研究。烟草禁令减少了工作日期间的香烟消费，但其对总消费量的影响尚不确定。我们未能发现给这些项目增加社会和环境支持会提高戒烟率。缺乏证据表明综合项目能降低吸烟率。竞赛和激励措施增加了戒烟尝试，尽管较少有证据表明它们提高了实际戒烟率。
我们发现1. 有力证据表明针对个体吸烟者的干预措施增加了戒烟的可能性。这些措施包括健康专业人员的建议、个体和团体咨询以及克服尼古丁成瘾的药物治疗。自助干预效果较差。所有这些干预措施无论在工作场所还是其他地方提供都是有效的。尽管接受这些干预措施的人更有可能戒烟，但实际戒烟的绝对人数较少。2. 有限证据表明雇主组织的竞赛和激励措施可提高参与项目的程度。3. 一致证据表明工作场所烟草政策和禁令可减少吸烟者在工作日的香烟消费以及非吸烟员工在工作时接触环境烟草烟雾，但关于它们是否降低吸烟率或吸烟者的总体烟草消费量存在相互矛盾的证据。4. 缺乏证据表明综合方法能降低吸烟率，尽管其使用有很强的理论依据。5. 缺乏关于工作场所项目成本效益的证据。
