professionals are also illustrated by the results of the OXCHECK and Family
Heart Study results (Muir et al. 1994; Wood et al. 1994), which are described in
Chapter 9.2 Worksite interventions. Over the past decade there has been an increasing interest
in developing worksite-based smoking cessation interventions. These take the form of
either a company adopting a no-smoking policy and/or establishing work-based
health promotion programmes. Worksite interventions have the benefit of reaching
many individuals who would not consider attending a hospital or a university-based
clinic. In addition, the large number of people involved presents the opportunity for
group motivation and social support. Furthermore, they may have implications for
reducing passive smoking at work, which may be a risk factor for coronary heart
disease (He et al. 1994). Research into the effectiveness of no-smoking policies has
produced conflicting results with some studies reporting an overall reduction in the
number of cigarettes smoked for up to 12 months (e.g. Biener et al. 1989) and others
suggesting that smoking outside work hours compensates for any reduced smoking at
the workplace (e.g. Gomel et al. 1993) (see Focus on research 5.2, page 122). In two
Australian studies, public service workers were surveyed following smoking bans in
44 government office buildings about their attitudes to the ban immediately after the
ban and after six months. The results suggested that although immediately after the
ban many smokers felt inconvenienced, these attitudes improved at six months with
both smokers and non-smokers recognizing the benefits of the ban. However, only
2 per cent stopped smoking during this period (Borland et al. 1990). Although work-
site interventions may be a successful means to access many smokers, this potential
does not yet appear to have been fully realized.
3 Community-based programmes. Large community-based programmes have been
established as a means of promoting smoking cessation within large groups of
individuals. Such programmes aim to reach those who would not attend clinics
and to use the group motivation and social support in a similar way to worksite
interventions. Early community-based programmes were part of the drive to reduce
coronary heart disease. In the Stanford Five City Project, the experimental groups
received intensive face-to-face instruction on how to stop smoking and in addition
were exposed to media information regarding smoking cessation. The results showed
a 13 per cent reduction in smoking rates compared with the control group (Farquhar
et al. 1990). In the North Karelia Project, individuals in the target community
received an intensive educational campaign and were compared with those in a
neighbouring community who were not exposed to the campaign. The results
from this programme showed a 10 per cent reduction in smoking in men in North
Karelia compared with men in the control region. In addition, the results also showed
a 24 per cent decline in cardiovascular deaths, a rate twice that of the rest of the
country (Puska et al. 1985). Other community-based programmes include the
Australia North Coast Study, which resulted in a 15 per cent reduction in smoking
over three years, and the Swiss National Research Programme, which resulted in an
8 per cent reduction over three years (Egger et al. 1983; Autorengruppe Nationales
Forschungsprogramm 1984).
SMOKING AND ALCOHOL USE 121