Will healthcare take tobacco addiction seriously? Using policy to drive practice.

Despite being the leading preventable cause of disability, death, and economic burden on society, tobacco-use detection and treatment is yet to be taken as seriously as the prevention and treatment of chronic diseases or other addictive behaviors (eg, hypertension, diabetes, alcohol/substance abuse, and mammography screening). This paper outlines the process of intervening at the policy level to incorporate tobacco-use screening and treatment in health practice. The National Committee for Quality Assurance (NCQA) call for new measures presented a window of opportunity. The NCQA report card (the Health Plan Employer Data Information Set [HEDIS]) is the most widely used and influential performance measure in managed care. Consequently, a 6-month process consisting of an expert panel review of research evidence and consensus building was initiated. Two measures were submitted to NCQA: (1) a primary measure based on chart review of tobacco-use screening and treatment implementation and (2) an adjunctive measure of population prevalence of tobacco use and physician advice to quit, based on a self-report survey of members. HEDIS eventually accepted the second measure. The mixed results, potential impact on societal disease burden and cost savings, and the lessons learned from the process are discussed.

Essential elements of self-help/minimal intervention strategies for smoking cessation.

Two decades of research suggest that self-help/minimal intervention strategies for smoking cessation may be the preferred means by which smokers stop and can produce success rates approximating those of more formal programs, at lower cost and with greater access to relevant populations. In order to make the best possible use of these self-help/minimal intervention approaches, the National Cancer Institute (NCI) supported a series of randomized, controlled intervention trials and, in June of 1988, convened an Expert Advisory Panel to address the question "What are the essential elements of self-help/minimal intervention strategies for smoking cessation?". The panel's recommendations were that: (1) Intervention efforts should focus on increasing smokers' motivations to make serious quit attempts; (2) Delivery of programs be broadened to include all smokers; (3) Programs be targeted to stages of cessation and specific populations; (4) All programs include (a) elements focused on health and social consequences of smoking, and (b) strategies and exercises aimed at quitting, maintenance of nonsmoking, relapse prevention, and recycling; (5) Materials and programs be made widely available rather than "fine tuning" existing programs or developing new ones; and (6) Programs make use of specific adjunctive strategies. In this way, a reacceleration of the decline in smoking prevalence may be realized in the 1990s and significantly contribute to the NCI's Year 2000 goals and the Surgeon General's aim of a smoke-free society.

Participation in workplace health promotion programs: the contribution of health and organizational factors.

Interest in workplace health promotion programs has raised important questions regarding these programs' ability to attract participants. Typically, participation has been examined as a function of personal characteristics of employees. But participation in a workplace health promotion program may be influenced as much by organizational characteristics as by health-related characteristics of employees. This preliminary study, conducted at AT&T Communications, used path analysis, a statistical technique for controlling for the effects of causally prior variables, to develop a model of participation. The influence of three sets of factors was detected: (1) Sex of employee was significant, with women more likely than men to participate in the program, (2) Increased perceived risk of illness led to decreased health satisfaction which in turn led to increased intention to change health habits culminating in increased participation, and (3) The organizational climate factor of perceived supportiveness of the supervisor contributed to participation. While several potential limitations require that these findings be replicated and extended, the study suggests that developers of workplace health promotion programs should attend to organizational work climate as well as personal health characteristics of employees in an effort to increase program impact.