Andrus LH: Smoking by high school students: Failure of a cam- paign to persuade adolescents not to smoke. California Medi- cine, 1964, 101:246-247. 9.
PUBLIC HEALTH BRIEFS 7. Weaver SC and Tennant FS: Effectiveness of drug education programs for secondary school students. Am J Psychiatry, 1973, 130:812-814. 8. Andrus LH: Smoking by high school students: Failure of a campaign to persuade adolescents not to smoke. California Medicine, 1964, 101:246-247. 9. Evans RR and Borgatta EP: An experiment in smoking dissuasion among university freshmen: A follow-up. J Health and Social Behavior, 1970, 11:30-36. 10. Holland WW: Cigarette smoking respiratory symptoms and anti-smoking propaganda. Lancet, 1968, 1:41. 11. Jeffreys M and Westaway WR: Catch them before they start: A report on an attempt to influence childrens' smoking habits. Health Education Journal, 1961, 19:3-17. 12. Monk M, et al: Evaluation of an anti-smoking program among high school students. Am J Public Health, 1965, 55:994-1004. 13. Morrison JB: Cigarette smoking: Surveys and a health education program in Winnepeg, Manitoba. Canadian J Pub Health, 1964, 55:16-22. 14. Sadler M: A pilot program in health education related to the hazards of cigarette smoking. Rhode Island Medical Journal, 1969, 52:36-38. 15. Evans RI, Rozelle RM, Mittelmark MB, et al: Deterring the onset of smoking in children: Knowledge of immediate physiological effects and coping with peer pressure, and parent modeling.
J Applied Social Psychology, 1978, 8:126-135. 16. Hurd PD, Johnson CA, Pehacek T, and Luepker RV: Prevention of cigarette smoking in seventh grade students. J of Behav Med, Vol 3, in press, 1980. 17. Perry CL, Killen JD, Slinkard LA, et al. Peer leadership to help adolescents resist pressures to smoke. Adolescence. (In press.) 18. McAlister A, Perry C, Killen J, et al: Pilot study of smoking, alcohol and drug abuse prevention. Am J Public Health, 1980, 70:718-720. 19. McFall, RM: Smoking-Cessation Research. J Consulting and Clin Psych, 1978, 46:703-712. 20. Vogt TM, Selvin S, Widdowson G, et al: Expired air carbon monoxide and serum thiocyanate as objective measures of cigarette exposure. Am J Public Health, 1977, 67:545-549. 21. Evans RI, Hansen WB and Mittelmark MB: Increasing the vitality of self-reports of behavior in a smoking in children investigation. J Applied Psych, 1978, 62:521-523. 22. Vogt TM, Selvin S, Billings JH: Smoking cessation program: Baseline carbon monoxide and serum thiocyanate levels as predictors of outcome. Am J Public Health, 1979, 69:1156-1159.
ACKNOWLEDGMENTS Special thanks are extended to Dr. John Krumboltz for his helpful comments on the manuscript.
Long-Term Outcome of Smoking Cessation Workshops DAVID EVANS, PHD,
AND
Abstract: Three hundred seventy-two (63 per cent) of 590 enrollees in nine smoking cessation workshops held over a five-year period responded to a follow-up survey. Outcome data were collected retrospectively for six-month intervals from workshop to follow-up. Forty nine per cent of all enrollees graduated, and 56 per cent of the respondents quit smoking during the program. Nonsmoking rates declined to an average of 25 per cent by the first year post-workshop and remained relatively stable thereafter for periods up to five years. (Am J Public Health 1980; 70:725-727.)
Introduction Many reports in the literature on smoking withdrawal Address reprint requests to Dr. Dorothy S. Lane, Chairman, Department of Community Medicine, Brookhaven Memorial Hospital, 101 Hospital Road, Patchogue, NY 11772. Dr. Lane is also Associate Professor of Community Medicine, School of Medicine, SUNY at Stony Brook; Dr. Evans is Research Associate at Brookhaven Hospital and Instructor of Clinical Community Medicine at SUNY. This paper, submitted to the Journal January 10, 1980, was revised and accepted for publication March 20, 1980. An earlier version was presented at the 106th Annual Meeting of the American Public Health Association in Los Angeles, October 1978.
AJPH July 1980, Vol. 70, No. 7
DOROTHY S. LANE, MD, MPH have sought to associate success in quitting with factors that the individual brings to the workshop. The principal findings have been that older smokers and males are more successful in quitting.'-8 Other characteristics associated with cessation have been reported, but not supported as consistently, including higher levels of education and being married,1'5' 9 a firm commitment to quit,2' 10 expectation of success," symptoms related to smoking,9 believing one's health is threatened by smoking,' 9 smoking fewer cigarettes,9' 12 having a nonsmoking spouse and the support of one's spouse.9 In addition, a review of 89 cessation clinics by Hunt and Bespalec showed a characteristic curve of relapse, with a rate of withdrawal declining to approximately 25 per cent after 12 months.'3 Several recent studies have provided long-term cessation rates over periods up to six years, with varying results.9' 14-16 This study presents long-term follow-up data from nine smoking cessation workshops held in a community hospital over a five-year period.
Setting and Methods Cessation workshops following the standard format of the American Lung Association and American Cancer Society were held every six months for a five-year period. Each workshop met six times over a three-week period, and com725
PUBLIC HEALTH BRIEFS TABLE 1-Percentage Non-Smokers by Workshop and Time Elapsed Respondents
Workshop
Fall 1977 Spring 1977 Fall 1976 Spring 1976 Fall 1975 Spring 1975 Fall 1974 Spring 1974 Spring 1973 All Workshops
Time Post-Workshop
N
%
46 30 33 59 41 32 48 35 48 372
71 71 73 80 75 59 70 41 48 63
Percentage Non-Smokers 54 40 61 59 66 53 52 60 52 56
44 30 42 36 42 41 35 40 35 38
37 27 30 29 29 31 21 34 23 29
23 33 27 22 25 19 29 23 25
EOW
3 mo
6 mo
1 yr
30 29 29 22 12 23 21 25 1.5
27 32 22 19 26 23 25 2
32 25 26 29 21 26
2.5
18 32 29 23 26
30 29 23 27
3
3.5
29 28 28
26 26
36 36
4
4.5
5 yr
Analysis of variance for each time period showed no significant differences in nonsmoking rates between workshops.
bined speakers, films, and group discussion led by a psychologist. Participants were educated about the effects of smoking on health and likely withdrawal symptoms. They were taught to identify and control environmental cues that stimulated them to smoke, and were taught techniques for coping with the urge to smoke. Group interaction and support were used to help people stop smoking completely, and the buddy system was used to provide support away from workshop sessions. Questionnaires were completed by enrollees at the first session, providing data on sociodemographic variables, smoking history, health beliefs, motives for enrolling, and commitment to quitting. A follow-up survey of all the workshops was conducted at one time, and a complete smoking history from the workshop to the follow-up was obtained from each respondent. Two waves of questionnaires and subsequent telephone calls were used to contact enrollees. Due to the considerable time lapses involved, we were able to locate only 65 per cent of the 590 people who participated in the workshops. Seven people had died and two refused to participate, so the 63 per cent (372) of the original enrollees responded to the follow-up survey. A majority of those who could not be contacted had moved away from the area. The data collected at the beginning of the workshop were explored for possible differences between respondents and non-respondents. There were no significant differences in demographic variables, including age, sex, occupation, and educational level, or in smoking habituation, health beliefs, reasons for enrolling, or smoking status at the end of the workshop. Non-respondents were significantly less likely, however, to have completed the workshop (46 per cent to 61 per cent for respondents: X2 = 10.65; p < .01). Since workshop dropouts were more likely to be smokers at follow-up, this may mean that non-respondents are more likely to be smokers. Estimates based on weighting for this factor indicate that the nonsmoking rate at follow-up would be decreased by 2 percent. Response rates also differed by workshop (see Table 1) primarily in that the two workshops with 726
the longest follow-up periods had response rates considerably lower than those of more recent workshops.
Findings and Discussion Forty-nine per cent (290) of the enrollees completed the workshop. Fifty-six per cent (209) of the respondents were nonsmokers at the end of the workshop, and 30 per cent (112) were nonsmokers at the point of follow-up. Nonsmoking rates are presented in Table 1 for each workshop at the end of the program, three months post-workshop, and subsequent six-month intervals up to the point of follow-up. The workshops all follow the pattern of rapid relapse during the first six months, but despite some fluctuation, there is no continued pattern of decline after one year post-workshop. The combined percentage of nonsmokers at each time interval declines to a low of 25 per cent from one to two years post-workshop. Participants who did not quit significantly decreased their daily cigarettes from 32 pre-workshop to 27 at the time of follow-up (t = 5.98; p < .001). Workshop graduates and dropouts differed significantly in cessation rates. Seventy-five per cent of the graduates and 30 per cent of the dropouts were nonsmokers at the end of the workshops (X2 = 62.02; p < .001). Thirty-eight per cent of the graduates were still nonsmokers six months post-workshop compared to 15 per cent of the dropouts (X2 = 20.60; p < .001). Finally, there was no significant association between nonsmoking rates and variables measured at enrollment, including sociodemographic factors, measures of habit strength, prior efforts to quit, health beliefs, or motives for enrolling. These findings must be interpreted with caution because of the inherent limitations of the retrospective nature of the study. There is potential for bias due to respondents' loss of recall over time of the dates of smoking status change, the influence of performance on reporting past events, and the poorer response rate and greater proportion of dropouts in earlier workshops. Tempered by these qualifications, the AJPH July 1980, Vol. 70, No. 7
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findings suggest that the nonsmoking rates achieved by oneyear post-workshop show good persistence over periods up to five years. Further prospective research in which program participants are followed at regular intervals is needed to more accurately determine long-term nonsmoking rates, patterns of smoking status change after the workshop, and factors that are related to long-term maintenance of nonsmoking.
REFERENCES 1. Delarue NC: The anti-smoking clinic: is it a potential community service? CMA Journal 1973; 108:1164-1193. 2. Guilford JS: Group treatment versus individual initiative in the cessation of smoking. J Applied Psychology 1972; 56:162-167. 3. Guilford JS: Factors related to successful abstinence from smoking: Final Report. Los Angeles: American Institute for Research, 1966. 4. Schwartz JL: A critical review and evaluation of smoking control methods. Pub Health Rep 1969; 84:483-506. 5. Schwartz JL and Dubitsky M: One year follow-up results of a smoking cessation program. Canadian J Public Health 1968; 59:161-165. 6. Graham S and Gibson RW: Cessation of patterned behavior: withdrawal from smoking. Soc Sci and Med 1971; 5:319-337. 7. Bosse R and Rose CL: Age and interpersonal factors in smoking
cessation, J Health & Soc Behavior 1973; 14:382-387. 8. Thompson EL: Smoking education programs, 1960-1976. Am J Public Health 1978; 68:250-257. 9. West DW, Graham S, et al: Five year follow-up of a smoking withdrawal clinic population. Am J Public Health 1977; 67:536544. 10. Nemzer DE: Results of four cigarette cessation clinics in Nassau and Suffolk Counties, American Lung Association of Nassau-Suffolk, New York, June 1973. 11. Schlegel RP and Kunetsky M: Immediate and delayed effects of the "Five Day Plan to Stop Smoking" including factors affecting recidivism. Prev Medi 1977; 6:454-461. 12. Pomerleau 0 and Adkins D, et al: Predictors of outcome and recidivism in smoking cessation treatment. Addictive Behaviors 1978;3:65-70. 13. Hunt WA and Bespalec DA: An evaluation of current methods of modifying smoking behavior. J Clin Psych 1974; 30:431-438. 14. Kanzler M, Joffe J and Zeidenberg P: Long and short-term effectiveness of a large scale proprietary smoking cessation program: A four year follow-up of Smokenders participants. J Clin Psych 1976; 32:661-669. 15. Lichtenstein E and Rodrigues MP: Long-term effects of rapid smoking treatment for dependent cigarette smokers. Addictive Behaviors 1977; 2:109-112. 16. Tongas PN: The long-term maintenance of nonsmoking behavior. NIDA Research Monograph No. 17, Research on Smoking Behavior: 355-363, 1977.
Preventing Tap Water Burns MARK S. BAPTISTE, MS, AND GERALD FECK, MPA
Abstract: Based on a 1974-1975 survey of hospital records in upstate New York, we estimate that 347 tap water burns will require inpatient treatment annually, with children and the elderly at increased risk. The number and severity of burns from tap water makes them an important prevention priority. Reducing the temperature of household hot water supplies could be a practical and effective prevention measure. (Am J Public Health 1980; 70:727-729.)
Introduction Many people are not aware that ordinary household tap water is the source of numerous burn injuries, many serious enough to require hospitalization. The U.S. Consumer ProdAddress reprint requests to Mark S. Baptiste, MS, Research Scientist, Division of Epidemiology, New York State Department of Health, Empire State Plaza, Tower Building, Albany, NY 12237. Mr. Feck is Director, Injury Control Program, NYSDH, Albany. This paper, submitted to the Journal December 10, 1979, was revised and accepted for publication April 8, 1980.
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uct Safety Commission (CPSC) recently estimated that 2,600 tap water scalds are treated in this country's emergency rooms annually. ' This problem has been addressed in a petition to CPSC to regulate household water temperatures.2 This presentation describes the use of data from upstate New York to quantify and describe the tap water burn problem as a basis for prevention planning.
Methods The methods of the New York burn survey have been described in detail in other papers.3 4 Briefly, the inpatient records of all persons hospitalized for at least one day for burns in upstate New York (all New York State except New York City) in 1974 and 1975 were collected and reviewed. Records were carefully screened to eliminate readmissions so the data set consists exclusively of patients with new burns hospitalized for the first time during the study period. From this population, the subset of tap water burns was identified and analyzed. City directories were used in an attempt to determine the distribution of tap water burns in single unit vs multi-unit dwellings.
Results Of 1,656 persons hospitalized for hot liquid burns in 727
