摘要：Objectives. This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. Methods. Twenty-four worksites were randomized to 6 conditions that differed in cessation program format and the use of incentives. Programs were offered for 18 months in each worksite. A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation. Results. A total of 407 (16.9%) of the smoker cohort registered for programs; on the 12- and 24-month surveys, 15.4% and 19.4% of the cohort, respectively, reported that they had not smoked in the previous 7 days. Registration for programs in incentive sites was almost double that of no-incentive sites (22.4% vs 11.9%), but increased registration did not translate into significantly greater cessation rates. Program type did not affect registration or cessation rates. Conclusions. Although incentives increase rates of registration in worksite smoking cessation programs, they do not appear to increase cessation rates. Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites. One of the weakest links in public health efforts to reduce smoking rates has been an inability to engage large numbers of smokers in intervention programs. Smokers are generally aware of the health risks of tobacco use, 1 and most express a desire to quit. 2 Only a small percentage do so in any given year, however, and very few use formal cessation programs that clearly increase the likelihood of success. 3 A prior study by this investigative group illustrates the problem. This research found that offering free group smoking cessation programs in worksites over a period of 24 months significantly increased cessation rates. 4 Moreover, there was a significant dose–response relationship between participation in cessation programs and outcomes; worksites with higher rates of participation had higher rates of cessation. Unfortunately, however, overall participation rates were low (12% of smokers in 24 months) so that the potential benefits of the free cessation programs were not maximized. This finding suggests that if methods could be found to induce more smokers to participate in cessation programs, much larger benefits might be realized. One approach to increasing participation in cessation programs is to offer incentives such as monetary payments, 5 competitions, 6 lotteries, 7 and tangible prizes like T-shirts. 8 Research suggests that such incentives may increase participation. 9– 13 Their effect on cessation is less clear, however, because studies have typically examined cessation rates only among program participants rather than among eligible smokers. Another method for increasing participation in smoking cessation programs is to make them more accessible and attractive to smokers. Most smokers who try to quit “prefer” do-it-yourself methods over formal cessation programs. 14, 15 It has thus been argued that programs that entail less time should attract more smokers. 16, 17 The present report describes the results of the SUCCESS study, a randomized trial that evaluated different approaches to increasing the participation of smokers in cessation programs and the effect of increased participation rates on cessation. Twenty-four worksites in the Minneapolis–St. Paul, Minn, metropolitan area were randomized to 1 of 6 experimental conditions in a 2 × 3 factorial design. Two levels of incentives for participation in smoking cessation programs (incentives vs no incentives) were crossed with 3 types of program offerings (group programs, phone counseling programs, and a choice of group programs or phone counseling programs). The principal study hypotheses were (1) that providing incentives for participation and cessation would increase rates of participation in programs and thereby lead to higher rates of cessation and (2) that offering smoking programs that are more convenient or flexible with regard to study participants' program preferences (i.e., phone counseling programs or choice between phone counseling and group programs) would attract larger numbers of smokers than group programs alone, thereby increasing overall cessation rates.
