The specific aims of this study are to ascertain differences in smoking cessation rates and costs per quitter among worksites that are randomized to either a smoking cessation intervention delivered by paid external staff or the same smoking cessation intervention delivered through community organization strategies. Forty-five worksites, employing 100 to 250 employees with high rates of smoking prevalence, will be randomized to one of the two intervention conditions or a control condition. A 20-month intervention period will be preceded in the intervention arms and followed in all arms by brief surveys on employee smoking patterns. The detrimental effects of smoking are well documented and there is significant evidence that smoking cessation greatly reduces the health consequences of smoking. One venue for smoking cessation has been the worksite, especially worksites that employ large numbers of smoking workers. Worksite smoking cessation interventions have achieved some success, especially those that include multiple components directed at both individual and environmental change. Many researchers have call for the inclusion of community organization strategies in worksite health promotion change programs. While the community organization approach is very appealing on a theoretical level, little evidence exists that such an approach is more or less effective than interventions not utilizing community organization strategies. Further, it is not obvious nor are there any data available to support assertions, that any additional effectiveness of such an approach is cost-effective, given the resources that must go into organizing a worksite. The extra resources and expenditures required for the community organization aspects of behavioral change programs may not result in justifiably large differences in behavior change. To ascertain the relative worksite-wide effectiveness and cost effectiveness of a smoking cessation intervention delivered by external staff or an intervention delivered through community organization strategies, worksites will be randomly allocated into one of these two arms. In addition, a control arm will ascertain the secular trend. Pilot work on intervention elements has been substantial and produced good employee response and high cessation rates. A process for recruiting worksites to participate in such a project has been developed and piloted. Pilot work has been conducted on the feasibility of implementing the intervention through community organization strategies. The study will be conducted in three waves to increase manageability and to reduce the human resource burden. The two primary endpoints of the project are: smoking cessation rates in the two intervention arms of the study; and costs associated with smoking cessation interventions. A control arm will be used to assess the secular trend in cessation rates. Smoking status will be assessed at baseline and at the end of the study, with procedures to follow employees who leave the worksite and to add new employees to the study.
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