Effectiveness of a smoking-cessation intervention and comprehensive environmental changes: A new but classical experience from Japan

Male smoking prevalence is considerably high in many Asian countries including Japan, but there have been few reports on effectiveness of smoking cessation measures. In this article, we examined the following four fundamental questions that public health professionals often face; 1) To what extent do smokers quit smoking? In many situations, we encourage smokers to quit smoking regardless of their intention to quit. In one of these situations, we implemented a smoking-cessation intervention in a workplace setting (263 male smokers, smoking prevalence: 62.9%) in a cross-over design, and ascertained that the cessation rate was 12.9% and 3.1% in the intervention and control groups, respectively. 2) To what extent do smokers maintain their cessation of smoking after having quit for more than four weeks? Many smokers successfully quit smoking, but later relapse. After our cross-over intervention study was completed, we then observed all ex-smokers who quit smoking at least once for more than four weeks, and ascertained that no relapse occurred after three years had passed since cessation and that 45% of them continued smoking cessation. 3) Is a small-scale intervention effective in reducing smoking prevalence? In smoking cessation programs, we are usually able to reach only a small portion of smokers, and most of them voluntarily participate in the program. We ascertained that small-scale annual interventions for smoking cessation repeated for ten years yielded lower smoking prevalence than doing no intervention at all. 4) Are comprehensive environmental changes as effective as direct intervention? It is usually hard to compare these two measures, because environmental changes affect all smokers, making concurrent comparison impossible. Smokers in Japan have experienced environmental changes since 2002, such as a price increase and implementation of laws. In the occupational setting described above, indoor smoking was banned in 2003. We compared the smoking abstinence rate in the intervention period and during the period of comprehensive environmental changes. We ascertained that the smoking abstinence rate was 8.9% and 7.1% in the periods of intervention and environmental changes, respectively, and revealed that comprehensive environmental changes are fairly effective in promoting smoking cessation.