Peer Review Committee on National Smoking Cessation Programs (USA)
Standards for the Evaluation of Group Smoking Cessation Programs
These are standards specifically for evaluation of program outcomes. They are not intended to serve as a guide to collection of data for other kinds of research or for more sophisticated and discriminated evaluation. Guidelines for Research on the Effectiveness of Smoking Cessation Programs, issued by the National Interagency Council on Smoking and Health is recommended for that purpose.
What these standards will provide, it is hoped, is some basis for avoiding confusion about what an organization’s claimed rate of success means and how it relates to the rates of other programs.
Therefore, it was agreed by those involved in the preparation of these standards that, even at the possible cost of foregoing opportunities to collect additional data that may someday have great value, simplicity should be strictly
The organizations listed below have agreed to conduct and report their program evaluation in accordance with these standards.
American Cancer Society
American Health Foundation
American Heart Association
American Lung Association
Five–Day Plan to Stop Smoking
Definitions and Measurement of Success
In order to evaluate group smoking cessation methodology and compare the result of one program with another, the criteria of success, the way program participants are accounted for, the follow–up period and the manner of reporting results must be uniform. The following are standard definitions.
Smoker – Anyone who smokes tobacco in any form.
Participant – Tobacco smoker who attends at least the first treatment session following orientation.
In-Term Quitter – Any participant who has completed the program and stopped smoking by the end of the program.
Dropout – Participant who did not complete the program.
Attrition Rate – Number of dropouts divided by number of participants.
Quitter (long-term) – In-Term Quitter who has not resumed smoking for at least one year after completion of the program.
Recidivist – Participant who stopped smoking by the end of the program but resumed smoking during the ensuing 12–month period.
Measurement of “Success”
The standard definition of success in smoking cessation programs is complete
abstention from smoking tobacco in any form for at least one year after completion of the program.
If other aspects of program impact are also reported, such as complete abstention for less than a year, switching to pipes or cigars, switching from high tar/nicotine, decreasing the number of cigarettes smoked, the criteria used must be clearly stated in the reporting of results and the term “success” should not be employed in connection with them.
A clear evaluation statement must contain:
The number of participants.
The number and/or percentage of participants who stopped smoking at the end of the program.
The number and/or percentage of participants completing the program who had not resumed smoking by the end of one year. (Organizations wishing to state the number or percentage of participants entering the program who had quit and not resumed smoking by the end of one year may do so.)
Collection of Data
Minimum Information Required
Each case–record should contain identifying information needed for follow-up purposes.
It should also state the beginning and ending dates of the program in which the participant was enrolled and records his/her attendance.
Finally, it should record smoking status at the program’s beginning and end and at the point of one-year follow-up.
At a minimum, the individual’s name, address and telephone number should be recorded. It is also useful for follow-up purposes to record employment address and telephone number.
Tobacco Use at Baseline and Follow-Up
Whether the participants smoke tobacco in any form should be recorded at the program’s beginning and end and at one-year follow-up. At the latter points whether the participant has smoked during the past year should also be reported.
The date of the first session following orientation and the last sessions of the program and the participant’s attendance at each are essential to record.
Timing and Methods of Data Collection
Identifying information should be collected prior to the first session as a part of the registration procedure so as to ensure the inclusion of all participants. If registration and the first session take place at the same meeting, it is important to allow enough time to collect the data before the session begins.
End of Program Data
To determine the in-term results of the program, data on the participant’s smoking status should be collected at the program’s conclusion. If he/she is not smoking at that point, he/she can be considered an In-Term Quitter. All persons who entered the program should be accounted for at the time and classified as in-term quitters, drop-outs, or smokers.
The one-year Follow-Up of In-Term Quitters is by far the most important measuring point and the basis for calculating rates of program success.
Follow-up data may be obtained either by mailed questionnaires or by telephone interviews. Telephone interviewers should receive specific training for this function.
It is essential to reach as many interim quitters as possible. Those not reached must be counted as smokers, as assumption amply warranted by the experience of numerous studies.
Defining and Accounting for All Participants.
A participant has been defined as a smoker who enters a program and attends at least the first treatment session following orientation. All participants should be accounted for in, the evaluation. Individuals who were nonsmokers or ex-smokers at the time of entering the program should be excluded from the analysis, even though they may have registered and attended one or more sessions.
Status of Participants at End of Program
At or shortly after the program’s conclusion, all participants who have completed the program should be asked whether they are still smoking. Those who report that they have stopped may be considered in-term quitters. Those about whom no information can be obtained must be listed with those still smoking in the denominator to calculate the in–term quit rate of the program.
Accounting for Participants at Program Conclusion and One-Year Follow-Up
All who registered for the program can be divided into categories.
a. Registered for program.
b. Registered, non-smoker or ex-smoker at program start.
c. Registered, but did not attend any sessions.
Participant (P) = a − (b + c)
d. Dropped out during program.
e. Still smoking at conclusion of program.
f. Quit smoking by conclusion of program.
In-Term Quit Rate = f ÷ p
Attrition Rate = (d + p) ÷ p
g. Completed program, has not smoked during one-year follow-up period.
h. Completed program, returned to smoking (regularly or intermittently) during follow up period.
i. Completed program, refused to respond.
j. Completed program, not located for follow–up.
k. Completed program, died during follow–up period.
Long Term Quit Rate = g ÷ (f − k)
[f = g + h + i + j]
Overall Success Rate = g ÷ p
Sample Size and Randomization
Programs that do not base in-term or long-term quit rates on their total population should collect and report data on no fewer than 500 participants annually.
These should be all individuals entering the program starting at any given point in time and continuing until the total of 500 (or some larger number) has been included.
Programs may wish to collect additional data for various purposes. At a minimum, however, the following questions should be asked:
At Program Completion:
At One–Year Follow–Up:
Do you currently smoke cigarettes?
How many cigarettes have you smoked in the last twelve months?
When did you last smoke a cigarette?
Do you now smoke cigars or a pipe?