The first nation-wide Quit and Win Contest in Sweden was held in 1988 with 12,840 participants. This corresponds to a participant rate of 6.4 per 1,000 daily tobacco users in Sweden. In order to follow up the long-term effects of cessation and to analyse the determinants for successful cessation, a panel (n = 946) of randomized participants were followed-up at 6 and 12 months with a mailed questionnaire. This gave a complete set of data for 557 (panel) respondents. Available baseline data from the participants' entry forms included sex, age, occupation, specific tobacco habits, quitting attempts during the previous year, and place of residence. At the 12-month follow-up 21% had been tobacco-free for the whole year. In addition 9% of the participants relapsed into tobacco-use, then quit again and were tobacco-free at the 12-month follow-up. The success rate for those participants (14%) who used smokeless tobacco (oral snuff) was similar to that of smokers. The logistic regression showed a significantly better prognosis for success among those without any earlier quitting attempts during the previous year (OR 2.35), if the subjects participated of their own volition rather than having been recruited by a non-tobacco user (OR 1.74), and if they were married/co-habiting (OR 1.92), the results were also significantly improved. The results also show that as a population-based method, Quit and Win produced many successful tobacco quitters, and one year after the contest one-fifth of the participants were still abstinent.

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In most questionnaire studies there are some subjects who do not respond, and the response rate is viewed as an indicator representative of the sample population (1). The critical issue is how the results should be interpreted because of non-response bias. In a comprehensive review of characteristics of respondents and non-respondents in medical surveys, it has been found that current smoking is associated with non-response (2), a connection that is recurrent in different types of surveys (3-6). There are recommendations that non-respondents should be classified as smokers (7). A great number of smoking cessation methods have been developed over the years (8). Abrams has described various types by their level of intervention: minimum, moderate, and intensive intervention (9). Minimum intervention comprises self-help material and other types of support. Moderate intervention comprises self-help material with access to brief advice and support from, for example, healthcare personnel. Intensive intervention comprises treatment at smoking cessation clinics with specially trained personnel.One example of a minimum intervention method for aiding tobacco-users to quit is the &dquo;Quit and Win&dquo;contest, a method based on a number of different theories and models, such as self-efficacy, locus of control, stages-of-change, and persuasion (10). The contest was first introduced in the Nordic countries, in 1985 in Finland and in 1988 in Sweden. During the 1990s the method has been diffused rapidly and applied worldwide in several countries by the WHO's Cindy Program (11).In this study, which is based on a one-year followup of participants from a national &dquo;Quit and Win&dquo; contest in Sweden in 1994 (12), we studied the bias in smoking prevalence because of the non-response. The participants in this contest were recruited mainly via mass-media efforts and at the workplace and had to remain tobacco-free for four weeks. The participants signed up for the contest by sending in a registration form.The statistical analysis has been completed, based on three approaches to assess the non-response bias: in the first approach, a univariate analysis, the participants were studied based on their response behavior and socio-demographic factors along with tobacco habits. The second approach, also a univariate analysis, was carried out to study the extent to which the participants had remained tobacco-free, and compared respondents who returned questionnaires after the initial request with those who responded after the first or second reminder letter, or who were interviewed by telephone at a later date. Finally, the third approach dealt with the rate of tobacco-free persons, and involved a comparison between the participants who responded to the questionnaire and those who were interviewed by telephone.The significance of non-response on the rate of tobacco-free individuals during a twelve-month period has been estimated through various assumptions. A pre-and post-test design using data from the participants entry forms and twel...

To explore the impact of various steps when introducing a smoking ban at the Karolinska Hospital (1000 beds; 6000 employees) in Stockholm, Sweden, a multiple evaluation strategy was performed over 5 years. All heads of clinical departments (N = 41) and a random sample of employees (n = 517) and a convenience sample of hospital labour managers (n = 17) were separately addressed through questionnaire surveys at different time intervals after the introduction of the ban in 1992. An observational and interview study completed the follow-up. The implementation process was supplemented by a comprehensive information strategy over 5 years. The two most important steps during implementation were management support and focus on environmental tobacco. The ban was well known at introduction. Heads of clinical departments reported a third of staff to be satisfied with the restrictions. In contrast, the staff survey revealed 62% to be positive. A shift in favour of a radical tobacco-free hospital was perceived during follow-up. Co-operation between hospital board, heads of clinical departments and local labour managers proved successful. The consecutive evaluations served as tools in labour management and contributed to staff compliance. A total ban, including the selling of tobacco and smoking in the hospital grounds is still to be achieved.

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