If you're trying to give your smoking cessation efforts some real bite, you might try to convince upper management to impose a smoking ban at your worksite.

Smoking bans imposed by industries and employers not only clear the air in the workplace, they help employees break the smoking habit altogether, a national study found.

Hospital workers reported significantly higher quit rates and greater progress toward stopping smoking than did members of comparison groups within their community, according to the study, reported in "Advances," the national newsletter of The Robert Wood Johnson Foundation, which funded the work. The study specifically focused on the hospital industry, which has made pioneering efforts in the area of smoking cessation: The Joint Commission on Accreditation of Healthcare Organizations, which regulates approximately 80 percent of hospitals, ordered its member organizations to be smoke-free by Dec. 31, 1993, but many sites have been under smoking bans for longer than that.

Yet, hospital employees smoke at rates equivalent to those found in the general population.

"In fact, 23 percent of nurses, the largest single category of hospital employees, are smokers, compared with 23.5 percent of the general female population and 25 percent of the general population," researchers noted.

But not for long, apparently. Hospital employees have made greater progress in reducing consumption of cigarettes or quitting altogether, the survey found.

Results are affected, however, by other steps that frequently accompany smoking bans, the researchers noted. For example, 85 percent of the hospitals in the study provide smoking cessation assistance to their employees as part of their no-smoking efforts.

Researchers argue that a comprehensive approach to tobacco control must address the "issue of workplace socialization, which contributes to habitual behaviors and addiction." They also said their findings indicate that "environmental interventions may facilitate change in individual behavior."

Behavior modification is particularly important for individuals addicted to the act of smoking.

"Smokers who can quit for a month or two are not addicted to nicotine; they are addicted to smoking," explained Craig Boisvert, D.O., an associate professor of family medicine at the West Virginia School of Osteopathic Medicine, Lewisburg. "These smokers cannot tolerate quitting for long because they cannot break the habit of smoking and the behavior that is associated with it, such as smoking after meals."

Desire To Quit of Utmost Importance

Moreover, smoking cessation efforts won't be successful unless the individual really wants to quit, and few actually do, according to "The DO."

"Smokers may say they want to quit, but what they actually mean is that they have occasional moments of ambivalence about smoking. And smokers know that other people want to hear them say that they are quitting," said Frank W. Meyers, D.O., former dean of the Ohio University College of Osteopathic Medicine, Athens.

Many smokers will not quit until they feel that the risks of smoking outweigh the perceived benefits.

"Most smokers see a benefit from smoking," explained Boisvert. "Some people say that smoking calms them down. Others say that it keeps weight off. They all have excuses that they see as benefits of smoking."

Ensuring that primary care physicians ask their smoking patients to quit can be extremely successful. Boisvert cited several studies that found brief discussions with patients on the health risks of smoking significantly increased the chances of patients quitting successfully. However, just one-third of smokers say their doctors encourage them to stop smoking, American Cancer Society statistics show.

Once smokers decide to quit, support from their physician, family and friends is important.

"Most people who successfully stop smoking get positive reinforcement from their families and their physicians," said Boisvert. "Whenever I see patients who have stopped smoking, I congratulate them, and I point out some of the benefits they have gained by stopping."

Addresses: The Robert Wood Johnson Foundation, P.O. Box 2316, Princeton, NJ 08543-2316. American Osteopathic Association, 142 E. Ontario Street, Chicago, IL 60611; (312) 280-5854.