MOBILE SMOKING CESSATION SERVICES (MSCS) TO ACHIEVE

SMOKEFREE WORKPLACESZaswiza MN*, M Haniki NM*, M Aznan MA**, Samsul D**, S Halimah Bux*, N Syafinaz AR*.

* KULLIYYAH OF PHARMACY, INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA, PAHANG.** KULLIYYAH OF MEDICINE, INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA, PAHANG.

BackgroundBackgroundSmoking Cessation Programmes:Remain one of the main agenda.It was common when smokers reported quitting ‘own their own’ through self-help, either by ‘cold turkey’ or gradually cutting down the number of cigarettes smoked (Rantucci, 2002).Assistance of cessation programs and pharmacotherapy, increase quit rates more than 20%. Interventions for 6 to 12 weeks of individual or group counselling usually more successful than self-help (Rantucci, 2002).

QUIT SMOKING CLINICS

MEDIA

-Most adults spend about Most adults spend about a third a third of their day in a workplace of their day in a workplace environment.environment. The workplace is The workplace is therefore the best setting to therefore the best setting to provide health promotion such provide health promotion such as quit smoking programme as quit smoking programme (Gruman, 1993).(Gruman, 1993).

- There are several advantages - There are several advantages to choose workplaces for to choose workplaces for smoking cessation program smoking cessation program such as such as provides access to a provides access to a large number of peoplelarge number of people who who make up a relatively stable make up a relatively stable population, population, potential for getting potential for getting higher participantshigher participants and may and may encourage sustained peer group encourage sustained peer group support and positive peer support and positive peer pressure pressure (The Cochrane (The Cochrane Collaboration, 2008).Collaboration, 2008).

WORKPLACES INTERVENTION:

Workplaces intervention:

workplace intervention workplace intervention can contribute to public can contribute to public health by reducing the health by reducing the prevalence of smoking in prevalence of smoking in society.society.

We established a mobile We established a mobile smoking cessation smoking cessation service (MSCS) to reach service (MSCS) to reach smokers at workplaces. smokers at workplaces. With difficulties in getting With difficulties in getting smokers to attend quit smokers to attend quit smoking clinics in smoking clinics in Malaysia, the existence Malaysia, the existence of such service is vital. of such service is vital.

To our knowledge, this is To our knowledge, this is the first mobile smoking the first mobile smoking cessation service ever cessation service ever established in Malaysia.established in Malaysia.

OBJECTIVES OF STUDYOBJECTIVES OF STUDY-To assist and provide psychosocial support to smokers intended to quit smoking and to provide pharmacotherapy whenever necessary.

INTRODUCTIONINTRODUCTION-Recruitment from November 2007 until September 2008.-Last follow-up at week 24 (the last groups) was on April 2009.-Team = > consisted of four pharmacists and two family medicine specialists. -Target => smokers aged 18 to 60 years old.

The flow of mobile smoking cessation programmeBaseline:

Recruitment-Motivational talks-Screening (inclusion and exclusion criteria)-Baseline tests (CO, PEFR, modified FTND)-Demographic and smoking history data

Motivational talk and counsellin

g at baseline

Screening and baseline tests

Self-administered demographic and smoking history

data

Booklets : record daily no.

of cigarettes smoked and withdrawal

(1)

RANDOMIZATION:

RANDOMIZED DOUBLE BLIND PLACEBO CONTROL TRIAL

2 GROUPS :

PHARMACOTHERAPY VS. PLACEBO

n = 75 n = 72

(2)

(3) FOLLOW-UP : WEEK 2

(4) FOLLOW-UP : WEEK 4

“QUIT DATE”

-Smoking status-ADR

(5) FOLLOW-UP WEEK 12

OR

Face-to –face interview / counselling

PlusCO test ( in addition to self-reported smoking status)

Telephone interview / counselling

NO CO test (self-reported

smoking status)

(6) Final follow-up week 24 (6 Months)(6) Final follow-up week 24 (6 Months)-Validation of self-reported abstinence :CO test and detection of cotinine in urine and/or saliva samples.- Booklet returned: withdrawal and daily cigarettes smoked, if any.

Taking and preparing urine and saliva samplesDetection

of cotinine in saliva using Saliva NicAlert® dipstick. CO test in

addition to cotinine detection tests using PiCO + smokerlyzer.

Detection of

cotinine in urine samples : HPLC –

UV analysis

.

RESULT

Enrolment and follow-up:

14

201 (attended programmes),4 (personal interviews) = TOTAL (205)

Met inclusion criteria and enrol (n=155)

Eligible , but chose not to enrol (n=50)

Randomised to group

Placebo + counselling (n=78)Viva QS® + counselling (n=77)

Wk 2: F/up (n=73)Missed F/up (3), w/drew (1)

a

Wk 2: F/up (n=71)Missed F/up (7)

Wk 12: F/up (n=73)Missed F/up (3)

Wk 4: F/up (n=73)Missed F/up (3)

Wk 4: F/up (n=67)Missed F/up (8), Drop outs

(3) b

Wk 24: F/up (n=73)Missed F/up (3) c

Wk 24: F/up (n=68)Missed F/up (7) c

Wk 12: F/up (n=67)Missed F/up (8)

Completion of study:

Viva QS® (N=75)

Placebo(N=72)

Notes: a One (1) subject withdrew

from study (not ready to quit).

b Three (3)* from placebo group were drop outs (n = 3).

c Three (3) subjects from placebo group and one (1) from Viva QS® group were excluded from final analysis because lost to follow-up from the beginning of study.

* Refused to take study medication.

CHARACTERISTICS OF SMOKERS AT BASELINECharacteristics n (%) *

Age (years) 18-30 52 (35.4) 31-45 71 (48.3) 46-60 24 (16.3)Race Malay 145 (98.6) Others 2 (1.4)

Marital status b

Married 125 (86.8) Never married or divorced

19 (13.2)

Education Secondary school 42 (28.6) Certificate 20 (13.6) Degree/ Diploma 85 (57.8)

b n = 144. Three (3) subjects with missing data.* Total n = 147

Characteristics n (%) Age begin smoking (years), n (%) 10-15 41 (27.9) 16-20 87 (59.2) 21-40 19 (12.9)Current tobacco use (No. of cigarette smoked per day), n (%) 1-10 sticks 35 (23.8) 11-20 sticks 91 (61.9) > 20 sticks 21 (14.3)

Mean (SD)Carbon monoxide (CO) level (ppm)

11.50 (4.564)

Modified Fagerstrom test score for nicotine dependence (FTND) a

5.03 (1.394)

CHARACTERISTICS OF SMOKING HISTORY AT BASELINE

a The FTND is a validated 6-items instrument to measure the level of dependence to nicotine. The total score range is 0 to 10, with ≥6 indicating high dependence.

7-days prevalence abstinence 7-days prevalence abstinence at week 24at week 24

QUITTERS , n(%)

SMOKERS, n(%)

P Value (Pearson Chi-

square)

OR (95% CI)

33 (22.4) 114 (77.6) 0.015 * 2.74 (1.20-6.28)Viva QS

Placebo

Viva QS

Placebo

23 (30.7)

10 (13.9)

52 (69.3)

62 (86.1)

* P < o.o5

7-days prevalence abstinence 7-days prevalence abstinence at week 4 and week 12at week 4 and week 12

QUITTERS, n(%)

SMOKERS, n(%)

P Value (Pearson Chi-

square)

OR (95% CI)

Week 451 (34.7) 96 (65.3) 0.038 * 2.08 (1.04-

4.16)Viva QS

Placebo

Viva QS

Placebo

32 (42.7)

19 (26.2)

43 (57.3)

53 (73.6)

Week 1236 (24.5) 111 (75.5) 0.031* 2.35 (1.07-

5.17)Viva QS

Placebo

Viva QS

Placebo

24 (32.0)

12 (16.7)

51 (68.0)

60 (83.3)

* P < 0.05

1. MSCS can be suggested as an acceptable new method for the hard to reach population.

2. This method can be developed and established more as it is convenient for many smokers who could not leave their workplaces to seek help from common quit smoking clinics available at present in Malaysia.

3. Combination of MSCS and pharmacotherapy would increase the quit rates.

4. Effectiveness of such program can be expanded to other possible settings such as schools and rural area by targeting adolescent and elderly smokers in the future.