Results of a smoking Results of a smoking cessation intervention cessation intervention
programme in the programme in the workplace: lessons learntworkplace: lessons learnt
Dr. Timea TOTHDr. Timea TOTH
Ruzsas E, Biro B, Olajos A, Nikl A, Jelencsics ZsRuzsas E, Biro B, Olajos A, Nikl A, Jelencsics Zs
Medicina Occupational Health Care Service, Medicina Occupational Health Care Service, Budapest, HungaryBudapest, Hungary
Hungary in EuropeHungary in Europe
Facts about HungaryFacts about Hungary Population: 10MPopulation: 10M Surface: 93 000 mSurface: 93 000 m22
Capital city: BudapestCapital city: Budapest Science: 13 Nobel prize Science: 13 Nobel prize
winnerswinners Gastronomy: goulash, chicken Gastronomy: goulash, chicken
paprika, stuffed cabbagespaprika, stuffed cabbages Music: Franz Liszt, BartokMusic: Franz Liszt, Bartok Sport: Puskas, 17 Olympic Sport: Puskas, 17 Olympic
medals/10M inhabitants (3. medals/10M inhabitants (3. highest in the world in 2000 highest in the world in 2000 and 2004)and 2004)
Politics: Politics: 1989-transition to market 1989-transition to market
economyeconomy 1 May 2004 - EU accession1 May 2004 - EU accession
Smoking prevalence: 35%Smoking prevalence: 35%
IntroductionIntroduction
Facts:Facts: Smoking is the lSmoking is the largest cause of argest cause of preventable mortality and morbidity preventable mortality and morbidity Action is neededAction is needed Evidence-based interventionsEvidence-based interventions
Cochrane review -2007Cochrane review -2007Strong evidence: Interventions directed towards individualStrong evidence: Interventions directed towards individual
smokers increase the likelihood of quitting smokingsmokers increase the likelihood of quitting smokingThis includes: This includes:
advice from a health professional advice from a health professional individual and group counselling individual and group counselling pharmacological treatment to overcome nicotine addictionpharmacological treatment to overcome nicotine addiction
Advice from a health Advice from a health professionalprofessional
The essential features of individual smoking The essential features of individual smoking cessation advice are: cessation advice are: AAsk (about smoking at every opportunity) sk (about smoking at every opportunity) AAdvise (all smokers to stop) dvise (all smokers to stop) AAssist (the smoker to stop) ssist (the smoker to stop) AArrange (the follow up) rrange (the follow up)
Design the intervention at the OHS (4th Design the intervention at the OHS (4th largest in Hungary)largest in Hungary)
ParticipantsParticipants
As part of a general screening As part of a general screening programme 912 employees programme 912 employees examinedexamined
Employed by 4 different companies Employed by 4 different companies of similar profileof similar profile
18 to 65 years old18 to 65 years old48% male, 52% female48% male, 52% female80% physical worker80% physical worker
ParticipantsParticipants
29% identified as 29% identified as smokers bysmokers by self reporting self reporting
(Fagerstrom test) (Fagerstrom test) andand
Carbon-monoxide Carbon-monoxide (CO) level in breath(CO) level in breath
Nicotine Nicotine dependence level dependence level was not associated was not associated with agewith age
Level of dependence among smokers
moderate34%
high42%
low24%
Design and settingDesign and setting
All smokers were offered:All smokers were offered:A series of one-to-one or group behavioural A series of one-to-one or group behavioural
interventiones with a trained OH adviser interventiones with a trained OH adviser Pharmacological treatment adjusted to Pharmacological treatment adjusted to
health condition, level of dependence and health condition, level of dependence and personal choice of the smoker (previous personal choice of the smoker (previous experience, cost, etc.)experience, cost, etc.)
2 of 4 employers offered to sponsor the 2 of 4 employers offered to sponsor the cost of the pharmacological treatmentcost of the pharmacological treatment
Person-to-person contactPerson-to-person contact
Based on personal preference:Based on personal preference: by individualby individual group group proactive telephone counseling proactive telephone counseling
In the first 3 month every 2 weeks than at 6 monthIn the first 3 month every 2 weeks than at 6 month Methods:Methods:
Set a date to stop completely Set a date to stop completely Review past experience and what helped Review past experience and what helped Concente on the positive consequences of quiting smoking and Concente on the positive consequences of quiting smoking and
remember them when temptedremember them when tempted Identify possible problems and how to cope with them Identify possible problems and how to cope with them Enlist the help of family and friendsEnlist the help of family and friends
Pharmacological treatment Pharmacological treatment
first-line pharmacotherapies were first-line pharmacotherapies were offered that were identified reliably offered that were identified reliably increase long-term abstinence rates: increase long-term abstinence rates: nicotine gum and transdermal system nicotine gum and transdermal system
patchespatches varenicline - a partial agonist for the varenicline - a partial agonist for the
nicotinic acetylcholine receptornicotinic acetylcholine receptor
ResultsResults
self-paid ; 49,8
sponsored by the employer; 70,6
0
10
20
30
40
50
60
70
80
partcipant rate %
Comparison of participant rates Comparison of participant rates
self-self-paidpaid
Sponsored by Sponsored by the employerthe employer
Difference (CI 95%)Difference (CI 95%) Odds ratio (CI Odds ratio (CI 95%)95%)
P valueP value
49,8 %49,8 % 70,6 %70,6 % 20,8 % (15,4%-20,8 % (15,4%-26,2%)26,2%)
2,47 (1,95-3,15) 2,47 (1,95-3,15) P<0,0001P<0,0001
ResultsResults
At 6 monthAt 6 month 33% of the 33% of the
participants participants non smokersnon smokers
(significantly (significantly reduced CO reduced CO levels, levels, p=0.04)p=0.04)
3%
5%
25% 67%
not smoked at all
relapsed and quit again
occasionally<5
smokers
ResultsResults
By filling a questionnaire 62% reported By filling a questionnaire 62% reported that the regular face-to-face contacts were that the regular face-to-face contacts were usefuluseful
44% reported that pharmaceutical 44% reported that pharmaceutical treatment reduced the severity of their treatment reduced the severity of their withdrawal symptomswithdrawal symptoms
the quit rate in the pharmacological the quit rate in the pharmacological treatment+behavioral intervention treatment+behavioral intervention subgroup was double compared to the subgroup was double compared to the bahavioral therapy only (p<0,001)bahavioral therapy only (p<0,001)
Lessons learntLessons learnt
In middle-income contries like In middle-income contries like Hungary participation rates Hungary participation rates are significantly higher when are significantly higher when employers play an active partemployers play an active part
Convincing the employersConvincing the employers DDiseases from tobacco iseases from tobacco result in result in
decrease of productivity, increase of decrease of productivity, increase of sick-days and loss of active life yearssick-days and loss of active life years
Lessons learntLessons learnt
Smoking cessation methodology has to be Smoking cessation methodology has to be adjusted to the individual caracteristics and adjusted to the individual caracteristics and needsneeds
Adding pharmacological treatment to behavioral Adding pharmacological treatment to behavioral intervention doubles the quit rate intervention doubles the quit rate
The attitude of the health care professionals has The attitude of the health care professionals has to be very supportive and positive (pressure and to be very supportive and positive (pressure and frightening are less effective)frightening are less effective)
ConclusionConclusion
Occupational health care professionals -Occupational health care professionals -because of the extent and ease of access because of the extent and ease of access to smokers- have a vital role in helping to smokers- have a vital role in helping
smokers to stop.smokers to stop.
Thank you for your Thank you for your attention!attention!
Top Related