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!