Title: Results of a smoking cessation intervention programme in the workplace: lessons learnt Dr. Timea TOTH Ruzsas E, Biro B, Olajos A, Nikl A, Jelencsics Zs Medicina Occupational Health Care Service, Budapest, Hungary
1 Results of a smoking cessation
intervention programme in the workplace lessons
learnt Dr. Timea TOTHRuzsas E, Biro B,
Olajos A, Nikl A, Jelencsics ZsMedicina
Occupational Health Care Service, Budapest,
Hungary
2Hungary in Europe
3Facts about Hungary
- Population 10M
- Surface 93 000 m2
- Capital city Budapest
- Science 13 Nobel prize winners
- Gastronomy goulash, chicken paprika, stuffed
cabbages - Music Franz Liszt, Bartok
- Sport Puskas, 17 Olympic medals/10M inhabitants
(3. highest in the world in 2000 and 2004) - Politics
- 1989-transition to market economy
- 1 May 2004 - EU accession
- Smoking prevalence 35
4Introduction
- Facts
- Smoking is the largest cause of
- preventable mortality and morbidity
- Action is needed
- Evidence-based interventions
- Cochrane review -2007
- Strong evidence Interventions directed towards
individual smokers increase the likelihood of
quitting smoking - This includes
- advice from a health professional
- individual and group counselling
- pharmacological treatment to overcome nicotine
addiction
5Advice from a health professional
- The essential features of individual smoking
cessation advice are - Ask (about smoking at every opportunity)
- Advise (all smokers to stop)
- Assist (the smoker to stop)
- Arrange (the follow up)
- Design the intervention at the OHS (4th largest
in Hungary)
6Participants
- As part of a general screening programme 912
employees examined - Employed by 4 different companies of similar
profile - 18 to 65 years old
- 48 male, 52 female
- 80 physical worker
7Participants
- 29 identified as smokers by
- self reporting (Fagerstrom test) and
- Carbon-monoxide (CO) level in breath
- Nicotine dependence level was not associated with
age
8Design and setting
- All smokers were offered
- A series of one-to-one or group behavioural
interventiones with a trained OH adviser - Pharmacological treatment adjusted to health
condition, level of dependence and personal
choice of the smoker (previous experience, cost,
etc.) - 2 of 4 employers offered to sponsor the cost of
the pharmacological treatment
9Person-to-person contact
- Based on personal preference
- by individual
- group
- proactive telephone counseling
- In the first 3 month every 2 weeks than at 6
month - Methods
- Set a date to stop completely
- Review past experience and what helped
- Concente on the positive consequences of quiting
smoking and remember them when tempted - Identify possible problems and how to cope with
them - Enlist the help of family and friends
10Pharmacological treatment
- first-line pharmacotherapies were offered that
were identified reliably increase long-term
abstinence rates - nicotine gum and transdermal system patches
- varenicline - a partial agonist for the
nicotinic acetylcholine receptor
11Results
12Comparison of participant rates Comparison of participant rates Comparison of participant rates Comparison of participant rates Comparison of participant rates
self-paid Sponsored by the employer Difference (CI 95) Odds ratio (CI 95) P value
49,8 70,6 20,8 (15,4-26,2) 2,47 (1,95-3,15) Plt0,0001
13Results
- At 6 month
- 33 of the participants non smokers
- (significantly reduced CO levels, p0.04)
14Results
- By filling a questionnaire 62 reported that the
regular face-to-face contacts were useful - 44 reported that pharmaceutical treatment
reduced the severity of their withdrawal symptoms - the quit rate in the pharmacological
treatmentbehavioral intervention subgroup was
double compared to the bahavioral therapy only
(plt0,001)
15Lessons learnt
- In middle-income contries like Hungary
participation rates are significantly higher when
employers play an active part - Convincing the employers
- Diseases from tobacco result in decrease of
productivity, increase of sick-days and loss of
active life years
16Lessons learnt
- Smoking cessation methodology has to be adjusted
to the individual caracteristics and needs - Adding pharmacological treatment to behavioral
intervention doubles the quit rate - The attitude of the health care professionals has
to be very supportive and positive (pressure and
frightening are less effective)
17Conclusion
- Occupational health care professionals -because
of the extent and ease of access to smokers- have
a vital role in helping smokers to stop.
18Thank you for your attention!