Current Situation of Services to Manage and Treat Tobacco Dependence in China

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Implementing Successful Cessation Program in
China Hospitals
Dan XIAO, M.D., Ph.D.
Email danxiao_at_263.net blog.sina.com.cn/cessation
WHO Collaborating Center for Tobacco or
Health Beijing Institute of Respiratory
Medicine Beijing Chao-Yang Hospital, Capital
Medical University
Oct 20th, 2011, Li Jiang
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Beijing Chao-Yang Hospital

• 3603 staff
• 1910 beds

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Beijing Institute of Respiratory Medicine

• Beijing Chao-Yang Hospital, Beijing Institute of
  Respiratory Medicine (BIRM) has been sixthly
  designated as WHO Collaborating Center for
  Tobacco or Health since 1986.
• The latest Re-nomination 2010

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Grandpa of Tobacco control in China
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Nearly one-third (28.1) of the Chinese
population smokes, including 52.9 of men and
2.4 of women. Smoking prevalence among medical
professionals 40.4 - Global Adult
Tobacco Survey (GATS) in China, 2010
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Cessation training

• Cessation training workshops (from 2000)
• Train the trainer program (from 2007)
• National CME Program - Clinical
• cessation intervention (from 2008)
• Certified Stop Smoking
• Specialist training program (from 2010)
• Online training program (from 2010)
• Promote cessation through series
• academic conferences (from 2007)

First cessation training workshop June 27-29, 2000
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China Clinical Smoking Cessation Guideline

• Trial version in 2007, update in 2009
• Core Conception for tobacco dependence as a
  chronic disease, recommendations for disease
  diagnosis and treatment

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Include the contents of the health hazards of
tobacco and tobacco control into the official
system of medical education

• 9 textbooks at least (Chapters )

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Asia Alliance for the Treatment of Nicotine
Dependence (ATND)
May 23-25, 2008, Shang Hai
Aug 8-9, 2009, Beijing
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Nicotine Dependence Conference

• Cooperated with Mayo Clinic (1st in 2006, 2nd in
  2008, 3rd in 2009)

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Network of WHO Collaborating Center for Tobacco
or Health for Medical Professionals against
Smoking
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Smoking Cessation Clinic

• The first Smoking Cessation Clinic in China(From
  1996)
• From Monday to Friday, 8 a.m. to 5 p.m., Beijing
  Chao-Yang Hospital
• Promote at national level

Every Respiratory Department should have a
Smoking Cessation Clinic, otherwise it is not a
complete Respiratory Department
Prof.WANG Chen
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Quit-line

• 010-65089393 in 2004
• The first Quit-line in China
• Upgraded as national Quit-line 400-888-5531 in
  2009
• Operated by the Center
• Staffed by qualified counsellors
• Support from MOH and WHO

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Integrate with health system

• Recommendation system for treatment of tobacco
  dependence in Beijing Chao-Yang hospital
• Aim screen and treat every smoker admitted to
  the
• outpatient department of Chao-Yang Hospital.
• Physicians should ask patients the following 3
  questions
• Have you smoked in the past 30 days?
• How many cigarettes do you smoke per day on
  average?
• Are you willing to get quit help?
• Current smoker will have a treatment referral
  printed automatically

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Example of treatment referral printedautomaticall
y
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Pilot Results
May, 2010
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Tobacco Control in Hospitals

• The National Hospital Committee of tobacco
  control under the Chinese Association for Tobacco
  Control was established on May 29th 2004 in
  Beijing. The office was set in the Center.
• The conference of making Criteria for Smoke Free
  Hospital Assessment was held in Beijing Chao-Yang
  Hospital on Nov.12 2004. The Criteria drafted out
  by the Center was discussed and formed in the
  conference.

May 29th, 2004, Beijing
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Building up smoking-free hospitals

• In 2005, the Chinese Ministry of Health
  designated Beijing Chao-Yang Hospital and Beijing
  Hospital as the pilot units for smoking-free
  hospital establishment.
• All employees, patients and visitors are
  requested to ban smoking in non-smoking areas in
  the hospital and only to smoke in designated
  smoking areas.

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Building up smoking-free hospitals

• The smoking rate among the employees in
  Chao-Yang Hospital

Number Smoking Male Female of smokers rate
Apr 242 11.3 37 1.2 Nov 133 6.1 18.2
0.3

• In June, 2007, Smoking rate decreased to 4.9

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National Smoke-free Hospital Designation
May, 2006
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Case introduction by the Union
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Evaluation of the Chinese versions of the
Minnesota Nicotine Withdrawal Scale and the
Questionnaire on Smoking Urges-Briefs

• MNWS and QSU-Brief were translated into Chinese
  version through 10 steps
• The reliability and validity were evaluated based
  on the data collected from 354 smokers.
  Cronbachs a was calculated and correlation
  analysis was examined.
• Chinese version of MNWS and QSU-Brief can be used
  in further research and clinical evaluation in
  Chinese smoking population with acceptable
  validity and reliability.

Nicotine Tob Res, 2010,12(6)630-634.
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A prospective, randomized, double-blind,
placebo-controlled, multi-center multinational
study of efficacy and safety of Varenicline
tartrate for smoking cessation
PI Prof. Chen WANG 15 sites Singapore
Thailand China (National level, 10sites)
Wang C, Xiao D, Chan KP, et al.Respirology. 2009,
14(3) 384-92.
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Varenicline CO-Confirmed Quit Rates and
Long-Term Abstinence
CA Week 9-24
LTQR Week 9-24
CQR Week 9-12
OR 2.31 (1.45, 3.67) P 0.0003
OR 2.29 (1.42, 3.71) P 0.0006
OR 1.92 (1.18, 3.13) P 0.0080
50.3
44.2
38.2
31.6
26.8
25.0
Respirology. 2009, 14(3) 384-92.
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Quit Projects- Help Chinese smoking physicians
quit with Champix, Nicotine gum patch
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HOPE Study

• Open-label, parallel, multi-center study
• 6 hospitals from Beijing, Shanghai and Guangzhou
• Targets physicians and hospital staff of
  smoke-free hospitals
• 300 smokers with motivation to quit
• Self-determine quit with gum or patch
• 11 ratio of gum or patch subjects
• 12 weeks NRT treatment, followed by 12 weeks
  off-treatment follow up

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Top-line Results

• 300 subjects enrolled, 293 finished the 24-week
  study
• Continuous Abstinence Rate
• 17 of subjects (n51) were continuously,
  CO-verified smoking abstinent from Week 2 until
  and including the 24 week visit
• Point Abstinence Rate
• CO-verified quit rates since last visit at Week
  6, 12 and 24 are 30.7, 36.7 and 35 (4-12 weeks
  interval)
• Smoking Reduction rates (highest in previous
  Nicorette studies)
• 53.0 (n159) reduced smoke to at least 75 and
  68.3 (n205) reduced to at least 50 at week 24
• Similar results were found in patch and gum groups

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Ongoing clinical trials

• Varenicline Phase IV study
• Observational study, 772 smokers enrolled,440
  smokers quit smoking(W9-12)
• Nicotine Mint Lozenge
• - A prospective, randomized, double-blind,
  placebo-controlled, multi-center study, 720
  smokers enrolled.

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Facilitating smoke free hospitals in China

• Facilitating Smoke Free Hospitals in China (Nov
  2008 Oct 2010)
• 41 hospitals from 20 provinces
• - 6 hospital presidents or vice presidents
  quit successfully
• - 329 smoking doctors in 41 hospitals quit
  smoking (self-report)

Supported by The Union CHINA-OC-400
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Role models
Professor YANG Yong Director of Urology
Department Beijing Chao-Yang Hospital
Professor ZHANG Jianqing President of Qinghai Red
Cross Hospital
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Quit smile program
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Free consultation
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Media Promotion
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www.smokefreehealthcare.org

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Blog.sina.com.cn/cessation
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Release of the first Surgeon Generals Report
Jan 11, 1964

• One of the 10 most important scientific books in
  last 100 years

To celebrate the librarys 1995 centennial,
librarians at the New York Public Library were
asked which books helped shape and define the
last 100 years.
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China Report on Harms of Smoking and Secondhand
Smoke
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A journey of 1000 miles begins with a single
step!
THANK YOU VERY MUCH FOR YOUR ATTENTION!