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

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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
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Hungary in Europe
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Facts 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

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Introduction

• 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

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Advice 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)

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Participants

• 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

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Participants

• 29 identified as smokers by
• self reporting (Fagerstrom test) and
• Carbon-monoxide (CO) level in breath
• Nicotine dependence level was not associated with
  age

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Design 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

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Person-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

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Pharmacological 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

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Results
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Comparison 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
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Results

• At 6 month
• 33 of the participants non smokers
• (significantly reduced CO levels, p0.04)

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Results

• 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)

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Lessons 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

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Lessons 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)

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Conclusion

• Occupational health care professionals -because
  of the extent and ease of access to smokers- have
  a vital role in helping smokers to stop.

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Thank you for your attention!