1. 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 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

2. Hungary in Europe

3. Facts about Hungary Population: 10M Population: 10M Surface: 93 000 m 2 Surface: 93 000 m 2 Capital city: Budapest Capital city: Budapest Science: 13 Nobel prize winners Science: 13 Nobel prize winners Gastronomy: goulash, chicken paprika, stuffed cabbages Gastronomy: goulash, chicken paprika, stuffed cabbages Music: Franz Liszt, Bartok Music: Franz Liszt, Bartok Sport: Puskas, 17 Olympic medals/10M inhabitants (3. highest in the world in 2000 and 2004) Sport: Puskas, 17 Olympic medals/10M inhabitants (3. highest in the world in 2000 and 2004) Politics: Politics: 1989-transition to market economy 1989-transition to market economy 1 May 2004 - EU accession 1 May 2004 - EU accession Smoking prevalence: 35% Smoking prevalence: 35%

4. Introduction Facts: Facts: Smoking is the largest cause of Smoking is the largest cause of preventable mortality and morbidity Action is needed Action is needed Evidence-based interventions Evidence-based interventions Cochrane review -2007 Cochrane review -2007 Strong evidence: Interventions directed towards individual smokers increase the likelihood of quitting smoking 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 addiction pharmacological treatment to overcome nicotine addiction

5. Advice from a health professional The essential features of individual smoking cessation advice are: Ask (about smoking at every opportunity) Ask (about smoking at every opportunity) Advise (all smokers to stop) Advise (all smokers to stop) Assist (the smoker to stop) Assist (the smoker to stop) Arrange (the follow up) Arrange (the follow up) Design the intervention at the OHS (4th largest in Hungary)

6. Participants As part of a general screening programme 912 employees examined As part of a general screening programme 912 employees examined Employed by 4 different companies of similar profile Employed by 4 different companies of similar profile 18 to 65 years old 18 to 65 years old 48% male, 52% female 48% male, 52% female 80% physical worker 80% physical worker

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

8. Design and setting All smokers were offered: All smokers were offered: A series of one-to-one or group behavioural interventiones with a trained OH adviser 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.) 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 2 of 4 employers offered to sponsor the cost of the pharmacological treatment

9. Person-to-person contact Based on personal preference: Based on personal preference: by individual by individual group group proactive telephone counseling proactive telephone counseling In the first 3 month every 2 weeks than at 6 month In 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 remember them when tempted Concente on the positive consequences of quiting smoking and remember 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 friends Enlist the help of family and friends

10. Pharmacological treatment first-line pharmacotherapies were offered that were identified reliably increase long- term abstinence rates: first-line pharmacotherapies were offered that were identified reliably increase long- term abstinence rates: nicotine gum and transdermal system patches nicotine gum and transdermal system patches varenicline - a partial agonist for the nicotinic acetylcholine receptor varenicline - a partial agonist for the nicotinic acetylcholine receptor

11. Results

12. 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) P<0,0001

13. Results At 6 month 33% of the participants non smokers 33% of the participants non smokers (significantly reduced CO levels, p=0.04)

14. Results By filling a questionnaire 62% reported that the regular face-to-face contacts were useful 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 44% reported that pharmaceutical treatment reduced the severity of their withdrawal symptoms the quit rate in the pharmacological treatment+behavioral intervention subgroup was double compared to the bahavioral therapy only (p<0,001) the quit rate in the pharmacological treatment+behavioral intervention subgroup was double compared to the bahavioral therapy only (p<0,001)

15. Lessons learnt In middle-income contries like Hungary participation rates are significantly higher when employers play an active part In middle-income contries like Hungary participation rates are significantly higher when employers play an active part Convincing the employers Convincing the employers Diseases from tobacco result in decrease of productivity, increase of sick-days and loss of active life years Diseases from tobacco result in decrease of productivity, increase of sick-days and loss of active life years

16. Lessons learnt Smoking cessation methodology has to be adjusted to the individual caracteristics and needs Smoking cessation methodology has to be adjusted to the individual caracteristics and needs Adding pharmacological treatment to behavioral intervention doubles the quit rate 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) The attitude of the health care professionals has to be very supportive and positive (pressure and frightening are less effective)

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

18. Thank you for your attention!