Hungary in Europe

1. Results of a smoking cessation intervention programme in the workplace: lessons learntDr. Timea TOTHRuzsas E, Biro B, Olajos A, Nikl A, Jelencsics ZsMedicina Occupational Health Care Service, Budapest, Hungary

2. Hungary in Europe

3. 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% Facts about Hungary

4. 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 individualsmokers increase the likelihood of quitting smoking This includes: • advice from a health professional • individual and group counselling • 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) • Advise (all smokers to stop) • Assist (the smoker to stop) • 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 • Employed by 4 different companies of similar profile • 18 to 65 years old • 48% male, 52% female • 80% physical worker

7. 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

8. 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

9. 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

10. 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

11. Results

13. Results At 6 month • 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 • 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)

15. 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

16. 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)

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.

18. Thank you for your attention!