Mobile Smoking Cessation Services (Mscs) To Achieve Smokefree Workplaces
MOBILE SMOKING CESSATION SERVICES (MSCS) TO ACHIEVE SMOKEFREE WORKPLACES Zaswiza MN* , M Haniki NM*, M Aznan MA**, Samsul D**, S Halimah Bux*, N Syafinaz AR*. * KULLIYYAH OF PHARMACY, INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA, PAHANG. ** KULLIYYAH OF MEDICINE, INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA, PAHANG.
Background <ul><li>Smoking Cessation Programmes: </li></ul><ul><li>Remain one of the main agenda. </li></ul><ul><li>It was common when smokers reported quitting ‘own their own’ through self-help, either by ‘cold turkey’ or gradually cutting down the number of cigarettes smoked (Rantucci, 2002). </li></ul><ul><li>Assistance of cessation programs and pharmacotherapy, increase quit rates more than 20%. </li></ul><ul><li>Interventions for 6 to 12 weeks of individual or group counselling usually more successful than self-help (Rantucci, 2002). </li></ul>QUIT SMOKING CLINICS MEDIA
<ul><li>Most adults spend about a third of their day in a workplace environment. The workplace is therefore the best setting to provide health promotion such as quit smoking programme (Gruman, 1993). </li></ul><ul><li>- There are several advantages to choose workplaces for smoking cessation program such as provides access to a large number of people who make up a relatively stable population, potential for getting higher participants and may encourage sustained peer group support and positive peer pressure (The Cochrane Collaboration, 2008). </li></ul>WORKPLACES INTERVENTION :
<ul><li>Workplaces intervention: </li></ul><ul><li>workplace intervention can contribute to public health by reducing the prevalence of smoking in society. </li></ul><ul><li>We established a mobile smoking cessation service (MSCS) to reach smokers at workplaces. With difficulties in getting smokers to attend quit smoking clinics in Malaysia, the existence of such service is vital. </li></ul>To our knowledge, this is the first mobile smoking cessation service ever established in Malaysia.
OBJECTIVES OF STUDY <ul><li>To assist and provide psychosocial support to smokers intended to quit smoking and to provide pharmacotherapy whenever necessary. </li></ul>
INTRODUCTION <ul><li>Recruitment from November 2007 until September 2008. </li></ul><ul><li>Last follow-up at week 24 (the last groups) was on April 2009. </li></ul><ul><li>Team = > consisted of four pharmacists and two family medicine specialists. </li></ul><ul><li>Target => smokers aged 18 to 60 years old. </li></ul>
The flow of mobile smoking cessation programme <ul><li>Baseline: Recruitment </li></ul><ul><li>Motivational talks </li></ul><ul><li>Screening (inclusion and exclusion criteria) </li></ul><ul><li>Baseline tests (CO, PEFR, modified FTND) </li></ul><ul><li>Demographic and smoking history data </li></ul>Motivational talk and counselling at baseline Screening and baseline tests Self-administered demographic and smoking history data Booklets : record daily no. of cigarettes smoked and withdrawal (1)
RANDOMIZATION: RANDOMIZED DOUBLE BLIND PLACEBO CONTROL TRIAL 2 GROUPS : PHARMACOTHERAPY VS. PLACEBO n = 75 n = 72 (2)
(5) FOLLOW-UP WEEK 12 OR Face-to –face interview / counselling Plus CO test ( in addition to self-reported smoking status) Telephone interview / counselling NO CO test (self-reported smoking status)
(6) Final follow-up week 24 (6 Months) <ul><li>-Validation of self-reported abstinence : </li></ul><ul><li>CO test and detection of cotinine in urine and/or saliva samples. </li></ul><ul><li>- Booklet returned: withdrawal and daily cigarettes smoked, if any. </li></ul>Taking and preparing urine and saliva samples Detection of cotinine in saliva using Saliva NicAlert® dipstick. CO test in addition to cotinine detection tests using PiCO + smokerlyzer. Detection of cotinine in urine samples : HPLC – UV analysis .
<ul><li>Enrolment and follow-up: </li></ul>201 (attended programmes), 4 (personal interviews) = TOTAL (205) Eligible , but chose not to enrol (n=50) Placebo + counselling (n=78) Viva QS® + counselling (n=77) Wk 2: F/up (n=73) Missed F/up (3), w/drew (1) a Wk 2: F/up (n=71) Missed F/up (7) Wk 12: F/up (n=73) Missed F/up (3) Wk 4: F/up (n=73) Missed F/up (3) Wk 4: F/up (n=67) Missed F/up (8), Drop outs (3) b Wk 24: F/up (n=73) Missed F/up (3) c Wk 24: F/up (n=68) Missed F/up (7) c Wk 12: F/up (n=67) Missed F/up (8) Met inclusion criteria and enrol (n=155 ) Randomised to group Completion of study: Viva QS® (N=75) Placebo(N=72)
<ul><li>Notes: </li></ul><ul><ul><li>a One (1) subject withdrew from study (not ready to quit). </li></ul></ul><ul><ul><li>b Three (3)* from placebo group were drop outs (n = 3). </li></ul></ul><ul><ul><li>c Three (3) subjects from placebo group and one (1) from Viva QS® group were excluded from final analysis because lost to follow-up from the beginning of study. </li></ul></ul><ul><ul><li>* Refused to take study medication. </li></ul></ul>
CHARACTERISTICS OF SMOKERS AT BASELINE b n = 144. Three (3) subjects with missing data. * Total n = 147 Characteristics n (%) * Age (years) 18-30 52 (35.4) 31-45 71 (48.3) 46-60 24 (16.3) Race Malay 145 (98.6) Others 2 (1.4) Marital status b Married 125 (86.8) Never married or divorced 19 (13.2) Education Secondary school 42 (28.6) Certificate 20 (13.6) Degree/ Diploma 85 (57.8)
CHARACTERISTICS OF SMOKING HISTORY AT BASELINE a The FTND is a validated 6-items instrument to measure the level of dependence to nicotine. The total score range is 0 to 10, with ≥6 indicating high dependence . Characteristics n (%) Age begin smoking (years), n (%) 10-15 41 (27.9) 16-20 87 (59.2) 21-40 19 (12.9) Current tobacco use (No. of cigarette smoked per day), n (%) 1-10 sticks 35 (23.8) 11-20 sticks 91 (61.9) > 20 sticks 21 (14.3) Mean (SD) Carbon monoxide (CO) level (ppm) 11.50 (4.564) Modified Fagerstrom test score for nicotine dependence (FTND) a 5.03 (1.394)
7-days prevalence abstinence at week 24 * P < o.o5 QUITTERS , n(%) SMOKERS, n(%) P Value (Pearson Chi-square) OR (95% CI) 33 (22.4) 114 (77.6) 0.015 * 2.74 (1.20-6.28) Viva QS Placebo Viva QS Placebo 23 (30.7) 10 (13.9) 52 (69.3) 62 (86.1)
<ul><li>MSCS can be suggested as an acceptable new method for the hard to reach population. </li></ul><ul><li>This method can be developed and established more as it is convenient for many smokers who could not leave their workplaces to seek help from common quit smoking clinics available at present in Malaysia. </li></ul><ul><li>Combination of MSCS and pharmacotherapy would increase the quit rates. </li></ul><ul><li>Effectiveness of such program can be expanded to other possible settings such as schools and rural area by targeting adolescent and elderly smokers in the future. </li></ul>