1ENSH WCTOH 2002

European smoke free hospital Network

Florin Mihaltan

Anne Marie Schoelcher

Jean Patrick Deberdt

Ariadni Ouranou

François Chieze

Yannis Tountas

Didier Vander Steichel

Stefano Nardini

Elvira Mendez

Bertrand Dautzenberg

Health Care Worker Surveys in Europe

ENSH WCTOH 2003 2

Aims of ENSH

• In Europe most workplaces are smoke-free by law,

• Implementation of non-smoking workplace policies is

incomplete,

• The hospital is not a common workplace,

• The hospital is a model for public health,

• A non-smoking hospital policy is impossible to implement

with a smoking staff,

• A staff of non-smokers is more credible for treatment of

smokers.

Decrease of smoking rate in medical staff is a major aim of the smoke-free hospital

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European Survey of ENSH

• European Network of smoke-free hospital members agree to have 13 common questions on the HCW tobacco questionnaire.

• This questionnaire was tested in small groups in 5 countries and in a large group in one.

• We present the results of these European surveys.

ENSH WCTOH 2003 4

The objectives of the study

• The use of common questions on smoking to assess smoking habits of HCW

• To assess the prevalence of smoking among professionals

To be a barometer for each country

Anti-smoking resources inside the hospitals

Measure the impact of the strategy for every nation

ENSH WCTOH 2003 5

HCW questionnaire

Age…..sex…..job…..night work……..

If you are a daily smoker:- On average how many cigarettes (or cigars or pipes) do you smoke per day ? /__/__/ cigarettes/days- How long after waking up do you smoke ? < 5 minutes 6-30 minutes 31-60 minutes > 60 minutes- Are you planning to quit ?

in the next month in the next 3-6 month in the next year not at this time no

If you are an ex-smoker:- age of smoking cessation

/__/__/ years old- on average, how many cigarettes (or pipe or cigars) did you smoke per day ?

/__/__/ cigarettes/days

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HCW common questions

• What are the barriers for implementing smoke free hospitals ?

• What are the factors influencing the decision of hospitals ?

• What are the targets in this hospital ?

• What are the needs ?

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The actual data of the study

• The following results were obtained from each country’s survey responses, which vary according to their national health systems and policies

• 6 countries answered to the questionnaire: France, Spain,Greece, Ireland, Belgium and Romania

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France

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Survey in France : method

• 58 hospitals

• n=18 579

• 36 questions concerning : social demographic data, smoking habits, opinions and practical aspects in the hospitals.

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Prevalence of smokers

Daily smokers

22%

Occassional smokers

9%

Ex-smokers

24%

Non smokers

45%

ENSH WCTOH 2003 11

16%

19%

35%

30%everytime

often

sometimes

never

Are they asking their patients about the smoking habit ?

ENSH WCTOH 2003 12

0%

20%

40%

60%

80%

100%

counsellinginformation

prescription

never

sometime

often

everytime

In case of a smoking patient what are you using as modalities to help them ?

ENSH WCTOH 2003 13

Conclusions for France survey

• A trend of decrease in the smoking rate of French professionals.

• There remains a discrepancy between the perception of the danger of smoking and the interest for therapy to quit smoking.

• More training is necessary to give professionals the tools and the motivation to quit smoking.

ENSH WCTOH 2003 14

Romania

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Survey in Romania : method

2000 and 2003

in 3 hospitals

Evolution of smoking prevalence and education

n=340

ENSH WCTOH 2003 16

Smoking of HCW in Romania

Smokers

31%

Ex-smokers

5%

non

smokers

64%

ENSH WCTOH 2003 17

Smokers

13%

40%

15%

32%

0%

10%

20%

30%

40%

50%

Doctors Medicalassistants

Nurses Auxiliarystaff

The prevalence of smoking by profession

ENSH WCTOH 2003 18

Conclusions for Romania

• The same level of smoking in hospital staff as in general population

• A low level of education concerning methods to quit smoking.

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SpainRESULTS FROM

THE CATALAN NETWORK

OF SMOKE-FREE HOSPITALS

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10 hospitals attached to the Catalan Network of Smoke-free Hospitals have carried out a smoking prevalence survey in 2002-2003

Total capacity of these hospitals is 2,502 beds

2,257 health staff have answered the questionnaire: 1,661 (73.6%) women and 596 (26.4%) men

In 9 hospitals the survey was conducted face to face by an interviewer. In these cases, response rate was 98%.

Spain : Method

ENSH WCTOH 2003 21

31.1%

43.3%

25.6%

%

Smokers31%

Ex-smokers

26%

non smokers

43%

Smoking of HCW in Spain

ENSH WCTOH 2003 22

Current smokers

%

Doctors Nurses Administratives Linesmen Other

17.9%

49.8%

15.0%

5.6%

11.6%

18%

50%

15%

6%12%

0%

10%

20%

30%

40%

50%

60%

doctors nursesadministratives

linesmen other

Distribution of smokers according to occupation in Spain

ENSH WCTOH 2003 23

More than half of smokers (57%) have attempted to quit smoking.

From those who had tried to quit smoking, 59% attempted to quit more than once without any positive results.

Previous attempts to quit smoking among current smokers in Spain

38

18

44

0

10

20

30

40

50

1 attempts 2-3 attemps >3 attempts

ENSH WCTOH 2003 24

0% 50% 100%

No exposure <1 hour 1-4 hours >4 hours

16.9 49.3 21.7 12.1

Environmental tobacco smoke at work in spanish hospitals

ENSH WCTOH 2003 25

They found a high smoking prevalence among our health staff (31%).

Nursing staff is occupation group with the highest smoking prevalence. Specific interventions to give up smoking should be addressed to them.

12% from the Health Staff have declared being exposed to smoke at work >4 hours per day. Interventions to reduce that exposure should be carried out.

Conclusions for Spain

ENSH WCTOH 2003 26

Ireland

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Survey in Ireland : method

• The HCW has been tested on 98 HCW.

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Smoking habits of HCW in Ireland

Smoker36%

Ex-smoker11%

Non-smoker

53%

ENSH WCTOH 2003 29

Conclusion for Ireland

• High prevalence of smokers

• 56% had intention to give up soon

ENSH WCTOH 2003 30

Greece

ENSH WCTOH 2003 31

Survey in Greece : method

• This analysis was based on information deducted from results of a survey carried out in four general hospitals in Athens, Greece

ENSH WCTOH 2003 32

Smoking habits of HCW in Greece

• The high prevalence of smoking is impressive taking into consideration that 38% of the people surveyed are Doctors.

smokers63%

non smokers

37%

ENSH WCTOH 2003 33

Conclusion for Greece• None of the personnel surveyed have ever

received smoking cessation help from their healthcare organization.

• 33% replied that they do not desire such assistance while an equal 33% mentioned that such help is either not easily accessible or has never been made available.

• 20% of the smokers surveyed have no plans of quitting while 7% hope to quit within the coming months and slightly more than 25% project to quit “someday”.

ENSH WCTOH 2003 34

Comparison between countries surveys

ENSH WCTOH 2003 35

HCW national questions

• For France: evolution of prevalence, concerning professionals in particular, policy and strategy of training.

• For Spain: prevalence datas, exposure to the environmental tobacco smoke at work.

• For Greece: desire to quit smoking, evolution of prevalence.

• For Belgium: evolution of prevalence.

ENSH WCTOH 2003 36

98100

2257

34059

18579

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

France Greece Romania Spain Belgium Ireland

Number of responses

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35

39

3533

4340

0

5

10

15

20

25

30

35

40

45

50

France Greece Romania Spain Belgium Ireland

Average age of participants (years)

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81%

71% 74%

86%

70%

8%

92%

19%

29.5% 26%

14%

30%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Male Female

France Greece Spain

Romania Belgium Ireland

Distribution by sex of the sample

ENSH WCTOH 2003 39

30%

13%

49%

38%

19%15%

28%29%

40%

7%

24%

7%

53%

14%

26%

3%

24%

42%

8%

31%

0%

10%

20%

30%

40%

50%

60%

Doctor Nurse Administrative Other

France Greece Romania Belgium Ireland

Distribution by profession of the sample

ENSH WCTOH 2003 40

Relevant data for France results is unavailable except to mention that smoking French health staff smoke 11,9 cig/day on average

Number of cigarettes smoked daily

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Greece Romania Spain Belgium Ireland

<10

.10 -20

>20 cig/d

ENSH WCTOH 2003 41

Distribution referring to the smoking habit

0%10%20%30%40%50%60%70%80%90%

100%

Belgium France Spain Ireland Romania Greece

No response

Non-smoker

Ex-smoker

Smoker

ENSH WCTOH 2003 42

Dependence : How many minutes after you wake do you smoke your first cigarette of the day ?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

France Greece Romania Spain Belgium Ireland

>31 min.

.10-30

<5

ENSH WCTOH 2003 43

Relevant data is unavailable for Spain. except to mention that 57.05% of the health staff smokers responding have unsuccessfully tried to quit smoking at least once.

Do you have any intention of giving up smoking soon?

0%

20%

40%

60%

80%

100%

France Greece Romania Belgium Ireland

No

Yes

ENSH WCTOH 2003 44

Conclusions• We remark that in all the samples it is a

predominance of women• Hospitals are barometer for particularities

of smoking to women• The level of dependency is medium• Interdictions of smoking in the hospitals

exists but are not respected, mainly in South and East

• Implications of staff is not sufficiently

ENSH WCTOH 2003 45

Conclusions

• There persists a high level of smokers amongst the medical staff.

• Hospitals must be exemplary places of smoke-free health.

• Nurses must be the first target in the hospitals.

Products to assist quitting smoking make free-of-charge for medical staff.

46ENSH WCTOH 2002