Tailored Interventions for Smoking Cessation: Experience

in the worksite

Meghan O’Connell, MPH

Yale-Griffin Prevention Research Center

Presentation Outline

Purpose Background Overview of Methods Results Conclusions

Purpose

To replicate the promising results of a

pilot study using an approach to

smoking cessation termed “impediment

profiling” in the worksite setting

Background Cigarette smoking is the leading cause of

preventable death in the U.S.1

The CDC’s Community Guide to Preventive Services recommends smoking cessation interventions be made available2

Worksites as an important venue3

Potential benefits to both employees and employers3

Novel “Impediment Profiling” methods applied in a community hospital setting

Methods

PLANNING Community hospital/PRC partnership for

planning and implementation

-administration, human resources, outpatient psychiatry, dietary, volunteer services depts.

Promotion of program for manager/supervisor buy-in

Hospital/PRC resource sharing

Methods (cont’d)

RECRUITMENT All smoking employees were invited to

participate via internal email, flyers, informational sessions for each department, information provided with employee benefits package, letters sent to all employees

Methods (cont’d.)

IMPLEMENTATION Use of Impediment Profiling (IP) instrument

(previously validated) for barrier identification Assignment to interventions as indicated by

measurement scales: NRT; treatment for anxiety/depression; dietarycounseling and PA for weight gain prevention;stress reduction; family support groups;referral to treatment of chemical co-dependencies

Methods (cont’d.)

Specific intervention components were…

Self-reported quit status was verified with measurement of carbon monoxide (CO) concentration in expired air

Smoking cessation was defined as CO reading of < 10ppm.

Results55 enrolled

4 dropped out prior to study commencement, resulting in sample of 51 employees

88% of participants had previously attempted to quit

Stages of Change survey indicated subjects were in the following stages at baseline: 8% precontemplative

69% contemplative

23% action

SubjectsTable 1: Characteristics of study participants Variable Overall

(Mean SD) Male

(Mean SD) Female

(Mean SD) Age (years) 41.9 + 11.3

N=49 35.0 + 4.2

N=2 42.2 + 11.5

N=47 Cig/ day 19.8 + 7.3

N=47 30.0 + 10.0

N=3 19.1 + 6.7

N=44 Years of smoking

25.9 + 11.3 N=49

18.5 + 6.6 N=2

26.2 + 11.4 N=47

(%) (%) (%) Race N=51 N=51 N=51

White 96 100 96 Af. American 4 0 4

Education N=48 N=3 N=45 High school or

less 31 33 31.1

Some college 42 0 44.4 College grad

or more 27 67 24.4

Income N=44 N=3 N=41 0-30,000 18 0 20 30,001-60,000 41 33 41 > 60,001 41 67 39

Percentage of subjects with impediments:

Nicotine dependence 100% (51) Chemical dependency 14% (7) Stress 14% (7) Anxiety 47% (24) Depression 18% (9) Weight concerns 78% (40) Household smoking 8% (4)

* percent (N)

Mean # impediments of total group Mean Std Deviation Min Max 2.6 1.2 1.0 6.0

Participation

Intervention component

Percent of subjects using/participating

Bupropion 74.5% (38) NRT-Patch 92.1% (47) Buspirone 52.9% (27) Family sessions 0% (0) Weight management 24% (12) Stress management 10% (5) N=51 Additional options: Accupuncture 35% (18) Reiki 8% (4) Sessions with ND 14% (7) N=51

Quit rate: CO measure cut off 10 3 Months 64.7%(33) 6 Months 49% (25) 12 Months 39% (20)

Quit rate: CO measure cut off 5 3 Months 58.8% (30) 6 Months 43% (22) 12 Months 37% (19)

Quit status based on carbon monoxide (CO) readings. *Drop-outs (n=11) assumed to be smoking

Quit rate excluding drop-outs: CO measure cut off 10 (N=40) 12 Months 50% (20) CO measure cut off 5 (N=40) 12 Months 48% (19) Quit status based on carbon monoxide (CO) readings.

Conclusions

This study achieved a 39% one-year quit rate, replicating pilot findings indicating that IP and tailoring of interventions results in a dramatic improvement over quit rates reported in the literature

Seventy-seven percent of participants were in either the precontemplative or contemplative “stage of change” at enrollment, suggesting that providing individualized assistance may be highly effective at increasing/maintaining motivation to quit

Conclusions (cont’d)

Independent of quit rate, profiling impediments to smoking cessation served to identify otherwise ignored health problems meriting treatment in their own right

Further study of impediment profiling as a smoking cessation adjunct in larger, longer, and randomized trials is warranted

Conclusions (cont’d)

The study demonstrated the feasibility of applying IP methods in a worksite setting

Hospitals in particular are ideal settings for smoking cessation interventions. By capitalizing on existing resources and involving stakeholders, creative programs can be implemented to benefit the entire workforce

Yale-Griffin Prevention Research Center

David L. Katz, MD, MPH, FACPM Project PIBeth Comerford, MS Co-investigatorMeghan O’Connell, MPH Research AssociateHilary Alonso Data Analyst Michelle LaRovera Research Assistant

For more information:Meghan.oconnell@yalegriffinprc.org

References

1. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs-August 1999. Atlanta GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, August 1999.

2. Wasserman, M.P. 2001. Guide to Community Preventive Services: State and local opportunities for tobacco use reduction. American Journal of Preventive Medicine: 20 (S2) pp 8-9.

3. Centers for Disease Control and Prevention. Making Your workplace Smoke-free: A decision makers guide. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Wellness Councils of America and American Cancer Society.