Transcript Tailored Interventions for Smoking Cessation

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; dietary
counseling and PA for weight gain prevention;
stress reduction; family support groups;
referral to treatment of chemical codependencies
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.

Results
55
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
Subjects
Table 1: Characteristics of study participants
Variable
Overall
Male
(Mean  SD)
(Mean  SD)
Age (years)
41.9 + 11.3
35.0 + 4.2
N=49
N=2
Cig/ day
19.8 + 7.3
30.0 + 10.0
N=47
N=3
Years of
25.9 + 11.3
18.5 + 6.6
smoking
N=49
N=2
(%)
(%)
Race
N=51
N=51
White
96
100
Af. American
4
0
Education
N=48
N=3
High school or
31
33
less
Some college
42
0
College grad
27
67
or more
Income
N=44
N=3
0-30,000
18
0
30,001-60,000
41
33
> 60,001
41
67
Female
(Mean  SD)
42.2 + 11.5
N=47
19.1 + 6.7
N=44
26.2 + 11.4
N=47
(%)
N=51
96
4
N=45
31.1
44.4
24.4
N=41
20
41
39
Percentage of subjects with impediments:
Nicotine dependence
Chemical dependency
Stress
Anxiety
Depression
Weight concerns
Household smoking
100% (51)
14% (7)
14% (7)
47% (24)
18% (9)
78% (40)
8% (4)
* percent (N)
Mean # impediments of total group
Mean
Std Deviation Min
2.6
1.2
1.0
Max
6.0
Participation
Intervention
component
Percent of subjects
using/participating
Bupropion
NRT-Patch
Buspirone
Family sessions
Weight management
Stress management
74.5% (38)
92.1% (47)
52.9% (27)
0% (0)
24% (12)
10% (5)
N=51
Additional options:
Accupuncture
Reiki
Sessions with ND
N=51
35% (18)
8% (4)
14% (7)
Quit rate: CO measure cut off 10
3 Months
6 Months
12 Months
64.7%(33)
49% (25)
39% (20)
Quit rate: CO measure cut off 5
3 Months
6 Months
12 Months
58.8% (30)
43% (22)
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
Beth Comerford, MS
Meghan O’Connell, MPH
Hilary Alonso
Michelle LaRovera
For more information:
[email protected]
Project PI
Co-investigator
Research Associate
Data Analyst
Research Assistant
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.