Tailored Interventions for Smoking Cessation: Experience in the worksite

1. Tailored Interventions for Smoking Cessation: Experience in the worksite Meghan O’Connell, MPH Yale-Griffin Prevention Research Center

2. Presentation Outline • Purpose • Background • Overview of Methods • Results • Conclusions

3. Purpose To replicate the promising results of a pilot study using an approach to smoking cessation termed “impediment profiling” in the worksite setting

4. 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

5. 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

6. 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

7. 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 co- dependencies

8. 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.

9. 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

10. Subjects

11. Percentage of subjects with impediments:

12. Participation

15. 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

16. 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

17. 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

18. Yale-Griffin Prevention Research Center David L. Katz, MD, MPH, FACPM Project PI Beth Comerford, MS Co-investigator Meghan O’Connell, MPH Research Associate Hilary Alonso Data Analyst Michelle LaRovera Research Assistant For more information: Meghan.oconnell@yalegriffinprc.org

19. References • 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.