WHO Collaborating Center for Tobacco or Health Beijing Institute of Respiratory Medicine

1. Implementing Successful Cessation Program in China Hospitals Dan XIAO, M.D., Ph.D. Email: danxiao@263.net blog.sina.com.cn/cessation WHO Collaborating Center for Tobacco or Health Beijing Institute of Respiratory Medicine Beijing Chao-Yang Hospital, Capital Medical University Oct 20th, 2011, Li Jiang

2. Beijing Chao-Yang Hospital • 3603 staff • 1910 beds

3. Beijing Institute of Respiratory Medicine • Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine (BIRM) has been sixthly designated as WHO Collaborating Center for Tobacco or Health since 1986. • The latest Re-nomination: 2010

4. “中国控烟运动之父” “Grandpa of Tobacco control in China”

5. Nearly one-third (28.1%) of the Chinese population smokes, including 52.9% of men and 2.4% of women. • Smoking prevalence among medical professionals: 40.4% • - Global Adult Tobacco Survey (GATS) in China, 2010

6. Cessation training • Cessation training workshops (from 2000) • Train the trainer program (from 2007) • National CME Program - Clinical • cessation intervention (from 2008) • Certified Stop Smoking • Specialist training program (from 2010) • Online training program (from 2010) • Promote cessation through series • academic conferences (from 2007) First cessation training workshop June 27-29, 2000

7. China Clinical Smoking Cessation Guideline • Trial version in 2007, update in 2009 • Core: Conception for tobacco dependence as a chronic disease, recommendations for disease diagnosis and treatment

8. Include the contents of the health hazards of tobacco and tobacco control into the official system of medical education 9 textbooks at least (Chapters )

9. Asia Alliance for the Treatment of Nicotine Dependence (ATND) May 23-25, 2008, Shang Hai Aug 8-9, 2009, Beijing

10. Nicotine Dependence Conference • Cooperated with Mayo Clinic (1st in 2006, 2nd in 2008, 3rd in 2009)

11. Network of WHO Collaborating Center for Tobacco or Health for Medical Professionals against Smoking

12. Smoking Cessation Clinic • The first Smoking Cessation Clinic in China（From 1996） • From Monday to Friday, 8 a.m. to 5 p.m., Beijing Chao-Yang Hospital • Promote at national level “Every Respiratory Department should have a Smoking Cessation Clinic, otherwise it is not a complete Respiratory Department” — Prof.WANG Chen

13. Quit-line • 010-65089393 in 2004 • The first Quit-line in China • Upgraded as national Quit-line 400-888-5531 in 2009 • Operated by the Center • Staffed by qualified counsellors • Support from MOH and WHO

14. Integrate with health system • Recommendation system for treatment of tobacco dependence in Beijing Chao-Yang hospital • Aim: screen and treat every smoker admitted to the outpatient department of Chao-Yang Hospital. • Physicians should ask patients the following 3 questions – Have you smoked in the past 30 days? – How many cigarettes do you smoke per day on average? – Are you willing to get quit help? • Current smoker will have a treatment referral printed automatically

15. Example of treatment referral printedautomatically

16. Pilot Results May, 2010

17. The National Hospital Committee of tobacco control under the Chinese Association for Tobacco Control was established on May 29th 2004 in Beijing. The office was set in the Center. The conference of making Criteria for Smoke Free Hospital Assessment was held in Beijing Chao-Yang Hospital on Nov.12 2004. The Criteria drafted out by the Center was discussed and formed in the conference. Tobacco Control in Hospitals May 29th, 2004, Beijing

18. Building up smoking-free hospitals • In 2005, the Chinese Ministry of Health designated Beijing Chao-Yang Hospital and Beijing Hospital as the pilot units for smoking-free hospital establishment. • All employees, patients and visitors are requested to ban smoking in non-smoking areas in the hospital and only to smoke in designated smoking areas.

19. Building up smoking-free hospitals • The smoking rate among the employees in Chao-Yang Hospital Number Smoking Male Female of smokers rate Apr 242 11.3% 37% 1.2% Nov 133 6.1% 18.2% 0.3% • In June, 2007, Smoking rate decreasedto 4.9%

20. National Smoke-free Hospital Designation May, 2006

21. 无烟医院经验推广 Case introduction by the Union

22. Evaluation of the Chinese versions of the Minnesota Nicotine Withdrawal Scale and the Questionnaire on Smoking Urges-Briefs • MNWSand QSU-Brief were translated into Chinese version through 10 steps • The reliability and validity were evaluated based on the data collected from 354 smokers. Cronbach‘s α was calculated and correlation analysis was examined. • Chinese version of MNWSand QSU-Briefcan be used in further research and clinical evaluation in Chinese smoking population with acceptable validity and reliability. Nicotine Tob Res, 2010,12(6):630-634.

23. A prospective, randomized, double-blind, placebo-controlled, multi-center multinational study of efficacy and safety of Varenicline tartrate for smoking cessation PI: Prof. Chen WANG 15 sites Singapore Thailand China (National level, 10sites) Wang C, Xiao D, Chan KP, et al.Respirology. 2009, 14(3): 384-92.

24. Varenicline: CO-Confirmed Quit Rates and Long-Term Abstinence CA Week 9-24 LTQR Week 9-24 CQR Week 9-12 OR = 2.31 (1.45, 3.67) P = 0.0003 OR = 2.29 (1.42, 3.71) P = 0.0006 OR = 1.92 (1.18, 3.13) P = 0.0080 50.3 44.2 38.2 31.6 26.8 25.0 Respirology. 2009, 14(3): 384-92.

25. Quit Projects- Help Chinese smoking physicians quit with Champix, Nicotine gum & patch

26. HOPE Study Open-label, parallel, multi-center study 6 hospitals from Beijing, Shanghai and Guangzhou Targets physicians and hospital staff of smoke-free hospitals 300 smokers with motivation to quit Self-determine quit with gum or patch 1：1 ratio of gum or patch subjects 12 weeks NRT treatment, followed by 12 weeks off-treatment follow up

27. Top-line Results • 300 subjects enrolled, 293 finished the 24-week study • Continuous Abstinence Rate: • 17% of subjects (n=51) were continuously, CO-verified smoking abstinent from Week 2 until and including the 24 week visit • Point Abstinence Rate: • CO-verified quit rates since last visit at Week 6, 12 and 24 are 30.7%, 36.7% and 35% (4-12 weeks interval) • Smoking Reduction rates (highest in previous Nicorette studies): • 53.0% (n=159) reduced smoke to at least 75% and 68.3% (n=205) reduced to at least 50% at week 24 • Similar results were found in patch and gum groups

28. Ongoing clinical trials • Varenicline Phase IV study • Observational study, 772 smokers enrolled，440 smokers quit smoking(W9-12) • Nicotine Mint Lozenge - A prospective, randomized, double-blind, placebo-controlled, multi-center study, 720 smokers enrolled.

29. 无烟医院经验推广 Facilitating smoke free hospitals in China • Facilitating Smoke Free Hospitals in China (Nov 2008 – Oct 2010) • 41 hospitals from 20 provinces • - 6 hospital presidents or vice presidents quit successfully • - 329 smoking doctors in 41 hospitals quit smoking (self-report) Supported by The Union: CHINA-OC-400

30. Role models Professor: YANG Yong Director of Urology Department Beijing Chao-Yang Hospital Professor ZHANG Jianqing President of Qinghai Red Cross Hospital

31. Quit smile program

32. Free consultation

33. Media Promotion

34. www.smokefreehealthcare.org

35. Blog.sina.com.cn/cessation

36. Release of the first Surgeon General’s Report Jan 11, 1964 • One of the 10 most important scientific books in last 100 years To celebrate the library’s 1995 centennial, librarians at the New York Public Library were asked which books helped shape and define the last 100 years.

37. China Report on Harms of Smoking and Secondhand Smoke

38. “A journey of 1000 miles begins with a single step!” THANK YOU VERY MUCH FOR YOUR ATTENTION!