HKU’s “Smoking Cessation Service for · 2010/1/19 4 |Smoking prevalence trends of female smokers in HK 20.5% 20% 25% 30% 35% 40% 45% k ing prevalence BACKGROUND |Low utilisation

2010/1/19

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HKU’s “Smoking Cessation Service for gFemale Smokers” Successfully Helped Women Quit and Reduce Smoking

Prof. Sophia SC ChanProfessor and Head, Department of Nursing Studies, LKS

f fFaculty of Medicine, The University of Hong Kong

Prof. TH LamChair Professor and Head, Department of CommunityMedicine, School of Public Health, LKS Faculty of Medicine,The University of Hong Kong

ACKNOWLEDGEMENTS

Teammembers

Principal investigator: Prof. Sophia Chan1

Co‐investigators : Prof. TH Lam2, Dr. Doris Leung1, Ms. Idy Fu1Co investigators : Prof. TH Lam , Dr. Doris Leung , Ms. Idy Fu

Funding Source

Health Care and Promotion Fund (Ref. no. 19050504)The Hong Kong Council on Smoking and Health (COSH)

Women Against Tobacco Taskforce (WATT)Includes:

The Family Planning Association of Hong KongHong Kong Outlying Islands Women’s Association LtdHong Kong Federation of Women 2

Note:1. Department of Nursing Studies, LKS Faculty of Medicine, The University of Hon g Kong2. Department of Community Medicine, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong

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PART I:PART I:

PROJECT OVERVIEW

INTRODUCTION

Women comprise about 20% of the world’s more than 1.25 billion daily smokers. Male rates of smoking have peaked, while female rates are on the riseWomen are a major target of opportunity for the tobacco industry, which needs to recruit new smokers to replace those who will die prematurely

4References: Shafey O, Eriksen M, Ross H, Mackay J. (2009). The Tobacco Atlas (3rd ed). Retrieved from http://www.tobaccoatlas.org

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BACKGROUNDSpecific hazards of smoking to woman’s health

Reproduction systemMenstrual symptoms and disturbance Menstrual symptoms and disturbance Increase chance of infertility Higher risk of cervical cancerHigher risk of breast cancerMiscarriageRetarded fetal growth Retarded fetal growth Sudden infant deathPreterm delivery

References: Lam TH, Ho SY, Hedley AJ, Mak KH, Peto R. (2001). Mortality and smoking in Hong Kong: case-control study of all adult deaths in 1998. British Medical Journal, 323, 1-6.

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Smoking prevalence trends of female smokers in HK

20.5%20%

25%

30%

35%

40%

45%

king

pre

valenc

e

BACKGROUND

Low utilisation rate of smoking cessation service

3.6%

0%

5%

10%

15%

82 83 84 86 88 90 93 96 98 2000 2003 2005 2008

Smok

Male Female

Table 1 : The prevalence of daily male and female smokers from1982 to 2008

100000

120000

s

No. of female smokers

Reference:1. Social Surveys Section. (2008). Thematic Household Survey, Report No.36: Pattern of Smoking. Hong Kong: Census and Statistics Department.

0

20000

40000

60000

80000

2005 2007 / 08

No. of fem

ale sm

okers

No. of female smokers whois aware of smokingcessation service in HK

No. of female smokers whotried smoking cessationservice

Aims of the project

To publicise quitting among female smokers

To encourage and support those who want to quitby providing face‐to‐face and/or telephonecounselling

8

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PROJECT DESIGN

Phase IWomen Against Tobacco Taskforce (WATT) has been foundedsince January 2007.It is a collaboration among local women organizations topromote smoking cessation in the community.A total of 17 organisations including 22 units are the members ofWATT.The learning needs, knowledge and attitude towards smokingcessation of volunteers and staff from WATT were assessedthrough questionnaires and focus group interviews.

女性反吸煙工作組

Wom e n A g a i n s t To b a c c o Ta s k f o r c e ( WAT T )9

PROJECT DESIGN

Press conference in January 200710

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PROJECT DESIGN

Phase II

A gender‐specific Smoking Cessation Counselling TrainingA gender specific Smoking Cessation Counselling TrainingProgramme was designed based on the results from phase I.

51 staff and volunteers from WATT received the training andthey are capable of providing a brief smoking cessation adviceto smokers.

11

PROJECT DESIGN

Training on 23 October 06

Training on 2 November 09

12

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PROJECT DESIGN

Phase III

A smoking cessation hotline has been launched since November2006.2006.

Experienced nurse counsellors provided a face‐to‐face smokingcessation counselling to female smokers.

13

PROJECT DESIGNThe intensive smoking cessation counseling protocol

Female smoker call the smoking cessation hotline

Smoker is invited to have counselling at HKUSmoker is invited to have counselling at HKU

First visit (baseline):i) Simple body check, ii) Assess smoking history andreadiness to quit,& iii) setting an individualised quit plan

1-week follow up: Telephone reminder

1-month follow up: Face-to-face or telephone interview

3-month follow up

6-month follow up14

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PART II:PART II:

PROJECT RESULTS

RESULTSFrom 1 November 2006 to 31 October 2009, there were 689 callersand 349 of them joined our smoking cessation service.

Until 31 October 2009, 332 participants were eligible for 6‐monthfollow up.

22 (6.6%)18 (5.4%) 10 (3.0%)

Website

Mass media (Newspaper, TV, magazine etc.)

N = 130 (39.2%)

N = 120 (36.1%)130 32 (9.6%)

16Sources of recruitment (N = 332)

Referred from others (family members, friends, social workers, hospitals and clinics)

Referred from other smoking cessation services

Posters & leaflets

Referred by WATT

( )

N = 32 (9.6%)

N = 22 (6.6%)

N = 18 (5.4%)

N = 10 (3.0%)

(39.2%)

120(36.1%)

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RESULTSBaseline demographics (N = 332)

N (%)

Age, (mean = 35.0, SD = 10.2)≤ 30

31 – 40

129126

(38.9)(38 0)31 40

≥ 41

12677

(38.0)(23.2)

Marital Status Single

Married

Widowed

Separated

Divorced

140138122

27

(42.2)(41.6)(3.6)(0.6)(8.1)

Cohabiting 13( )(3.9)

Educational attainment, missing = 1No formal education & primary

Junior secondary (F. 1 – F. 5)

Senior secondary (F. 6 – F. 7)

Post secondary

Tertiary or above

19216202452

(5.7)(65.1)(6.0)(7.2)(15.7)

17

RESULTSBaseline demographics (N = 332)

Housewife71 (21.4%)

Unemployed 24 (7.2%)

Retired 8 (2.4) Full-time

student7 (2.1%)

Poor 16 (4.8%)

Excellent 3 (0.9%)

Very good 117 (35.2%)

Normal 89 (26.8%)

Occupational status Missing = 2

Employed 220 (66.3%)

( )

Perceived health status

Good 107 (32.2%)18

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RESULTS: BASELINE

Smoking profile

Mean ± SD

Age of starting smoking 18.1 ± 5.7

Years of smoking at least one cigarette per day 16.7 ± 8.8

Daily cigarette consumption 14.3 ± 8.5

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RESULTS: BASELINESituations that female smokers smoked most*

N (%)

Place- At home 307 (92.5)- Being around by smokers 277 (83.4)

- At work 125 (37.7)- No child nearby 81 (24.4)Time- After meal 308 (92.8)- Drinking 177 (53.3)- With friends 149 (44.9)

* Participants were allowed to chose more than one option in the above question.

With friends 149 (44.9)Psychosocial status- Feeling relaxed 313 (94.3)- Feeling bored 299 (90.1)- Feeling anxious 282 (84.9)- To concentrate 131 (39.5)

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RESULTS: BASELINESmoking and drinking habit

N (%)

D i ki h bit i i 2Drinking habit, missing = 2- No drinking habit - Drink daily- Drink 4-6 days per week- Drink 1-3 days per week- Drink 1-3 days per month- Drink less than once a month

19492

443546

(58.4)(2.7)(0.6)(13.3)(10.5)(13.9)

Smoking after drinking, missing = 10- Smoke more 199 (59.9)Smoke more - Smoke less - No difference- Don’t know

3119

1

( )(0.9)(35.8)(0.3)

RESULTS:BASELINE

Fagerstrom Test for Nicotine Dependence

1. How soon do you smoke after you wake up?Within 5 mins (3) 6-30 mins (2) 31-60 mins (1) >60mins (0)

2. Do you find it difficult to refrain from smoking in places where smoking isforbidden?

Yes (1) No (0)

3. Which cigarette would you hate most to give up?First in the morning (1) All others (0)

4. Do you smoke more frequently during the first hours after waking than duringthe rest of the day?

Yes (1) No (0)(1) (0)

5. Do you smoke if you are so ill that you are in bed most of the day?Yes (1) No (0)

6. How many cigarettes do you smoke per day?10 or less (3) 11-20 (2) 21-30 (1) 30 or more (0)

Score: Mild (0-3), Moderate (4-5) & Severe (6-10)22

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RESULTS:BASELINE

Fagerstrom Test for Nicotine Dependence (N = 332)

114 (34.3%)

108

110

112

114

111 (33.4%)

( )

107(32.2%)

23102

104

106

Mild Moderate Severe

RESULTS: BASELINE

Stage of readiness to change

Contemplation

Preparation

Action55 (16.6%)

77 (23.1%)

140 (42.2%)

0 20 40 60 80 100 120 140

Pre‐contemplation

p

60 (18.1%)

24

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RESULTS: BASELINEQuitting profile

N (%)

Attempted to quit smoking before (for at least 24 hours), missing = 4 235 (70.8)

Among the attempters (N = 235)

Number of quit attempt

‐ Once

‐ 2 – 5 times

‐ 6 – 10 times

‐More than 10 times

110

108

14

3

(46.8)

(46.0)

(6.0)

(1.2)

Th l t i d th t ith t kiThe longest period that can go without smoking

‐ Less than 1 day

‐ 1 – 30 days

‐ 1 – 6 months

‐ 7 – 12 months

‐More than 12 months

18

139

38

21

19

(7.7)

(59.1)

(16.2)

(8.9)

(8.1)25

RESULTS: BASELINEBaseline quitting profile (N =235)

N (%)

Three most cited methods of quitting used in the last quit attempt

‐ Cold turkey

‐ NRT

140

36

(59.6)

(15.3)

‐ Seek health care professional advices 2

( )

(0.9)

Five most cited reasons for relapse

‐ Desire to smoke

‐ Feeling happy / unhappy

‐ Being around by smokers

‐Work pressure

‐ Feeling bored

99

95

90

58

49

(29.8)

(28.6)

(27.1)

(17.5)

(14.8)

* Participants were allowed to chose more than one option in the above questions. 26

Five most cited reasons for quitting

‐ Leading a healthy life

‐ Improving appearance

‐ Feeling a sense of control on life

‐ Proved that I am able to quit smoking

‐ Saving money

283

142

105

90

80

(85.2)

(42.8)

(31.6)

(27.1)

(27.1)

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RESULTS: 6 MONTH FOLLOW UP6‐month follow up rate (N = 332)

N (%)

Successful follow up rate 280 (85.1)

Quit rate (N = 332, intention to treat analysis)

Th it t f d i i l l t di

N (%)

7-day point prevalence quit rate 88 (26.5)

The quit rates found in previous local studies,Female smokers: 21.9%1

Male smokers: 28.4%1

Youth smokers: 22.1%2

27References:1. Chan SCC. (2004). Gender difference in response to smoking cessation intervention by Smoking Cessation Health Centre. Unpublished manuscript, The University of Hong Kong. 2. Chan SCC, Wong DCN, Fong DYT, Leung AYM, Lam DOB, Mak YW & Lam TH. (2009). The Establishment and Promotion of the First Youth Quitline in Hong Kong. Evaluation of the Health Professions, 31 (3): 258-271.

RESULTS: FOLLOW UP

Comparison between smoking status at 3‐month and 6‐month follow up

Quit rate at 3‐month: 83/332 = 25.0%Quit rate at 6‐month: 88/332 = 26.5%No. of participants relapsed at 6‐month follow up: 19/332 =5.7%No. of participants smoked at 3‐month but quitted at 6‐month: 24/332 = 7.2%

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RESULTS: Baseline and 6 month comparisonStage of readiness to quit

(N = 280, excluding those who failed to be followed up)

60%

80%

100%

176 (62.9%) 166 (59.3%)

0%

20%

40%

Baseline 6-month follow up

Contemplation / Pre-contemplation

Preparation

Action

63 (22.5%)

41 (14.6%)

22 (7.9%)

92 (32.8%)

RESULTS: Baseline and 6 month comparisonFor those who continue to smoke at 6‐month follow‐up (N =192, excluding quitters and those who lost to follow up)

Daily cigarette consumption (p‐value <0.01a)y g p (p )

10

12

14

16

15.2 ± 9.0

9.4 ± 6.5

0

2

4

6

8

Baseline 6-month follow up

a = Paired t-test

30

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RESULTS: Baseline and 6 month comparisonFor those who continued to smoke at 6‐month follow upPerceived health status (N = 192)

1 = Poor to 5 = excellentp‐value= 0.037a

2.97

2.98

2.99

3

2.94 ± 0.9

3.0 ± 0.5

2.91

2.92

2.93

2.94

2.95

2.96

Baseline 6‐month follow up

2.94 0.9

a = Paired t-test

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RESULTS: Baseline and 6 month comparisonSelf‐efficacy to resist smoking (N = 192)

1 = lowest to 5 = highest degree of certainty to quit smokingp‐value = 0.001a for internal stimulip‐value = 0.017a for external stimulip value 0.017 for external stimuli

1 5

2

2.5

3

Internal stimuli

External stimuli

2.1 ± 0.62.6 ± 0.5 2.3 ± 0.7

2.7 ± 0.6

0

0.5

1

1.5

Baseline 6‐month follow up

a = Paired t-test

32

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RESULTS

100

com

pare

d

Percentage of cigarette consumption at different time‐point (N = 275)

0

20

40

60

80

ciga

rette

con

sum

ptio

n as

w

ith b

asel

ine

QuittersA ( 16.4%, 45/275)

0 30 60 90 120 150 180Days

Notes:A = Quit smoking quickly at 1 month (16.4%, 42/275)B = Quit smoking by reduction approach (15.6%, 43/275)C = Reduced cigarette consumption ≥ 50% at 6 months (29.8%, 82/275)D = Reduced cigarette consumption < 50% at 6 months (26.2%, 72/275)E = Returned to baseline cigarette consumption level (12.0%, 33/275)

%

(Excluding 57 lost to follow up at 6 months)

RESULTS

100

com

pare

d

Percentage of cigarette consumption in different time‐point (N = 275)

0

20

40

60

80

ciga

rette

con

sum

ptio

n as

w

ith b

asel

ine

QuittersB ( 15.6%, 43/275)

0 30 60 90 120 150 180Days


%


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RESULTS

100

com

pare

d


0

20

40

60

80

ciga

rette

con

sum

ptio

n as

w

ith b

asel

ine

ReducersC ( 29.8%, 82/275)

0 30 60 90 120 150 180Days


%


RESULTS

100

com

pare

d


R i t t k

0

20

40

60

80

ciga

rette

con

sum

ptio

n as

w

ith b

asel

ine

Resistant smokersD (26.2%, 72/275)

0 30 60 90 120 150 180Days


%


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RESULTS

100

com

pare

d


Resistant smokersE (12.0%, 33/275)

0

20

40

60

80

ciga

rette

con

sum

ptio

n as

w

ith b

asel

ine

0 30 60 90 120 150 180Days


%


RESULTS – Baseline characteristics of women smokers in different quitting trajectories

QuittersDaily cigarette consumption ↓ Nicotine addiction ↓Perceived importance on quitting ↑Perceived confidence on quitting ↑Stage of readiness to quit smoking ↑

Quitters

g q gPerceived physical health ↑

ReducersDaily cigarette consumption ↑↑ Nicotine addiction ↑↑Perceived importance on quitting ↓Perceived confidence on quitting ↓↓Stage of readiness to quit smoking ↓Perceived physical health ↓

Reducers

Photo extracted from http://news.bbc.co.uk/chinese/trad/hi/newsid_3760000/newsid_3764400/3764409.stm

Resistant smokersDaily cigarette consumption ↑ Nicotine addiction ↑Perceived importance on quitting ↓Perceived confidence on quitting ↓Stage of readiness to quit smoking ↓Perceived physical health ↑

Resistantsmokers

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PART III:PART III:

CONCLUSIONS

CONCLUSIONS

HKU “Smoking cessation service for female smokers” isthe first gender‐specific smoking cessation service in HK.

To raising public awareness on smoking cessation, wefounded WATT and trained smoking cessation counsellorsin the community.

Until 31 October 2009, the HKU smoking cessation hotlineanswered nearly 700 inquiries with 332 female smokersanswered nearly 700 inquiries, with 332 female smokersreceived counselling and completed 6‐month follow up.

40

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CONCLUSIONS

At 6‐month follow up, 26.5% of the participants quittedsmoking. The tobacco abstinence rate is slightly higherwhen compared to other local studies.

For those who continued to smoke, they

Reduced daily cigarettes consumption (from 15.2 to 9.4)

Had better perceived health status

Had higher self‐efficacy to resist smoking (regarding bothHad higher self efficacy to resist smoking (regarding both

internal and external stimuli)

41

CONCLUSIONS

Comparing baseline characteristics among quitters, reducers and resistant smokers, quitters had

lower daily cigarette consumption mild level of nicotine dependencyhigher level of perceived importance of quittinghigher level of perceived confidence of quittinggood to excellent perceived health statushigher stage of readiness to quitg g q

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CONCLUSIONDue to the tobacco tax increase in 2009, the number of inquiry andrecruitment of the HKU woman smoking cessation programme surged .Tobacco tax increase does motivate smokers to quit and seek help.

Number of inquiry and recruitment from 1 November 2006 to 31

October 2009

30

40

50

60

70

mbe

r of s

mok

ers

Number of inquiry

Number ofrecruitment

Number of inquiry and recruitment from 1 November 2006 to 31

October 2009

30

40

50

60

70

mbe

r of s

mok

ers

Number of inquiry

Number ofrecruitment

43

0

10

20

Nov, 0

6

Jan, 0

7M

arM

ay Jul

Sep

Nov

Jan, 0

8M

arM

ay Jul

Sep

Nov

Jan, 0

9M

arM

ay Jul

Sep

Time

Num

b

0

10

20

Nov, 0

6

Jan, 0

7M

arM

ay Jul

Sep

Nov

Jan, 0

8M

arM

ay Jul

Sep

Nov

Jan, 0

9M

arM

ay Jul

Sep

Time

Num

b

Enforcement of anti-smoking legislation Tobacco tax increase

WORLD NO TOBACCO DAY 2010

WHO selected “Gender and tobacco with an emphasison marketing to women” as the theme for World NoTobacco Day (31 May 2010)

The WHO Framework Convention, Expresses alarm “the increase in smoking by women and young girl worldwide”Recognizes “the need for gender‐specific tobacco control strategies”.

WHO encourage governments to protect womenagainst tobacco companies and the lure of tobacco.

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CONTACT INFORMATION

Hotline: 6752‐6266ot e 675 6 66Website: www.wquit.hku.hk

45

SupplementaryCharacteristics of participants

35 years old on average and working women

Perceived having good healthg g

Started smoking at early adulthood (18 years old)

Smoked 14 cigarettes per day in average

Nearly half of them are in contemplation stage

70.8% tried to quit before

Less than 1% sought professional help for smoking

cessation before

A desire for a healthy lifestyle is the reason for most

smoker to quit smoking46

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RESULTS (Supplementary)Significant differences on baseline characteristics among 3 groups (N = 275, excluding those who lost to follow up and did not report her cigarette consumption at 6-month follow up)

Quitters (A +B)(N = 88)

Reducers (C)

(N = 82)

Resistant Smokers (D + E)

(N = 105)

p‐value a

Mean ± SD

Daily cigarette consumption 11.9 ± 5.8 17.7 ± 9.8 13.7 ± 8.1 <0.01 (Q<R)(Q<RS)

Perceived importance on quitting(S 1 100)

89.2 ± 13.1 83.7 ± 17.0 83.8 ± 15.4 <0.05 (Q>R)(Q>RS)(Score: 1 ‐100) (Q>RS)

Perceived confidence in quitting(Score: 1 ‐100)

63.0 ± 19.9 55.6 ± 23.1 58.0 ± 21.6 <0.05 (Q>R)(Q>RS)

a = ANOVA

RESULTS (Supplementary)Significant differences on baseline characteristics among 3 groups (N = 275, excluding those who lost to follow up and did not report her cigarette consumption at 6-month follow up)

Quitters (A B)

Reducers (C)

Resistant Smokers (D E)

p‐valueb

(A +B)(N = 88)

(C)(N = 82)

(D + E)(N = 105)

N (%)

Level of nicotine dependence‐Mild ‐Moderate‐ Severe

393118

(44.3)(35.2)(20.5)

222634

(26.8)(31.7)(41.5)

323835

(30.5)(36.2)(33.3)

<0.05

Perceived health statusF i t P 27 (30 7) 35 (42 7) 27 (25 7)

<0.05‐ Fair to Poor‐ Good to Excellent

2761

(30.7)(69.3)

3547

(42.7)(57.3)

2778

(25.7)(74.3)

Stage of readiness ‐ Action‐ Preparation‐ Contemplation‐ Pre‐contemplation

1922397

(21.6)(25.0)(44.3)(8.0)

8173521

(9.8)(20.7)(42.7)(25.6)

12214626

(11.4)(20.0)(43.8)(24.8)

<0.05

b = Chi-square test

HKU’s “Smoking Cessation Service for · 2010/1/19 4 |Smoking prevalence trends of female smokers in HK 20.5% 20% 25% 30% 35% 40% 45% k ing prevalence BACKGROUND |Low utilisation

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