Smoking Reduction is the First Step Towards Smoking Cessation Dr. SSC Chan 1, Prof. TH Lam 2, Dr. VT Wong 3, Mr. AYW Chan 4, Prof, AJ Hedley 2 1 Department of Nursing Studies, HKU LKS Faculty of Medicine 2 Department of Community Medicine, School of Public Health, HKU LKS Faculty of Medicine 3 Hospital Authority 4 Hong Kong Council on Smoking and Health
Organising Units and Funding Sources Organising units Department of Nursing Studies, HKU LKS Faculty of Medicine Department of Community Medicine, School of Public Health, HKU LKS Faculty of Medicine Joint effort with Hospital Authority and Hong Kong Council on Smoking and Health Funding Source Health and Health Services Research Fund
Background 7,000 deaths were attributable to smoking every year Costing over $5 billion 60% of HK smokers have no intention to quit smoking in near future Reduction in smoking can be an intermediate step before complete cessation
Previous Research A randomized trial conducted in US* indicated participants who received the treatment are 1 time more likely to reduce cigarette smoking by half and 3.5 times more likely to quit smoking Carpenter MJ, Hughes JR, Solomon, LJ, Callas PW. (2004). Both smoking reduction with nicotine replacement therapy and motivational advice increase future cessation among smokers unmotivated to quit. Journal of consulting and clinical psychology, 72(3), 371-381
HKU Study Objectives To examine the effect of a special designed smoking reduction intervention on Smoking cessation Reducing daily cigarette consumption To assess the effectiveness of an adherence intervention in enhancing Adherence rate Reduction rate Quit rate
Inclusion Criteria Adult Chinese male or female No intention to quit in the near future or were unsuccessful in the previous quitting attempt using NRT Intends to reduce smoking No contraindication to NRT and is not participating in other smoking cessation interventions
Research Design Randomised controlled trial Intervention group: Smoking reduction intervention provided by trained nurse counsellor Nicotine replacement therapy (NRT) Adherence intervention (for A1 group only) Control group Simple quitting advice provided by nurse counsellor Self help material
Research Protocol Randomisation (n = 640) Intervention group A1 (n = 249) Intervention group A2 (n = 267) Control group B (n = 124) 1 week and 1 month follow up visit 3 month telephone follow up interview 6 month follow up telephone interview Biochemical validation if participants quit smoking or reduced 50% consumption of cigarette
Participants Characteristics (N=640) 83% are male Mean age: 42 years old 71% are married 41% achieved senior secondary (F.4 to F.5) education level 85% are employed 42% have personal income ranged from $10,000 to $19,999 14% of the participants spouse smoke On average, smoking for 24 years
Age of Starting Smoking Age Number % 11 23 4 12 to 14 105 16 15 to 17 207 33 18 302 47
3 Key Smokers Characteristics Addiction Lack of Confidence Motivation and Social Support
ADDICTION Smoking more than the average HK smokers (20 cpd vs. 14 cpd*) 98% think they are addicted to tobacco * Thematic Household Survey Report No. 16 (2003). Census and Statistics Department.
Number of Cigarettes Smoked On average, participants smoked 20 cigarettes every day 14% 9% 22% 31 or more 21-30 11-20 10 or less 55%
Fagerstrom Nicotine Dependence Test 1. How soon after you wake up do you smoke your first smoke? 2. Do you find it difficult to refrain from smoking in places where it is forbidden, e.g. in shopping mall, MTR or lifts? 3. Which cigarette would you hate most to give up? First in the morning (1) Within 5 mins (3) 6-30 mins (2) 31-60 mins (1) 60+ mins (0) Yes (1) No (0) All others (0) 4. Do you smoke more frequently during the first hours after waking than the rest of the day? 5. Do you smoke if you are so ill that you are in bed most of the day? 6. How many cigarettes per day do you smoke? Yes (1) No (0) Yes (1) No (0) 31 or more (3) 21-30 (2) 11-20 (1) 10 or less (0) Scoring displayed in brackets Score 0 to 3: Mild 4 to 5: Moderate 6 to 10: Severe
Nicotine dependence level Fagerstrom nicotine dependence score: mean 5.13 (scale of 0 to 10) 22% 46% Low Moderate Severe 32%
ADDICTION 44% think it is difficult to refrain smoking in places where it is forbidden Difficult situations to resist smoking: Dealing with withdrawal symptoms 42% Being under stress (work, social relationship, etc) 16% Having smokers around 16%
ADDICTION Smoking pattern After meals (93%) When relaxing (89%) Bored (89%) Smokers around (88%) When stay at home (84%) Feeling anxious (76%)
LACK OF CONFIDENCE 81% had tried reducing smoking in the past 73% had tried quitting smoking in the past, but failed 75% felt embarrassed when they smoke 64% perceived difficulty in reducing smoking
Number of Quit Attempts 41% 3% 5% 27% 24% none 1 attempt 2 to 5 attempts 6 to 10 attempts more than 10 attempts
LACK OF CONFIDENCE Reasons of failure in quitting: Urge to smoke (49%) Peer/friend s influence (43%) Habit (38%) Only 14% reported strong confidence in reducing their daily cigarette consumption by half
LACK OF CONFIDENCE To boost confidence: Counseling Smoking reduction with short term goals Small achievable goal Build up confidence gradually
MOTIVATION & SOCIAL SUPPORT 84% think it is important to reduce smoking Reason to reduce smoking: Harmful effects of smoking on own health (92%) Harmful effect of smoking on family health (61% ) Encouraged by family members, friends or relatives (48% ) Save money (33%) To be a responsible parent (30%)
MOTIVATION & SOCIAL SUPPORT Source of support: Spouse (59%) Children (45%) Parents (28%) Friends (28%) 77% are interested in making a serious attempt to stop smoking in the near future
Difficulties of Quitting Smoking Moderate heavy smokers Addicted to nicotine Stress and peer smoking Lack of confidence Abrupt quitting is difficult
Benefits of smoking reduction intervention (1) 1. Physical intervention Pharmacological intervention Reduce withdrawal symptoms Carbon monoxide level feedback Exhaled CO concentration Reflect smoking status
Benefits of Smoking Reduction Intervention (2) 2. Behavioural and social intervention through assessment and counselling Established individualised reduction plan Establish reduction goals and build up small successes Identify motivator Build up confidence to reduce/ quit smoking
Conclusion First evidenced-based examination of unique characteristics of smokers Strength: awareness of own/family health, family and social support Barriers: Moderately high nicotine dependence, low confidence in quitting/reducing smoking
Contact Information For smokers who do not want to quit in the near future, but want to REDUCE smoking, please contact us to join the programme Friends, relatives and colleagues please refer smokers to join Smoking Reduction Programme 6752-6266 2819-2697
Acknowledgements Pifzer for NRT sponsor Mr. Bernard Yeung, Research Assistant Smoking Reduction/ Cessation Counsellors
Sharing by HKU Smoking Reduction Nurse Counsellors