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1ENSH WCTOH 2002
European smoke free hospital Network
Florin Mihaltan
Anne Marie Schoelcher
Jean Patrick Deberdt
Ariadni Ouranou
François Chieze
Yannis Tountas
Didier Vander Steichel
Stefano Nardini
Elvira Mendez
Bertrand Dautzenberg
Health Care Worker Surveys in Europe
ENSH WCTOH 2003 2
Aims of ENSH
• In Europe most workplaces are smoke-free by law,
• Implementation of non-smoking workplace policies is
incomplete,
• The hospital is not a common workplace,
• The hospital is a model for public health,
• A non-smoking hospital policy is impossible to implement
with a smoking staff,
• A staff of non-smokers is more credible for treatment of
smokers.
Decrease of smoking rate in medical staff is a major aim of the smoke-free hospital
ENSH WCTOH 2003 3
European Survey of ENSH
• European Network of smoke-free hospital members agree to have 13 common questions on the HCW tobacco questionnaire.
• This questionnaire was tested in small groups in 5 countries and in a large group in one.
• We present the results of these European surveys.
ENSH WCTOH 2003 4
The objectives of the study
• The use of common questions on smoking to assess smoking habits of HCW
• To assess the prevalence of smoking among professionals
To be a barometer for each country
Anti-smoking resources inside the hospitals
Measure the impact of the strategy for every nation
ENSH WCTOH 2003 5
HCW questionnaire
Age…..sex…..job…..night work……..
If you are a daily smoker:- On average how many cigarettes (or cigars or pipes) do you smoke per day ? /__/__/ cigarettes/days- How long after waking up do you smoke ? < 5 minutes 6-30 minutes 31-60 minutes > 60 minutes- Are you planning to quit ?
in the next month in the next 3-6 month in the next year not at this time no
If you are an ex-smoker:- age of smoking cessation
/__/__/ years old- on average, how many cigarettes (or pipe or cigars) did you smoke per day ?
/__/__/ cigarettes/days
ENSH WCTOH 2003 6
HCW common questions
• What are the barriers for implementing smoke free hospitals ?
• What are the factors influencing the decision of hospitals ?
• What are the targets in this hospital ?
• What are the needs ?
ENSH WCTOH 2003 7
The actual data of the study
• The following results were obtained from each country’s survey responses, which vary according to their national health systems and policies
• 6 countries answered to the questionnaire: France, Spain,Greece, Ireland, Belgium and Romania
ENSH WCTOH 2003 9
Survey in France : method
• 58 hospitals
• n=18 579
• 36 questions concerning : social demographic data, smoking habits, opinions and practical aspects in the hospitals.
ENSH WCTOH 2003 10
Prevalence of smokers
Daily smokers
22%
Occassional smokers
9%
Ex-smokers
24%
Non smokers
45%
ENSH WCTOH 2003 11
16%
19%
35%
30%everytime
often
sometimes
never
Are they asking their patients about the smoking habit ?
ENSH WCTOH 2003 12
0%
20%
40%
60%
80%
100%
counsellinginformation
prescription
never
sometime
often
everytime
In case of a smoking patient what are you using as modalities to help them ?
ENSH WCTOH 2003 13
Conclusions for France survey
• A trend of decrease in the smoking rate of French professionals.
• There remains a discrepancy between the perception of the danger of smoking and the interest for therapy to quit smoking.
• More training is necessary to give professionals the tools and the motivation to quit smoking.
ENSH WCTOH 2003 15
Survey in Romania : method
2000 and 2003
in 3 hospitals
Evolution of smoking prevalence and education
n=340
ENSH WCTOH 2003 17
Smokers
13%
40%
15%
32%
0%
10%
20%
30%
40%
50%
Doctors Medicalassistants
Nurses Auxiliarystaff
The prevalence of smoking by profession
ENSH WCTOH 2003 18
Conclusions for Romania
• The same level of smoking in hospital staff as in general population
• A low level of education concerning methods to quit smoking.
ENSH WCTOH 2003 20
10 hospitals attached to the Catalan Network of Smoke-free Hospitals have carried out a smoking prevalence survey in 2002-2003
Total capacity of these hospitals is 2,502 beds
2,257 health staff have answered the questionnaire: 1,661 (73.6%) women and 596 (26.4%) men
In 9 hospitals the survey was conducted face to face by an interviewer. In these cases, response rate was 98%.
Spain : Method
ENSH WCTOH 2003 21
31.1%
43.3%
25.6%
%
Smokers31%
Ex-smokers
26%
non smokers
43%
Smoking of HCW in Spain
ENSH WCTOH 2003 22
Current smokers
%
Doctors Nurses Administratives Linesmen Other
17.9%
49.8%
15.0%
5.6%
11.6%
18%
50%
15%
6%12%
0%
10%
20%
30%
40%
50%
60%
doctors nursesadministratives
linesmen other
Distribution of smokers according to occupation in Spain
ENSH WCTOH 2003 23
More than half of smokers (57%) have attempted to quit smoking.
From those who had tried to quit smoking, 59% attempted to quit more than once without any positive results.
Previous attempts to quit smoking among current smokers in Spain
38
18
44
0
10
20
30
40
50
1 attempts 2-3 attemps >3 attempts
ENSH WCTOH 2003 24
0% 50% 100%
No exposure <1 hour 1-4 hours >4 hours
16.9 49.3 21.7 12.1
Environmental tobacco smoke at work in spanish hospitals
ENSH WCTOH 2003 25
They found a high smoking prevalence among our health staff (31%).
Nursing staff is occupation group with the highest smoking prevalence. Specific interventions to give up smoking should be addressed to them.
12% from the Health Staff have declared being exposed to smoke at work >4 hours per day. Interventions to reduce that exposure should be carried out.
Conclusions for Spain
ENSH WCTOH 2003 29
Conclusion for Ireland
• High prevalence of smokers
• 56% had intention to give up soon
ENSH WCTOH 2003 31
Survey in Greece : method
• This analysis was based on information deducted from results of a survey carried out in four general hospitals in Athens, Greece
ENSH WCTOH 2003 32
Smoking habits of HCW in Greece
• The high prevalence of smoking is impressive taking into consideration that 38% of the people surveyed are Doctors.
smokers63%
non smokers
37%
ENSH WCTOH 2003 33
Conclusion for Greece• None of the personnel surveyed have ever
received smoking cessation help from their healthcare organization.
• 33% replied that they do not desire such assistance while an equal 33% mentioned that such help is either not easily accessible or has never been made available.
• 20% of the smokers surveyed have no plans of quitting while 7% hope to quit within the coming months and slightly more than 25% project to quit “someday”.
ENSH WCTOH 2003 35
HCW national questions
• For France: evolution of prevalence, concerning professionals in particular, policy and strategy of training.
• For Spain: prevalence datas, exposure to the environmental tobacco smoke at work.
• For Greece: desire to quit smoking, evolution of prevalence.
• For Belgium: evolution of prevalence.
ENSH WCTOH 2003 36
98100
2257
34059
18579
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
France Greece Romania Spain Belgium Ireland
Number of responses
ENSH WCTOH 2003 37
35
39
3533
4340
0
5
10
15
20
25
30
35
40
45
50
France Greece Romania Spain Belgium Ireland
Average age of participants (years)
ENSH WCTOH 2003 38
81%
71% 74%
86%
70%
8%
92%
19%
29.5% 26%
14%
30%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Male Female
France Greece Spain
Romania Belgium Ireland
Distribution by sex of the sample
ENSH WCTOH 2003 39
30%
13%
49%
38%
19%15%
28%29%
40%
7%
24%
7%
53%
14%
26%
3%
24%
42%
8%
31%
0%
10%
20%
30%
40%
50%
60%
Doctor Nurse Administrative Other
France Greece Romania Belgium Ireland
Distribution by profession of the sample
ENSH WCTOH 2003 40
Relevant data for France results is unavailable except to mention that smoking French health staff smoke 11,9 cig/day on average
Number of cigarettes smoked daily
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Greece Romania Spain Belgium Ireland
<10
.10 -20
>20 cig/d
ENSH WCTOH 2003 41
Distribution referring to the smoking habit
0%10%20%30%40%50%60%70%80%90%
100%
Belgium France Spain Ireland Romania Greece
No response
Non-smoker
Ex-smoker
Smoker
ENSH WCTOH 2003 42
Dependence : How many minutes after you wake do you smoke your first cigarette of the day ?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
France Greece Romania Spain Belgium Ireland
>31 min.
.10-30
<5
ENSH WCTOH 2003 43
Relevant data is unavailable for Spain. except to mention that 57.05% of the health staff smokers responding have unsuccessfully tried to quit smoking at least once.
Do you have any intention of giving up smoking soon?
0%
20%
40%
60%
80%
100%
France Greece Romania Belgium Ireland
No
Yes
ENSH WCTOH 2003 44
Conclusions• We remark that in all the samples it is a
predominance of women• Hospitals are barometer for particularities
of smoking to women• The level of dependency is medium• Interdictions of smoking in the hospitals
exists but are not respected, mainly in South and East
• Implications of staff is not sufficiently
ENSH WCTOH 2003 45
Conclusions
• There persists a high level of smokers amongst the medical staff.
• Hospitals must be exemplary places of smoke-free health.
• Nurses must be the first target in the hospitals.
Products to assist quitting smoking make free-of-charge for medical staff.