Cessation Program in Hospitals - China Tobacco Control Partnership

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					   Implementing Successful Cessation
        Program in China Hospitals

              Dan XIAO, M.D., Ph.D.

  WHO Collaborating Center for Tobacco or Health
       Beijing Institute of Respiratory Medicine
Beijing Chao-Yang Hospital, Capital Medical University

             Oct 20th, 2011, Li Jiang
Beijing Chao-Yang Hospital

• 3603 staff
• 1910 beds
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
   “Grandpa of Tobacco
   control in China”
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
                        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             First cessation training workshop
    academic conferences (from 2007)                     June 27-29, 2000
   China Clinical Smoking Cessation Guideline

• Trial version in 2007, update in
  – Core: Conception for tobacco
    dependence as a chronic disease,
    recommendations for disease
    diagnosis and treatment
    Include the contents of the health hazards of
 tobacco and tobacco control into the official system
                of medical education
 9 textbooks at least (Chapters )
Asia Alliance for the Treatment of
Nicotine Dependence (ATND)

May 23-25, 2008, Shang Hai   Aug 8-9, 2009, Beijing
  Nicotine Dependence Conference
• Cooperated with Mayo Clinic (1st in 2006, 2nd in 2008, 3rd in 2009)
Network of WHO Collaborating Center for
     Tobacco or Health for Medical
    Professionals against Smoking
       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

• Promote at national level

   “Every Respiratory Department should have a Smoking Cessation Clinic,
   otherwise it is not a complete Respiratory Department”
                                                — Prof.WANG Chen
• 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

• Support from MOH and WHO
        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
Example of treatment referral printed
Pilot Results

                May, 2010
          Tobacco Control in Hospitals
• 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

• The conference of making Criteria
  for Smoke Free Hospital
  Assessment was held in Beijing
  Chao-Yang Hospital on Nov.12
                                          May 29th, 2004, Beijing
  2004. The Criteria drafted out by the
  Center was discussed and formed
  in the conference.
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.
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 decreased to 4.9%
National Smoke-free Hospital Designation

                                  May, 2006
Case introduction by the Union
  Evaluation of the Chinese versions of the
Minnesota Nicotine Withdrawal Scale and the
  Questionnaire on Smoking Urges-Briefs
 MNWS and 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 MNWS and
  QSU-Brief can 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.
 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
   China (National level, 10sites)

                                     Wang C, Xiao D, Chan KP, et
                                     al.Respirology. 2009, 14(3): 384-92.
Varenicline: CO-Confirmed Quit Rates
    and Long-Term Abstinence
          CQR              CA                              LTQR
        Week 9-12        Week 9-24                        Week 9-24
          OR = 2.31
          (1.45, 3.67)                                      OR = 2.29
          P = 0.0003                                        (1.42, 3.71)
   60                    OR = 1.92
                                                            P = 0.0006
                         (1.18, 3.13)
         50.3            P = 0.0080
   50                                                     44.2
   40                                      Varenicline
                 31.6                      Placebo
   30                                                             26.8



          week 9-12      week 9-24 CA           .        week 24 LTQR

                                 Respirology. 2009, 14(3): 384-92.
      Quit Projects

  - Help Chinese smoking
physicians quit with Champix,
    Nicotine gum & patch
                     HOPE Study

• Open-label, parallel, multi-center study
• 6 hospitals from Beijing, Shanghai and Guangzhou
• Targets physicians and hospital staff of smoke-free
• 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
                 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
         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.
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
                       Role models

Professor ZHANG Jianqing                  Professor: YANG Yong
President of Qinghai Red Cross Hospital   Director of Urology Department
                                          Beijing Chao-Yang Hospital
Quit smile program
Free consultation
Media Promotion
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.
China Report on Harms of
Smoking and Secondhand Smoke
“A journey of 1000 miles begins with a single step!”


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