SMOKING CESSATION SMOKING CESSATION IN A GROUP OF IN A GROUP OF

FOUNDRY WORKERS FOUNDRY WORKERS AGED 40 +AGED 40 +

Elena-Ana Pauncu, PhD, MD, University of Medicine and Pharmacy “Victor Babes” Discipline of Occupational Health, Timisoara, Romania;Professor Dr. Dorin Bardac, Medical Faculty ”V.Papilian, Sibiu, Romania;

Dr. Mihaela Stoia, Department of Public Health, Sibiu, Romania;Dr. Mihaela Hărătău, Public Health Specialist, Romtens Foundation,

Bucharest, Romania

Healthy LifeHealthy Life…………

Healthy citiesHealthy cities…………

Healthy Healthy workplacesworkplaces

…………

AimAim

To present some results of a smoking To present some results of a smoking cessation program developed in an cessation program developed in an enterprise, particularly in a foundry enterprise, particularly in a foundry factory from Timisoara, Romania.factory from Timisoara, Romania.

ROMANIAROMANIA

ROMANIA ROMANIA (01.07.2003)(01.07.2003)

Population – Population – 21,733,55621,733,556

Surface – Surface – 238,391 km238,391 km22

TotalTotal UrbanUrban RuralRural

MM 48.848.8 4848 49.749.7

FF 51.251.2 5252 50.350.3

TIMISTIMIS (01.07.2003)(01.07.2003)

TotalTotal MM FF

UU 53.453.4 52.552.5 54.254.2

RR 46.646.6 47.547.5 45.845.8

Population – Population – 661,171661,171

(Timisoara – (Timisoara – 308,019)308,019)

Surface – Surface – 8,697 km8,697 km22

Medium duration of life, Medium duration of life, Timis countyTimis county

PeriodPeriod Both sexesBoth sexes MaleMale FemaleFemale

1990-19921990-1992 68,9968,99 65,3265,32 72,8272,82

1995-19971995-1997 68,6568,65 64,6564,65 72,9072,90

1998-20001998-2000 70,4470,44 66,9366,93 73,9773,97

1999-20011999-2001 71,0571,05 67,3667,36 74,7774,77

2000-20022000-2002 71,2071,20 67,4967,49 74,9174,91

2001-20032001-2003 71,2171,21 67,7067,70 74,7074,70

Action LevelAction Level

The workplace, a foundry factory (medium The workplace, a foundry factory (medium size enterprise) in Timisoara (Timis county / size enterprise) in Timisoara (Timis county / Romania)Romania)

SettingSetting

The project took place in a foundry The project took place in a foundry section of a metallurgic factorysection of a metallurgic factoryDuration – 1 year (+ 1 year optional) Duration – 1 year (+ 1 year optional) A local research was performed among A local research was performed among the workers (questionnaire)the workers (questionnaire)The employees working in the factory The employees working in the factory were divided in two groups, according were divided in two groups, according to their age (the age limit was to their age (the age limit was 40 years40 years).).

Tools / MethodsTools / MethodsQuestionnaire regarding the smoking habits applied Questionnaire regarding the smoking habits applied to 186 workers.to 186 workers.Health education sessions (performed by Health education sessions (performed by Pneumologist + Public Health specialist)Pneumologist + Public Health specialist)Smoking cessation counseling – using the Smoking cessation counseling – using the Counseling Medical Office established within the Counseling Medical Office established within the Pneumology Hospital very close to the enterprise)Pneumology Hospital very close to the enterprise)Health status evaluation of the workers included in Health status evaluation of the workers included in the study (medical examination and comparison of the study (medical examination and comparison of the data before and after the implementation of the the data before and after the implementation of the program)program)Tobacco Control Policy – elaboration and Tobacco Control Policy – elaboration and implementationimplementation

Why in a foundry ?Why in a foundry ?

Smoking habits (high prevalence, Smoking habits (high prevalence, around 65 %)around 65 %)Nutrition habits (high cholesterol Nutrition habits (high cholesterol values)values)Concurrence of professional exposure Concurrence of professional exposure and unhealthy lifestyleand unhealthy lifestyle

Occupational exposure of Occupational exposure of workersworkers

Silica dust Silica dust

ClimateClimate

FumesFumes

PAHsPAHs

FormaldehydesFormaldehydes

Physical effortPhysical effort

Metal dust (iron, steel, non-ferrous, etc.)Metal dust (iron, steel, non-ferrous, etc.)

Cigarette smokingCigarette smoking

B

T

N

Eb

X

A

FP

C

The chromatogram of the resin extract from foundry (continuous line) compared with a standard mixture of PAHs and other compounds (interrupted line). Column C8 (Octyl), elution 80% MeOH, detection at 254 nm (B - benzene, T - toluene, N - naphthalene, X - xylene, A -anthracene, F - fluorantene, P - pirene and C - crisen)

Comparison between the chromatograms of the foundry dust extract from the filter, in two different days

A

F

PN X

B

T

PARAMETER G1 (n=112)Age 40 - 58

G2 (n=74)Age 18 - 39

Average age 47.125 10.125 28.014 9.721

Seniority at work 24.857 9.688 9.107 9.751

Seniority at work in the actual workplace

15.036 8.223 6.034 9.121

Questionnaire Research -Questionnaire Research -Characteristics of Studied GroupsCharacteristics of Studied Groups

no persons with silicosis, same gender no persons with silicosis, same gender malemale

PARAMETER G1 (n=112) G2 (n=74)

Smokers 73 65.17% 48 64.86%

Ex-smokers (before starting the study)

10 8.90% 4 5.40%

Non-smokers (do include the ex-smokers)

39 34.82% 26 35.14

Average consum of cigarettes / day

15.305 7.350 16.175 7.993

Limit of cigarette consuming, per day

1 - 40 1 - 40

Average duration of smoking

15.207 9.677 4.304 8.763

Starting smoking at … 18.624 8.203 17.728 7.988

Questionnaire Research Questionnaire Research -- Company Smoking ProfileSmoking Profile

Respiratory symptomsRespiratory symptoms

5.35

41.07

71.42

50

4.46

13.51

16.21

48.64

9.45

2.70

10

20

30

40

50

60

70

80

G1 G2

Dry caugh

Productive caugh

Effort dispneea

Torax pain

Increasedperspiration

Pulmonary function tests Pulmonary function tests resultsresults

0

10

20

30

40

50

60

70

80

FEV1 normal SAD Restriction Obstruction Mixtdisfunction

G1

G2

Respiratory pathologyRespiratory pathology

0

5

10

15

20

25

30

35

40

G1 G2

Bronchitis

Respiratoryantecedents

Tonsillitis

Pharingitis

Laryngitis

Sinusitis

Repeated acuterespiratory diseases

Elaboration / Implementation of a Elaboration / Implementation of a Tobacco Control PolicyTobacco Control Policy

Steps (entire process took 1 year and was coordinated by the Steps (entire process took 1 year and was coordinated by the Safety Officer):Safety Officer):Establish a working group (Safety Officer, Occupational Establish a working group (Safety Officer, Occupational Health Physician, Human Resources Manager)Health Physician, Human Resources Manager)Get support from the managementGet support from the managementReview existing regulations / initiativesReview existing regulations / initiativesDevelop the PolicyDevelop the PolicyReviewing the Policy with the managementReviewing the Policy with the managementAgreeing the Policy with the workforce (continuous Agreeing the Policy with the workforce (continuous process) – more informing them rather than getting their process) – more informing them rather than getting their feed-backfeed-backAnnouncing the PolicyAnnouncing the PolicyImplementing the Policy (it is young – 1 year almost)Implementing the Policy (it is young – 1 year almost)

ResultsResultsInitially, the percent of smokers was Initially, the percent of smokers was similar, 65%.similar, 65%.The adherence to the program was The adherence to the program was good, in both groups. Only 3% of good, in both groups. Only 3% of participants’ participants’ dropped outdropped out after one or after one or two months of the program.two months of the program.The respiratory complains in the group The respiratory complains in the group aged 40 and older (G1) were more aged 40 and older (G1) were more frequent, compared to those in the frequent, compared to those in the second group,(G2), younger than 40 second group,(G2), younger than 40 years. years.

PARAMETER G1 (n=73) G2 (n=48)

Initial participants 73 48

Dropped out 2 1

Participants after 2 months 71 47

Number of smokers whom visited the Counseling Office

(all smokers)

73 48

Non-smokers after one month of program implementation

12 6

Reduced smoking after 6 months

11 12

Non-smokers after 1 year including those from the (1st

month)12 + 7 6+2

ResultsResults

ResultsResults

The actual results are satisfactoryThe actual results are satisfactory12 persons in the G1 “older group” and12 persons in the G1 “older group” and6 persons in the “younger group” G2 6 persons in the “younger group” G2 became non-smokers after one month became non-smokers after one month of program implementation, andof program implementation, andanother 23 persons had a good another 23 persons had a good response after six months of response after six months of implementation.implementation.

Motivation of adherence at Motivation of adherence at the cessation programthe cessation program

Impossibility to solve himself the Impossibility to solve himself the problemproblem

Need of saving money/personal Need of saving money/personal reasonsreasons

Health related problemsHealth related problems

Family attitudeFamily attitude

Motivation to continuing Motivation to continuing smokingsmoking

Immediate consequences of cessation / Immediate consequences of cessation / withdrawal syndromewithdrawal syndrome

The attitude of smokers – environment The attitude of smokers – environment impactimpact

Imperious need to smoke Imperious need to smoke

Automatism related reasonsAutomatism related reasons

PersonalityPersonality

EvaluationEvaluation

The results regarding the motivation for The results regarding the motivation for continuing smoking showed very continuing smoking showed very diverse and interesting individual diverse and interesting individual approaches. approaches.

The smoke free workplace policy played The smoke free workplace policy played had an important role in changing the had an important role in changing the reaction of workers towards non-reaction of workers towards non-smoking into a positive one.smoking into a positive one.

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ROMANIAROMANIA