上海交通大学附属瑞金医院吕安康 MD

China to Control Tobacco Smoking Doctors in Action

中国控烟 医师在行动中国控烟 医师在行动

China ： the Largest Smoking Population

Prevalence of physician and general population smoking in China

China consumes more ciagrettes than any other country in the world and is home to 350 million current smokers

The catastrophic events of human

拯救他们 , 是我们的使命

一 . 开劈多科同治

开设健康控烟中心

瑞金健康控烟中心模式

PCI 等

护士台填写登记

录入电脑

总登记页

心脑血管组

呼吸组

心理组

妇儿组

肿瘤组

重选登记

会诊登记

选定科室后专

科深度评价

治疗

随访

门诊

住院研究单元

俱乐部

培训单元

二 . 医院、医护人员做表率

创建无烟医院

医师戒烟项目

STOP 中华医师戒烟

三 . 无烟上海，在努力之中

专家联合签名

立法建议听证会

三 . 无烟上海

.肆 无烟 ,祖国 心血管控烟的营造和推动

培训 推广

以媒体呼吁控烟体验营

戒烟体验营 --- 瑞金站第一期 戒烟体验营—瑞金站

第二期 戒烟体验营

活动现场，为戒烟明星颁奖

成功的喜悦 分享戒烟成功者的喜悦

五 . 控烟的酸与痛

Key Factors Related to Smoking Cessation

KEYKEYFACTORSFACTORS

Smoker Attitudes

National Strategy

Physician Behavior and Practice

• Cigarette tax increases • Enforcement of smoke-free enviroments• Advertising restrictions• Countermarketing

• Gender, • Education, • Marital Status ,• Race/ethnicity• Past quitting history :Number of quit attempts ever• Environmental: others smoking at home , no-smoking policy at work

• Yuan Jiang,et al. Am J Prev. Med. 2007;33(1):15-22• Physician Behavior and Practice Patterns Related to Smoking Cessation 2007 Association of American Medical Colleges• Chung-won Lee,et al. American Journal of Public Health 2007,97(8): 1503-1509•WHO. In: WHO Report on the Global Tobacco Epidemic. France, 2008

• Advise patients to stop smoking• Ask about smoking status• Discuss counseling options• Discuss pharmacotheraphies• Monitor patient progress in attempting to quit• Arrange follow-up visit• Warn about the dangerous of tobacco

Visits to health professionals and provision of cessation advice by country

0%

10%

20%

30%

40%

50%

60%

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Visited, but no advice

Visited and advised

History of quit attempts by country

0%

10%

20%

30%

40%

50%

60%

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Z

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Ever tried

Tried in last year

ITC project, unpublished data

• Physicians have a unique opportunity to:• Engage and educate their patients about smoking

cessation• Monitor their patients’ abstinence • Assist in preventing relapse

Black III JH. J Vasc Surg; In Press, Corrected Proof, 2010

The Physician’s Role in Smoking Cessation

Approaches to smoking cessation ---Models

In the early 1980s, a ‘stages of change’ model The 2008 US practice guidelines on the treatment of

tobacco use and dependence have based their recommendations for helping smokers to quit smoking on two stages of change models:

the ‘5 A's’ and ‘5 R's’ approach Recently ,the ‘3 Ts’ (tension, trigger, treatment).

Copyright © 2008 The Royal College of Psychiatrists

CHILVERS, R. et al. Br J Psychiatry 2002;181:99-101

In 1983 A ‘stages of change’ model

•Prochaska, J. O. & Di Clemente, C. C. (1983) Stages and processes of self-change of smoking: toward an integrative model of change. •Journal of Consulting and Clinical Psychology, 5, 390-395.•Prochaska, J. O. & Di Clemente, C. C. (1983) Stages and processes of self-change of smoking: toward an integrative model of change. •Journal of Consulting and Clinical Psychology, 5, 390-395.

move through stages of pre-contemplation, contemplation, decision, active change maintenance

move through stages of pre-contemplation, contemplation, decision, active change maintenance

Current smokers who want to smoke

• Physicians are urged counsel patients who want to quit smoking

• Practice the 5 A’s:• ASK to quit at every visit• ADVISE to quit at every visit• ASSESS willingness to quit at every visit• ASSIST quitting within 2 weeks with pharmacotherapy and counseling• ARRANGE follow-up contact in the first week after quitting

Black III JH. J Vasc Surg; In Press, Corrected Proof, 2010

Current smokers who do not want to quit

• Why don’t patients want to quit smoking?• Lack of information about the harmful effects• Lack of financial resources• Frustration with previous quit attempts

• Practice the 5 R’s:• RELEVANCE: why quitting should be important to them• RISKS: negative consequences of continuing to smoke• REWARDS: benefits of smoking cessation• ROADBLOCKS: identify things that may prevent the patient from quitting (with

drawal, weight gain, fear)• REPETITION: repeat every time the patient comes to the clinic

Black III JH. J Vasc Surg; In Press, Corrected Proof, 2010

3 Ts ---tension ， trigger, treatment the majority of attempts to stop smoking are made without

previous planning, and that unplanned quit attempts are more likely than planned ones to be successful.

The value of this ‘3T's’ model : a trigger for action (eg, engage the smoker in a conversati

on about the risks of smoking, regardless of whether they say they are ready to stop smoking or not)

the immediate availability of smoking cessation support (eg, medication or referral to counselling) may be most effective for increasing smoking cessation.

smoking cessation with varenicline: a 1-year outcomes of pilot study

Smoking Control Center

Ruijin Hosptal

Study Design

Enrolled cortortN= 39

Cold Turkey withdrawaln= 11

Nicotine Replacement Therapy n= 1

Vareniclinen= 27

Follow up at 2 weeks, once every two weeks or irregular thereafter , by telephone or outpatient ,for 1 year

Enroll date ： December 2008 ~ April 2009The last visit ： April 2010

Gender : male 37, female 2 Age ,mean , y : 46 Cigarette/d ,mean ： 19 (10-40) Pack Years , mean ,yrs ： 26 (10-52)

Result ： 1-Year Follow-up

Quitting Smoking Cases（ n ） Ratio

Failure Access Lost contact 12 31%

Succeed Never Smoking 13 33%

Failure

Occassional （ 3/d ） 3 8%

Relapse 2 5%

Never stop smoking 9 23%

Successful Probability

Successful Probability

0%5%

10%15%20%25%30%35%40%45%

Col d-Turkeywi thdrawal

NRT Vareni cl i ne

18%

40%

Changes of Number of Cigarettes with Time During Treatment with Varenicline

Case

Number of Cigarettes (pieces)

0 1 w 2 w 3w 4w 5w 6w

Case 1 35 0 0 0 1 0 0

Case 11 25 25 20 8 1 0 0 　Case 7 20 1 0 0 0 0 　 0

Case 2 15 — 8 3 - - 2 　Case 3 40 20 15 0 0 - 　 0

Case 9 40 — 20 — 2 0 0

Case 10 20 0 0 0 0 0 0

Case 4 15 10 5 0 0 0 0

Case 8 20 0 0 0 0 0 0

Case 5 15 0 0 0 0 0 0

Case 6 20 15 12 0 0 0 0

Changes of Number of Cigarettes with Time During Treatment with Varenicline

Overdose Time

More times of visit during follow-up , Higher smoking cessation rate

Times of visit during Follow-up Smoking Cessation Rate

0-1 12.4%

2-3 16.3%

4-8 20.9%

> 8 24.7%

Summary

To decrease the prevalence of smoking in China ,we need a system to get people to try to quit

Smoking associated with cardiovascular mortality Significantly Increased

Smoking Cessation is the Best Approach to Prevent Cardiovascular Risk

Encouraging smoking cessation among Chinese physicians is an important tobacco-control method

Varenicline (Champix) is the first line therapies.

This time for Africa

六 . 控烟主旋律

This time for smoking cessation奋进 困难 腾飞 永不放弃

Thank for your

attending