1. 1 ENSH 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

2. 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

3. 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.

4. 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

5. 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 ?  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

6. 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 ?

7. 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

8. ENSH WCTOH 2003 8 France

9. 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.

10. ENSH WCTOH 2003 10 Prevalence of smokers Daily smokers 22% Occassional smokers 9% Ex-smokers 24% Non smokers 45%

11. ENSH WCTOH 2003 11 16% 19% 35% 30% everytime often sometimes never Are they asking their patients about the smoking habit ?

12. ENSH WCTOH 2003 12 0% 20% 40% 60% 80% 100% counselling information prescription never sometime often everytime In case of a smoking patient what are you using as modalities to help them ?

13. 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.

14. ENSH WCTOH 2003 14 Romania

15. ENSH WCTOH 2003 15 Survey in Romania : method 2000 and 2003 in 3 hospitals Evolution of smoking prevalence and education n=340

16. ENSH WCTOH 2003 16 Smoking of HCW in Romania Smokers 31% Ex-smokers 5% non smokers 64%

17. ENSH WCTOH 2003 17 Smokers 13% 40% 15% 32% 0% 10% 20% 30% 40% 50% DoctorsMedical assistants NursesAuxiliary staff The prevalence of smoking by profession

18. 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.

19. ENSH WCTOH 2003 19 Spain RESULTS FROM THE CATALAN NETWORK OF SMOKE-FREE HOSPITALS

20. 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

21. ENSH WCTOH 2003 21 31.1% 43.3% 25.6% % Smoking of HCW in Spain

22. ENSH WCTOH 2003 22 Current smokers % DoctorsNursesAdministrativesLinesmenOther 17.9% 49.8% 15.0% 5.6% 11.6% 18% 50% 15% 6% 12% 0% 10% 20% 30% 40% 50% 60% doctorsnurses administratives linesmen other Distribution of smokers according to occupation in Spain

23. 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 attempts2-3 attemps>3 attempts

24. ENSH WCTOH 2003 24 16.949.321.712.1 Environmental tobacco smoke at work in spanish hospitals

25. 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

26. ENSH WCTOH 2003 26 Ireland

27. ENSH WCTOH 2003 27 Survey in Ireland : method The HCW has been tested on 98 HCW.

28. ENSH WCTOH 2003 28 Smoking habits of HCW in Ireland

29. ENSH WCTOH 2003 29 Conclusion for Ireland High prevalence of smokers 56% had intention to give up soon

30. ENSH WCTOH 2003 30 Greece

31. 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

32. 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. smokers 63% non smokers 37%

33. 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”.

34. ENSH WCTOH 2003 34 Comparison between countries surveys

35. 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.

36. ENSH WCTOH 2003 36 Number of responses

37. ENSH WCTOH 2003 37 Average age of participants (years)

38. ENSH WCTOH 2003 38 Distribution by sex of the sample

39. ENSH WCTOH 2003 39 Distribution by profession of the sample

40. 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

41. ENSH WCTOH 2003 41 Distribution referring to the smoking habit

42. ENSH WCTOH 2003 42 Dependence : How many minutes after you wake do you smoke your first cigarette of the day ?

43. 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?

44. 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

45. 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.

46. 46 ENSH WCTOH 2002