Occupational Medicine 2006 56(1):59-60; doi:10.1093/occmed/kqj001
© The Author 2005. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Effectiveness of smoking cessation advice for asbestos workers
Andrew Johnson,
Peter Farrow and
Roland Jenkins
Chest Clinic, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, UK
Correspondence to: Andrew Johnson, Kent and Canterbury Hospital–Chest Clinic, Ethelbert Road, Canterbury, Kent CT1 3NG, UK. Tel: +44 1227 766877; fax: +44 1227 864102; e-mail: andrew.johnson{at}ekht.nhs.uk
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Abstract
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Aim To assess effectiveness of smoking cessation advice to asbestos
workers at statutory medical examinations.
Methods Workers are required to be examined every 2 years while continuing potential exposure to asbestos, including cessation advice if smokers. Records of 170 workers seen between 1986 and 2004 in Kent and Canterbury Hospital were reviewed. Respiratory symptoms, signs, lung function, radiological findings and smoking status were analysed.
Results At initial visit 109 (64%) were smokers. Thirty-four of these attended twice. Despite verbal advice, including emphasis on respiratory abnormalities detected in 62%, only three (9%) had ceased smoking by self-reporting at the second visit.
Conclusion Despite appropriate counselling regarding the potential risks of asbestos exposure and smoking, the cessation rate among asbestos workers was disappointingly low. Further measures to encourage asbestos workers to enter smoking cessation programmes should be considered.
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Introduction
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In the United Kingdom under the Asbestos Regulations [
1], asbestos
workers must undergo assessment by a Health & Safety Executive
appointed doctor every 2 years. Suggested components of the
assessment include a respiratory symptoms questionnaire, clinical
examination and spirometry. Chest radiography was required until
2003 but is now at the discretion of the appointed doctor. The
appointed doctor completes a standardized medical assessment
form which also asks by means of a checkbox for confirmation
that the asbestos worker has been given advice about smoking
cessation. This is in view of the increased risk of lung cancer
in smokers exposed to asbestos fibres [
1,
2].
Our impression from carrying out consecutive asbestos medicals on the same workers is that simple cessation advice is ineffective. We therefore carried out an audit of consecutive medicals to assess the proportion of asbestos workers who ceased smoking.
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Methods
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The records of all asbestos medicals performed under the Asbestos
Regulations at the Kent and Canterbury Hospital between 1986
and 2004 were identified. All medicals within this time frame
were performed by a single appointed doctor (AJJ), a specialist
respiratory physician who undertakes all asbestos medical examinations
within East Kent. From these records, workers who attended consecutive
two yearly medicals at least once were identified. The following
data were collated for analysis: age, sex, occupation, worker-reported
smoking status, respiratory symptoms (cough, sputum, haemoptysis,
dyspnoea or chest pain), clinical findings, spirometry [forced
expiratory volume in 1 s (FEV1), forced vital capacity (FVC)
and FEV1/FVC ratio] and chest radiology. Abnormalities were
recorded as any chest symptoms or signs, FEV1 or FVC < 80%
predicted or FEV1/FVC ratio < 75%, or any radiological pulmonary
or pleural changes. It was the standard practice of AJJ to give
all smokers clear verbal advice concerning the importance of
quitting, including the greatly increased risk of lung cancer
in smokers with asbestos inhalation.
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Results
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Records of 170 asbestos workers were available for analysis.
All were male with an average age of 37 years (range 16–61).
At their first visit 109 (64%) were current smokers (
Table 1).
One hundred and twenty-two workers did not attend for a second
medical examination, leaving 48 for further analysis. Thirty-four
(71%) of these were smokers initially, but only three (9%) reported
cessation at the second visit. Of the 34 initial smokers followed
up, 21 (62%) had some abnormalities (
Table 2).
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Discussion
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This study found that a very high proportion of asbestos workers
smoke (64%) and may be at greatly increased risk of malignancy
as a result. Only a small proportion attended for a further
medical and only 9% of these had stopped smoking in the meantime
despite clear verbal advice regarding their increased risk of
malignancy. The study also found a high proportion of symptoms
or abnormalities on examination and investigation in smokers.
The low second attendance rate may be due to workers leaving the industry or moving elsewhere or other factors. The weaknesses of this study are its small numbers and lack of control group. Comparison with other cessation studies is hindered by lack of age and sex comparability. However, Campbell et al. [3] found an 8.7% cessation rate at 1 year in their unselected control group given simple advice. The 9% rate observed in our series is similar. Validation of non-smoking claims was not made, so our data may overestimate the true rate.
The poor response to simple cessation advice is disappointing, and leads to concern whether these workers follow any health and safety recommendations. Nevertheless, further measures may be helpful. Nicotine replacement therapy [4] and bupropion [5] have shown efficacy in increasing cessation rates. Non-pharmacological techniques have been advocated, although success rates are small [6]. However, smoking cessation interventions can be obtained at low cost per life-year gained [7]. Appointed doctors already should report any abnormalities to the general practitioner with workers' consent. We recommend that workers indicating any willingness to quit smoking should be referred to a comprehensive cessation programme either via their general practitioners, or directly by the appointed doctor in their working area.
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Conflicts of interest
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None declared.
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References
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- Control of Asbestos at Work Regulations 2002 Handbook for Appointed Doctors. HMSO, revised 2003.
- Hammond E, Selikoff I, Seidman H. Asbestos exposure, cigarette smoking and death rates. Ann N Y Acad Sci 1979;330:473–490.[Medline]
- Campbell IA, Lyons E, Prescott RJ. Stopping smoking: do nicotine chewing gum and postal encouragement add to doctors' advice? Practitioner 1987;231:114–117.[Web of Science][Medline]
- Tang JL, Law M, Wald N et al. How effective is nicotine replacement therapy in helping people to stop smoking? Br Med J 1994;308:21–26.[Abstract/Free Full Text]
- Jorenby DE, Leischow SJ, Nides MA et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both, for smoking cessation. N Engl J Med 1999;340:685–691.[Abstract/Free Full Text]
- Crowley TJ, Macdonald MJ, Walter MI. Behavioural anti-smoking trial in chronic obstructive pulmonary disease patients. Psychopharmacology 1995;119:193–204.[CrossRef][Medline]
- Parrott S, Godrey C, Raw M et al. Guidance for commissioners on the cost effectiveness of smoking cessation interventions. Thorax 1998;53(Suppl. 5, Part 2):S4–S10.
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Abstract
Introduction