Effectiveness of smoking cessation program in health service units in Nakhon Ratchasima Province

Abstract

Tobacco smoking is the leading health risk factor for burden of diseases in Thailand. The study on economic burden of smoking-related diseases in Thailand in 2014 found that 55,000 died from diseases caused by smoking (accounting for 11.2% of all deaths). Significant efforts led by the World Health Organization (WHO) and several countries have resulted in the development and introduction of clinical practice guidelines for medical personnel to help smokers quit, particularly in developing countries. The objective of this study was to evaluate the effectiveness of the smoking cessation program consisting of administration of varenicline as an aid to smoking cessation therapy in combination with counseling at the level of health service units in Nakhon Ratchasima Province. This prospective case-control study involved a 12- week treatment period with follow-up of the smoking status of all participants at 14^th day, 12^th week and 24^th week. A total of 2,000 current smokers were enrolled from October 2017 - July 2018 at 32 hospitals and health promotion centers in Nakhon Ratchasima Province, Thailand. Subjects were included if they were >15 years old, smoked regularly at least one year prior to study, and desired to quit smoking. Exclusion criteria were psychiatric patients and those who used illicit drugs. Intervention group consisted of 1,000 subjects with heavy smoking or had chronic non-communicable diseases (NCDs) such as diabetes, heart disease, chronic obstructive pulmonary disease (COPD), or smokers who failed from previous quitting efforts and wanted to quit smoking. and the intervention group received varenicline and counseling services. Comparative group included other 1,000 smokers who wanted to quit smoking and this control group received only counseling services to quit smoking. Results showed that smoking cessation rate at 24 weeks (6 months) was significantly higher in the experiment group (39.3%) than in the comparative group (15.3%) (OR = 3.58 95% CI (2.89, 4.44), p<0.001). Conclusions: The study provides information on the effectiveness of different interventions between varenicline and counseling or counseling only in smoking cessation clinic at health service units in Thailand. When compared to counseling only, varenicline prescription along with counseling was 2-3 times more effective at both hospital and hospital and health promotion center levels in Nakhon Ratchasima Province. To improve effectiveness of smoking cessation program, medication along with counseling should be considered by public health authority as appropriate treatment option for patients, if clinically indicated.