Impact of a Counseling Consultation in the Workplace for Smoker Health Professionals

Smoking is still a major cause of premature death in France (75,000 deaths a year). Healthcare professionals also seem to be affected by smoking, and few studies have been carried out on this population of smokers.

In 2010, 23% of nurses and 40% of nursing auxiliaries in France said they smoked every day. In a more recent study on parisian hospitals, the prevalence of daily smoking was observed among 26.8% of nurse auxiliaries, 26.3% of nurses, 16.7% of physiotherapists, 27.6% of health managers and 27% of doctors. Among the 3,659 respondents to a study at the Hospices Civils de Lyon, the smoking rate among paramedics (nurses, nursing auxiliaries, and health managers) was 25.6%. Among doctors, pharmacists and dentists, the proportion of smokers is 17.3%, while it reaches 46% among technical and logistics staff. The same survey also showed that paramedical students are three times more likely to be smokers than medical students, and that night staff are 1.5 times more likely to be smokers, given the same age.

In mental health establishments, smoking is prevalent among both patients and healthcare professionals. Investigators now know that smoking affects mood and sleep. It aggravates all pathologies (somatic and psychological) and predisposes people to more diabetes, chronic bronchitis, cardiovascular disease, cancer, etc. It interacts with many psychotropic and analgesic drugs. Smoking screening and cessation assistance have become a quality of care indicator in mental health institutions.

Investigators hypothesise that easier access to smoking cessation consultations in the workplace will improve uptake of this support and encourage smoker carers to change their smoking habits, and that experimenting with this support will increase smoker carers' confidence in their ability to manage their patients' smoking.

The issue of smoking in patients with psychiatric comorbidity is a major one. Smoking significantly reduces their life expectancy: an average of 25 years less, compared with 10 years for smokers without mental disorders. Cardiovascular disease and cancer are the leading causes of premature death. Smoking also affects their quality of life by increasing their metabolic risk (diabetes), reducing their respiratory capacity (chronic obstructive bronchitis) and increasing their risk of chronic disabling pain (arteritis of the lower limbs). Healthcare professionals are expected to play an active role in the fight against smoking and to act as role models for those receiving care, promoting appropriate lifestyles to maintain good health.

Smoking by health professionals does not appear to be more prevalent at the Centre Hospitalier Alpes-Isère than in the general population: 25.9% compared with 25.5%, but this is still significant and probably contributes to the erroneous representations of smoking in psychiatry.

Today, the recommendations of the Haute Autorité de Santé specify that psychological support and assistance are the basis of treatment. Nicotine substitutes supplement this support if the smoker shows signs of nicotine dependence. For smoker health professionals, the offer of smoking counselling in the workplace is likely to encourage them to use these aids and to succeed.

In previous studies, investigators found cessation rates at 12 months of 33% in an intensive intervention group (NST, intensive advice and outpatient telephone follow-up) compared with 20% in a control group (minimal advice) (RR = 1.7; 95% CI: 1.1 to 2.7).

In a study of hospital smoking clinics, 29.5% of patients (schizophrenic patients were excluded) maintained cessation at 1 year: female gender and prematurely interrupted follow-up were significantly associated with the risk of relapse at 1 year.

With regard to smoker healthcare professionals, a meta-analysis published in 2020 of ten studies (6 cohort studies and 4 clinical trials) measured a one-year cessation rate of 21% following the application of pharmacological or behavioural interventions. Hajek et al. showed in a randomised trial that the vaporiser could double the success rate at 1 year compared with treatment with nicotine replacement therapy alone, if accompanied by behavioural support.

Invesigators therefore believe it is possible to achieve a one-year cessation rate of 30% with workplace consultations combining support, nicotine replacement therapy and/or a vapour device where appropriate.

Doctors' smoking status and attitudes towards smoking are known to influence their enthusiasm for advising their patients against smoking.

As the Nagahapitye et al. study made clear: 'It is reasonable to assume that a healthcare professional who is not a smoker or is a former smoker will be more committed and more convincing in spreading messages about smoking and cessation. Health professionals smoking habits are therefore an important factor in the prevention of tobacco-related diseases.

The hypotheses of PSYTaB are :

• To improve cessation and reduction rates among smokers working in mental health,
• To improve the management of their patients' smoking and representations of smoking.

This study may also highlight benefits for the healthcare establishment and society, notably in terms of reduction in sick leave rates.

This study involves no risk for the subject.

Inclusion criteria

• Age ≥ 18 years
• Health professional
• Daily smoker of at least 1 cigarette or joint per day and every day
• Willingness to quit smoking
• Patient physically able and willing to undertake a carbon monoxyde measurement
• Patient affiliated to a social security scheme or beneficiary of such a scheme
• Signature of informed consent

Exclusion criteria

• Smoking via vaporizer exclusively
• Occasional (i.e. not daily) smoker or exhaled carbon monoxyde at inclusion < 9 ppm
• Resignation, transfer or end of employment contract during the study period (1 year)
• Unable to undergo study follow-up for geographical, social or psychological reasons
• Persons under legal protection or unable to express their consent.