“Tobacco Free With FDNY”: The New York City Fire Department World Trade Center Tobacco Cessation Study

doi:10.1378/chest.129.4.979

Chest

Volume 129, Issue 4, April 2006, Pages 979-987

https://doi.org/10.1378/chest.129.4.979 Get rights and content

Context

After the World Trade Center (WTC) collapse, 15% (1,767) of rescue workers from the Fire Department of the City of New York (FDNY) considered themselves to be current cigarette smokers. Post-WTC collapse, 98% reported acute respiratory symptoms, and 81% reported health concerns. Nonetheless, 29% of current smokers increased tobacco use, and 23% of ex-smokers resumed cigarette smoking.

Objective

To determine the effect of a comprehensive tobacco-cessation program using combination tobacco-dependency treatment medications adjusted to the individual's daily tobacco use.

Design

FDNY cigarette smokers enrolled in “Tobacco Free With FDNY,” a no-cost quit-smoking program providing counseling, support, and medications. At the end of the 3-month treatment phase and at the 6-month and 12-month follow-up visits, abstinence rates were confirmed by expired carbon monoxide levels or by the verification of a household member.

Setting

FDNY Bureau of Health Services between August 1, 2002 and October 30, 2002.

Participants

A total of 220 current cigarette smokers from the FDNY.

Results

At study enrollment, the mean (± SD) tobacco use was 20 ± 7 cigarettes per day, and the mean tobacco dependency, as assessed by a modified Fagerstrom test score, was 6.7 ± 2.5 (maximum score, 10). Based on tobacco use, 20% of enrollees used three types of nicotine medications, 64% used two types, 14% used one type, and 3% used no medications. Additionally, 14% of enrollees used bupropion sustained release. The confirmed continuous abstinence rates were 47%, 36%, and 37%, respectively, after 3 months of treatment and at the 6-month and 12-month follow-up. Abstinence rates did not correlate with the history of tobacco use but correlated inversely with tobacco dependency. Adverse events and maximal nicotine medication use were unrelated, and no one experienced a serious adverse event.

Conclusion

Tobacco dependency treatment using combination nicotine medications is effective and safe. Future studies should consider the following: (1) both history of tobacco use and withdrawal symptoms to determine the number and dose of nicotine medications; and (2) continuing combination treatment for > 3 months.

Section snippets

Materials and Methods

Through mailings, postings, and media exposure, the FDNY Bureau of Health Services invited all FDNY tobacco users and their household family members who smoked to attend the “Tobacco-Free with FDNY” program. Enrollment in this study was from August 1, 2002, to October 30, 2002. Introductory meetings were held monthly at designated FDNY facilities during off-duty hours. With labor-management support, all workers understood that decisions to enroll, participate, or withdraw at any time were

Results

Between August 1, 2002, and October 30, 2002, the “Tobacco Free with FDNY” program enrolled 164 FDNY rescue workers (9% of FDNY rescue workers acknowledging tobacco use on the WTC Medical Screening Evaluation) and 56 household family members for a total of 220 enrollees. Table 2shows enrollee characteristics. The mean tobacco use during the prior year was 20 ± 7 cigarettes per day, the mean expired CO levels at study entry were 20 ± 11 ppm, and the mean Fagerstrom test score was 6.7 ± 2.5. At

Discussion

After September 11, 2001, the presumed synergy between tobacco smoking and WTC exposure to produce potential serious health consequences stimulated the FDNY Bureau of Health Services to design and implement a unique postexposure intervention by offering to FDNY rescue workers who were tobacco smokers a free, voluntary, nonpunitive, comprehensive tobacco-dependence treatment program. Of the nearly 12,000 rescue workers screened, 15% reported active cigarette smoking. Assuming that the period

ACKNOWLEDGMENT

We wish to thank the members of the FDNY for their support and heroism during these trying times. We also wish to thank the pulmonary fellows from Montefiore Medical Center, Albert Einstein College of Medicine, and Memorial Sloan-Kettering Cancer Center for volunteering as tobacco-cessation treatment specialists during this program. We also wish to thank Virginia Reichert, NP, and her staff at the Center for Tobacco Control, and North Shore-LIJ Health System for assisting us as

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

This research was supported by the Chest Foundation, Pfizer Pharmaceuticals, the New York City Fire Commissioner's Fire Safety Education Fund, The Fire Department of the City of New York, the Uniformed Fire Officers Association, the Uniformed Firefighters Association, Emergency Medical Services unions (DC37 locals 2507 and 3621), and the International Association of Firefighters 9/11 Fund. Additional support is now provided by a September 11 recovery grant from the American Red Cross Liberty Disaster Relief Fund.

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Chest

Original Research“Tobacco Free With FDNY”: The New York City Fire Department World Trade Center Tobacco Cessation Study

Context

Objective

Design

Setting

Participants

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

ACKNOWLEDGMENT

Chest

Addict Behav

Chest

The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire

Br J Addict

Health behaviors of adults

Comparison of nicotine patch versus nicotine nasal spray alone versus a combination for treating smokers: a minimal intervention randomized multicenter trial in a non-specialized setting

Nicotine Tob Res

Original Research
“Tobacco Free With FDNY”: The New York City Fire Department World Trade Center Tobacco Cessation Study