Effect of a Personalized Cardiovascular Risk Score Report on Employee Smoking Behavior in a Private Hospital


  • Wannapat Wanitchatchawan Graduate student in Master of Science (Public Health), Major in Public Health Administration. Faculty of Graduate Studies and Faculty of Public Health, Mahidol University, Bangkok, THAILAND
  • Charuwan Tadadej Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, THAILAND
  • Krit Pongpirul Clinical Research Center, Bumrungrad International Hospital, THAILAND; Faculty of Medicine, Chulalongkorn University, THAILAND; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA


Cardiovascular risk score, Smoking behavior, Randomized controlled trial


Smoking is a major cause of non-communicable diseases. The World Health Organization identified that 10% of cardiovascular diseases are attributable to smoking. Thailand 2019 statistics indicated that cardiovascular disease was the second leading cause of death in the Thai population. The death rate associated with cardiovascular disease was 33.90 per 100,000 population. In other words, not smoking is the best way to reduce the risk of developing heart disease and, in those who experience coronary heart disease, stopping smoking reduces the incidence of recurrence and death. Smoking cessation has been one of the Thai national strategies for tobacco control to decrease smoking prevalence since the last decade. Employee health is a crucial factor for organizational effectiveness. To promote employee health, the hospital that was the setting for this study provides a health checkup for their employees once a year. This conventional checkup report is sent to each employee. Previous studies have shown a correlation between the use of the cardiovascular risk score report and mortality and morbidity. However, there is no evidence of using the cardiovascular risk score report to motivate individuals to stop smoking.

            This research aimed to compare the effect of a personalized cardiovascular risk score report on employee smoking behavior in a private hospital located in the Bangkok Metropolitan Area. The study was a randomized controlled trial. The experimental and comparison groups consisted of 36 current smokers who were employed full-time at the hospital, and who voluntarily participated in this study. The participants were randomly divided into three groups. Group 1 received the modified cardiovascular risk score, true cardiovascular risk score, and conventional checkup report. Group 2 received the true cardiovascular risk score and conventional checkup report. Group 3 received the conventional checkup report. The participants in each group received the allotted intervention during week 0, 4, 8 and 12. Data were collected using a questionnaire from January to April 2020. We used descriptive statistics, Fisher’s Exact test, one-way ANOVA, repeated-measures ANOVA, GEE, Unpaired t-test, and McNemar Chi Square for data analysis.

The mean ± SD age of the participants was 35.66 ± 10.54 years. 97.2% were males, 33.3% of them had graduated with a bachelor’s degree, and 55.6% had non-clinical indirect-care positions. Their average income was 25,341.18 ± 15,465.90 Baht per month. 72.2% of the participants were not addicted to nicotine. 66.7% had a low level of cardiovascular risk. Before the experiments were performed, the participants smoked 53.03 ± 47.88 cigarettes per week and 66.7% of the participants had no intention to quit smoking. There was no significant difference among the three groups at baseline (week 0). The results showed that different types of cardiovascular risk score report had no effect on smoking behavior (p=0.91). However, the number of cigarettes smoked per week in the intervention groups significantly decreased when compared to the comparison group (p<0.05). In addition, cardiovascular risk score report had no effect on the intention to quit smoking in the intervention group.


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Bray I. Healthy employees, healthy business: Easy affordable ways to promote workplace wellness. 2nd ed. California: NOLO; 2012.

World Health Organization. Healthy workplaces: A WHO global model for

action. Geneva, World Health Organization; 2010. Available

from: http://www.who.int/occupational_health/publications/healthy_workplaces_

model_action.pdf, accessed 3 April, 2017.

World Health Organization. WHO reveals leading causes of death and disability worldwide: 2000-2019 Geneva: World Health Organization; 2020. Available from: https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019, accessed 3 April, 2017.

World Health Organization. Cardiovascular diseases (CVDs). Geneva, World Health Organization; 2016 Available from:

http://www.who.int/ cardio vascular diseases/world-heart-day/en /, accessed 20 March, 2017.

Division of Non-Communicable Diseases. Number and mortality rate, noncommunicable diseases and injuries calendar year 2019 Ministry of Public

Health Thailand 2020. Available from:


accessed 25 September, 2020. (In Thai)

Chuenchareonsook K. Service Plan Year 2018-20. Bangkok: The Agricultural Cooperative Federation of Thailand Limited; 2018. (In Thai)

National Center for Chronic Disease Prevention and Health Promotion (US)

Office on Smoking and Health. The health consequences of smoking - 50

years of progress: A report of the Surgeon General. Atlanta (GA): Centers for

Disease Control and Prevention (US); 2014. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK179276/, accessed 23 April, 2017.

Poldervaart JM, Reitsma JB, Koffijberg H, Backus BE, Six AJ, Doevendans

PA, et al. The impact of the heart risk score in the early assessment of

patients with acute chest pain: Design of a stepped wedge, cluster randomised

trial. BMC Cardiovascular Disorders 2013; 13(1): 77.

Studziński K, Tomasik T, Krzyszton J, Jóźwiak J, Windak A. Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: Protocol for an overview of systematic reviews. BMJ Open 2017; 7(3): e014206.

Grammer TB, Dressel A, Gergei I, Kleber ME, Laufs U, Scharnagl H, et al. Cardiovascular risk algorithms in primary care: Results from the Detect Study. Sci Rep 2019; 9(1): 1101.

Lloyd-Jones DM, Braun LT, Ndumele CE, Smith Jr SC, Sperling LS, Virani SS, et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: A special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2019; 73(24): 3153-67.

Punset K, Kingkaew A. Cardiovascular risk among staff working at the

Central Ministry of Public Health using risk assessment of Rama-EGAT

Heart Score. Nursing Journal of the Ministry of Public Health 2015; 25(2): 57-70.

(In Thai)

Kitayaporn D, Sudlah N, Athirakul K, Jenkolrob K, Anuras S, Anuras J.

Incidence and factors associated with overweight and obesity, and

hypertensive disorders, among staff in a private healthcare setting: A

retrospective cohort study. J Med Assoc Thai 2011; 94(9): 1044-52. (In Thai)

World Health Organization. A comprehensive global monitoring framework,

including indicators, and a set of voluntary global targets for the

prevention and control of noncommunicable diseases. Revised WHO

Discussion Paper; 2012. Available from: http://www.who.int/nmh/events/2012/discussionpaper220120322.pdf, accessed 20 March, 2017.

Goff Jr DC, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 2014; 129(25 Suppl 2): S49-73.

Lakkam A, Kengganpanich M, Kengganpanich T, Factors predicting smoking cessation among smokers in Pakham District, Buriram Province, Thailand. Thai Journal of Public Health 2020; 50(2): 184-96. (In Thai)

Junnual N, Wilasri S. The application of self-efficacy theory in achieving

smoking behavior change among police officers at Chaiyaphum police

station. Journal of Health and Nursing Education 2017; 23(1): 44-58. (In Thai)

Rogers RW. Cognitive and physiological processes in fear appeals and

attitude change: A revised theory of protection motivation. In Cacioppo JT and

Petty R (eds.), Social psychophysiology: A sourcebook. New York: Guilford Press.

pp. 153-77.

Yamsri W, Maneesriwongkul W, Phanphakdee O. The effect of motivational

interviewing on smoking behavior in persons at risk for coronary artery

disease. Journal of Thai Public Health Nursing 2016; 27(3): 41-57. (In Thai)

Ruamsook T, Kalampakorn S, Rawiworrakul T. The effect of smoking

cessation by applying the Protection Motivation Theory in patients with

hypertension. Thai Journal of Nursing 2018; 67(1): 1-10. (In Thai)

Bualuang T, Hengudomsub P, Dallas JC. The effect of motivational

enhancement program on intention to stop drinking and drinking behavior

among males with risky drinking. Journal of the Thai Army Nurses 2018; 19

(Suppl): 119-28. (In Thai)

Brewer NT, Hall MG, Lee JG, Peebles K, Noar SM, Ribisl KM. Testing warning messages on smokers' cigarette packages: A standardised protocol. Tobacco Control 2016; 25(2): 153-9.

Brewer NT, Hall MG, Noar SM, Parada H, Stein-Seroussi A, Bach LE, et al. Effect of pictorial cigarette pack warnings on changes in smoking behavior: A randomized clinical trial. JAMA Intern Med 2016; 176 (7): 905-12.

Yangpaksee P, Srithongphet J, Chaiyakiat C, Bundit N, Chayakul T, Engchuan N, et al. Factors predicting the intention to quit smoking among military officers in Bangkok. Thai Journal of Nursing 2019; 68(2): 9-16. (In Thai)





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