[Multicomponent treatment of tobacco in primary care: Follow-up over 5years]

OBJECTIVES

To analyze the effectiveness of a multicomponent treatment for smoking cessation carried out in primary care and to evaluate the evolution of the consumption of tobacco that the people who participated had, more than 5 years after the end of the treatment.

DESIGN

Longitudinal study of 307 participants in a multicomponent program in group format of tobacco cessation.

EMPLACEMENT

Santander (Spain) Primary Care Health Center.

PARTICIPANTS

Smokers from the basic health zone who wanted to quit smoking between 2006 and 2012 and requested help.

INTERVENTIONS

Multicomponent treatment of 5face-to-face sessions and follow-up for up to 12 months.

PRIMARY MEASUREMENTS

The activity was evaluated in 263 participants more than 5years after the end of treatment. The results of continuous and punctual withdrawal were obtained by self-declaration and the data recorded in the medical record. The punctual was also validated with co-oximetry.

RESULTS

After a year 42.7% of participants declared continuous abstinence. From 5 to 12 years later, the continuous declared abstinence further than 12 months was 40.7%. They did not smoke again since the end of the treatment 66 people; 68.0% of those who relapsed made new attempts and 45.5% of them requested help to quit smoking.

CONCLUSIONS

The proposed multi-component treatment is effective. Abstinence at 12 months predicts long-term maintenance and participating in disabling groups favors further attempts in case of relapse and the request for help to quit smoking.

[Do COPD patients lie about their smoking habit?]

OBJECTIVE

To determine the deception rate or concordance between the interview on smoking and cooximetry in COPD patients from a monographic consultation.

DESIGN

Prospective observational study to evaluate the concordance between the values of cooximetry and the response to a clinical interview on smoking.

SETTING

COPD monographic consultation, Pneumology, Seville.

PARTICIPANTS

Patients with a confirmed diagnosis of COPD in any degree.

INTERVENTIONS

Clinical interview and measurement of carbon monoxide by cooximetry.

MAIN MEASUREMENTS

Cooximetry values, responses on smoking, sociodemographic variables.

RESULTS

n: 169. 107 patients presented values less than or equal to 6 ppm compared to 62 with values greater than 6 ppm, determining a prevalence of active smoking of 36.7%. The deception rate was 19.5% of the total sample (24.3% of all those who claimed not to smoke), with a Cohen kappa of 0.48 and p < 0.000. 40% of patients confessed not having told the truth. No relationship of this data was found with age, accumulated tobacco consumption or FEV1. A significant relationship with sex was found (deception rate: 31.8% in women vs. 15.2% in men, p 0.017).

CONCLUSIONS

In spite of our attempts to make patients stop smoking, a considerable deception rate was found in our consultation; higher among women, recent ex-smokers or in the process of abandonment, so it would be essential to incorporate objective measures such as the cooximeter in the approach of this type of patient.

Metric properties of the "prescribe healthy life" screening questionnaire to detect healthy behaviors: a cross-sectional pilot study

Background

Feasible and valid assessment of healthy behaviors is the first step for integrating health promotion in routine primary care. Therefore, the aim of this study was to develop and evaluate the validity and reliability of the “prescribe healthy life” screening questionnaire, a brief tool for detecting physical activity levels, consumption of fruit and vegetables, tobacco use and patients’ compliance with minimal recommendations.

Methods

An observational cross-sectional study to determine the reliability and validity of this questionnaire by means of mixed (qualitative and quantitative) methods. Thirteen healthcare professionals designed the questionnaire. One hundred and twenty-six patients from three primary care health centers within Osakidetza (Basque Health Service, Spain) filled in the “Prescribe Healthy Life” Screening Questionnaire and completed an accelerometry record, the PREDIMED Food Frequency Questionnaire and a co-oximetry as gold standards for physical activity, dietary intake and tobacco use, respectively. Correlations, sensitivities, specificities, likelihood ratios and test-retest reliability were calculated. Additionally, the feasibility and utility of the questionnaire were evaluated.

Results

Both reliability and concurrent validity for the consumption of fruit and vegetables (r_spearman = 0.59, r_spearman = 0.50) and tobacco use (r_spearman = 0.76, r = 0.69) as their overall performance in the detection of unhealthy diet (accuracy = 76.8%, LR + = 3.1 and LR- = 0.31) and smokers (accuracy = 86.8%, LR + = 6.1 and LR- = 0.05) were good. Meanwhile, the reproducibility (0.38), the correlation between the minutes of physical activity (0.34) and LR+ (1.00) for detection of physical activity were low. On average the questionnaire was considered by patients easy to understand, easy to fill in, short (5–6 min) and useful.

Conclusion

The “Prescribe Healthy Life” Screening Questionnaire, PVS-SQ, has proved to be a simple and practical tool for use in the actual context of primary care, with guarantees of validity and reliability for the diet and tobacco scales. However, the physical activity scale show unsatisfactory results, and alternative questions ought to be tested.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3898-8) contains supplementary material, which is available to authorized users.

E-Cigarettes for Immediate Smoking Substitution in Women Diagnosed with Cervical Dysplasia and Associated Disorders

The aim of this study was to determine if 31 women with cervical dysplasia and associated conditions exacerbated by smoking would be successful substituting cigarettes with their choice of either nicotine replacement therapy (NRT) or electronic cigarettes (EC). Women received motivational interviewing and tried both NRT and ECs, choosing one method to use during a six-week intervention period. Daily cigarette consumption was measured at baseline, six, and 12 weeks, with differences analyzed by the Wilcoxon signed-rank test. Study analysis consisted only of women choosing to use ECs (29/31), as only two chose NRT. At the 12-week follow-up, the seven day point prevalence abstinence from smoking was 28.6%, and the median number of cigarettes smoked daily decreased from 18.5 to 5.5 (p < 0.0001). The median number of e-cigarette cartridges used dropped from 21 at the six-week follow-up to 12.5 at the 12-week follow-up. After initiating EC use, women at risk for cervical cancer were able to either quit smoking or reduce the number of cigarettes smoked per day. Although a controlled trial with a larger sample size is needed to confirm these initial results, this study suggests that using ECs during quit attempts may reduce cigarette consumption.

Usage and effectiveness of a fully automated, open-access, Spanish Web-based smoking cessation program: randomized controlled trial

BACKGROUND

The Internet is an optimal setting to provide massive access to tobacco treatments. To evaluate open-access Web-based smoking cessation programs in a real-world setting, adherence and retention data should be taken into account as much as abstinence rate.

OBJECTIVE

The objective was to analyze the usage and effectiveness of a fully automated, open-access, Web-based smoking cessation program by comparing interactive versus noninteractive versions.

METHODS

Participants were randomly assigned either to the interactive or noninteractive version of the program, both with identical content divided into 4 interdependent modules. At baseline, we collected demographic, psychological, and smoking characteristics of the smokers self-enrolled in the Web-based program of Universidad Nacional de Educación a Distancia (National Distance Education University; UNED) in Madrid, Spain. The following questionnaires were administered: the anxiety and depression subscales from the Symptom Checklist-90-Revised, the 4-item Perceived Stress Scale, and the Heaviness of Smoking Index. At 3 months, we analyzed dropout rates, module completion, user satisfaction, follow-up response rate, and self-assessed smoking abstinence.

RESULTS

A total of 23,213 smokers were registered, 50.06% (11,620/23,213) women and 49.94% (11,593/23,213) men, with a mean age of 39.5 years (SD 10.3). Of these, 46.10% (10,701/23,213) were married and 34.43% (7992/23,213) were single, 46.03% (10,686/23,213) had university education, and 78.73% (18,275/23,213) were employed. Participants smoked an average of 19.4 cigarettes per day (SD 10.3). Of the 11,861 smokers randomly assigned to the interactive version, 2720 (22.93%) completed the first module, 1052 (8.87%) the second, 624 (5.26%) the third, and 355 (2.99%) the fourth. Completion data was not available for the noninteractive version (no way to record it automatically). The 3-month follow-up questionnaire was completed by 1085 of 23,213 enrolled smokers (4.67%). Among them, 406 (37.42%) self-reported not smoking. No difference between groups was found. Assuming missing respondents continued to smoke, the abstinence rate was 1.74% (406/23,213), in which 22,678 were missing respondents. Among follow-up respondents, completing the 4 modules of the intervention increased the chances of smoking cessation (OR 1.95, 95% CI 1.27-2.97, P<.001), as did smoking 30 minutes (OR 1.58, 95% CI 1.04-2.39, P=.003) or 1 hour after waking (OR 1.93, 95% CI 1.27-2.93, P<.001) compared to smoking within the first 5 minutes after waking.

CONCLUSIONS

The findings suggest that the UNED Web-based smoking cessation program was very accessible, but a high level of attrition was confirmed. This could be related to the ease of enrollment, its free character, and the absence of direct contact with professionals. It is concluded that, in practice, the greater the accessibility to the program, the lower the adherence and retention. Professional support from health services and the payment of a reimbursable fee could prevent high rates of attrition.

Effectiveness of varenicline as an aid to smoking cessation: results of an inter-European observational study

BACKGROUND

Varenicline tartrate, a selective partial agonist of the α4β2 nicotinic receptor, has been shown to be an effective smoking cessation aid with an acceptable safety profile in a number of randomized, controlled trials. The aim of the CHOICES (Champix Observational Investigation in the Cessation of Smoking) study was to investigate the effectiveness and safety of varenicline in real-world clinical practice.

METHODS

The CHOICES study was a 12-week, prospective, observational, non-comparative study of varenicline conducted in four European countries (Belgium, Greece, Hungary, and Slovenia) between November 21, 2007 and August 3, 2009. Participants were prescribed varenicline according to the recommendations on the European Summary of Product Characteristics (SmPC). Smoking abstinence rates in the 7 days between week 11 and 12 were determined based on verbal reporting using a nicotine use inventory. The safety profile of varenicline was also assessed.

RESULTS

Of 566 participants enrolled in this study, 551 received varenicline and were evaluated for effectiveness and safety. At baseline, the overall study population had a mean age of 45.5 years; a mean history of smoking of 27.0 years; and a mean score on the Fagerström Test of Nicotine Dependence (FTND) of 6.1. Overall, 64.6% (95% CI 60.1, 68.3) of participants successfully quit smoking by the end of the treatment phase at week 12. The most frequent treatment-emergent (all causality) adverse events were nausea (8.9%), insomnia (2.9%), and sleep disorder (2.2%) of mostly mild or moderate intensity. Discontinuations from the study due to treatment-related adverse events occurred in 3.4% of participants.

LIMITATIONS

Abstinence rates were not validated by carbon monoxide measurements, as this is not a practice uniformly used in European countries.

CONCLUSIONS

The CHOICES study shows that in a real-world clinical practice setting outside a clinical trial environment, varenicline is an effective smoking cessation aid with an acceptable safety profile.

Effectiveness of a cognitive orientation program with and without nicotine replacement therapy in stopping smoking in hospitalised patients

INTRODUCTION

We analysed the effectiveness of a high intensity behavioural-cognitive intervention compared to minimal intervention started during a hospital stay, to see if the combination of nicotine replacement therapy (NRT) can increase the quitting rate at 12 months of follow up.

METHOD

A total of 2560 active smokers were studied during their hospital stay. Of these, 717 smokers refused to enter the study and after a minimal intervention they were asked if we could telephone them after one year to ask if they still smoked. The remaining 1843 smokers who received high intensity cognitive therapy were randomised to receive or not receive NRT. The follow up after discharge was carried out by outpatient visits or with telephone sessions.

RESULTS

At one year of follow up, 7% of those who declined to enter the study had stopped smoking compared to 27% of those who entered the study (p<0.001). There were significant differences between the group that only had behavioural therapy (21% stopped) compared to the group that also had NRT (33% stopped; p=0.002). In this latter group there were significant differences (p=0.03) between those who had follow up in clinics (39% stopped) compared to those who were followed up telephone sessions (30%). In the multivariate analysis, the predictors of quitting at 12 months were: to have used NRT (OR 12.2; 95% CI, 5.2-32; p=0.002) and a higher score in the Richmond Test (OR 10.1; 95% CI, 3.9-24.2; p=0.01).

CONCLUSIONS

A cognitive type intervention started on smokers when admitted to hospital increases quitting rates at 12 months, compared to a minimal intervention, and these rates increase even more significantly if NRT is added.

Effectiveness of intensive group and individual interventions for smoking cessation in primary health care settings: a randomized trial

Objectives

Primary: To compare the effectiveness of intensive group and individual interventions for smoking cessation in a primary health care setting; secondary: to identify the variables associated with smoking cessation.

Methods

Three-pronged clinical trial with randomisation at the individual level. We performed the following: an intensive individual intervention (III), an intensive group intervention (IGI) and a minimal intervention (MI). Included in the study were smokers who were prepared to quit smoking. Excluded from the study were individuals aged less than 18 years or with severe mental conditions or terminal illnesses. The outcome measure was continued abstinence at 12 months confirmed through CO-oximetry (CO). The analysis was based on intention to treat.

Results

In total, 287 smokers were recruited: 81 in the III, 111 in the IGI, and 95 in the MI. Continued abstinence at 12 months confirmed through CO was 7.4% in the III, 5.4% in the IGI, and 1% in the MI. No significant differences were noted between III and MI on the one hand, and between IGI and MI on the other [RR 7.04 (0.9-7.2) and RR 5.1 (0.6-41.9), respectively]. No differences were noted between IGI and III [RR 0.7 (0.2-2.2)]. In multivariate analysis, only overall visit length showed a statistically significant association with smoking cessation.

Conclusions

The effectiveness of intensive smoking interventions in this study was lower than expected. No statistically significant differences were found between the results of individual and group interventions.

Trial registration number

ISRCTN32323770

[Quitting and prevalence of smoking: gender, social class, and primary health care]

OBJECTIVE

To analyse the joint role of social class and primary health care in giving up smoking.

DESIGN

Cross-sectional study.

SETTING

Barcelona (Catalonia, Spain), 2000-2001.

PARTICIPANTS

A sample of the resident non-institutionalized population, restricted to people aged 15-50 who have a habitual primary care source (n=4178).

MAIN MEASUREMENTS

These were obtained from the Barcelona Health Interview Survey. Independent variables include sex, social class and usual source of primary health care. Dependent variables are having ever been a smoker, having quit, and being a current smoker. Age-adjusted proportions were calculated (95% CI).

RESULTS

Social class shows that more manual workers have been smokers. Men smoked more than women. Overall quitting is similar in both sexes. Quitting showed a social gradient in men. Measurement of source of care showed quitting was higher among users of private clinics, but CI overlapped. On stratifying the source of primary care by social class, an effect seemed to emerge for men, but the CI overlapped. Prevalence at the time of the survey was higher for men; a class gradient in current prevalence emerged for men, but was less visible for women, where CI overlapped.

CONCLUSIONS

Social class is a powerful determinant of smoking. Men in low-classed jobs are at greater risk of starting to smoke, are less likely to give up, and smoke more. The proportion of quitting seems lower in of public clinics users. Health advice is efficacious, but in population terms other factors seem to have greater influence.

[In-patient smoker? - Providing appropriate intervention]

Tobacco use is the most avoidable cause of death. Other than provoking multiple diseases requiring hospitalisation, Tobacco Use is also a disease requiring management in the hospital setting, not only in terms of controlling the withdrawal symptoms of the patient, who has been abruptly prohibited from smoking, but also for fulfilling legislation which prohibits tobacco use in the health services, the only efficient way of preventing exposure of non-smokers to environmental tobacco smoke. Treating the in-patient smoker in an appropriate way also provides a window of opportunity for promoting not just a temporary but a complete smoking cessation.

[Results of smoking cessation therapy in a specialist unit]

OBJECTIVE

The aim of this study was to assess the results of smoking cessation therapy in a specialist unit by calculating the probability of continued abstinence at 6-month follow-up and analyzing differences according to the characteristics of the individuals.

PATIENTS AND METHODS

A prospective longitudinal study was undertaken in smokers who received multicomponent smoking-cessation therapy over a period of 3 months. Continued abstinence was assessed on the basis of self-report by participants and confirmed by measurement of exhaled carbon monoxide levels. Kaplan-Meier survival analysis was performed to assess the probability of continued abstinence. Log-rank tests were used to analyze differences in continued abstinence according to different qualitative variables.

RESULTS

The 1120 patients who participated in the study (56% men and 44% women) had a mean (SD) age of 44.1 (9.5) years. The mean score on the Fagerström test was 6.3 (2.1). Nicotine replacement therapy was provided in 70.8% of patients while 29.2% received bupropion. The probability of continued abstinence at 6 months was 62.2%. Individuals with a high dependence had a lower probability of continued abstinence at 6 months, as did those in whom treatment adherence was poor. No differences were observed in the probability of abstinence according to sex or type of pharmacological treatment.

CONCLUSIONS

Individuals with a high nicotine dependence can benefit from intensive smoking-cessation treatment in a specialist unit to achieve continued abstinence.

Diseño y primera evaluación de un programa de tratamiento de tabaquismo por teléfono. Comparación con un modelo estándar

BACKGROUND AND OBJECTIVE

To assess an intensive proactive telephone smoking cessation program and compare it with a similar group in face to face treatment.

DESIGN

A prospective, controlled, observational study performed during daily clinical practice.

PATIENTS AND METHOD

PARTICIPANTS

383 smokers, 176 in telephone treatment and 207 in face to face group treatment, aged greater than 18 years old. They smoked more than 10 cigarettes per day and both groups were recruited between April and November 2003. The study was performed between April 2003 and May 2004. Treatment technique: 11 congnitive-behavioral interventions for six months plus 24 hour nicotine patches in standard doses and 2 mg nicotine gum on demand. Main variable: Prolonged abstinence self-professed at 24 hours, 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks, 12, weeks, 16 weeks, 20 weeks and 24 weeks.

RESULTS

In the first and second week, abstinence was significantly higher in the face to face group than in telephone treatment (1st. week 80.2% vs. 65.9% p = .001; 2nd. week 77.3% vs 65.3% p = .007). Subsequently, the difference was not significant, and at 24 weeks abstinence remained similar for the two treatment methods, 54.6% in the face to face group treatment and 54.5% in telephone treatment.

CONCLUSIONS

Intensive smoking cessation treatment programs, with nicotine replacement therapy, are equally effective if performed by proactive telephone or in face to face treatment sessions.

Abstinencia de tabaquismo tras 12 meses de seguimiento en una unidad de tabaquismo integral

BACKGROUND AND OBJECTIVE

To assess the cessation and relapse rates of smoking, and analyze the associated variables in a 12-month follow-up study at a smoking cessation unit.

SUBJECTS AND METHOD

Patients from the Area de Salud 19 of the Conselleria de Sanitat of the Generalitat Valenciana, coming to a smoking cessation unit.

VARIABLES

sociodemographic, smoking habits, smoking social context, psychiatric or medical problems, use of other substances, and treatment. Treatment was administered either individually or in group, and with or without pharmacological support. Type of pharmacological treatment: nicotine replacement therapy and/or bupropion. Evaluation of smoking cessation and relapse: at the end of the treatment, and at follow-up months 1, 3, 6, 9, and 12. Criteria to accept cessation were: it had to be uninterrupted, referred as such by the patient and corroborated by relatives or other witnesses, and supported by a co-oxymetry level < or = 6 ppm.

STATISTICAL ANALYSES

description of quantitative and qualitative variables, evaluation of the relationship between relapse rate and follow-up time when it happens by means of Kaplan-Meier curves, Cox regression, construction of curves of prediction of cessation for subjects with different patterns in the independent variables, and estimations of risk of relapse between any 2 subjects, according to those patterns.

RESULTS

255 subjects (46.7% males); 41.8 (10.8) years of mean age (standard deviation); 25 years of mean duration of the smoking habit; a mean of 2 to 3 previous attempts of cessation smoking, mean duration of the longest period of cessation 6 to 7 months; smoking habit 26.5 (12.1) mean of cigarrettes per day, the average nicotine dependency was moderate, and the average co-oxymetry levels high. Of all the subjects included, 53.3% received single therapy (60% together with pharmacological treatment) and 46.7% had group therapy (18.4% also with pharmacological treatment). Pharmacological treatment was 14.9% nicotine replacement therapy, 17.3% bupropion, and 7.1% both. At the end of the treatment, 42.7% of the subjects kept smoking and, at the end of the follow-up period only 11.4% remained abstinent. Median cessation extent was one month. VARIABLES associated to the extent of the cessation: type of therapy (individual or in a group), pharmacological support, and previous daily amount of cigarrette consume.

CONCLUSIONS

There were high relapse rates, that depended on the previous amount of consume and on the treatment applied. Both group therapy and pharmacological treatment are significantly useful in order to obtain the best results in long-term cessation rates.