How a 5-Day Stay in the Tobacco-Free Environment of the Stoptober House Supports Individuals to Quit Smoking: A Mixed Methods Pilot Study

INTRODUCTION

The Stoptober House is part of the annual national Stoptober smoking cessation campaign in the Netherlands. During the first week of October, 48 volunteers resided in the tobacco-free Stoptober House for 5 days and received smoking cessation counseling. This pilot study explored how the Stoptober House may have facilitated smoking cessation among participants.

METHODS

We included 48 individuals who were selected for the Stoptober House (intervention group) and 67 individuals who were not selected (control group). Surveys were conducted at baseline, immediately after 2 and 8 weeks of post-intervention. We compared self-reported abstinence, psychosocial mediators related to smoking cessation, and perceived active elements of the Stoptober House between the intervention and control groups using t/χ2 tests and linear mixed model (LMM) analysis. Sixteen semi-structured qualitative interviews were conducted to explore participants' perspectives on the elements contributing to their success in quitting smoking.

RESULTS

At 8 weeks of follow-up, a higher proportion of participants in the intervention group (24/48 [50%]) reported being abstinent compared to the control group (5/67 [7%]; p < 0.001). Among participants who reported making a quit attempt, 22/38 (57.9%) in the intervention group remained abstinent compared to 4/17 (23.5%) in the control group (p = 0.022). The intervention group also exhibited higher self-efficacy to quit smoking throughout the follow-up period and higher social support immediately after the Stoptober House. No significant differences were observed in other psychosocial factors. The interviews highlighted several perceived elements of the Stoptober House that contributed to smoking cessation success, including restricted smoking opportunities, access to smoking cessation counselors, and peer support.

CONCLUSION

This pilot study suggests that the Stoptober House provides support that can help people quit smoking. Further research is needed to confirm these findings and determine the cost-effectiveness of this intervention in promoting long-term abstinence among specific groups of smokers.

Is smoking an independent risk factor for developing cervical intra-epithelial neoplasia and cervical cancer? A systematic review and meta-analysis

Introduction: Cervical cancer is the fourth most common form of cancer among women. Smoking tobacco seems to be a risk factor for the development of cervical intra-epithelial neoplasia (CIN) and cervical cancer, but the exact role of smoking in the process of cervical carcinogenesis is not known. The aim of this study is to investigate the relationship between smoking and the development of CIN and cervical cancer. Areas covered: We searched Embase, Medline, Cochrane Central, Web of Science, and Google Scholar for studies on smoking and CIN and cervical cancer, published between 2009 and 2018. The following were the outcomes: CIN3 alone, CIN2 and CIN3 combined, CIN2+, CIN3+, and cervical cancer alone. We included 49 studies in our review and 45 in our meta-analyses. Expert opinion: Based on the available evidence it can be - cautiously - concluded that smoking increases the risk of cervical abnormalities. However, the high risk of bias indicates that for future studies, it will be important to adjust for relevant predictors, to separate CIN from cervical cancer as outcome measures, and to report research methods in detail.

How can vulnerable groups be recruited to participate in a community-based smoking cessation program and perceptions of effective elements: A qualitative study among participants and professionals

INTRODUCTION

Smokers from vulnerable groups, such as smokers with a low socioeconomic position, often have more difficulty quitting smoking and often are more difficult to recruit for smoking cessation programs. It is important to know how vulnerable groups can be recruited and motivated to participate in a smoking cessation program and what participants and professionals perceive as effective elements.

METHODS

Qualitative interviews were performed with participants of a communitybased smoking cessation program in the Netherlands (n=18) and professionals involved in the recruitment of participants or as trainers in the community-based smoking cessation program (n=8). They were interviewed twice: once before the program had started and once after the program had ended. Interviews were semi-structured and conducted between September 2018 and February 2019.

RESULTS

We found that organizing the program in the neighborhood lowered the threshold to participate, that registration should be quick and easy, that an active approach is needed, and that personal contact is important. This study also showed that information sharing, social support, commitment of the trainer, and personal contact are perceived as effective elements of such a program.

CONCLUSIONS

This study shows that vulnerable smokers can be successfully recruited for a smoking cessation program. We recommend that such interventions include a group setting, extensive personal contact between participants and a committed trainer, and implementation of the program at a location in the neighborhood of the target group. Practical recommendations for professionals are to personally approach people multiple times if needed, to make sure that registration is quick and easy, and to fill in the registration form immediately during recruitment.

Three Diagnoses for Problematic Hypersexuality; Which Criteria Predict Help-Seeking Behavior?

This study aimed to assess the best combination of indicators of problematic hypersexuality (PH), in a survey (n = 58,158) targeting individuals wondering if they were sex addicted. The survey allowed for testing of criteria from three theoretical models used to conceptualize PH. Factor analyses for women and men yielded an interpretable grouping of indicators consisting of four factors. In subsequent logistic regressions, these factors were used as predictors for experiencing the need for help for PH. The factors Negative Effects and Extreme positively predicted experiencing the need for help, with Negative Effects as the most important predictor for both women and men. This factor included, among others, withdrawal symptoms and loss of pleasure. The Sexual Desire factor negatively predicted the need for help, suggesting that for the targeted population more sexual desire leads to less PH. The Coping factor did not predict experiencing the need for help. Outcomes show that a combination of indicators from different theoretical models best indicates the presence of PH. Therefore, a measurement instrument to assess existence and severity of PH should consist of such a combination. Theoretically, this study suggests that a more comprehensive model for PH is needed, surpassing existing conceptualizations of PH.

Alcohol Marketing and Underage Drinking: Which Subgroups Are Most Susceptible to Alcohol Advertisements?

OBJECTIVES

The aim of this study was as follows: (a) to study the relation between alcohol advertisement exposure and the initiation of (binge) alcohol drinking among secondary school students, and (b) to identify subgroups of students that may be more vulnerable for the influence of alcohol marketing than others.

METHODS

A longitudinal survey was conducted with three waves (12- and 24-month interval). Eight secondary schools of various school levels in the Netherlands participated. Participants included 942 second grade students, average age 13.2 years, 46.0% boys. Exposure to alcohol and non-alcohol advertisements was measured at baseline with images of 16 commercial advertisements with all brand information removed. Students were asked to indicate contact frequency and recall brand names. Outcome measure was initiation of (binge) alcohol drinking between baseline and 12- and 24-month follow-up.

RESULTS

The results showed small but statistically significant associations between alcohol advertisement exposure and both drinking and binge drinking initiation over a 12-month interval. Over a 24-month interval, a statistically significant association was only found for initiation of binge drinking. The association was stronger for students from the lowest school level.

CONCLUSION

The study confirms previous longitudinal studies demonstrating an association between exposure to alcohol marketing and initiation of (binge) drinking among adolescents. This association is moderated by school level. Students from the lower school levels may therefore be the most appropriate target group for selective prevention efforts and should be taken particularly into account when formulating policies to reduce and prevent underage drinking.

Internet-Related Disorders: Development of the Short Compulsive Internet Use Scale

The addiction treatment system only reaches a small number of individuals suffering from Internet-related disorders. Therefore, it is important to improve case detection for preventive measures and brief interventions. Existing screening instruments are often time-consuming and rarely validated using clinical criteria. The aim of this study is to develop an optimized short screening for problematic Internet use and Internet addiction (IA). A regression analysis was conducted in random subsamples of a merged sample (N = 3,040; N = 1,209) to examine the item performance of the Compulsive Internet Use Scale (CIUS). Based on the results, a short version of the CIUS was developed and compared with the original CIUS. A fully structured diagnostic interview, covering the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for the Internet gaming disorder with a broader focus on all Internet activities, was conducted. A five-item version of the short screening performed best across the samples. Comparing the area under the curve (AUC) of the receiver operating characteristic between the Short CIUS and the original test revealed no significant difference (AUC = 0.968; 0.977). A cutoff point of 7 turned out to perform best for case detection and yielded a sensitivity of 0.95 and a specificity of 0.87, Cronbach's alpha was 0.77. The analysis showed that the performance of the Short CIUS is just as good in detecting problematical Internet use and IA as the performance of the original CIUS. The Short CIUS provides an economical and valid instrument for the assessment of problematic Internet use and IA.

Psychometrische Eigenschaften und Normierung der deutschen Version der Compulsive Internet Use Scale (CIUS)

Zusammenfassung. Die epidemiologische Beschreibung von Internetabhängigkeit und die Entwicklung von Interventionen erfordern eine reliable und ökonomische Erfassungsmethode von Internetabhängigkeit. Die Compulsive Internet Use Scale (CIUS) erfasst die Kernelemente von Internetabhängigkeit mit 14 Items, allerdings fehlten bisher bevölkerungsrepräsentative Normwerte für die deutsche Version der CIUS. In der vorliegenden Studie werden nun teststatistische Kennwerte und Normwerte für die deutsche Version der CIUS vorgelegt. 8 132 Personen aus der Allgemeinbevölkerung (14 – 64 Jahren) mit einer durchschnittlichen privaten Internetnutzung von einer Stunde oder länger, an mindestens einem Tag in der Woche oder am Wochenende beantworteten die CIUS. Insgesamt weist die CIUS gute psychometrische Eigenschaften auf und die vorgelegten Normwerte bieten die Möglichkeit für Vergleiche von individuellen Werten mit denen der internetnutzenden Bevölkerung.

An fMRI study of cognitive control in problem gamers

A small proportion of video game players develop uncontrolled gaming behavior. A dysfunctional cognitive control circuit may explain this excessive behavior. Therefore, the current study investigated whether problem gamers are characterized by deficits in various aspects of cognitive control (inhibitory control, error processing, attentional control) by measuring brain activation using functional magnetic resonance imaging during Go-NoGo and Stroop task performance. In addition, both impulsivity and attentional control were measured using self-reports. Participants comprised 18 problem gamers who were compared with 16 matched casual gaming controls. Results indicate significantly increased self-reported impulsivity levels and decreased inhibitory control accompanied by reduced brain activation in the left inferior frontal gyrus (IFG) and right inferior parietal lobe (IPL) in problem gamers relative to controls. Significant hypoactivation in the left IFG in problem gamers was also observed during Stroop task performance, but groups did not differ on behavioral and self-reported measures of attentional control. No evidence was found for reduced error processing in problem gamers. In conclusion, the current study provides evidence for reduced inhibitory control in problem gamers, while attentional control and error processing were mostly intact. These findings implicate that reduced inhibitory control and elevated impulsivity may constitute a neurocognitive weakness in problem gamers.

Occurence of internet addiction in a general population sample: a latent class analysis

BACKGROUND

Prevalence studies of Internet addiction in the general population are rare. In addition, a lack of approved criteria hampers estimation of its occurrence.

AIMS

This study conducted a latent class analysis (LCA) in a large general population sample to estimate prevalence.

METHODS

A telephone survey was conducted based on a random digit dialling procedure including landline telephone (n=14,022) and cell phone numbers (n=1,001) in participants aged 14-64. The Compulsive Internet Use Scale (CIUS) served as the basis for a LCA used to look for subgroups representing participants with Internet addiction or at-risk use. CIUS was given to participants reporting to use the Internet for private purposes at least 1 h on a typical weekday or at least 1 h on a day at the weekend (n=8,130).

RESULTS

A 6-class model showed best model fit and included two groups likely to represent Internet addiction and at-risk Internet use. Both groups showed less social participation and the Internet addiction group less general trust in other people. Proportions of probable Internet addiction were 1.0% (CI 0.9-1.2) among the entire sample, 2.4% (CI 1.9-3.1) in the age group 14-24, and 4.0% (CI 2.7-5.7) in the age group 14-16. No difference in estimated proportions between males and females was found. Unemployment (OR 3.13; CI 1.74-5.65) and migration background (OR 3.04; CI 2.12-4.36) were related to Internet addiction.

CONCLUSIONS

This LCA-based study differentiated groups likely to have Internet addiction and at-risk use in the general population and provides characteristics to further define this rather new disorder.

Compulsive use of social networking sites in Belgium: prevalence, profile, and the role of attitude toward work and school

A representative sample (n=1,000) of the Belgian population aged 18 years and older filled out an online questionnaire on their Internet use in general and their use of social networking sites (SNS) in particular. We measured total time spent on the Internet, time spent on SNS, number of SNS profiles, gender, age, schooling level, income, job occupation, and leisure activities, and we integrated several psychological scales such as the Quick Big Five and the Mastery Scale. Hierarchical multiple regression modeling shows that gender and age explain an important part of the compulsive SNS score (5%) as well as psychological scales (20%), but attitude toward school (additional 3%) and income (2.5%) also add to explained variance in predictive models of compulsive SNS use.

Faktorielle Struktur der deutschen Version der Compulsive Internet Use Scale (CIUS) nach konfirmatorischer Faktorenanalyse

Zusammenfassung. Für die Diagnostik der Internetabhängigkeit liegen inzwischen Vorschläge zur Aufnahme des Störungsbildes in das DSM-V vor. Mit der ,Compulsive Internet Use Scale’ (CIUS) existiert für den angloamerikanischen Sprachraum eine Konzeptualisierung zur psychometrischen Erfassung einer abhängigen Internetnutzung. Ziel der vorliegenden Arbeit war die Untersuchung der Faktorenstruktur der deutschen Version der CIUS mittels einer konfirmatorischen Faktorenanalyse sowie der psychometrischen Kennwerte. N = 2.506 Probanden nahmen an der Onlineuntersuchung teil. Erhoben wurde die deutsche Version der CIUS und die tägliche Internetnutzungsdauer. Für die deutsche Version der CIUS konnte hierbei die Ein-Faktorenstruktur bestätigt werden. Es kann geschlussfolgert werden, dass auch die deutsche Version der CIUS ein kurzes und reliables Screeninginstrument zur Erfassung einer auffälligen Internetnutzung ist.

[Summary of the practice guideline 'Problematic alcohol consumption' (second revision) from the Dutch College of General Practitioners]

Compared with the former guideline, more attention is paid to the attitude of the general practitioner towards problem drinkers (about 200 problem drinkers in a standard practice of 2350 patients) and the combined use of alcohol and drugs among young people. The five-shot questionnaire has replaced the earlier 'cutdown, annoyed, guilty, eye-opener' (CAGE) test. Laboratory tests are of little value in the diagnosis. The general practitioner is given tools with which to motivate problem drinkers to change their behaviour. Medication is of minor importance.

Predicting Compulsive Internet Use: It's All about Sex!

The objective of this research was to assess the predictive power of various Internet applications on the development of compulsive Internet use (CIU). The study has a two-wave longitudinal design with an interval of 1 year. The first measurement contained 447 adult heavy Internet users who used the Internet at least 16 h per week and had Internet access at home for at least 1 year. For the second measurement, all participants were invited again, of whom 229 responded. By means of an online questionnaire, the respondents were asked about the time spent on various Internet applications and CIU. On a cross-sectional basis, gaming and erotica seem the most important Internet applications related to CIU. On a longitudinal basis, spending a lot of time on erotica predicted an increase in CIU 1 year later. The addictive potential of the different applications varies; erotica appears to have the highest potential.

ACCURACY OF CARBOHYDRATE-DEFICIENT TRANSFERRIN IN THE DETECTION OF EXCESSIVE ALCOHOL CONSUMPTION: A SYSTEMATIC REVIEW

AIMS

Excessive alcohol consumption is a common problem in society and medical practice. There is a need for a diagnostic tool with both high sensitivity and specificity for the detection of excessive alcohol consumption in unselected medical populations. Therefore, we evaluated the diagnostic accuracy of carbohydrate-deficient transferrin (CDT) in the detection of excessive alcohol consumption.

METHODS

Computerised literature searches in Medline, Embase and Current Contents databases (01/1966-06/2003) and reference checking. Articles on the detection of excessive alcohol consumption reporting CDT levels and self-reported alcohol consumption as a reference test were selected (n = 101). Studies concerning treatment, relapse detection and traffic offenders were excluded. Quality assessment and data-extraction was done by two reviewers independently. Only studies scoring positive on core validity criteria by Lijmer were eligible for quantitative analysis (n = 29).

RESULTS

Only two CDT-assays (CDTect and CDTriTIA) were evaluated in more than two high validity studies fulfilling the criteria for inclusion in the statistical analysis. Sensitivity of CDTect (14 data points) ranged from 20 to 85%, whereas specificity ranged from 77 to 95%. A summary ROC curve was computed for CDTect. Sensitivity of CDTTriTIA (4 data points) ranged from 10 to 67%, and specificity ranged from 90 to 100%. No summary measure could be computed for CDTTriTIA. The heterogeneity of results could not be explained clinically.

CONCLUSIONS

The validity of CDT as a diagnostic tool is still questionable. If the higher values for sensitivity that some studies report can be confirmed by others it is a useful diagnostic tool in unselected populations. However, more methodologically sound, comparable studies need to be performed before firm conclusions can be drawn.

Comparing the diagnostic accuracy of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean cell volume in a general practice population

In certain populations, the biological alcohol marker carbohydrate-deficient transferrin (CDT) is known to have a high diagnostic accuracy. The aim of this study was to compare the diagnostic accuracy of CDT, gamma-glutamyltransferase (gamma-GT), and mean cell volume (MCV) in a general practice population; more specifically, to ascertain whether CDT is a better tool than gamma-GT and MCV for (early) recognition of excessive alcohol use. To represent the general practice situation as realistically as possible, three different drinking patterns are defined: irregular excessive, regular excessive, and very excessive. From a sample of 524 men from seven general practices, sensitivity, specificity, and predictive values of the three markers for the three drinking patterns were compared, and receiver-operating characteristic analysis was used to compare differences between the markers. The results indicate that drinking patterns do influence the (difference in) diagnostic accuracy. CDT has a higher diagnostic accuracy for all three drinking patterns than gamma-GT and higher predictive values for hazardous [(ir)regular excessive] drinking patterns than MCV. However, receiver-operating characteristic analyses failed to demonstrate a significant difference between these patterns. It is concluded that the performance of all tests is too low to be useful for screening procedures in a general population; however, some tests may be useful for case finding. CDT seems to be the best alcohol marker available, although the difference between CDT and MCV is small.

The specificity of the CDT assay in general practice: the influence of common chronic diseases and medication on the serum CDT concentration

Early recognition of alcohol problems by general practitioners might be enhanced by the use of better alcohol markers. Several studies have revealed promising results for the carbohydrate-deficient transferrin (CDT) assay in certain populations. The aim of our study was to examine the specificity of the CDT assay in a general practice population. The main research question was whether common chronic diseases and/or the accompanying prescribed drugs have a negative influence on the specificity of the CDT assay. The 524 men who participated were selected from seven general practices and were suffering from one or more of the following diseases: hypertension, asthma/bronchitis, diabetes mellitus, adipositis/lipid metabolism disorder, angina pectoris, depression, and disorders of the digestive tract. None of the studied diseases or of the accompanying prescribed drugs had an influence on the specificity of the CDT assay. The overall specificity in this general practitioner population was 0.92. It can be concluded that the studied diseases do not bear an influence on the serum CDT concentration, and that, therefore, the CDT assay is a highly specific instrument for use in assessing alcohol consumption in general practice patients.

Effectiveness of a drug-free detention treatment program in a Dutch prison

Several Dutch penitentiaries, which have relatively severe drug-use related problems, experimented with drug-free detention treatment programs (DVA). These programs aim at controlling drug use by offering a therapeutic atmosphere and serve as linkage to detention posttreatment. In a Rotterdam jail (335 cells), ca. 10% were the DVA. Information was gathered from 86 male inmates who volunteered to enter the program, and 42 from other wings. After 1 year the drug-free detention group more actively searched and accepted treatment. No differences were found in drug use, recidivism, or physical, social, and psychological problems.

The Dutch instant lottery: prevalence and correlates of at-risk playing

After a long and contentious political debate, the instant lottery was introduced in the Netherlands in 1994. One of the conditions for allowing the introduction was that an evaluation study should be conducted with regard to possible negative side effects of the instant lottery in terms of excessive playing or addiction. This article reports on the main results of this evaluation study. In a random sample of 4497 instant lottery players, at-risk players were differentiated from recreative players on the basis of level of involvement in the instant lottery, impaired control and the experienced negative consequences of playing. Of the sample, 4.1% could be classified as an at-risk player. Actual problems resulting from playing in the instant lottery were experienced by 0.7% of the players. At-risk players and recreative players did not only differ substantially in their playing behaviour, but also with regard to their socio-economic background, playing motivation, participation in other games of chance, and involvement in alcohol use and use of marijuana. To summarize, at-risk players were more likely to come from a poor socio-economic background, to play the instant lottery with a negative playing motivation, to be heavily involved in other forms of gambling, to have used marijuana and to drink alcohol excessively.

Enrollment in a drug-free detention program: the prediction of successful behavior change of drug-using inmates

Factors predicting the behavior change of drug-using detainees were investigated in detainees in two penitentiaries in The Netherlands. Subjects attended either a standard program or a Drug-Free Detention Program (DFDP) and were assessed at the beginning of detention, at release/transfer, and at 2 years after the end of detention. Predictors of postprogram contact with treatment agencies and changes in criminal recidivism, substance abuse, and psychosocial functioning were investigated using regression analysis. Detainees who started drug use early, without previous DFDP detention, and who frequently expressed self-esteem and who had many family problems realized meetings with drug treatment agencies more often. Those with a legal source of income showed decreases in addiction severity and in the number of days in which hard drugs were used. Comparison of the normal program and the DFDP showed that only for the normal wing could changes in substance use and psychosocial functioning be predicted. Results show the value of multiple-outcome criteria in criminal recidivism research and call for more studies investigating change processes.