Smoking among Brazilian adolescents during the COVID-19 pandemic: a cross-sectional study

ABSTRACT BACKGROUND: The social distancing measures during the coronavirus disease 2019 (COVID-19) pandemic resulted in mental suffering among adolescents, leading to risky consumption of psychoactive substances such as tobacco. OBJECTIVE: To analyze the factors associated with tobacco use among adolescents during the COVID-19 social distancing period in Brazil. DESIGN AND SETTING: Cross-sectional study used data from ConVid Adolescentes survey in Brazil. METHODS: Tobacco use was assessed before and during social distancing. The explanatory variables investigated were sex, age, race/skin color, type of school, maternal education, region of residence, adherence to social restriction measures, number of close friends, sleep quality during the pandemic, mood, passive smoking, use of alcoholic beverages during the pandemic, sedentary behavior, and physical activity. A logistic regression model was used for the data analysis. RESULTS: Tobacco use by adolescents did not change during the pandemic (from 2.58% to 2.41%). There was a higher chance of tobacco use among adolescents aged between 16 and 17 years, self-reported black ones, residing in the South and Southeast regions, reported feeling sad and loneliness, had sleeping problems that worsened, were using alcoholic beverages during the pandemic, and were passive smokers at home. Adolescents whose mothers had completed high school or higher, had strict social restrictions, and increased their physical activity during the pandemic had a lower chance of tobacco use. CONCLUSION: Tobacco uses during the COVID-19 pandemic was higher in vulnerable groups, such as black adolescents and those with mental suffering.

Effects of educational level on the choice of intervention strategies for smoking cessation in patients with moderate to severe tobacco dependence / 中国基层医药

Objective:To investigate the effects of educational level on smoking cessation in patients with moderate to severe tobacco dependence, explore effective individualized smoking cessation methods, and increase smoking cessation rate.Methods:A total of 480 patients with moderate to severe tobacco dependence who were willing to quit smoking and received treatment in the Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital from January to December 2020 were included in this study. They were divided into four groups ( n = 120/group) according to their educational level: group A (elementary school and below), group B (junior high school and senior high school), group C (technical secondary school or college), and group D (university and above). All patients were randomly assigned to undergo "5A" intervention alone or "5A" intervention combined with varenicline intervention (combined intervention). Patients' awareness of the health risks of tobacco smoking was compared among the four groups. The smoking cessation rate measured at different time points was compared between different intervention strategies. Results:The scores of health risk of tobacco smoking in groups D, C, B, and A were (806.5 ± 35.7) points, (710.8 ± 26.2) points, (643.6 ± 43.4) points, and (512.4 ± 30.1) points, respectively. Patients with high education levels had high awareness of the health risk of tobacco smoking ( F = 1 543.26, P < 0.001). At 1, 3, and 6 months, the smoking cessation rate of combined intervention was higher than that of "5A" intervention alone in each group (group A: χ2 = 3.85, 4.23, 4.10, group B: χ2 = 4.30, 4.09, 4.60, group C: χ2 = 6.81, 4.30, 4.03, group D: χ2 = 6.71, 6.51, 4.73, all P < 0.05). The smoking cessation rate after 6 months of "5A" intervention alone or combined intervention in group D was 60.0% and 78.3% respectively, which were significantly higher than 41.7% and 60.0% in group C, 23.3% and 41.7% in group B, and 20.0% and 36.7% in group A ( χ2 = 26.59, 26.12, both P < 0.001). At different time points, the smoking cessation rates of the "5A" intervention alone in group D were significantly higher than those of combined intervention in groups A and B ( χ2 = 9.25, 25.04, 7.29, all P < 0.05). Conclusion:Awareness of the health risks of tobacco smoking is related to a patient's educational level, and affects smoking cessation. Individualized smoking cessation interventions based on a patient's educational level can increase the rate of smoking cessation.

Smoking Rationalisation, Tobacco Dependence and Intention to Quit among Indian Adults and Adolescents

Introduction: Unfortunately, indicators of tobacco dependence are present even after low levels of exposure in young smokers. Early emergence of these signal risk for subsequent chronic smoking and nicotine dependence is negatively associated with cessation in young adults. One important yet understudied modifiable predictor of intention to quit among smokers is smoking rationalization. Smokers often subscribe to smoking rationalisation beliefs, also known as self?exempting beliefs, to justify or rationalize their smoking behaviors. Smoking rationalizations can predict a lack of intention to quit. Objective: To assess the correlation between smoking rationalisation, tobacco dependence and intention to quit among Indian adults and adults. Methodology: A cross?sectional pilot study was carried out among 18–60?year?old subjects. Data were collected for tobacco dependence, smoking rationalisation and intention to quit (no/yes) by structured interview. Data were analysed using IBM SPSS statistics for windows, version 16 (IBM Corp, Armork, NY.) The independent t?test and one way ANOVA and binary logistic regression were performed for inferential statistics. Results: Smokers with no intention to quit and high tobacco dependence scores had significantly higher smoking rationalisation than those to quit and low dependence scores. Logistic regression models demonstrated that all types of rationalisation beliefs were consistently inversely associated with the intention to quit and low tobacco dependence. Conclusion: Findings suggest that smoking rationalisation plays an important role in the lack of intention to quit among Indian smokers. Future interventions should tackle smoking rationalisation beliefs as a strategy to promote smoking cessation.

Impacts of nicotine metabolite rate and acupuncture frequency on smoking cessation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the efficacy of different acupuncture frequencies in tobacco-dependent patients and explore the impact of nicotine metabolite rate (NMR) on smoking cessation in the intervention with acupuncture.@*METHODS@#A total of 120 cases of tobacco-dependent patients were randomly divided into a high-frequency group (60 cases, 12 cases dropped off) and a low-frequency group (60 cases, 6 cases dropped off). In the two groups, smoking cessation counseling was provided prior to acupuncture. Acupuncture was applied to Baihui (GV 20), Lieque (LU 7), Zusanli (ST 36), etc. Additionally, electric stimulation was added at Lieque (LU 7) and Zusanli (ST 36), with continuous wave, 15 Hz in frequency. The duration of treatment was 8 weeks in either group. In the high-frequency group, the treatment was given 5 times weekly from week 1 to week 4, and was 3 times weekly from week 5 to week 8. In the low-frequency group, the treatment was given 3 times weekly from week 1 to week 4, and was twice a week from week 5 to week 8. The immediate withdrawal rate, persistent withdrawal rate, the score of Fagerstrőm test for nicotine dependence (FTND) before and after treatment, as well as the score of Minnesota nicotine withdrawal scale (MNWS) in 1 and 8 weeks of treatment were compared among the patients with high and low NMR between the two groups separately. The Logistic regression analysis was used to screen the influencing factors of smoking cessation in the intervention with acupuncture.@*RESULTS@#After treatment, there was no statistical significance of the differences in the immediate withdrawal rate (35.4% [17/48] vs 29.6% [16/54]) and the persistent withdrawal rate (33.3% [16/48] vs 25.9% [14/54]) between the high-frequency group and the low-frequency group (P>0.05). The difference in withdrawal rate had no statistical significance between high and low NMR patients (P>0.05). FTND scores after treatment were lower than those before treatment (P<0.01) and MNWS scores were lower than those in 1 week of treatment (P<0.01) in the two groups. However, the differences had no statistical significance between the two groups and between the patients with high NMR and low NMR (P>0.05). Age, education level and NMR were the influencing factors of smoking cessation in the intervention with acupuncture (P<0.05).@*CONCLUSION@#Acupuncture with different frequencies has no obvious impact on the efficacy in tobacco-dependent patients. The lower nicotine metabolite rate in individuals, the better efficacy of acupuncture. The smokers with high nicotine metabolite rate may obtain a better effect of cessation in the high-frequency intervention with acupuncture.

Smoking-related behavior among residents in Changning District of Shanghai / 上海预防医学

Objective:To determine the proportion of tobacco smoking and tobacco dependence among residents in Changning District of Shanghai， and provide scientific evidence for future intervention. Methods:A questionnaire survey was conducted among 1 760 residents over 15 years old in Changning District， covering smoking behavior， tobacco dependence and smoking relapse. Chi-square test was used to compare the proportions of smoking-related behavior among different groups， and logistic regression model was used to determine the risk factors. Results:Smoking proportion among residents over 15 years old in Changning District was determined to be 17.0%（299/1 760）， which was 35.8% （285/795） for males and 1.5% （14/965） for females. The smoking proportion was significantly higher in the residents being male， older， with less education and underlying diseases （P<0.05）. The residents "knowing the hazard of smoking but remaining smoking" was the most serious tobacco dependence， which was determined to be 85.3% （255/299） among the smokers. The most common symptom leading to smoking relapse was "impulse to smoking " （61.1%，138/226）. Among them， "smoking impulse"（χ2=8.512，P=0.004）， " restlessness "（χ2=4.000，P=0.045）， and "depression" （χ2=6.328，P=0.010） are the three symptoms which had an effect on whether the smokers relapsed. Conclusion:The smoking rate in Changning District of Shanghai is lower than the national and local average. Tobacco dependence mainly focuses on awareness and attitude. Intervention should focus on the key population with high smoking rate. We should correct the severe tobacco dependence， intervene the main adverse symptoms， and guide smoking cessation. In addition， we should provide more accurate and effectives smoking cessation services based on health communication.

Prevenção de recaídas baseada em mindfulness no tratamento do tabagismo - Brasil / Relapse Prevention Based on Mindfulness in the Treatment of Tobacco Dependence - Brazil / Prevención de recaídas basada en Mindfulness en el tratamiento del tabaquismo - Brasil

Resumo Realizou-se um ensaio clínico randomizado com o objetivo de analisar os efeitos de um programa de Prevenção de Recaídas baseado em mindfulness no tratamento do tabagismo. O estudo foi conduzido no Centro de Atenção Psicossocial de Álcool e Drogas (CAPSad) em 2017 na cidade de Porto Velho, capital de Rondônia, Brasil. Participaram da pesquisa 52 pacientes em tratamento para o tabagismo, com idades entre 29 a 60 anos de ambos os sexos, usuários apenas de tabaco. Para a realização deste trabalho foram formados dois grupos: G1=experimental e G2=controle, ambos formados por 26 cada um. No pré-teste, os dados mostraram não haver diferença significativa entre esses dois grupos. Na comparação do pós-teste ocorreu uma diferença significativa na diminuição dos sintomas de ansiedade (p = 0,043) e nível de monóxido de carbono-CO2 (p = 0,03) nos pulmões dos participantes. No resultado da análise de proporção, houve diferença no G1 pós-intervenção com diminuição de sintomas de ansiedade (p == <0,001), depressão (p = 0,012) e monóxido de carbono (p = <0,001), respectivamente. Estes achados mostraram efeitos significativos do mindfulness para a pre- venção de recaídas e diminuição de sintomas de ansiedade, depressão e nível de monóxido de carbono nos pulmões, no G1 pós-intervenção nos pacientes fumantes e fumantes dependentes em tratamento no CAPSad.

Abstract A randomized clinical trial was conducted to analyze the effects of a Mindful-ness-based relapse prevention program for tobacco dependence treatment. The study was conducted at the Center for Psychosocial Care of Alcohol and Drugs (CAPSad), in the city of Porto Velho, capital of Rondônia, Brazil, 2017. 52 patients aged between 29 to 60, of both sexes, who were only tobacco users, participated in the research. To carry out this study, two groups were made up: G1 = experimental and G2 = control, both consisted of 26 people. In the pre-test, the data showed that there was no significant difference between these two groups. In the post-test comparison, there was a considerable difference in the reduction of anxiety symptoms (p = 0.043) and carbon monoxide-CO2 level (p = 0.03) in the lungs of smoking patients. In the result of the proportion analysis, there was a difference in G1 post-intervention with decreased symptoms of anxiety (p = <0.001), depression (p = 0.012) and carbon monoxide (p = <0.001), respectively. These fin-dings showed significant effects of mindfulness in preventing relapse and reducing symptoms of anxiety, depression and carbon monoxide level the post-intervention group of smokers and dependent smokers treated at CAPSad.

Resumen Se realizó un ensayo clínico aleatorizado con el objetivo de analizar los efectos de un programa de prevención de recaídas basado en Mindfulness para el tratamiento del tabaquismo. El estudio se realizó en el Centro de Atención Psicosocial del Alcohol y las Drogas (CAPSad), en 2017, en la ciudad de Porto Velho, capital de Rondônia, Brasil. Participaron en la investigación 52 pacientes, de ambos sexos, con edades comprendi-das entre 29 y 60 años, consumidores de tabaco solamente. Para la realización de este trabajo, se formaron dos grupos: G1 = experimental y G2 = control, formados por 26 personas cada uno. En la prueba previa, los datos mostraron que no había diferencia significativa entre los grupos. En la comparación de los resultados en la prueba pos-terior se halló una diferencia significativa en la reducción de los síntomas de ansiedad (p = 0.043) y en el nível de monóxido de carbono-CO2 (p = 0.03) em los pulmones de los participantes. Como resultado del análisis de proporciones, se presentó una diferencia en el G1 en la prueba posterior, con síntomas disminuidos de ansiedad (p = <0.001), depresión (p = 0.012) y monóxido de carbono (<0.001), respectivamente. Estos hallazgos mostraron los efectos significativos del mindfulness para la pre-vención de recaídas y reducción de los síntomas de ansiedad, depresión y nível de monóxido de carbono em los pulmones, en el grupo de experimento posterior a la intervención en fumadores y fumadores dependientes que reciben tratamiento en el CAPSad.

Prevalence and Treatment of Tobacco Use Among Patients Being Treated for Mental Disorders / Prevalencia y Tratamiento del Uso de Tabaco Entre Pacientes de Servicios de Salud Mental / Prevalência e Tratamento do Uso de Tabaco Entre Pacientes Tratados em Serviços de Saúde Mental

Abstract: Background: People with mental disorders use tobacco as a strategy for coping with various symptoms and the side effects of prescribed medications. In addition to being harmful to their health, tobacco use also interferes with their treatment process. Objective: To examine tobacco use among patients being treated for mental disorders in a public health system in a Brazilian the city. Methods: were interviewed 362 patients being treated by the specialized services for mental health. The participants included persons who met the diagnostic criteria for schizophrenia, schizotypal, and delusional disorders, mood (affective) disorders, or neurotic, stress-related, and somatoform disorders. Results: The median age of participants was 46.4 years, of which 73.5% were women and 42.5% were unmarried, 37.8% smokers. Among the smokers, 82% claimed they wanted to quit smoking, and 49% made daily visits to the health center. 79.6% of the participants had tried to quit smoking previously, and of these, 84.3% had tried to do so on their own. Conclusion: Tobacco use is an important factor to be considered in developing treatment plans for people with mental disorders. It is necessary to develop strategies to help people quit smoking and train health professionals to incorporate these strategies into the treatment process.

Resumen: Antecedentes: Personas con trastornos mentales utilizan el tabaco como estrategia de afrontamiento para diversos síntomas y efectos colaterales de los medicamentos utilizados. Además de los múltiples daños causados a la salud, el uso de tabaco perjudica el tratamiento de personas con trastornos mentales. Objetivo: Caracterizar el consumo de tabaco en la población con trastorno mental en tratamiento, en la ciudad de Juiz de Fora, Brasil. Métodos: Fueron entrevistados 362 pacientes en tratamiento, en los servicios especializados en salud mental, con diagnósticos de Esquizofrenia, Trastornos Esquizotípicos y Delirantes, Trastornos del Humor (afectivos) o Trastornos Neuróticos, Trastornos Relacionado con Estrés y Trastornos Somatomorfos. Resultados: La edad promedio de los participantes fue de 46,4 años; el 73,5% eran del sexo femenino, el 42,5% eran solteros y un 37,8% eran fumadores. El 82% afirmó que les gustaría dejar de fumar y el 49% frecuentaron el servicio diariamente. Aquellos que ya intentaron parar de fumar alguna vez totalizaron el 79,6% y, de los cuales el 84,3% lo hicieron por cuenta propia. Conclusión: El consumo de tabaco es un factor importante a ser considerado en la elaboración de procedimientos terapéuticos de la población con trastornos mentales. Es necesario desarrollar intervenciones para el cese del consumo de tabaco, que puedan ser aplicados en la cotidianidad de los servicios de forma integrada.

Resumo: Antecedentes: Pessoas com transtornos mentais utilizam o tabaco como estratégia de enfrentamento para diversos sintomas e efeitos colaterais dos medicamentos utilizados. Além dos diversos prejuízos à saúde, o uso de tabaco prejudica o tratamento de pessoas com transtornos mentais. Objetivo: caracterizar o consumo de tabaco na população portadora de transtorno mental em tratamento na cidade de Juiz de Fora, Minas Gerais. Métodos: Foram entrevistados 362 pacientes em tratamento nos serviços especializados em saúde mental, com diagnósticos para Esquizofrenia, Transtornos Esquizotípicos e Delirantes, Transtornos do Humor (afetivos), ou Transtornos Neuróticos, Transtornos Relacionados ao Stress e Transtornos Somatoformes. Resultados: A idade média dos participantes foi de 46,4 anos; 73,5% eram do sexo feminino e 42,5% solteiros e 37,8% eram fumantes. 82% alegaram que gostariam de parar de fumar e 49% frequentavam o serviço diariamente. Aqueles que já tentaram parar de fumar alguma vez totalizaram 79,6% e, desses, 84,3% o fizeram por conta própria. Conclusão: O consumo de tabaco é um fator importante a ser considerado na elaboração do plano terapêutico da população com transtornos mentais. É necessário desenvolver intervenções para a cessação do consumo de tabaco que possam ser aplicadas no cotidiano dos serviços de forma integrada.

Prevalence of Psychiatric Comorbidity in Individuals with Chronic Obstructive Pulmonary Disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory disorder characterized by airflow limitation that is usually progressive. Chronicity of this illness has been found to impair the day-to- day functioning in this population. These individuals are predisposed to psychiatric disorders which impact their morbidity. This study was planned as Indian literature in this area are sparse.Aim: This study aims to study the psychiatric morbidity in individuals with COPD.Methodology: Fifty inpatients in the Department of Pulmonology, Kempegowda Institute of Medical Sciences, Bengaluru, diagnosed with COPD (Grade 3 and 4) consenting for the study were included in the study. Severity of COPD was staged using Global Initiative for Chronic Obstructive Lung Disease criteria. Psychiatric disorders were diagnosed using ICD-10 criteria and Mini International Neuropsychiatric Interview. A descriptive study is used.Results: Thirty- six of 50 patients assessed were found to have syndromal psychiatric disorders. Among them, 33 patients had tobacco dependence syndrome (TDS); 10 of whom had an additional psychiatric disorder (7 – alcohol dependence, 1 – moderate depression, 1 – generalized anxiety, and 1 – mixed anxiety-depression). The rest three had a single psychiatric diagnosis (1 – moderate depression, 1 – generalized anxiety, and 1 – dysthymia).Discussion and Conclusion: This study showed increased psychiatric morbidity in patients suffering from COPD and two-third had TDS. Depression and anxiety were also seen associated with this illness. The presence of psychiatric disorders in COPD leads to increased morbidity. However, these have not been screened for routinely. Early detection and treatment of psychiatric comorbidity in COPD will help in reducing the morbidity and increase in the level of functioning.

SMOKING CESSATION – A PRACTICAL PARADIGM FOR DOCTORS

@#Helping people to stop smoking is a highly cost-effective and an important means of preventing cardiovascular disease such as ischemic heart disease and stroke. A doctor who fails to provide smoking cessation counselling to a patient who smokes is no better than a doctor who neglects to prescribe a cholesterol – lowering drug. Many smokers want to stop smoking, and others may be receptive to encouragement to stop. As doctors, we are in a unique position to help our patients stop smoking because our advice on health matters is trusted more than anyone else’s (or so we should hope to think). This article was first published in the Singapore Family Physician in 2008, and focuses on what a doctor should do with a patient who smokes. An additional update on alternatives to cigarettes has been added.

Comparative study of acupoint catgut embedding and bupropion hydrochloride sustained-release tablets for tobacco dependence / 中国针灸

OBJECTIVE@#To compare the clinical efficacy of acupoint catgut embedding and bupropion hydrochloride sustained-release tablets in the treatment of tobacco dependence.@*METHODS@#A total of 100 patients with tobacco dependence who met the inclusion criteria were randomly divided into an acupoint catgut embedding group and a drug group, 50 cases in each group. In the acupoint catgut embedding group, acupoint catgut embedding was applied at Xinshu (BL 15), Shenmen (HT 7), Tianmei (Extra), Taichong (LR 3), the treatment was given once every 2 weeks for 4 times; The bupropion hydrochloride sustained-release tablets was orally administered in the drug group for 7 weeks, 150 mg each time, once a day for the first 3 days, twice daily from day 4 to day 7, and once a day after day 8. The Fagerström test for nicotine dependence (FTND) score before and after treatment, the 4th and 8th week smoking cessation rate, the continuous smoking cessation rate and efficacy, compliance rate and adverse reaction rate were compared in the two groups.@*RESULTS@#A total of 100 patients were enrolled, and 97 patients completed the study (loss rate was 3%), including 49 cases in the acupoint catgut embedding group and 48 cases in the drug group. The FTND scores in the two groups were lower than those before treatment (both 0.05). At the 4th and the 8th week, the smoking cessation rate in the acupoint catgut embedding group was 40.8% (20/49) and 79.6% (39/49) respectively, the smoking cessation rate in the drug group was 41.7% (20/48) and 83.3% (40/48) respectively, the two groups were equally effective (both >0.05). The continuous smoking cessation rate in the acupoint embedding group was 40.8% (20/49), which was equivalent to 41.7% (20/48) in the drug group (>0.05). The rate of complete compliance in the acupoint embedding group was 61.2% (30/49), which was significantly better than 37.5% (18/48) in the drug group (<0.05). The adverse reaction rate in the acupoint catgut embedding group was 12.2% (6/49), which was significantly lower than 29.2% (16/48) in the drug group (<0.05).@*CONCLUSION@#Acupoint catgut embedding can effectively improve the symptoms of tobacco dependence after smoking cessation. Its curative effect is close to that of bupropion hydrochloride sustained-release tablets, and it has good clinical compliance and less adverse reactions.

Smokeless tobacco cessation interventions: A systematic review

Background & objectives: Smokeless tobacco (SLT) consumption is a global health issue with about 350 million users and numerous adverse health consequences like oral cancer and myocardial disorders. Hence, cessation of SLT use is as essential as smoking cessation. An update on the available literature on SLT cessation intervention studies is provided here. Methods: Through an extensive literature search on SLT cessation intervention studies, using keywords such as smokeless tobacco, cessation, interventions, quitlines, brief advice, nicotine replacement therapy, nicotine gum, nicotine lozenge, nicotine patch, bupropion, varenicline, mHealth, etc., 59 eligible studies were selected. Furthermore, efficacy of the interventions was assessed from the reported risk ratios (RRs) [confidence intervals (CIs)] and quit rates. Results: Studies were conducted in Scandinavia, India, United Kingdom, Pakistan and the United States of America, with variable follow up periods of one month to 10 years. Behavioural interventions alone showed high efficacy in SLT cessation; most studies were conducted among adults and showed positive effects, i.e. RR [CI] 0.87 [0.7, 1.09] to 3.84 [2.33, 6.33], quit rate between 9-51.5 per cent, at six months. Regular telephone support/quitlines also proved beneficial. Among pharmacological modalities, nicotine lozenges and varenicline proved efficacious in SLT cessation. Interpretation & conclusions: Globally, there is limited information available on SLT cessation intervention trials, research on which must be encouraged, especially in the low-resource, high SLT burden countries; behavioural interventions are most suitable for such settings. Appropriate training/sensitization of healthcare professionals, and school-based SLT use prevention and cessation programmes need to be encouraged.

The Role Of Psychiatrists And Tobacco Dependence Treatmen

Objective: Global tobacco control efforts in both prevention and treatment have advanced to levels never imagined 20 years ago. This review examines the relationship between mental illness and tobacco use, with particular focus on the role of psychiatrists in the treatment of tobacco dependence. Methods: The literature search utilised MEDLINE, Embase and PsychINFO databases using the terms psychiatry, psychiatrist, smoking cessation, tobacco use disorder and tobacco dependence treatment. A manual search of all references from relevant scientific articles obtained was also conducted. Finally, further material sourced included all major guidelines for smoking cessation or tobacco dependence treatment from the United States, United Kingdom, Canada, Australia and New Zealand. Results: Psychiatry has ignored tobacco dependence and its treatment resulting in multiple missed opportunities in improving the health and well-being of smokers with mental illness. Improvement in the training and knowledge of psychiatrists and those in the mental health sector will be the most effective activity to rectify this situation. Conclusion: Psychiatry must recognise tobacco dependence as equally important as the primary mental illness and to treat accordingly. A significant change in the training of future psychiatrists, introducing or implementing smoke free mental health services, changes in the management of caring for the mentally ill, and the introduction of tobacco treatment specialists within the mental health system is needed if psychiatry is serious about confronting this problem.

Modelos explicativos de la dependencia y consumo de tabaco en estudiantes de preparatoria / An Explanatory Model of Tobacco Consumption among High School Students

El propósito principal del estudio fue explicar la dependencia tabáquica y el consumo de cigarros desde una perspectiva motivacional en una muestra de estudiantes de preparatoria de sexo indistinto. Se emplearon cuatro escalas del Inventario de Wisconsin de Motivos de Dependencia del Tabaco, una escala de normas paternas y una de amigos fumadores; así como dos medidas internacionales de consumo de cigarrillos y un cuestionario de dependencia tabáquica. El análisis de regresión múltiple de dependencia tabáquica mostró que exposición a claves, normas paternas y reforzamiento positivo explicaron el 54.30% de la varianza. Se elaboró un modelo estructural de la dependencia al tabaco que incluyó los motivos mencionados y el número de días de consumo, el cual se ajustó bien a los datos. Todos los efectos directos sobre las medidas de dependencia fueron significativos, así como las covarianzas entre los motivos. De acuerdo al estadístico Wald que se obtuvo en el análisis de clases latentes, hubo diferencias significativas entre los tres grupos en los cuatro indicadores: dependencia, exposición a claves, amigos fumadores y número de días de consumo.

The main purpose of the study was to explain tobacco dependence and consumption of cigarettes from a motivational perspective on a sample of high school students of both sexes. We used four scales of the Wisconsin Inventory of Smoking Dependence Motives, a scale of parental rules and a scale of smoking friends; as well as two international measures for cigarette consumption and a tobacco dependence questionnaire. The multiple regression analysis of tobacco dependence showed that the key exposure, parental rules and positive reinforcement, accounted for 54.30% of the variance. In this study, was developed a structural model of the tobacco dependence that included the four motives and the number of days of consumption, which fits well with the data; all direct effects on measures of dependency were significant, as the covariance among the motives. According to the Wald statistic obtained in the latent class analysis, there were significant differences among the three groups in the four indicators: dependency, exposure to key, smoking friends and number of days of consumption.

Diagnóstico y tratamiento psicosocial del tabaquismo / Smoking cessation: Diagnosis and psychosocial intervention

Tobacco dependence is an addictive chronic disease, characterized by its trend to the recurrence, in which the relapses are part of the process of smoking cessation. It is recommended a complete clinical evaluation, including the application of certain tests that can allow level of dependence, motivation and psychiatric comorbidities evaluation. The current treatment of smoking has two pillars: psycho-social intervention and pharmacological therapy. The current interventions are based on two theoretical models that try to understand changes of smoking behavior: The Stages of Change and PRIME Theory. Brief intervention is a strategy internationally approved because of its population impact on smoking cessation. The methodology used is named "5A's": Ask, Advise, Asses, Assist and Arrange follow-up. For not motivated patients at the intervention time it can be used the "5R 's" methodology: Relevance, Risks, Rewards, Roadblocks and Repetition. The actual approach used in smokers management, is Motivational Interview, which tries to produce the behavioral change from inside and not imposing it. Its four tools are: express empathy, develop discrepancy, roll with resistance and support self efficacy. The useful psychosocial strategies, in which exists consensus, are: 1) Give practical counseling of problem solving and skills training to face risky situations; 2) Intra-treatment support, encouraging attempts of smoking cessation and communicate caring and concern.

El tabaquismo es una enfermedad crónica adictiva, caracterizada por su tendencia a la recurrencia, en que las recaídas son parte del proceso de dejar de fumar. Se recomienda una evaluación clínica completa de los fumadores, incluyendo la aplicación de algunos tests que permitan evaluar nivel de adicción, motivación y comorbilidad psiquiátrica. El tratamiento actual del tabaquismo tiene dos pilares: intervención psicosocial y terapia farmacológica. las intervenciones actuales, se basan en dos modelos teóricos que intentan comprender los cambios de la conducta de fumar de las personas: las Etapas de Cambio y la Teoría PRIME. la Consejería Breve es una estrategia aprobada internacionalmente por su impacto poblacional en dejar de fumar. la metodología que utiliza se denomina las 5 A: Averiguar, Aconsejar, Acordar, Ayudar y Acompañar. Para los pacientes no motivados al momento de la intervención se utiliza la metodología de las 5 R: Relevancia, Riesgos, Recompensas, Resistencias y Repetición. El enfoque actualmente utilizado en el manejo de los fumadores, es la Entrevista Motivacional, que intenta producir el cambio conductual desde dentro y no imponiéndolo. Sus cuatro herramientas son: expresar empatia, desarrollar las discrepancias, lidiar con las resistencias y mejorar la autoeficacia. Hay consenso en que las estrategias psicosociales útiles son: 1) la entrega de consejos prácticos para resolución de problemas y desarrollo de habilidades para enfrentar situaciones de riesgo; 2) el apoyo intratratamiento, incentivando los intentos por dejar de fumar y trasmitiendo preocupación y apoyo.

Effect of Cancer Diagnosis on Smoking Behavior / 가정의학회지

BACKGROUND: Smoking is universally recognized as the foremost preventable cause of cancer. And smoking behavior causes many negative effects in cancer patients. Based on the mounting evidence that smoking affects cancer treatment outcomes and survival, we studied whether the cancer diagnosis affects smoking behavior. METHODS: During August 2007, 279 patients who were hospitalized with the diagnosis of cancer were surveyed by a questionnaire and a follow up survey was performed at 3 months and 7 months afterwards. Follow up survey was performed via telephone and finally 246 patients were enrolled. Questions in the survey included smoking history, nicotine dependence, stage of change and the reason for quit smoking or keep smoking. In the follow up survey at 7 month, we asked whether they needed smoking cessation interventions. RESULTS: At the end of the study, the subjects who kept smoking were 27 patients, but the degree of nicotine dependence was decreased compared to the preceding 2 surveys and contemplation as well as preparation stage turned out to be the most prevalent stage of change. The main reasons to keep smoking were behavioral habits and stress. Regardless of their smoking history, almost all cancer patients wanted smoking cessation interventions. CONCLUSION: Smoking is a critical variable that affects cancer treatment and outcome. We surely found there is a smoking subgroup after cancer diagnosis and we should advise them to quit smoking.

Utilização do teste de dependência à nicotina de Fagerstrõm como um instrumento de medida do grau de dependência / Use of the Fagerstrõm test for nicotine dependence as an instrument to measure nicotine dependence

O tabagismo é considerado a maior causa de morte evitável. O número de cigarros consumidos apresenta correlação com o aumento de incidência da doença aterosclerótica, podendo ser o maior contribuinte para o aumento do risco de doença em combinação com outros fatores de risco. É classificado como dependência de nicotina e está incluído no grupo de transtornos mentais e de comportamentos decorrentes do uso de substâncias psicoativas segundo a classificação da Organização Mundial da Saúde. No manejo de pacientes tabagistas, a utilização de um instrumento para avaliar o grau de dependência de nicotina é muito importante. Existe uma correlação entre nível de dependência nicotínica e resposta às diversas terapias. Pacientes com nível de dependência baixa poderão ser tratados apenas com abordagem cognitivo-comportamental. Os de grau mais elevado de dependência necessitarão de terapia farmacológica. Nesta revisão, observa-se que o teste de dependência à nicotina de Fagerstrõm (FTND) é utilizado mundialmente para avaliar a gravidade da dependência. Esse artigo apresenta uma revisão da literatura sobre o FTND como instrumento de avaliação no manejo de pacientes tabagistas

Tobacco smoking is considered the leading cause of avoidable death. Use of cigarettes presents correlation with increased incidence of atherosclerotic disease and could be the largest contributor to growth in risk of diseases combined with other factors. It is classified as nicotine dependence and is included in the group of mental disorders and behaviors caused by use of psychoactive substances by the World Health Organization. It is important to have an instrument to evaluate the degree of nicotine dependence in the management of smokers. There is a correlation between degree of nicotine dependence and response to different treatments. Smokers with lower degree of dependence can be treated only with the cognitive behavioral approach. Those with higher degree require pharmacological therapy. This review of literature showed that the Fagerstrõm test for nicotine dependence (FTND) is used worldwide to evaluate severity of nicotine dependence. This article presents a review of FTND as an evaluation instrument in the management of smokers

Pharmacotherpy of Smoking Cessation

Cigarette smoking is motivated primarily by a desire for nicotine. Nicotine provides direct effects such as pleasure, stimulation, and stress relief, and it also reverses the unpleasant symptoms of nicotine withdrawal. Most smokers try to quit smoking but find it difficult because of nicotine addiction. Both behavioral counseling and and pharmacotherapy increase the cessation rates, and the effects of these interventions are generally additive. Recent guidelines for smoking cessation recommend that all smokers trying to quit should be offered pharmacotherapy. Two classes of medications have been approved for smoking cessation: nicotine replacement medications and bupropion, which was originally marketed as an antidepressant drug. The choice of medications should be individualized-based on the patient's preference,tolerance of adverse effects, and smoking habits.The combination nicotine replacement therapy-a patch plus short acing formulations such as gum or troche is increasingly prescribed to patients with severe addiction. All types of smoking cessation medications, if used properly, double the smoking cessation rate compared with placebo treatment. Some data suggest that the combination and extended duration of pharmacotherapies may offer some advantages, especially in dependent smokers, but these results have been inconclusive. The optimal combinations of medications for tobacco dependence treatment are not yet determined, and few studies have evaluated the effects of more complex combinations.

Nicotine dependence and smoking cessation after hospital discharge among inpatients with coronary heart attacks

This study focuses on the predictability of two alternative questionnaires for nicotine dependence, i.e., the Fagerstrom Tolerance Questionnaire (FTQ) and the Tobacco Dependence Screener (TDS), each of which represents a different aspect of dependence, among patients with coronary heart disease (CHD). Twenty-nine male inpatients that had been newly diagnosed as CHD were followed up for 30 weeks after hospital discharge. The baseline information included age, number of cigarettes per day, years of smoking, disease type (angina pectoris [AP] or acute myocardial infarction [AMI), whether they had received a briefing on smoking cessation, the FTQ, and the TDS. At 30 weeks after hospital discharge, 19 (66%) were abstainers. The group with a high TDS score (of 6 or greater) was significantly less likely to quit smoking than the group with a low TDS score (p=0.046). The FTQ score was not significantly different between the abstainers and non-abstainers. The subjects with AP were significantly less likely to quit smoking than those with AMI (p=0.021). Multiple logistic regression analysis showed that belonging to the high-TDS group and being diagnosed as AP were significantly associated with failure in smoking cessation (p<0.05). The present study suggests that the TDS may have higher predictability than the FTQ concerning smoking cessation among CHD inpatients.

Nicotine Dependence and Smoking Cessation after Hospital Discharge among Inpatients with Coronary Heart Attacks

This study focuses on the predictability of two alternative questionnaires for nicotine dependence, i.e., the Fagerstrom Tolerance Questionnaire (FTQ) and the Tobacco Dependence Screener (TDS), each of which represents a different aspect of dependence, among patients with coronary heart disease (CHD). Twenty-nine male inpatients that had been newly diagnosed as CHD were followed up for 30 weeks after hospital discharge. The baseline information included age, number of cigarettes per day, years of smoking, disease type (angina pectoris [AP] or acute myocardial infarction [AMI]), whether they had received a briefing on smoking cessation, the FTQ, and the TDS. At 30 weeks after hospital discharge, 19 (66%) were abstainers. The group with a high TDS score (of 6 or greater) was significantly less likely to quit smoking than the group with a low TDS score (p=0.046). The FTQ score was not significantly different between the abstainers and non-abstainers. The subjects with AP were significantly less likely to quit smoking than those with AMI (p=0.021). Multiple logistic regression analysis showed that belonging to the high-TDS group and being diagnosed as AP were significantly associated with failure in smoking cessation (p<0.05). The present study suggests that the TDS may have higher predictability than the FTQ concerning smoking cessation among CHD inpatients.