Libres de humo: efectividad de un programa de cesación tabáquica en un Centro de Salud Comunitario de la Ciudad Autónoma de Buenos Aires / Smoke-free: effectiveness of a smoking cessation program in a Community Health Center of the Autonomous City of Buenos Aires

Introducción. El consumo de tabaco representa un importante desafío para la salud pública debido a su alta incidencia y mortalidad, y es el principal factor de riesgo modificable para desarrollar enfermedades crónicas no transmisibles. La Residencia de Medicina General y Familiar del Hospital General de Agudos Dr. Teodoro Álvarez desarrolló un programa de cesación tabáquica en el Centro de Salud y Acción Comunitaria N◦34, que forma parte desde 2012 del Programa de Prevención y Control del Tabaquismo del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, Argentina. Objetivo. Documentar los resultados de la eficacia de este programa y explorar las variables relacionadas con la probabilidad de éxito y recaída. Materiales y métodos. Estudio cuantitativo, de corte transversal analítico, con datos obtenidos de historias clínicas electrónicas entre 2017 y 2020. Fueron incluidos los pacientes que consultaron al menos en dos ocasiones al programa de cesación tabáquica y establecieron un día D al menos 30 días antes del abandono del consumo de tabaco. La eficacia terapéutica fue definida como haber permanecido al menos seis meses sin fumar, y la recaída, como el reinicio de consumo del tabaco luego de haber logrado 24 horas de abstinencia con fecha posterior al día D.Resultados.De 59 pacientes, 24 (40,7 %) lograron la eficacia terapéutica, de los cuales 5 (20,8 %) presentaron recaídas.De los 35 pacientes que no lograron alcanzar la etapa de mantenimiento, 30 (85,7 %) recayeron durante las primeras ocho semanas. El sexo masculino y el consumo de tabaco superior a 20 paquetes-año mostraron una mayor correlación con las recaídas. Conclusiones. El programa presentó una eficacia terapéutica del 40,7 % en el periodo evaluado. Se encontraron asociaciones entre una mayor eficacia terapéutica y ciertas características de los pacientes, pero se requieren más estudios para confirmar esta hipótesis. (AU)

Background. Tobacco consumption represents an important challenge for public health due to its high incidence and mortality and is the main modifiable risk factor for developing chronic non-communicable diseases. The General and Family Medicine Residence of the Hospital General de Agudos Dr. Teodoro Álvarez developed a smoking cessation program in Health and Community Action Centre N◦34. Since 2012 it has been part of the Program for the Prevention and Control of Smoking of the Ministry of Health of the Government of Buenos Aires, Argentina. Objective. To document the results of the effectiveness of the program and explore the variables related to the probability of success and relapse. Materials and methods. Quantitative, analytical cross-sectional study, with data obtained from electronic medical records between 2017 and 2020. Patients who consulted the smoking cessation program at least twice and established a D-day 30 days before quitting tobacco consumption were included. Therapeutic efficacy was defined as having remained at least six months without smoking, and relapse, as the resumption of tobacco consumption after having achieved 24 hours of abstinence with a date after day D. Results. Of 59 patients, 24 (40.7 %) achieved therapeutic efficacy, of which 5 (20.8 %) presented relapses. Among the35 patients who failed to reach the maintenance stage, 30 (85.7 %) relapsed during the first eight weeks. Male sex and tobacco consumption of more than 20 pack per year showed a greater correlation with relapses. Conclusions.The program presented a therapeutic efficacy of 40.7 % in the evaluated period. Associations were found between greater therapeutic efficacy and certain patient characteristics but more studies are required to confirm this hypothesis. (AU)

Identificación de estrategias no farmacológicas para reducir y cesar el consumo de tabaco en estudiantes universitarios / Identifying non-pharmacological strategies for reduction and cessation of tobacco use in university students / Identificação de estratégias não farmacológicas para reduzir e suspender o consumo de tabaco por estudantes universitários

RESUMEN Objetivo. Identificar las estrategias no farmacológicas para reducir y cesar el consumo de tabaco dirigidas a la comunidad estudiantil universitaria de pregrado. Métodos. Revisión sistemática clásica de literatura científica experimental publicada en los últimos 20 años en bases de datos y literatura gris. El algoritmo de búsqueda consistió en utilizar la máxima cantidad de terminología que describiera la pregunta de investigación y así disponer del mayor número de resultados en las diferentes bases de datos. Los cuadros de evidencias se construyeron con el instrumento FLC 3.0® y Excel 2021®. La herramienta GRADE permitió evaluar la calidad de evidencia científica. El riesgo de sesgos se estimó con base a las recomendaciones del Manual Cochrane de revisiones sistemáticas de intervenciones. Se suministrő un resumen narrativo de los estudios incluidos con alto grado de heterogeneidad establecida por estadística I2. Resultados. Se realizó la búsqueda en bases de datos y literatura gris y se obtuvieron 40 823 artículos. Luego de la aplicación de los criterios de inclusión y exclusión, se incluyeron 7 artículos: un estudio con impacto en casación, dos estudios sobre reducción y cuatro estudios con efectos tanto en la reducción como la cesación del consumo de tabaco. La calidad metodológica evaluada mediante la herramienta GRADE fue "buena". El riesgo de sesgos de forma global fue "bajo". La alta heterogeneidad clínica y metodológica de los estudios impidió su agrupación para la construcción del metaanálisis. Conclusión. Los datos extraídos de los siete artículos muestran la capacidad de las intervenciones no farmacológicas para reducir y cesar el consumo de tabaco en la población estudiantil universitaria, aunque la evidencia sea aún limitada. Se considera necesario realizar más estudios para elaborar recomendaciones fuertes para su implementación.

ABSTRACT Objective. Identify non-pharmacological strategies for reduction and cessation of tobacco use, aimed at the community of undergraduate university students. Methods. Classic systematic review of experimental scientific literature published in the last 20 years in databases and grey literature. The search algorithm consisted of using the maximum amount of terminology that described the research question, resulting in the largest number of results in the different databases. Evidence tables were constructed with the FLC 3.0 assessment tool and Excel 2021. Use of the GRADE tool enabled assessment of the quality of scientific evidence. Risk of bias was estimated in accordance with recommendations in the Cochrane Handbook of Systematic Reviews of Interventions. A narrative summary of the included studies was provided, given the high degree of heterogeneity established by I2 statistics. Results. A search of databases and grey literature obtained 40 823 articles. After the application of inclusion and exclusion criteria, seven articles were included: one study with impact on cessation, two studies on reduction, and four studies with an impact on both the reduction and cessation of tobacco use. The methodological quality was "good" according to the GRADE tool. The overall risk of bias was 'low'. The high clinical and methodological heterogeneity of the studies prevented grouping for the construction of a meta-analysis. Conclusion. Data from the seven articles show that non-pharmacological interventions can result in reduction and cessation of tobacco use in the university student population, although the evidence is still limited. Further studies are necessary in order to develop strong recommendations for implementation.

RESUMO Objetivo. Identificar estratégias não farmacológicas para reduzir e suspender o consumo de tabaco dirigidas à comunidade de estudantes universitários de graduação. Métodos. Revisão sistemática clássica da literatura científica experimental publicada nos últimos 20 anos em bases de dados e da literatura cinzenta. O algoritmo de busca consistiu em usar a quantidade máxima de terminologia que descrevesse a pergunta da pesquisa e, assim, dispor do maior número de resultados nas diversas bases de dados. As tabelas de evidências foram construídas usando as ferramentas FLC 3.0® e Excel 2021®. A ferramenta GRADE permitiu avaliar a qualidade das evidências científicas. O risco de viés foi estimado com base nas recomendações do Manual Cochrane de Revisões Sistemáticas de Intervenções. Foi fornecido um resumo narrativo de estudos com alto grau de heterogeneidade estabelecida pela estatística I2. Resultados. Foram pesquisadas bases de dados e literatura cinzenta e foram obtidos 40 823 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram incluídos sete artigos: um estudo com impacto na interrupção, dois estudos sobre a redução e quatro estudos com efeitos tanto na redução quanto na interrupção do consumo de tabaco. A qualidade metodológica segundo a avaliação com a ferramenta GRADE foi "boa". O risco geral de viés foi "baixo". A alta heterogeneidade clínica e metodológica dos estudos impediu o agrupamento para a construção de meta-análise. Conclusão. Os dados dos sete artigos mostram a capacidade de intervenções não farmacológicas para reduzir e suspender o uso do tabaco pela população estudantil universitária, embora as evidências ainda sejam limitadas. Considera-se necessário fazer mais estudos para formular recomendações sólidas para implementação.

Effect of MDR C3435T polymorphism on Varenicline treatment in quit smoking

Despite so many global efforts, smoking still remains to be one of the most common addictions worldwide. Even though most smokers wish to quit smoking, many of them fail. In this respect, genetic variants are thought to be remarkable factors in nicotine dependence and in treatment of smoking cessation. This is a paper investigating a single variant p-glycoprotein (P-gp) polymorphisms and its effect on Varenicline efficacy in the smoking cessation. 158 smokers and 52 non-smoker healthy volunteers were included. We determined the P-gp C3435T gene polymorphisms in all subjects. Face to face interviews with smokers were performed for smoking cessation and Varenicline was given for smoking cessation. Cessation success was evaluated in the 6th month and success rates were compared according to the P-gp genotype distributions. In our study, smoking cessation rate by Varenicline was 57.0%. This rate was 55.0% in females, and 57.2% in males (p=0.85). The P-gp C3435T gene distribution was similar in control, quitters and not-quitter groups. Cessation rate was at highest point in genotype CT (62.2%) and at the lowest in TT (47.6%). It was 53.8% in genotype CC and there was no statistically significant difference (p=0.27). Our results suggest that genetic variants of P-gp C3435T did not significantly affect Varenicline treatment for smoking cessation.

Cambio de comportamiento en personas fumadoras posimplementación de legislación antitabaco en Argentina / Behavioral changes in smokers after implementation of anti-smoking legislation in Argentina / Mudança de comportamento nos fumantes após a implementação da legislação antifumo na Argentina

RESUMEN Objetivo Identificar factores asociados al cambio de comportamiento en personas fumadoras mayores de 18 años luego de la implementación de políticas provinciales 100% libre de humo en Argentina. Métodos Se realizó un estudio analítico de corte transversal. Se utilizó la técnica de modelos multiniveles trabajando con datos de distintas jerarquías. Se utilizaron fuentes de datos secundarios: Encuesta Nacional de Factores de Riesgo 2005, 2009 y 2013. Resultados En el análisis individual de las variables explicativas, se obtuvo que los pobladores de las provincias que no tienen legislación tuvieron un 40% más de probabilidad de no pensar en dejar de fumar que las personas que viven en provincias con legislación. En las provincias sin legislación, el sexo masculino y la edad mayor de 65 años son las características que aumentan las chances de las personas a no pensar en dejar de fumar, en comparación con las provincias que tiene legislación. Conclusiones Los resultados sugieren que una legislación basada en el artículo 8 del Convenio Marco resultaría efectiva para estimular la cesación tabáquica en Argentina.

ABSTRACT Objective Identify factors related to behavioral changes in smokers over 18 years of age following implementation of provincial policies for 100% smoke-free spaces in Argentina. Methods A cross-sectional analytical study was conducted. The multilevel technique was used with data from different hierarchies. Secondary data sources were used: National Risk Factor Surveys 2005, 2009, and 2013. Results The individual analysis of explanatory variables revealed that residents of provinces that do not have smoke-free legislation were 40% less likely to consider quitting smoking than people who live in provinces with such legislation. In provinces without smoke-free spaces, males over 65 years old are even less likely to think about quitting smoking. Conclusions The results suggest that legislation based on Article 8 of the Framework Convention would be effective in promoting tobacco cessation in Argentina.

RESUMO Objetivo Identificar os fatores associados à mudança de comportamento nos fumantes maiores de 18 anos após a implementação de políticas provinciais de proibição do fumo na Argentina. Métodos Foi realizado um estudo analítico de corte transversal. Foi usada uma técnica de modelos multiníveis com dados de diferentes hierarquias. As fontes de dados secundários consultadas foram as iterações de 2005, 2009 e 2013 da Pesquisa Nacional de Fatores de Risco. Resultados Na análise individual das variáveis explicativas, verificou-se que os habitantes das províncias sem legislação antifumo tinham uma probabilidade 40% maior de não considerar parar de fumar quando comparados aos moradores das províncias com legislação antifumo. Em comparação às províncias com legislação antifumo, nas províncias sem esta legislação, ser do sexo masculino e ter idade acima de 65 anos foram as características associadas a uma maior chance de não considerar parar de fumar. Conclusões Os resultados do estudo indicam que uma legislação em conformidade com o Artigo 8 da Convenção-Quadro para o Controle do Tabaco da OMS seria efetiva para incentivar as pessoas a pararem de fumar na Argentina.

Fatores associados à cessação do tabagismo entre participantes de um programa antitabagista em uma unidade básica de saúde de Joinville - SC / Factors associated smoking cessation among participants of an antismoking program in a basic health unit in Joinville - SC

Introdução: O tabagismo é considerado um problema de saúde pública, sendo seu controle sistemático um desafio para o Sistema Único de Saúde (SUS). Objetivo: Conhecer os fatores associados à cessação do tabagismo em usuários participantes do Programa Nacional de Controle de Tabagismo desenvolvido por uma unidade básica de saúde da família, em Joinville, no período de 2011 a 2016. Material: Estudo descritivo que investigou, por meio da análise de dados secundários, de forma retrospectiva, os fatores associados à cessação do tabagismo entre 76 usuários. A análise dos dados foi realizada por meio do cálculo das frequências absolutas (n) e relativas (%). Resultados: A proporção de cessação de tabagismo foi de 57,89%. A maior prevalência pela procura ao programa e pelo interesse em cessar o tabagismo esteve presente entre as mulheres. A maioria dos participantes iniciou o uso do tabaco na adolescência. 48% dos que cessaram apresentaram grau de dependência elevada, 34% dos que não cessaram apresentaram grau de dependência muito elevado e 28% elevado. A ansiedade foi o motivo observado (61%) que mais levou os participantes deste estudo a voltarem a fumar. Conclusão: A tendência observada foi o aumento do percentual dos casos de cessação ao longo dos seis anos investigados. O processo de cessação esteve relacionado a vários fatores, como grau de dependência química e a motivação para parar de fumar. Os aspectos para a determinação da cessação do tabagismo devem ser mais explorados, sugerindo-se, a realização de novos estudos que permitam avaliar as estratégias em saúde direcionadas aos indivíduos usuários de tabaco.

Introduction: Smoking is considered a public health problem, and its systematic control is a challenge for the single health system (SUS). Objective: To know the factors associated with smoking cessation in users participating in the National Smoking Control Program developed by a basic health unit in Joinville/SC from 2011 and 2016. Methodology: Descriptive study which investigated through the analysis of secondary data retrospectively the factors associated with smoking cessation among 76 users. The data analyses was made by calculating absolute frequencies (n) and relative frequencies (%). Results: The proportion of tobacco smoking cessation was 57,89%, the highest search and prevalence in the program was among women. Most users started to use tobacco in their teen years. 48% of those who quit showed very high degree of dependence, among those who did not quit, 34% showed very high degree of dependence and 28% an elevated degree. Anxiety was the reason observed that most lead the participants (61%) in this study to start smoking again. Conclusion: The observed tendency was the percentage increase of smoking cessation cases during the six years investigated. The process of quitting was related to a variety of factors as the degree of dependency and motivation to quit smoking. The aspects to determine the smoking cessation must be further explored, it is suggested the production of new studies which permit the evaluation of health strategies directed to tobacco users.

Abordaje interdisciplinario del tabaquismo en la consulta odontológica: Aplicación de técnicas de intervención psicológicas / Interdisciplinary Approach to Smoking in Dental Practice: Psychological Intervention Techniques Application

Resumen Actualmente, en la comunidad odontológica existe confusión y duda sobre la extensión de la responsabilidad del profesional en la intervención y prevención del tabaquismo, lo cual se podría atribuir, en gran medida, al desconocimiento al respecto. Sin embargo, el odontólogo tiene el compromiso de participar activamente en esta adicción como parte del tratamiento bucodental. Por lo tanto, este artículo presenta una revisión actualizada de la literatura internacional relacionada con el tabaquismo desde la perspectiva de la consulta odontológica, enfocada al empleo de estrategias psicológicas para ofrecer un abordaje interdisciplinario, donde se enmarca el rol del odontólogo y su equipo de trabajo. De esta forma, la psicología de la salud ofrece diversas técnicas de intervención que resultan altamente efectivas para reducir o eliminar el tabaquismo, a saber: entrevista motivacional, exposición con prevención de respuesta, control de estímulos, entrenamiento en solución de problemas, terapia cognitivo-conductual, entrenamiento progresivo en reducción de la ansiedad y el estrés, entrenamiento en habilidades sociales, manejo de la ira y la agresividad, manejo de contingencias, autocontrol, técnicas de estimulación aversiva, técnica de reducción gradual de ingestión de nicotina y alquitrán (RGINA), terapia de pareja y familiar para atender situaciones de conflictos en relaciones interpersonales y terapia grupal.

Abstract Currently, in the dental community there is confusion and doubt about the extent of professional responsibility in the intervention and prevention of smoking, which could be attributed, to a large extent, to lack of knowledge about it. However, the dentist is committed to actively participate in this addiction as part of oral treatment. Therefore, this article presents an updated review of the international literature related to smoking from the perspective of dental consultation, focused on the use of psychological strategies to offer an interdisciplinary approach, which frames the role of the dentist and his team. In this way, health psychology offers several intervention techniques that are highly effective in reducing or eliminating smoking, namely: motivational interviewing, response prevention, stimulus control, problem solving training, cognitive-behavioral, progressive training in anxiety and stress reduction, social skills training, anger management and aggressiveness, contingency management, self-control, aversive stimulation techniques, gradual reduction technique of nicotine and tar consumption (RGINA), couple and family therapy to deal with conflict situations in interpersonal relationships and group therapy.

Intervenciones no farmacológicas realizadas por enfermería para promover la cesación del tabaco / Non-pharmacological interventions performed by nursing to promote tobacco cessation

OBJETIVO: describir las intervenciones no farmacológicas realizadas por enfermería que han sido reportadas en la literatura actual para promover el cese del consumo de tabaco. MÉTODO: revisión integradora de literatura mediante búsqueda en bases de datos Google Académico, Scopusc, Cochrane y Pubmed. Se tomaron los artículos publicados entre los años 2014 a 2018. Los principales descriptores de búsqueda fueron: "tobacco use cessation" y "nursing care". Se incluyeron un total de 11 manuscritos que fueron analizados por nivel de evidencia, tipo de intervención y principales resultados. RESULTADOS: el 54,5% de los manuscritos correspondía a publicaciones de evidencia media, 36,4% estudios de evidencia alta y el 9,1% evidencia baja, según criterios de Jover y Navarro-Rubio. Las intervenciones mayormente realizadas por enfermería se relacionan con la asesoría breve e intensiva cara a cara y el asesoramiento telefónico. CONCLUSIÓN: la mayor parte de los estudios analizados se ubican en evidencia media y alta. Enfermería logra demostrar con sus intervenciones el aumento de las tasas de abstinencia puntual en todos los estudios; a pesar de esto, la evidencia muestra que se requiere de una mayor preparación desde el proceso enfermero para poder intervenir y promover el cese del tabaco.

OBJECTIVE: to describe the non-pharmacological interventions carried out by nursing that have been reported in the current literature to promote cessation of tobacco use. METHOD: integrative review of literature through Google Scholar, Scopusc, Cochrane and Pubmed databases. The articles published between 2014 and 2018 were taken. The main search descriptors were: "tobacco use cessation" and "nursing care". A total of 11 manuscripts were included that were analyzed by level of evidence, type of interventionand main results. RESULTS: 54.5% of the manuscripts corresponded to publications of medium evidence, 36.4% studies of high evidence and 9.1% low evidence, according to criteria of Jover and Navarro-Rubio. Interventions mainly carried out by nursing are related to brief and intensive face-to-face counseling and telephone counseling. CONCLUSION: most of the studies analyzed are located in medium and high evidence. Nursing is able to demonstrate with its interventions the increase of the rates of punctual abstinence in all the studies; In spite of this, the evidence shows that a greater preparation is required from the nursing process in order to intervene and promote tobacco cessation.

Terapia de remplazo nicotínico asociada con reducción gradual del consumo de cigarrillos como estrategia de cesación de tabaco. Reporte de caso / Nicotinic Replacement Therapy Associated with Gradual Reduction as a Strategy of Smoking Cessation. Case report

El habitual proyecto de definir una fecha para dejar de fumar abruptamente ha sido refutado por muchos pacientes que han mostrado interés por reducir su consumo de modo gradual. La reducción progresiva utilizando terapia sustitutiva con nicotina previa a la cesación permitiría tratar a un mayor número de fumadores. El artículo presenta el caso de un paciente con alta dependencia a la nicotina, interesado en dejar de fumar, pero no de manera abrupta.

The usual approach to the treatment of smoking to set a date to stop smoking abruptly has been refuted by many patients who show interest in reducing their consumption gradually. The Progressive reduction using nicotine replacement therapy prior to cessation would treat a greater number of smokers. It's the case of a patient with high nicotine dependence, interested in quitting but not abruptly.

Cigarrillos eléctrónicos: ¿Podemos recomendar su uso? / Electronic cigarettes: can we recommend its use?

Los cigarrillos electrónicos (Cig-e) son dispositivos que contienen un líquido compuesto por un solvente, saborizantes y, en la mayoría de los casos, nicotina. Este liquido, al ser calentado en el dispositivo, se vaporiza, siendo aspirado por el usuario. En los últimos años, el uso de los Cig-e ha aumentado rápidamente, especialmente entre escolares y gente joven, sin existir hasta el día de hoy evidencias ciertas sobre su seguridad y efectos a largo plazo. En este artículo revisamos la evidencia existente en cuanto a los efectos y seguridad de cada uno de los componentes de los Cig-e y analizamos sus potenciales indicaciones en distintos escenarios clínicos.

Electronic cigarettes (Cig-e) are devices that contain a liquid composed of a solvent, flavors and, in most cases, nicotine. This liquid, when heated in the device, vaporizes, being aspirated by the user. In recent years, the use of Cig-e has increased rapidly, especially among schoolchildren and young people, with no clear evidence of safety and long-term effects to date. In this article we review the existing evidence regarding the effects and safety of each of the components of Cig-e and analyze their potential indications in different clinical scenarios.

Intervención profesional para la deshabituación tabáquica / Professional intervention for tobacco cessation

Cuando se realiza una intervención profesional para ayudar a los pacientes Cuando se realiza una intervención profesional para ayudar a los pacientes a dejar de fumar, el propósito fundamental es la abstinencia tabáquica. Para lograr esto, el pacientefumador debe avanzar en las fases de abandono a través de entrevistas motivacionales, ayuda conductual, farmacológica y psicológica. Todas las intervenciones en el tratamiento del tabaquismo van dirigidas a superar ladependencia física, psicológica y social y los síntomas que acompañan a la abstinencia del consumo de tabaco.Desde cualquier consulta de deshabituación tabáquica se pueden plantear diferentes niveles de actuación como son: 1. Intervención Mínima Sistematizada (IMS) 2. Educación para la Salud 3. Consejo Profesional 6. Reducción de daños7. Seguimiento del Fumador La intervención mínima está considerada como una de las intervenciones esenciales y más coste-efectivas en el tratamiento del tabaquismo. Los estudios publicados en las últimasdécadas indican que el consejo para dejar de fumar constituye un motivo importante para iniciar el proceso de abandono del consumo de tabaco. Un elemento primordial es la educación para la salud, que incluye el conjunto de consejos higiénico-dietético-sanitariosque se ofrecen y que el paciente, en cierta medida, debe asumir; para llevarla a cabo, es importante que el profesional conozca determinados aspectos del tabaquismo y asimismo, informe a los pacientes fumadores. El consejo profesional es función de cualquier profesional de la salud, independientemente de su especialidad, y debe ser incorporado asu actividad asistencial. Debe formar parte de cualquier intervención para la prevención y tratamiento del tabaquismo. El principal objetivo del abordaje del tabaquismo es adaptar el tratamiento a la situación particular de cada fumador, haciéndole progresar por las distintas fases de abandono deltabaco y posteriormente ayudar a consolidar su abstinencia...

Programa de evaluación y control del tabaquismo en funcionarios del hospital doctor Gustavo Fricke, Viña del Mar, Chile / Program of evaluation and control of smoking in hospital staff at Hospital Doctor Gustavo Fricke, Viña del Mar, Chile

El tabaquismo, mantiene alta prevalencia a nivel de la población general, lo que se manifiesta también en los funcionarios de la salud en nuestro país. Objetivos: Se planificó un programa antitabaco para los funcionarios del Hospital Dr. Gustavo Fricke, Viña del Mar con el objetivo de realizar un diagnóstico de la situación, evaluar a los funcionarios comprometidos y realizar acciones programáticas orientadas al cese. Material y método: Se encuestaron entre marzo y junio del 2013, 551 funcionarios en forma directa, de los cuales, los que fumaban y manifestaron su deseo a dejarlo, se les aplico 4 test (Fagestrom, Richmond, Goldberg y De los porqué) y se les ofreció integrarse a un programa de cesación con terapia farmacológica y no farmacológica. Resultados: Se pesquisaron 249 fumadores (45 por ciento), de los cuales 158 (63,4 por ciento) desean dejar de fumar. Las tasas más altas fueron de los profesionales no de la salud (70 por ciento) y las más bajas de los médicos (18 por ciento). Se pesquiso un 20 por ciento de fumadores severos (>15 al día) y una gran motivación al cese. Hasta Agosto 2014, 60 funcionarios (38 por ciento de los que deseaban dejar de fumar) , estaban en programa, los cuales se evaluaron con ficha clínica “ad hoc”, test de Fagestrom, Richmond, De los por qué y Goldberg (depresión). Las modalidades de terapia fueron consejería individual y farmacológica con vareniclina y/o chicles de nicotina, de acuerdo a flujograma que consideraba grados de adicción y motivación. Hasta agosto /2014, 10 funcionarios habían recibido terapia farmacológica, de los cuales 6 completaban 6 meses de cesación, 2 abandonos y 2 recaídas. Conclusiones: Fue posible realizar un programa de cesación tabáquica en funcionarios hospitalarios de acuerdo a lo programado...

Smoking, maintaining a level high prevalence in the general population, which is also evident in the subjects working health in our country. Objectives: A smoking cessation program was planned for subjects working Dr. Gustavo Fricke Hospital, Vina del Mar in order to make a diagnosis of the situation, evaluate and make subjects working committed actions aimed at cessation program. Material and method: They were surveyed between March and June 2013, 551 subjects working directly, of which, those who smoked and expressed his desire to leave, they applied four tests (Fagestrom, Richmond, Goldberg and “Of the why”) and offered integrated a cessation program with pharmacological and non-pharmacological therapy. Results: 249 smokers (45 percent), of which 158 (63.4 percent) want to stop smoking. The highest rates were among non-health professionals (70 percent) and the lowest of physicians 18 percent. 20 percent of heavy smokers (> 15 per day) and a great motivation to terminate. Until August 2014, 60 staff (38 percent of those who wanted to stop smoking), were in the program, which were evaluated with clinical record "ad hoc" test Fagestrom, Richmond, “Of the why” and Goldberg (depression). Modalities therapy, were individually counseling and pharmacological therapy with varenicline and / or nicotine gum, according to flowchart considered degrees of addiction and motivation. Until August / 2014, 10 staff had received drug therapy, of which 6 completed 6 months of cessation, 2dropouts and 2 relapses. Conclusions: It was possible to make a smoking cessation program in hospital officials as scheduled...

Community-based tobacco cessation program among women in Mumbai, India.

BACKGROUND: Globally tobacco epidemic kills nearly six million people annually. Consumption of tobacco products is on the rise in low‑ and middle‑income countries. Tobacco is addictive; hence, tobacco users need support in quitting. AIMS: Providing tobacco cessation services to women in community enabling them to quit tobacco, identifying factors associated with quitting and documenting the processes involved to establish a replicable “model tobacco cessation program.” SETTINGS AND DESIGN: This is a community based tobacco cessation program of one year duration conducted among women in a low socioeconomic area of Mumbai, India. SUBJECTS AND METHODS: It involved three interventions conducted at three months interval, comprised of health education, games and counseling sessions and a post intervention follow‑up. STATISTICAL ANALYSIS: Uni and multivariate analysis was performed to find out association of various factors with quitting tobacco. RESULTS: The average compliance in three intervention rounds was 95.2%. The mean age at initiation of tobacco was 17.3 years. Tobacco use among family members and in the community was primary reasons for initiation and addiction to tobacco was an important factor for continuation, whereas health education and counseling seemed to be largely responsible for quitting. The quit rate at the end of the programme was 33.5%. Multivariate logistic regression analysis found that women in higher age groups and women consuming tobacco at multiple locations are less likely to quit tobacco. CONCLUSIONS: Changing cultural norms associated with smokeless tobacco, strict implementation of antitobacco laws in the community and work places and providing cessation support are important measures in preventing initiation and continuation of tobacco use among women in India.

Efectividad de consejería de cesación tabáquica en dos tipos de intervenciones en centros de salud de APS en Chile / Effectiveness of two types of smoking cessation counseling

Este estudio explora la efectividad de dos tipos de consejería de cesación tabáquica, para ello se reclutaron 34 mujeres entre 18 y 48 años pertenecientes a dos CESFAM de la Región Metropolitana en Chile, de las cuales 30 cumplían con los criterios de inclusión. Fueron aleatorizadas en 2 grupos homogéneos de 15 personas cada uno y se sometieron a dos modalidades de consejería de cesación tabáquica según estrategia de las 5A.Posteriormente se realizó un seguimiento de 2 meses para observar el cambio de conducta. No hubo diferencias significativas en el porcentaje de cesación de ambos grupos: 23.08 por ciento de las mujeres dejó de fumar en el grupo 1 y 21,43 por ciento en el grupo 2. Se puede evidenciar que a pesar de realizar dos tipos diferentes de intervenciones, no se obtuvieron diferencias significativas en el porcentaje de cesación de ambos grupos.

This study explores the effectiveness of two types of smoking cessation counseling and for this we recruited 34women between 18 and 48 years from two CESFAM Metropolitan Region in Chile, of which 30 met the inclusion criteria. They were randomized into two homogeneous groups of 15 people each and were subjected to two forms of smoking cessation counseling by the 5A strategy. Subsequently followed up for two months to observe the change in behavior. No significant differences in the percentage of cessation of both groups: 23.08 percent of women quit smoking in group I and 21.43 percent in group II. It may show that despite making two different types of interventions, no significant differences in the percentage of cessation of both groups.

Prevalência da abstinência ao tabaco de pacientes tratados em unidades de saúde e fatores relacionados / The prevalence of abstinence from tobacco in patients treated in health units and related factors

O objetivo é conhecer a prevalência e identificar as variáveis relacionadas com a abstinência do tabaco em pacientes tratados nos Grupos de Apoio Terapêutico ao Tabagista (GATT) em unidades de saúde do município de Vitória (ES), no ano de 2009. Estudo transversal com 160 participantes do GATT que participaram de 75% das sessões. Realizada entrevista por telefone, 9 a 20 meses após o tratamento, e usado dados secundários do roteiro de entrevista inicial. Na análise estatística, foram utilizados os testes qui-quadrado e Fisher. A significância estatística foi 5%. Eram abstinentes 28,7%, recaíram 51,9% e 19,4% não pararam de fumar. Houve diferença estatística entre os grupos nas variáveis estado civil (0,039), tentativas anteriores para parar de fumar (0,029), quantidade de cigarros fumados por dia (0,019), uso de fármacos (0,001) e transtorno do humor referidos (0,040). O grupo de abstinente teve mais casados, tentou mais vezes parar de fumar, fumou menos cigarro/dia, apresentou menos ansiedade/alteração do humor. A abstinência foi semelhante a outros estudos e o maior percentual de sujeitos recaiu.

The scope of this study is to discover the prevalence and identify the variables related to tobacco abstinence in patients treated for quitting smoking through group therapy or support groups in primary health care units of the municipality of Vitória, State of Espirito Santo, in the year of 2009. A cross-sectional study was performed with 160 participants of the support groups who participated in 75% of the sessions. Telephone interviews were conducted 9 to 20 months after treatment and secondary data from the text of the initial interview were used. Chi-square and Fischer tests were used in statistical analysis and the statistical significance was 5%. It was found that 28.7% were abstainers, 51.9% had relapsed and 19.4% never stopped smoking. There was a statistical difference between the groups in the variables of marital status (0.039), previous attempts to stop smoking (0.029), amount of cigarettes smoked per day (0.019), use of medication (0.001) and reported anxiety/mood disorders (0.040). The abstaining group included more married people, people who had tried to quit smoking several times, smoked fewer cigarettes/day, showed less anxiety/mood change. The incidence of abstinence was similar to other studies and the highest percentage of subjects relapsed.

Assessment of changes in nicotine dependence, motivation, and symptoms of anxiety and depression among smokers in the initial process of smoking reduction or cessation: a short-term follow-up study / Avaliação de mudanças na dependência da nicotina, motivação e sintomas de ansiedade e depressão em fumantes no processo inicial de redução ou cessação do tabagismo: estudo de seguimento de curto prazo

Introduction: The first days of a quit attempt represent an important challenge to long-term abstinence, especially because of the changes that take place over this period. Objective: To examine whether smokers who have recently changed their smoking behavior show changes in the intensity of nicotine dependence, motivational stage, or symptoms of anxiety and depression relative to smokers without recent changes in smoking behavior. Methods: Smokers attending a support group for smoking cessation in Porto Alegre, southern Brazil, were invited to participate. The program consisted of four weekly sessions. Smokers answered questionnaires covering intensity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression at baseline and in the fourth week. Urine was collected at both time points, tested for cotinine concentration, and used to determine the final status of smokers. Results: Of the 54 smokers included in the study, 20 (37%) stopped smoking or decreased tobacco use. Both smokers who stopped or reduced tobacco use and those who did not change their behavior presented a decrease in nicotine dependence scores (p = 0.001). Conversely, only the smokers who changed behavior presented an increase in scores in the maintenance stage (p < 0.001). Conclusion: When modifying tobacco use, smokers face a difficult process, marked by several changes. A better understanding of these changes and their implications for treatment are discussed.

Introdução: Os primeiros dias de uma tentativa de parar de fumar representam um desafio importante para a abstinência a longo prazo, especialmente por causa das mudanças que ocorrem nesse período. Objetivo: Examinar se fumantes que mudaram recentemente seu hábito de fumar mostram mudanças na intensidade da dependência à nicotina, no estágio motivacional ou nos sintomas de ansiedade e depressão em comparação com fumantes sem mudanças recentes em seu hábito de fumar. Métodos: Fumantes participando de um grupo de apoio para a cessação do tabagismo em Porto Alegre, sul do Brasil, foram convidados a participar do estudo. O programa consistia de quatro sessões semanais. Os fumantes responderam a questionários que avaliaram a intensidade da dependência à nicotina, o estágio motivacional e sintomas de ansiedade e depressão no início do programa e na 4ª semana. Amostras de urina foram coletadas nos dois momentos para avaliar a concentração de cotinina para determinar o status final dos fumantes. Resultados: Dos 54 fumantes incluídos no estudo, 20 (37%) pararam de fumar ou reduziram o uso de tabaco. Tanto os fumantes que pararam ou reduziram o uso de tabaco quanto aqueles que não mudaram seu hábito apresentaram diminuição nos escores de dependência à nicotina (p = 0,001). Por outro lado, apenas os fumantes que mudaram seu hábito apresentaram aumento nos escores do estágio de manutenção (p < 0,001). Conclusão: Ao modificar o uso de tabaco, os fumantes enfrentam um processo difícil, marcado por várias mudanças. Um melhor entendimento dessas mudanças e suas implicações para o tratamento são discutidas.

Intention to quit among Indian tobacco users: Findings from International Tobacco Control Policy evaluation India pilot survey.

Introduction: Tobacco users face barriers not just in quitting, but also in thinking about quitting. The aim of this study was to understand factors encouraging intention to quit from the 2006 International Tobacco Control Policy (TCP) Evaluation India Pilot Study Survey. Materials and Methods: A total of 764 adult respondents from urban and rural areas of Maharashtra and Bihar were surveyed through face-to-face individual interviews, with a house-to-house approach. Dependent variable was "intention to quit tobacco." Independent variables were demographic variables, peer influence, damage perception, receiving advice to quit, and referral to cessation services by healthcare professionals and exposure to anti-tobacco messages. Logistic regression model was used with odds ratio adjusted for location, age, gender, and marital status for statistical analysis. Results: Of 493 tobacco users, 32.5% intended to quit. More numbers of users who were unaware about their friends' tobacco use intended to quit compared to those who were aware (adjusted OR = 8.06, 95% CI = 4.58-14.19). Higher numbers of users who felt tobacco has damaged their health intended to quit compared to those who did not feel that way (adjusted OR = 5.62, 95% CI = 3.53-8.96). More numbers of users exposed to anti-tobacco messages in newspapers/magazines (adjusted OR = 1.76, 95% CI = 1.02-3.03), restaurants (adjusted OR = 2.47, 95% CI = 1.37-4.46), radio (adjusted OR=4.84, 95% CI = 3.01-7.78), cinema halls (adjusted OR = 9.22, 95% CI = 5.31-15.75), and public transportation (adjusted OR = 10.58, 95% = 5.90-18.98) intended to quit compared to unexposed users. Conclusion: Anti-tobacco messages have positive influence on user's intentions to quit.

Tobacco use and cessation counseling in India-data from the Global Health Professions Students Survey, 2005-09.

Context: Tobacco use by health professionals reflects the failure of healthcare systems in protecting not only beneficiaries of the system but also those involved in health care delivery. Aim: The aim of this study was to report findings from the Global Health Professions Students Survey (GHPSS) conducted in medical, dental, nursing and pharmacy schools in India. Settings and Design: A cross-sectional survey was conducted in Indian dental and medical schools (in 2009), nursing (in 2007), and pharmacy (in 2008) schools. Materials and Methods: Anonymous, self-administered GHPSS questionnaire covering demographics, tobacco use prevalence, secondhand smoke (SHS) exposure, desire to quit smoking and training received to provide cessation counseling to patients was used. Statistical Analysis: Proportions and prevalence were computed using SUDAAN and SPSS 15.0. Results: Current cigarette smoking and other tobacco use ranged from 3.4-13.4% and 4.5-11.6% respectively, in the four health professional schools, with the highest numbers for medical schools and males. Enforcement of smoking ban in medical schools was low (53%) compared to nursing (86.4%), pharmacy (85.5%), and dental (90.8%) schools. Ninety percent students thought health professionals have a role in giving smoking cessation advice to their patients. Three out of five current smokers wanted to quit. However, one out of two reported receiving help/advice to quit. Although all expressed the need, 29.1-54.8% students received cessation training in their schools. Conclusion: Tobacco control policy, cessation training and initiatives to help students quit smoking should be undertaken.

Banning smokeless tobacco in India: Policy analysis.

India is the second largest producer and third largest consumer of tobacco. According to GATS India Report (2009-10), the users of only smokeless tobacco (SLT) are more than double than that of smokers. SLT use is an imminent public health problem, which is contributing to high disease burden in India. It is a "unique" tobacco product due to its availability in myriad varieties, easy access, and affordability especially for adolescents. It has been studied to be a gateway product and facilitates initiation. Currently, the Food Safety and Standards Authority of India (FSSAI) have prohibited the use of tobacco and nicotine in any food products; yet, the implementation of a permanent ban on SLT across India is still pending. This paper examines how multiple legislations have failed to effectively control or regulate SLT in India and regionally; thus, there is need to strengthen SLT control efforts as "no ordinary product."

Tobacco cessation in India: A contemporary issue in public health dentistry.

In India, tobacco use is incredibly linked to poverty and accounts for the high public health costs of treating tobacco-related diseases. Dental public health programs aid in detecting the tobacco-related periodontal diseases, oral cancers, etc., where the majority belongs to the submerged portion of iceberg, which otherwise leads to substantial morbidity and mortality. Moreover, public health dentists plays a key role in identifying both clinical and subclinical cases and aid in tobacco use cessation through various modes of health education and counseling. Therefore, the community-based measures are deemed to be the most cost-effective tool for tobacco cessation.