Fatores preditivos de sucesso do grupo de apoio ao tabagista: validação prospectiva / Predictors of success of the group smoking cessation program: prospective validation

RESUMO

O tabagismo é um problema de saúde pública, com dimensões variáveis de país para país. É responsável pelas maiores causas de mortes no Brasil e no mundo, as doenças cardiovasculares e o câncer. A expectativa de vida de um indivíduo que fuma muito é 25% menor que a de um não fumante. A redução do hábito de fumar em 50% poderá evitar 20 a 50 milhões de mortes prematuras somente nos próximos 25 anos. O presente estudo, através de suas três etapas conseguiu Na etapa I Desenvolver uma classificação por grupos de riscos através de um score separando os fumantes em amostra de 342 fumantes que participaram do grupo de apoio ao tabagista no Centro de Tratamento e Pesquisa- Hospital do Câncer –SP, de 1997 a 1999, selecionados através de estudo prévio, em dois grupos de riscos para o insucesso no programa de apoio ao tabagista, com alta e baixa probabilidade de insucesso... Na etapa II Validou a classificação por grupos de riscos em nova amostra retrospectiva, na mesma instituição, em amostra de 217 fumantes adultos, que procuraram voluntariamente o programa de janeiro de 2001 a dezembro de 2002. Na etapa III Validou a classificação por grupos de riscos em nova amostra prospectiva, no Instituto Dante Pazzanese de Cardiologia em amostra de 124 fumantes adultos. A procura foi voluntária ou por solicitação médica. A amostra estudada participou do programa de junho de 2004 a agosto de 2005. Os resultados desse estudo indicam que a classificação por grupos de riscos parece ser um instrumento importante que poderá ser utilizado na triagem do tabagista, nos grupos de apoio, possibilitando o reconhecimento dos fumantes que terão as maiores possibilidades de insucesso, necessitando de outras formas de abordagem para obterem a abstinência...

ABSTRACT

Smoking is a public health issue, with variable dimensions country to country lt is a responsible for the mayor death causes in Brazil and in the word, even surpassing the cardiovascular and cancer occurrences. The life expectation of an individual that smokes much is a 25°/o less than a non-smoking one. The reduction of 50°/o of the smoking habit could avoid to 20 to 50 millions of premature deaths within the next 25 years. Taking into account so important data related to mortality, and considering the difficulties to stop smoking many studies are being carried out. Despite that, few identified the predictive factors of the anti- smoking programs failure, identifying the sub- group of the smokers with higher possibilities of not attaining the abstinence, needing thus other approaches. The current study, through its three phases, achieved In phase1 To develop a ranking by risk groups by means of a score splitting the smokers in samples of 342 who participated in the group of support to the smokers at the Centro de Tratamento e Pesquisa do Hospital do Câncer-SP, from 1997 to 1999, selected through a previous study, and separated in two risk groups for the failure in the mentioned program, for high and low probability of failure. The variables selected for the development of score were the following • Participation in the group of support to the smokers (GAT); • Be the spouse against the smoking habit; • Have obtained a score between 2 and 8 in the Fagerstrõm Test; • Presence of the hiss symptoms; • Presence of the DPOC symptoms. Based on the results obtained from the multivariate analysis, different weights of punctuation were attributed to the variables identified as independents. The result many be demonstrated by the formula Participation in the GAT x 11 ,3)+(spouse against the smoking habit x 19,5) - (up to 8 points in the agertrom test x 5,3) + (presence of hiss x 3,3)+(presence of DPOC x 26,4 )= patient punctuation, that corresponds to the chances of failure or recidivating. The weights attributed for each variable were • Participation in the GAT answers yes=1 and answers no=O; • Spouse against the smoking habit answer yes, is against= 1 and answer no the spouse even stimulates=O; • Fagerstrom Test answer O= 2 to 8 points and answer 1 = more than 8 points; • Presence of hiss answers 1 =presence of hiss and answers O= absence of hiss; • Presence of DPOC answers 1 =presence of DPOC and answers O= absence of DPOC. In phase 11- validated the ranking by risk groups by a new retrospective sample, in the same lnstitute, in samples of 217 adult smokers, who, as volunteer sought the program from January 2001 to December 2002 In phase 111- Validated the ranking by risk groups by a new prospective sample, now in the lnstitute Dante Pazzanese de Cardiology, in sample 124 adult smokers. The individuais engaged the program as volunteers or by medicai recommendation. The studied sample participated in the program from July 2004 and August 2005 the results from these studies indicated classification by groups of risk seams to the an important tool which could be used to split the smokers, in the support group, enabling the recognition of the smokers who will have the higher possibilities of failure, calling for other forms off approach to achieve the abstinency (AU)