Niveles de asertividad, perfil sociodemográfico, dependencia a la nicotina y motivos para fumar en una población de fumadores que acude a un tratamiento para dejar de fumar / Assertiveness levels, sociodemographic profile, nicotine dependence and reasons for smoking in a group of smokers attending teatment to stop smoking

ABSTRACT

Introduction Tobacco consumption is a serious public health problem and the principal cause of death worldwide. It is linked to chronic obstructive pulmonary disease (COPD), coronary disease, and various cancers such as lung cancer, which is the most frequent, and cancer of the larynx and other organs. Smoking affects the quality of life of millions of people. Those who live with smokers also become involuntary or passive smokers. It is important to determine the factors that influence initiation and continuation of smoking and the reasons that facilitate or favor smoking cessation. The dependence of cigarette smoking acts as a modulator of the relationship that smokers have with their social environment and on the expression of their feelings. We considered important to study the assertiveness of smokers, which is considered to be the social skill that individuals have to express what they think, feel and opine about respecting their rights and the rights of others as a factor that may influence smoking cessation or continuation of smoking. Objective We undertook this study to determine the levels of assertiveness and the sociodemographic profile of a population of 130 patients who were smokers and who came to the <Smoking>> located at a tertiary level teaching and research hospital in Mexico City. This was the first attempt for these patients to undergo cognitive behavioral treatment to stop smoking. We sought to determine if there are any significant differences between those patients who smoke and who continue treatment and those patients who abandon treatment. Material and methods Only patients who were active smokers were studied. Of a total of 130 subjects, 65 completed the treatment and 65 abandoned treatment. For each patient, the socioeconomic profile was investigated with regard to gender, age, marital status, education, occupation, and contribution to the family income. The Gambrill and Richey Assertiveness Inventory for the Mexico City population was used. The Fagerström questionnaire was applied for evaluation of nicotine dependence, with a value >6 considered to be positive to qualify as dependence and the Russell reasons for smoking, which include stress reduction, the need to smoke, relaxation, the stimuli to perform activities and manipulation. Results were analyzed by descriptive analysis evaluating the assertiveness profile by probability of assertive response and the degree of discomfort classified as high, medium and low. The level of assertiveness was diagnosed according to the probability of response and the degree of discomfort as indifferent, assertive, nonassertive, average level of assertiveness and anxiety; a group was not classified between the groups mentioned. We used Χ2 for comparison of the levels of assertiveness between those who completed the treatment and those who did not. Results Of the 130 subjects studied, 65 completed the study satisfactorily and 65 abandoned treatment. Average age of the group of patients was 39.8 years (range 19-60 years). There were 56.9% (74/130) females and 43.07% (56/130) males. It was determined that 60% of the population lived with a partner (78/130). Of the study population, those reporting a higher educational level (51.5%) (67/130) had a slight predominance over those subjects with either primary or secondary level of education. Of the 130 patients studied with the Fagerström questionnaire, 56.4% were nicotine dependent (73/130) and 47.4% (57/130) were not dependent. According to the Russell questionnaire for reasons for smoking, the most important reasons for smoking were stress reduction in 30.4% (42/130), the need to smoke in 33.1% (43/130) and for relaxation, with no difference between those who completed treatment and those who abandoned treatment. Stimulation, habit and manipulation were less frequently observed reasons. In general, the population studied presented a low level of assertiveness and a deficit in social behavior without significant differences between those who leave or continue the treatment. Only 20% of all smokers were assertive, 19% were not assertive, 30% were indifferent, 15% had an average level of assertiveness, 5% demonstrated anxiety and 36% of those who had other levels remained in the <analysis of reactives demonstrated that the smokers presented a low probability of response in the areas that manifested in the expression of annoyance, anger or disagreement with others, recognizing personal limitations and acting in defense of rights in commercial situations and interactions with neighbors. They demonstrated a greater degree of discomfort in the areas of confrontation, defense of views and resisting pressure from others. Discussion Knowledge of the socioeconomic environment of smokers who desire to stop smoking using cognitive behavioral therapy is important because the environment in which the smoker lives exerts an influence on the success or failure of the attempt to stop smoking. Gender, age, living with a partner, economic status and educational level are factors that may influence adherence to treatment and also influence the tendency to abandon treatment. Nicotine dependence was a determinant factor regarding completion or abandonment of treatment. Stress reduction and searching for and needing relaxation were the most frequently mentioned reasons for smoking. The level of assertiveness does not appear to playa definitive role for treatment success or for abandoning the smoking habit. Only 20% of the smokers were assertive and, of those, only half completed the treatment, with no difference between those who did not complete the treatment. The probability of an assertive response and the degree of discomfort did not show differences in the two groups mentioned, which suggests that assertiveness does not have a great influence on the final results. In general, the population studied had a deficit in social abilities. In the reactive analysis it was found that there is an opposition in the areas of defense of opinions and for resisting pressure from others, for manifesting annoyance, anger or disagreement and in regard to the defense of rights in commercial situations and interaction with others. There were no significant differences observed in between-group comparisons (Χ2 0.406). There were also no significant differences between those who are assertive and those who have a low level of assertiveness. These individuals prefer to reduce stress, satisfy their needs and seek relaxation or the stimulation produced by nicotine vs. the effort required to follow smoking cessation treatment, particularly within a social environment where smoking may be an element that eases relationships with others. The observations obtained in this study suggest that assertiveness training specific to the type of smoker who tends to abandon treatment may be appropriate to obtain positive results and contribute not only to avoid abandoning treatment but also to maintaining positive results and to avoid relapses. This training may influence those susceptible subjects to avoid initiating a smoking habit. Conclusion The level of assertiveness is not an important factor to explain the success or failure of a smoking cessation program. Training in assertiveness may be useful to enhance success of treatment to quit smoking.

RESUMEN

Introducción El tabaquismo es un problema de salud pública, es la principal causa de muerte evitable en el mundo, se vincula a padecimientos -como enfermedad pulmonar obstructiva crónica (EPOC), enfermedad coronaria y diversos cánceres, como el de pulmón, que es el más frecuente, y el de laringe- y afecta la calidad de vida de miles de seres. Los que conviven con el fumador se convierten en <<fumadores involuntarios>> o pasivos. Es importante conocer los factores que influyen en el inicio y mantenimiento de la conducta de fumar y los motivos para abandonarla. El hábito de fumar cigarrillos actúa como modulador de la relación entre el fumador y el medio social en que se desenvuelve y en la expresión de sus propios sentimientos. Se consideró importante estudiar la asertividad como la habilidad social para comportarse y expresar lo que piensa, siente y opina el fumador respetando sus derechos y los de los demás como un factor que puede influir en la cesación del consumo de tabaco. Objetivo Conocer la influencia de los niveles de asertividad y el perfil sociodemográfico de una población de 130 pacientes fumadores que acudieron por primera vez a tratamiento cognitivo-conductual para dejar de fumar, a la Clínica Contra el Tabaquismo de un hospital de tercer nivel con instalaciones de enseñanza e investigación, para determinar si existen diferencias entre los que siguen el tratamiento y los que lo abandonan. Material y métodos Con una investigación descriptiva transversal, se estudiaron sólo pacientes fumadores activos. En cada paciente se investigó el perfil socioeconómico para obtener información de género, edad, convivencia con una pareja, grado de escolaridad y ocupación. Se empleó el Inventario de Asertividad de Gambrill y Richey estandarizado para la población de la Ciudad de México. Se aplicaron los cuestionarios de Frageström para valorar la dependencia a la nicotina y el de motivos de fumar de Russell que comprende reducir tensión, necesidad, relajamiento, estímulo para reducir actividades y manipulación. Los resultados se analizaron por estadística descriptiva y se hizo una comparación por Χ² de los niveles de asertividad que presentaron los que terminaron el tratamiento y los que lo interrumpieron. Resultados Del total de 130, terminaron el tratamiento 65 y lo abandonó el mismo número. La población estudiada presentó un bajo nivel de asertividad y un déficit en habilidades sociales. El análisis de reactivos demostró que los fumadores presentan un mayor grado de incomodidad (GI) en las áreas de confrontación, defensa de opiniones y resistencia a la presión de otras personas y una baja probabilidad de respuesta (PR) en las áreas de manifestar molestia, enfado o desacuerdo, reconocer limitaciones personales y en la defensa de derechos en situaciones comerciales e interacciones con personas cercanas. Las circunstancias observadas sugieren que es conveniente un entrenamiento asertivo específico para esta población de fumadores. Discusión El conocimiento del estado socioeconómico de los fumadores que se someten a un tratamiento cognitivo-conductual para dejar de fumar es importante porque el medio influye en la adherencia o el abandono del intento para dejar el tabaco. El género, la edad, la pareja y el nivel educacional influyen en la adherencia al tratamiento o en su abandono. La dependencia a la nicotina puede ser un factor importante. La reducción de la tensión y la necesidad de relajación fueron las razones más frecuentemente encontradas para continuar fumando. El nivel de asertividad no parece cumplir un papel importante para el éxito o abandono del tratamiento para dejar de fumar. Sólo 20% de los fumadores resultaron asertivos y de éstos sólo la mitad completó el tratamiento sin diferencias con los que sí lo terminaron. La probabilidad de una repuesta asertiva y el grado de incomodidad no tuvieron diferencias entre los dos grupos, lo que sugiere que la asertividad no cumple un papel importante en los resultados finales. En general, la población estudiada mostró un déficit de habilidades sociales. En el análisis de reactivos la oposición en las áreas de defensa de opiniones y de resistencia a la presión de otros para manifestar incomodidad, angustia o desagrado en relación con la defensa de derechos en situaciones comerciales fueron importantes sin diferencias significativas (Χ² = 0.406). Tampoco hay diferencias ente los asertivos y los de baja asertividad; estos últimos prefieren continuar fumando con una sensación de relajamiento o estimulación producidos por la nicotina a la tensión que implica dejar de fumar, particularmente en un medio donde el fumar facilita la relación con los demás. Es posible que un entrenamiento asertivo pueda mejorar los resultados no sólo para terminar un tratamiento sino para evitar recaídas. Este tratamiento serviría también para impedir el inicio del consumo de tabaco. Conclusión La asertividad no influye en la adherencia o abandono de un tratamiento para dejar de fumar. Un entrenamiento asertivo específico simultáneo con la terapia grupal sería útil para apoyar la adherencia al tratamiento de la dependencia a la nicotina en un determinado medio social.