Género y salud: Estudiar las diferencias para mejorar los resultados / Gender and health: Studying the differences to improve the outcomes

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Maternal active smoking and newborn body composition.

OBJECTIVE: Maternal smoking during pregnancy is associated with a reduction in birth size but very few studies have collated changes in neonatal anthropometry. Our aims were both to assess body composition differences by anthropometry between new-borns from smoking mothers and those from non-smoking mothers, and to show whether these differences affect proportional body mass distribution. METHODS: Caucasian mothers and their full term singleton new-borns (N=1216) were selected during 2009. A structured questionnaire was completed regarding obstetric and demographic data, as well as tobacco consumption. Women were categorized, according to their smoking habits, into a non-smoking group (never smoked or stopped smoking prior to pregnancy) and a smoking group (smoked throughout pregnancy). RESULTS: 22.1% of mothers smoked during pregnancy (median: 6 cigarettes/day, range: l-40). Smoking mothers were significantly younger than non-smoking mothers but there were no differences regarding other aspects which could affect infant weight. Infants from non-smoking mothers were heavier, longer, and body circumferences were all larger than those from smoking mothers (p<0.001), but the Ponderal Index showed no statistical differences. Skinfold thicknesses were significantly lower in new-borns from smoking mothers but these differences were less evident than those from body size. Subcutaneous fat distribution did not show statistical differences between the two groups. After gestational age, to smoke during gestation is the second main determinant of birth weight. CONCLUSIONS: Smoking during pregnancy involves a generalized reduction of most axiological parameters as a result of proportionate fetal growth impairment. In those infants born from mothers who smoked during gestation, neonatal lean body mass appears to be more affected than body fat, and distribution of subcutaneous fat is not different.

Estudio de la publicidad exterior de tabaco y alcohol en el entorno de centros de enseñanza secundaria de Zaragoza (España) / Study of static advertising on tobacco and alcohol around the secondary school places in Zaragoza (Spain)

OBJETIVOS. Estudiar la publicidad exterior de los alrededores de doce centros de enseñanza secundaria, analizando el número de anuncios de bebidas alcohólicas y tabaco encontrados en un mismo trimestre de los años 2004 y 2007. Comprobar si en el año 2007 se cumplen las restricciones respecto a publicidad exterior de la nueva Ley antitabaco 28/2005. MÉTODOS. Se seleccionaron doce centros de enseñanza secundaria de Zaragoza. Se han ido haciendo fotografías digitales semanales a lo largo de los meses de febrero, marzo y abril de los años 2004 y 2007, de una valla publicitaria que estuviera a menos de 200 metros de cada uno de los centros, anotando si hace referencia a alcohol, tabaco, campañas antidrogas u otros productos. Finalmente se compararon las cifras de los años 2004 y 2007. RESULTADOS. Vemos que del año 2004 al 2007, la publicidad exterior de bebidas alcohólicas ha disminuido de un 25,8 a un 20,1%. También observamos que ha desaparecido la publicidad de tabaco (en 2004 había un 7,8% a pesar de la ¿autorregulación¿ de las compañías de tabaco) y la de campañas antidrogas (un 3,9% en 2004). CONCLUSIONES. Estas diferencias encontradas en la publicidad de tabaco se deben seguramente a la entrada en vigor de la Ley 28/2005, en la que se prohíbe la publicidad de este producto. Respecto a las bebidas alcohólicas, vemos que los fabricantes siguen dirigiendo claramente su publicidad a los menores, un sector social no habilitado para consumir (AU)

OBJECTIVES. To study static advertising on tobacco andalcohol around the secondary school places and to analyzethe number of announcements of alcoholic drinks and tobaccoin the same quarter of the years 2004 and 2007.To verify if the restrictions regarding static advertising ofthe new advertising ban on tobacco products 28/2005 werefulfilled in 2007.METHOD. Twelve secondary school centers in Zaragoza(Spain) were selected. Several digital pictures of static advertisementslocated within 200 meters of each center weretaken on a weekly basis during February, March and April,in both 2004 and 2007. The locations of tobacco, alcohol oranti-drugs advertisement campaigns were recorded. Finally,data for the years 2004 and of 2007 were compared.RESULTS. It was verified that static advertising of alcoholicdrinks decreased from 25.8% to 20.1% from 2004 to2007. We also observed that external advertising of tobaccoproducts disappeared in 2007 (in 2004 there was 7.8% regardlessof the “self-regulations” of tobacco companies) andthat of anti-drug advertising, which was 3.9% in 2004.CONCLUSIONS. The tobacco advertising ban in 2005 hasled to the end of tobacco advertising. However, manufacturersof alcohol drinks have clearly continued to direct theiradvertising towards minors, a social sector in which theirconsumption is not permitted (AU)

Guía SEPAR para el tratamiento del tabaquismo en la empresa / SEPAR guide for treatment of smoking habit in the work sites

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[Assessment of behavioral dependence with the Glover-Nilsson test in smoking cessation treatment]. / Evaluación de la dependencia psicológica mediante el test de Glover-Nilsson en el tratamiento del tabaquismo.

OBJECTIVE: To assess behavioral dependence using the Glover-Nilsson test and determine its association with successful smoking cessation. MATERIAL AND METHODS: An analytical longitudinal study was carried out, the target population of which consisted of smokers who enrolled in a smoking cessation clinic for treatment. The following variables were examined: age, sex, nicotine dependence (Fagerström test), psychoactive drug use, prior attempts at quitting, and behavioral dependence measured with the Glover-Nilsson test. The most recent version of this test is an 11-item questionnaire which classifies behavioral dependence according to the scores obtained: mild (<12), moderate (12-22), severe (23-33), and very severe (>33). Successful cessation was defined as self-reported abstinence confirmed by measurement of expired CO level (< or =10 ppm). Results were expressed as means (SD) for quantitative variables and percentages and absolute frequencies for qualitative variables. RESULTS: The study population consisted of 167 smokers--89 men (53.3%) and 78 women (46.7%)--with a mean age of 43.5 (9.9) years, a nicotine dependence score (Fagerström test) of 6.5 (2.2) points, and a Glover-Nilsson score of 23.3 (6.6). Of the study population, 65.9% (n=110) had made previous attempts at quitting. Abstinence at 3 months was 55.1% (n=92). Differences between the sexes were found for age and previous attempts at quitting. Younger patients had higher scores on the Glover-Nilsson test and the Fagerström test and lower abstinence rates. CONCLUSIONS: Severe behavioral dependence can result in less successful cessation outcome. All aspects related to dependence must be assessed to help select the most adequate pharmacological and psychological treatment for results to be optimized.

Evaluación de la dependencia psicológica mediante el test de Glover-Nilsson en el tratamiento del tabaquismo / Assessment of behavioral dependence with the glover-nilsson test in smoking cessation treatment

Objetivo: Evaluar la dependencia psicológica mediante el test de Glover-Nilsson y establecer su relación con el éxito al finalizar el tratamiento. Material y métodos: Se ha realizado un estudio analítico longitudinal, cuya población objetivo han sido los fumadores que accedieron a una unidad de tabaquismo para deshabituación tabáquica. Se estudiaron las siguientes variables: edad, sexo, dependencia a la nicotina (test de Fagerström), consumo de psicofármacos, intentos previos de cesación y dependencia psicológica mediante el test de Glover-Nilsson. Este cuestionario, en su versión más reciente, consta de 11 ítems y clasifica la dependencia psicológica, según la puntuación obtenida, en leve ( 33). Se consideró éxito la abstinencia autodeclarada confirmada con cooximetría (monóxido de carbono ≤ 10 ppm). Los resultados se expresan como medias ± desviación estándar (variables cuantitativas) y como proporciones y frecuencias absolutas (variables cualitativas). Resultados: La población de estudio estaba compuesta por 167 fumadores --89 varones (53,3%) y 78 mujeres (46,7%)--, con una edad media de 43,5 ± 9,9 años, dependencia a la nicotina (test de Fagerström) de 6,5 ± 2,2 puntos y media en el test de Glover-Nilsson de 23,3 ± 6,6 puntos. El 65,9% (n = 110) había hecho intentos previos para dejar de fumar. El éxito a los 3 meses fue del 55,1% (n = 92). Según el sexo, se observaron diferencias en la edad y en la existencia de intentos previos. Los individuos más jóvenes obtuvieron mayor puntuación en el test de Glover-Nilsson y en el test de Fagerström y presentaron una menor tasa de éxito. Conclusiones: La elevada dependencia psicológica puede condicionar peores resultados en el éxito de la deshabituación. Es necesario valorar todos los aspectos relacionados con la dependencia, ya que puede ayudar a seleccionar el tratamiento farmacológico y psicológico más adecuado para optimizar los resultados

Objective: To assess behavioral dependence using the Glover-Nilsson test and determine its association with successful smoking cessation. Material and Methods: An analytical longitudinal study was carried out, the target population of which consisted of smokers who enrolled in a smoking cessation clinic for treatment. The following variables were examined: age, sex, nicotine dependence (Fagerström test), psychoactive drug use, prior attempts at quitting, and behavioral dependence measured with the Glover-Nilsson test. The most recent version of this test is an 11-item questionnaire which classifies behavioral dependence according to the scores obtained: mild (33). Successful cessation was defined as self-reported abstinence confirmed by measurement of expired CO level (≤10 ppm). Results were expressed as means (SD) for quantitative variables and percentages and absolute frequencies for qualitative variables. Results: The study population consisted of 167 smokers --89 men (53.3%) and 78 women (46.7%)--with a mean age of 43.5 (9.9) years, a nicotine dependence score (Fagerström test) of 6.5 (2.2) points, and a Glover-Nilsson score of 23.3 (6.6). Of the study population, 65.9% (n=110) had made previous attempts at quitting. Abstinence at 3 months was 55.1% (n=92). Differences between the sexes were found for age and previous attempts at quitting. Younger patients had higher scores on the Glover-Nilsson test and the Fagerström test and lower abstinence rates. Conclusions: Severe behavioral dependence can result in less successful cessation outcome. All aspects related to dependence must be assessed to help select the most adequate pharmacological and psychological treatment for results to be optimized

El tabaquismo en la mujer: una atracción fatal / Women and smoking: fatal attraction

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[Results of a comprehensive workplace program for the prevention and treatment of smoking addiction]. / Resultados de un programa integral de prevención y tratamiento del tabaquismo en el entorno laboral.

OBJECTIVES: To assess a comprehensive smoking prevention and treatment program in an electrical appliances company with 1600 employees. MATERIAL AND METHODS: The program included smoking restrictions with the designation of smoking areas and the offer of smoking cessation treatment for the smokers affected. Study variables were age, sex, nicotine dependence (Fagerström Test), carbon monoxide in expired air, adherence to therapy, and smoking abstinence at 1 week, 1 month, 3 months (end of treatment), and 6 months. Successful smoking abstinence was defined as continuous abstinence from the beginning of treatment. RESULTS: Smoking prevalence was 34.8% and 19.5% of smokers requested treatment (77.4% men and 22.6% women). Mean (SD) age was 41.3 (10.3) years. Mean score of nicotine dependence was 5.3 (2.6) and the mean quantity of carbon monoxide in expired air was 35.6 (23.7) ppm. Adherence to therapy was good in 80% of patients. Rate of abstinence was 57.5% at 6 months, signifying a 4% reduction in prevalence. CONCLUSIONS: Workplace smoking cessation programs reduce prevalence and facilitate the establishment of smoking restrictions at the worksite. Companies are convenient settings for the implementation of programs aimed at smoking prevention and treatment.

Resultados de un programa integral de prevención y tratamiento del tabaquismo en el entorno laboral / Results of comprehensive workplace`program for the prevention and treatment of smoking addiction

OBJETIVOS: Evaluar un programa integral de prevención y tratamiento del tabaquismo en una empresa de electrodomésticos con 1.600 trabajadores. MATERIAL Y MÉTODOS: El programa incluyó restricción para fumar con delimitación de espacios para fumadores y oferta de deshabituación tabáquica a los fumadores afectados. Las variables de estudio fueron: edad, sexo, dependencia a la nicotina (test de Fagerström), monóxido de carbono en aire espirado, cumplimiento del tratamiento y abstinencia en el consumo de tabaco a la semana, al mes, a los 3 (fin del tratamiento) y a los 6 meses. Se definió como éxito la abstinencia mantenida en el consumo de tabaco desde el inicio del tratamiento. RESULTADOS: La prevalencia de tabaquismo era del 34,8%. Solicitaron tratamiento el 19,5% de los fumadores (un 77,4% eran varones y el 22,6%, mujeres). La media de edad (± desviación estándar) era de 41,3 ± 10,3 años. El valor medio de la dependencia a la nicotina fue de 5,3 ± 2,6 puntos y la media de monóxido de carbono en aire espirado de 35,6 ± 23,7 ppm. El cumplimiento del tratamiento fue bueno en el 80% de los casos. El índice de abstinencia fue del 57,5% a los 6 meses, lo que supone una reducción de la prevalencia del 4%. CONCLUSIONES: Las intervenciones sobre el tabaquismo en el entorno laboral reducen la prevalencia y facilitan establecer restricciones del consumo en el lugar de trabajo. La empresa representa un escenario oportuno para realizar intervenciones dirigidas a la prevención y tratamiento del tabaquismo

OBJECTIVES: To assess a comprehensive smoking prevention and treatment program in an electrical appliances company with 1600 employees. MATERIAL AND METHODS: The program included smoking restrictions with the designation of smoking areas and the offer of smoking cessation treatment for the smokers affected. Study variables were age, sex, nicotine dependence (Fagerström Test), carbon monoxide in expired air, adherence to therapy, and smoking abstinence at 1 week, 1 month, 3 months (end of treatment), and 6 months. Successful smoking abstinence was defined as continuous abstinence from the beginning of treatment. RESULTS: Smoking prevalence was 34.8% and 19.5% of smokers requested treatment (77.4% men and 22.6% women). Mean (SD) age was 41.3 (10.3) years. Mean score of nicotine dependence was 5.3 (2.6) and the mean quantity of carbon monoxide in expired air was 35.6 (23.7) ppm. Adherence to therapy was good in 80% of patients. Rate of abstinence was 57.5% at 6 months, signifying a 4% reduction in prevalence. CONCLUSIONS: Workplace smoking cessation programs reduce prevalence and facilitate the establishment of smoking restrictions at the worksite. Companies are convenient settings for the implementation of programs aimed at smoking prevention and treatment

[Predictors of success at 6-month follow-up for smokers treated at a smoking cessation clinic]. / Factores predictores de éxito a los 6 meses en fumadores tratados en una unidad de tabaquismo.

OBJECTIVE: To identify the predictors of successful outcome in a smoking cessation program at 6-month follow-up. MATERIAL AND METHODS: Cross-sectional descriptive study of a sample of smokers who attended a smoking cessation clinic for combined medical and cognitive-behavioral group therapy. The independent variables assessed included age, sex, level of education, nicotine dependence (Fagerström test), prior attempts to quit smoking, medication prescribed, compliance with group therapy regimen, and success at one week and 3 months. Success was defined as self-reported abstinence, confirmed by CO-oximetry (carbon monoxide <10 ppm). Odds ratios (with 95% confidence intervals) were calculated for the categorical variables and a test of statistical significance of differences between means was performed for quantitative variables. Univariate logistic regression analysis was performed and significant variables were entered into a multivariate logistic regression model. RESULTS: The study population comprised 248 individuals, 67.7% male and 32.3% female, with a mean (SD) age of 43.1 (10.5) years. The mean score on the Fagerström test was 6.3 (2.1) points and 84.7% of the individuals complied with the treatment regimen. Success rates were as follows: 77% at one week, 30.2% at 3 months, and 31.9% at 6 months. Three variables--success at 3 months, age, and nicotine dependence--were entered into the multivariate logistic regression model; the only variable predictive of successful smoking cessation at 6 months was success at 3 months. CONCLUSIONS: Individuals who fully comply with treatment and abstain from smoking during the first weeks are more likely to be successful at 6 months.

[Smoking habits among sixth-year medical students in Spain]. / Consumo de tabaco en estudiantes de sexto curso de medicina de España.

OBJECTIVE: To describe and analyze the smoking habits of sixth-year Spanish medical students. MATERIAL AND METHODS: The target population of this descriptive cross-sectional study was students completing their sixth year in Spanish medical schools. An anonymous, self-administered questionnaire was sent to the students' homes by ordinary mail. The relationships between the variables were analyzed using contingency tables, the chi2 test, the Student t test, and analysis of variance with a significance level of P< .05. The software package was SPSS. RESULTS: A total of 3840 questionnaires were distributed to students, and 1340 were returned completed (34.9%). Of the respondents, 27% were smokers (8.7% smoked only on weekends, and 18.3% were daily smokers). The mean (SD) number of cigarettes smoked per day was 10.54 (7.89). Consumption was significantly higher among men than among women. The mean age of initiation was 17.20 years. Of the students who were smokers, 32.54% stated that they had started smoking during their medical studies. The percentage of smokers who stated that they wanted to quit was 76.3%, and 56.6% said that they had already made at least one quit attempt. CONCLUSIONS: It is cause for concern that a large number of students start smoking after they enter medical school. One of the reasons for this is the lack of concern about smoking as a health problem within medical schools. The smoking habits of medical students are affected by the same phenomena that affect those of the general public, such as the increase in the number of women smokers, the influence of sociocultural factors, and the increasingly broader age range of initiation. The lower prevalence of smoking among medical students with respect to other populations is probably due to the fact that, in general, these students have better health habits than the general public, and/or the reasons that led them to study medicine also make them disinclined to smoke.

[Evaluation of the influence of medical education on the smoking attitudes of future doctors]. / Evaluación de la influencia que ejerce la facultad de medicina en los futuros médicos respecto al tabaquismo.

OBJECTIVE: To evaluate whether medical education influences the prevalence, awareness of, and attitudes to smoking of medical students in the first 3 years of their degree. MATERIAL AND METHODS: In this descriptive longitudinal questionnaire-based study of university students, data for medical and veterinary students in their first 3 years were compared. RESULTS: Of the 226 registered first-year medical students, 181 (80%) returned the questionnaire. Of the 180 first-year veterinary students, 161 (89%) replied to the questionnaire. In the third year, 151 questionnaires from medical students and 139 from veterinary students were returned. There were no differences in age or sex between the 2 groups, and both had more women. The prevalence of smokers increased between the first year and the beginning of the third (from 20% to 31% among medical students and from 28% to 32% among veterinary students). An improvement in the awareness of smoking as a risk factor was observed for medical students, but no change in attitude was observed. CONCLUSIONS: The influence of medical education on this health concern is limited as there is no reduction in the prevalence of smoking. Medical education also seems unable to change attitudes to smoking. More students relate smoking to risk factors for certain diseases, showing greater awareness of the health problems caused by smoking.

[A survey on the relationship between tobacco use and physical exercise among university students]. / Encuesta sobre tabaquismo en estudiantes universitarios en relación con la préde ejercicio físico.

OBJECTIVE: To determine the prevalence of tobacco use among university students who participate in sports activities. MATERIALS AND METHODS This was a descriptive, cross-sectional study based on a self-administered questionnaire completed by students who participated in activities at a university sports center. The variables studied were age, sex, tobacco use, cigarettes/day, prior history of physical exercise, awareness of the regulations concerning tobacco use in force on the university campus, opinion on the relationship between smoking and reduced physical performance, and desire to quit smoking. RESULTS: A total of 406 completed questionnaires were received (41.2% of the target population); 71.7% were from women and 28.3% from men. The mean (SD) age of the sample was 22 (3.6) years, and the prevalence of smoking was 30.3%. The mean number of cigarettes smoked per day was 10.5 (6.7) for the sample as a whole, 9.3 (6.1) for women, and 14.7 (7.4) for men; the differences were statistically significant. No significant differences were found with respect to the relationship between exercise and tobacco use. A total of 98.8% of the subjects were of the opinion that smoking reduced physical performance, and 46.3% expressed a desire to quit. CONCLUSIONS: The practice of physical exercise during adolescence as part of a prevention program might interfere with the factors that lead young people to start smoking and thereby contribute to a reduction in the prevalence of tobacco use in the population as a whole.

Encuesta sobre tabaquismo en estudiantes universitarios en relación con la práctica de ejercicio físico / A survey on the relationship between tobacco use and physical exercise among university students

OBJETIVO: Conocer la prevalencia de tabaquismo en estudiantes universitarios que practican ejercicio físico. MATERIAL Y MÉTODOS: Estudio descriptivo transversal con encuesta autoadministrada a la población universitaria que realiza ejercicio físico en el Servicio de Actividades Deportivas de la Universidad. Las variables de estudio son: edad, sexo, consumo de tabaco, cigarrillos/día, práctica de ejercicio físico previo, conocimiento de la legislación vigente en la Universidad sobre tabaco, opinión sobre la relación entre fumar y disminución del rendimiento físico y deseo de cesación tabáquica. RESULTADOS: Se recogieron 406 cuestionarios (el 41,2 por ciento de la población diana), un 71,7 por ciento respondidos por mujeres, y un 28,3 por ciento por varones. La media de edad ñ desviación estándar de la muestra era de 22 ñ 3,6 años, y la prevalencia de fumadores, del 30,3 por ciento. La media de cigarrillos/día del total de la muestra era de 10,5 ñ 6,7; en mujeres, de 9,3 ñ 6,1, y en varones, de 14,7 ñ 7,4, existiendo diferencias estadísticamente significativas. No se encontraron diferencias significativas al relacionar la práctica de ejercicio con el consumo de tabaco. El 98,8 por ciento opina que el consumo de tabaco disminuye el rendimiento físico y el 46,3 por ciento quiere dejar de fumar. CONCLUSIONES: La práctica de ejercicio físico durante la adolescencia, incluida dentro de los programas de prevención, podría interferir con los factores de inicio en el consumo de tabaco y contribuir a disminuir la prevalencia de tabaquismo en la población (AU)

[Profile of smokers who seek treatment at a smoking cessation clinic]. / Perfil de los fumadores que solicitan tratamiento en una unidad de tabaquismo.

OBJECTIVES: The variety of smoking cessation therapies that have proven effective ranges from simple counseling to intensive interventions. The objective of our study was to identify the characteristics of smokers who currently seek treatment at a smoking cessation clinic. METHODS: Descriptive observational study. The target population consisted of smokers who sought treatment at a smoking cessation clinic. The following variables were studied: sex; age; referral source; marital status; educational level; age at which smoking began, age at which it became a regular habit and the time elapsed between the two moments; level of nicotine dependence (Fagerström Test for Nicotine Dependence); number of cigarettes per day; number of years smoking; use of other potentially-addictive substances (alcohol, caffeine, psychotropic medications and other drugs); presence of concomitant disease; previous attempts to quit smoking; current reasons for smoking cessation; and concentration of expired air carbon monoxide (CO). An initial medical history was taken from each smoker on the waiting list for treatment at the clinic in order to gather data on the study variables; these individuals were then enrolled in a 3-month group smoking cessation program that utilized both medication and cognitive-behavioral therapy. The results are presented in percentages and means with standard deviations (SD) and 95% confidence intervals (CI). RESULTS: 385 smokers were studied--239 (62%) men and 146 (38%) women--the average age being 43.05 years (SD: 9.07). Mean nicotine-dependence (Fagerström Test score) was 6.05 (SD: 2.19); mean number of cigarettes per day: 25.9 (SD: 12.11); mean number of years as a smoker: 25.3 (SD: 9.04); and mean expired air CO: 39.30 (SD: 25.18). Associated disease was present as chronic bronchitis for 27.5% and cardiovascular risk factors for 15%. Previous attempts to quit smoking were reported by 72%; the reasons for the present attempt to quit smoking were the prevention of disease (38%), awareness of dependence (20%) and parental desire to serve as a positive role model for children (10%). CONCLUSIONS: At present, the smokers who attend a smoking cessation clinic are young, severely-dependent adults in the initial stage of preparing to quit. The prevalence of symptoms in this population is low. The profile of the population seeking specialized smoking cessation treatment is expected to change in the future as those with smoking-related diseases and other specific populations of smokers become included.

Perfil de los fumadores que solicitan tratamientoen una unidad de tabaquismo / Profile of smokers who seek treatment at a smoking cessation clinic

OBJETIVOS: El tratamiento del tabaquismo incluye diversas intervenciones terapéuticas que han demostrado ser eficaces, desde el consejo mínimo hasta la atención intensiva. El objetivo de nuestro trabajo es conocer las características que presenta la población de fumadores que actualmente solicitan tratamiento de deshabituación tabáquica en una unidad de tabaquismo. MÉTODO: Estudio descriptivo observacional. La población objetivo fueron los fumadores que acuden a una unidad de tabaquismo para deshabituación tabáquica. Se estudiaron las siguientes variables: sexo, edad, procedencia, estado civil, nivel de formación, edad de primer consumo de tabaco y de consumo regular y tiempo transcurrido entre ambos, grado de dependencia a la nicotina (test de Fagerström), número de cigarrillos-día, número de años de fumador, consumo de otras sustancias con capacidad de originar adicción (alcohol, cafeína, psicofármacos, otras drogas), presencia de patología concomitante, intentos previos de cesación, motivos actuales de abandono y determinación de monóxido de carbono en aire espirado. A todos los fumadores incluidos en la lista de espera se les realizó una historia de primer día en la que se recogían las variables de estudio y se les incluía en un programa de deshabituación tabáquica en grupo, mediante tratamiento multicomponente (farmacológico y terapia cognitivo-conductual) a lo largo de 3 meses. Se presentan los resultados como proporciones y medias con sus desviaciones estándar (DE) y sus intervalos de confianza (IC) del 95 por ciento. RESULTADOS: Se estudió a 385 fumadores 239 [62 por ciento] varones y 146 [38 por ciento] mujeres, con una edad media de 43,05 años (DE, 9,07). La dependencia media a la nicotina (test de Fagerström) fue de 6,05 (DE, 2,19); media de cigarrillos/día, 25,9 (DE, 12,11); media de número de años de fumador, 25,3 años (DE, 9,04), y media de monóxido de carbono, 39,30 (DE, 25,18). En cuanto a la presencia de patología asociada, el 27,5 por ciento de los pacientes presentaba bronquitis crónica, y el 15 por ciento, factores de riesgo cardiovascular asociados. El 72 por ciento había tenido intentos previos de cesación; los motivos actuales para dejar de fumar eran la prevención de enfermedades (38 por ciento), la conciencia de dependencia (20 por ciento) y el papel ejemplar para los hijos (10 por ciento). CONCLUSIONES: Actualmente los fumadores que acuden a una unidad de tabaquismo son adultos jóvenes, en fase de preparación, con alto grado de dependencia y con escasa prevalencia de síntomas. En un futuro se prevé que la población que solicite tratamiento especializado se modifique, con la incorporación de fumadores con patología o características específicas (AU)

[Reliability of a questionnaire on smoking to evaluate prevalence, knowledge and attitudes of medical students]. / Estudio de fiabilidad de una encuesta utilizada para valorar la prevalencia, los conocimientos y las actitudes sobre el tabaquismo en estudiantes de medicina.

OBJECTIVE: To evaluate the reliability and reproducibility of results obtained from a questionnaire on the smoking habits of medical students. METHOD: A questionnaire with 30 variables was designed to measure three main parameters: prevalence, knowledge and attitudes toward smoking. First-year medical students at the University of Zaragoza (1997-98 academic year) were asked to fill in the questionnaire, and a code was assigned to each individual respondent. A test-retest method was then used to assess reliability: the same questionnaire was answered by the subjects after a period of time had elapsed. The Kappa coefficient was calculated to measure agreement. RESULTS: The questionnaire was filled in by 181 students at registration and 7 weeks later by 43 students. The first- and second-time questionnaires for 35 individuals were matched by codes. Reliability was good for most variables related to the main characteristics of smoking (such as prevalence, number of cigarettes smoked daily and consonance-dissonance). Reliability was acceptable for most variables related to knowledge but was low for 3 items. Reliability was acceptable for half the items related to attitudes and low for half. CONCLUSIONS: The questionnaire has a generally good level of reliability, with regard to reproducibility, or the likelihood that an individual will respond to an item in the same way at two different times. Some variables that measure attitudes toward smoking, however, are less reliable. Results obtained for those items should therefore be interpreted cautiously.