Factors relating to failure to quit smoking: a prospective cohort study / Fatores relacionados ao insucesso na cessação tabágica: um estudo de coorte prospectivo

CONTEXT AND OBJECTIVE: Considering the difficulties in stopping smoking, this article aimed to identify factors relating to failure of attempts to quit smoking among smokers who sought care at an outpatient clinic in a general university hospital. DESIGN AND SETTING: Prospective cohort study evaluating 100 smokers who sought treatment at the Psychoactive Substances Outpatient Clinic. METHODS: The variables gathered were sociodemographic factors; degree of dependence (Fagerström questionnaire); stage of motivation for change (University of Rhode Island Change Assessment Scale); and presence of depression and anxiety (Hospital Anxiety and Depression Scale). The patients were followed up after 4, 8, 12 and 24 weeks to identify factors relating to failure to quit smoking. RESULTS: The patients were mostly women (75 percent), between 40 and 59 years of age (67 percent); with incomplete elementary education (60 percent); with leisure activities (57 percent); suffering from tobacco-related disease (53 percent); with previous attempts to quit smoking (70 percent); with a medical recommendation to stop (51 percent); with encouragement to stop (66 percent); and with a high degree of dependence (78 percent). The main motivational stage was contemplation/action (43 percent); the anxiety rate was 64 percent and the depression rate was 39 percent. The quitting rate was 66 percent among adherents and 17 percent among non-adherents (P < 0.001). Lack of success was correlated with absence of leisure, higher education and absence of tobacco-related disease. CONCLUSION: The variables of lack of leisure activities, higher education and/or lack of tobacco-related disease correlated with failure to quit smoking among smokers who sought treatment at an outpatient clinic in a tertiary general hospital.

CONTEXTO E OBJETIVO: Considerando as dificuldades na cessação do tabagismo, este artigo objetiva identificar fatores relacionados ao insucesso na tentativa de cessação tabágica de fumantes que procuraram atendimento em ambulatório de um hospital geral universitário. TIPO DE ESTUDO E LOCAL: Estudo de coorte prospectivo, que avaliou 100 fumantes que procuraram tratamento no Ambulatório de Substâncias Psicoativas. MÉTODOS: Avaliaram-se variáveis sociodemográficas, grau de dependência (Questionário de Fagerström), estágio de motivação para a mudança (University of Rhode Island Change Assessment), presença de depressão e ansiedade (Hospital Anxiety and Depression Scale). Os pacientes foram acompanhados em 4, 8, 12 e 24 semanas para identificar fatores relacionados ao insucesso na cessação do tabagismo. RESULTADOS: Os pacientes eram, na maioria, mulheres (75 por cento), entre 40 e 59 anos de idade (67 por cento), com ensino fundamental incompleto (60 por cento), com atividades de lazer (57 por cento), portadores de doença tabaco-relacionada (DTR) (53 por cento), com tentativas anteriores de parar de fumar (70 por cento), que receberam recomendação médica (51 por cento) e incentivo para a cessação (66 por cento) e com elevado grau de dependência (78 por cento). O estágio de motivação principal foi contemplação/ação (43 por cento), a taxa de ansiedade foi de 64 por cento e de depressão, 39 por cento. A taxa de cessação foi de 66 por cento entre os que aderiram e de 17 por cento entre aqueles que não aderiram (P < 0,001). O insucesso foi relacionado à ausência de lazer, maior escolaridade e ausência de DTR. CONCLUSÃO: Falta de atividades de lazer, maior nível educacional e/ou não ter DTR foram variáveis relacionadas ao insucesso na cessação tabágica para tabagistas que procuram tratamento em ambulatório inserido em hospital geral terciário.

Factors relating to failure to quit smoking: a prospective cohort study.

CONTEXT AND OBJECTIVE: Considering the difficulties in stopping smoking, this article aimed to identify factors relating to failure of attempts to quit smoking among smokers who sought care at an outpatient clinic in a general university hospital. DESIGN AND SETTING: Prospective cohort study evaluating 100 smokers who sought treatment at the Psychoactive Substances Outpatient Clinic. METHODS: The variables gathered were sociodemographic factors; degree of dependence (Fagerström questionnaire); stage of motivation for change (University of Rhode Island Change Assessment Scale); and presence of depression and anxiety (Hospital Anxiety and Depression Scale). The patients were followed up after 4, 8, 12 and 24 weeks to identify factors relating to failure to quit smoking. RESULTS: The patients were mostly women (75%), between 40 and 59 years of age (67%); with incomplete elementary education (60%); with leisure activities (57%); suffering from tobacco-related disease (53%); with previous attempts to quit smoking (70%); with a medical recommendation to stop (51%); with encouragement to stop (66%); and with a high degree of dependence (78%). The main motivational stage was contemplation/action (43%); the anxiety rate was 64% and the depression rate was 39%. The quitting rate was 66% among adherents and 17% among non-adherents (P < 0.001). Lack of success was correlated with absence of leisure, higher education and absence of tobacco-related disease. CONCLUSION: The variables of lack of leisure activities, higher education and/or lack of tobacco-related disease correlated with failure to quit smoking among smokers who sought treatment at an outpatient clinic in a tertiary general hospital.

[Therapeutic group for smokers: results after two-year follow-up]. / Grupo terapêutico para tabagistas: resultados após seguimento de dois anos.

OBJECTIVE: To evaluate the smokers' profile, immediate results and outcome after 25 months of treatment at a university public service. METHODS: One hundred and seventy one smokers were evaluated for treatment in the Therapeutic Group (TG) of the Service of Psychoactive Substances. We evaluated sociodemographic variables, history of smoking, presence of medical comorbidity and psychiatric symptoms, initial and late outcomes (median 25 months), by telephone contact. Frequency analysis and multiple logistic regression analysis were used, with a significance level of 5% for associated factors. RESULTS: Most patients were female (73.4%), married (48%), had basic education (74.6%), were working (57%); 65.2% started to smoke before the age of 15, 63.8% smoked for more than thirty years, 76% already had tried to stop smoking, 46.2% had severe dependence, 72.1% had medical comorbidity and 36% presented psychiatric symptoms. The service was sought by 51%, mainly concerned with health. During treatment, 79.1% stopped smoking. After 25 months, 62% remained abstinent. The variable associated with failure of smoking cessation was the presence of psychiatric symptoms. Variables related to relapse were psychiatric symptoms and lesser attendance at Motivation Group sessions. There was an association between clinical comorbidity and years of smoking and years of inactivity CONCLUSION: This study reinforces the importance of understanding the profile of the subjects to evaluate strategies employed and adequacy of treatment proposed for smokers to improve the rates of smoking cessation and reduce rates of relapse.

Grupo terapêutico para tabagistas: resultados após seguimento de dois anos / Therapeutic group for smokers: results after two-year follow-up

OBJETIVO: Descrever os pacientes atendidos em ambulatório de tratamento de tabagistas em serviço universitário, resultados de tratamento imediatos e de seguimento de dois anos. MÉTODOS: Levantamento dos 171 tabagistas avaliados para tratamento no Grupo Terapêutico do Ambulatório de Substâncias Psicoativas do HC/UNICAMP. Avaliaram-se variáveis sociodemográficas, história do tabagismo, presença de comorbidades clínicas e sintomas psiquiátricos e desfecho inicial e tardio (mediana de 25 meses), por contato telefônico. Realizaram-se análises de frequência e, para identificar fatores associados, análise de regressão logística múltipla, com nível de significância de 5 por cento. RESULTADOS: População com maioria de mulheres (73,4 por cento), casada (48 por cento), escolaridade fundamental (74,6 por cento), trabalhando (57 por cento), 65,2 por cento começaram a fumar antes dos 15 anos, 63,8 por cento tinham mais de 30 anos de tabagismo, 76 por cento já tinham tentado parar de fumar, 46,2 por cento com dependência grave, 72,1 por cento apresentavam comorbidade clínica e 36 por cento sintomas psiquiátricos; 51 por cento procuraram espontaneamente o serviço, principalmente por preocupação com a saúde. Com relação à cessação do tabagismo, 79,1 por cento pararam de fumar durante o tratamento; após 25 meses, 62 por cento continuavam sem fumar. A variável associada a não-cessação foi presença de sintomas psiquiátricos. As variáveis relacionadas à recaída foram sintomas psiquiátricos e menor número de sessões no Grupo de Motivação. Houve associação entre comorbidade clínica e tempo de tabagismo e inatividade profissional. CONCLUSÃO: Este estudo reforça a importância do reconhecimento das características da clientela atendida para avaliação das estratégias empregadas e adequação das propostas de tratamento para tabagistas visando melhora das taxas de cessação e redução dos índices de recaída.

OBJECTIVE: To evaluate the smokers' profile, immediate results and outcome after 25 months of treatment at a university public service. METHODS: One hundred and seventy one smokers were evaluated for treatment in the Therapeutic Group (TG) of the Service of Psychoactive Substances. We evaluated sociodemographic variables, history of smoking, presence of medical comorbidity and psychiatric symptoms, initial and late outcomes (median 25 months), by telephone contact. Frequency analysis and multiple logistic regression analysis were used, with a significance level of 5 percent for associated factors. RESULTS: Most patients were female (73.4 percent), married (48 percent), had basic education (74.6 percent), were working (57 percent); 65.2 percent started to smoke before the age of 15, 63.8 percent smoked for more than thirty years, 76 percent already had tried to stop smoking, 46.2 percent had severe dependence, 72.1 percent had medical comorbidity and 36 percent presented psychiatric symptoms. The service was sought by 51 percent, mainly concerned with health. During treatment, 79.1 percent stopped smoking. After 25 months, 62 percent remained abstinent. The variable associated with failure of smoking cessation was the presence of psychiatric symptoms. Variables related to relapse were psychiatric symptoms and lesser attendance at Motivation Group sessions. There was an association between clinical comorbidity and years of smoking and years of inactivity CONCLUSION: This study reinforces the importance of understanding the profile of the subjects to evaluate strategies employed and adequacy of treatment proposed for smokers to improve the rates of smoking cessation and reduce rates of relapse.

Atenção aos tabagistas pela capacitação de profissionais da rede pública / Approach on smoking cessation by training public health providers

O estudo avaliou desdobramentos de um treinamento para abordagem de tabagistas para 40 profissionais da rede pública, de novembro de 2004 a março de 2007. Os profissionais realizaram abordagem mínima individual (3.419 tabagistas) e grupal (982). Dos pacientes fumantes que participaram dessas atividades, 9,2 por cento conseguiram parar de fumar. As dificuldades relatadas pelos profissionais foram baixa adesão dos pacientes (11 por cento), falta de medicação (38 por cento) e de apoio/estrutura da unidade (29 por cento). O treinamento aumentou a população abordada pelas unidades de saúde nas estratégias de prevenção do tabagismo.

The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2 percent quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11 percent); lack of medications (38 percent); and lack of health unit infrastructure/support (29 percent). The training allowed to reaching out a larger population through smoking cessation approaches at health units.

[Approach on smoking cessation by training public health providers]. / Atenção aos tabagistas pela capacitação de profissionais da rede pública.

The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2% quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11%); lack of medications (38%); and lack of health unit infrastructure/support (29%). The training allowed to reaching out a larger population through smoking cessation approaches at health units.