Are "Delayed Quitters" More Likely to Relapse Than Smokers Who Quit on Their Target Quit Date? A Retrospective Analysis of Clinical Records.

INTRODUCTION: Most smokers who are initially successful in their quit attempts return to smoking within the first few months. Identifying sub-populations at higher risk of relapse could help in relapse prevention efforts. We examined relapse rates in short-term abstainers who stopped smoking completely on their target quit date (TQD) and in those who needed more time to quit completely; and whether any difference in relapse between the two groups can be explained by baseline variables. AIMS AND METHODS: We identified 1172 smokers who achieved biochemically validated abstinence four weeks after their TQD at a stop-smoking clinic in London, and compared those who were abstinent from the TQD (immediate quitters) and those who only stopped smoking later (delayed quitters) in baseline characteristics. In a subsample of 308 clients followed up at one year, we compared relapse rates in immediate and delayed quitters while controlling for potential confounders. RESULTS: Delayed quitters smoked their first cigarette of the day earlier, had more past quit attempts, had lower confidence in quitting successfully, were more likely female and more likely to use varenicline. One-year relapse rates were 53% for immediate quitters and 77% for delayed quitters (OR = 2.83; 95% CI: [1.70-4.72]). In a multivariable regression adjusted for potential confounders delayed quitting remained significantly associated with relapse at one year (OR=2.41; 95% CI: [1.38-4.21]). CONCLUSIONS: Ex-smokers who do not achieve abstinence on their TQD are at a higher risk of relapse than those who do. The effect was not explained by baseline variables. IMPLICATIONS: Encouraging smokers to adhere to their TQD could improve treatment results. Relapse prevention efforts such as extended support and extended medication are likely to be particularly useful for delayed quitters.

Individual Determinants of Rest-Break Behavior in Occupational Settings.

AIMS: Work breaks improve well-being, productivity, and health. The aim of this study was to investigate the individual determinants of rest-break behavior during work using the theory of planned behavior (TPB). METHODS: The association between attitude, control, and subjective norm and rest-break intention (i.e., taking rest breaks regularly), and rest-break behavior (average number of rest breaks/workhour) was analyzed with stepwise linear regression in a cross-sectional design. The study participants included 109 clerical employees, and 215 nurses. RESULTS: Attitude and control were positively associated with rest-break intention. Intention and control were positively associated with rest-break behavior. The effect of intention was moderated by occupation, with intention being more weakly associated with rest-break behavior in nurses who had less behavioral control. CONCLUSIONS: Job control is the major predictor of rest-break behavior, with attitudes playing a minor role, and social norm playing no role. To increase rest-break behavior, a greater extent of job control is necessary.

Pathways leading to success and non-success: a process evaluation of a cluster randomized physical activity health promotion program applying fuzzy-set qualitative comparative analysis.

BACKGROUND: Health promotion programs can only lead to improvements in health outcomes if they are effectively implemented. However, most studies assessing implementation success focus on only one condition, although more conditions influence this process. Therefore, evidence is scarce on what conditions play a role in successful implementation and how they interact. Hence, we aimed to identify which combinations of teacher and implementation process characteristics affected the emotional and social school experience (SCE) of pupils participating in a school-based health promotion program. METHODS: This study was part of an effectiveness and process evaluation including 24 intervention and 27 control classes. We used fuzzy-set qualitative comparative analysis (fsQCA) to identify combinations of conditions that were associated with either an increase or no increase in the outcome SCE in comparison to the control group at 20 months post intervention. We deductively selected five conditions based on the Consolidated Framework for Implementation Research: teachers' perceived self-efficacy, teachers' expectations of the benefits of the intervention, teachers' previous knowledge about the intervention, dosage of physical activity breaks, and quality of the implementation. RESULTS: We identified five different pathways that led to no increase in the pupils' outcome (parameters of fit: consistency 94%, coverage 66%). The combination of an unsatisfying quality of implementing the intervention and a low previous knowledge about the intervention showed the highest empirical relevance. Similarly, fewer physical activity breaks in combination with other conditions impeded the program's success. Furthermore, we identified two different pathways characterizing ways to success (consistency: 81%, coverage: 52%). The most relevant combination was good quality implementation of physical activity breaks, implemented by teachers with a high self-efficacy, and a good previous knowledge about the intervention. CONCLUSIONS: QCA has potential for an in-depth analysis of complex interventions as it can rely on small to medium sample sizes and analyze pathways to success and non-success separately. The investigated program can be improved by considering the following suggestions: The quality of the implementation process should be monitored during the implementation phase, and regular feedback loops and learning opportunities for teachers should accompany a program. Clear recommendations regarding the dosage should be established. TRIAL REGISTRATION: German register of clinical studies: DRKS00000622 . Retrospectively registered: December 3, 2010, ( http://www.drks.de/drks_web/setLocale_EN.do ). Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107-2010).

German language questionnaires for assessing implementation constructs and outcomes of psychosocial and health-related interventions: a systematic review.

BACKGROUND: Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnaires used in English-speaking countries but limited their search processes to mental health and public health settings. Our aim was to identify questionnaires used in German-speaking countries measuring the implementation of interventions in public health and health care settings in general and to assess their psychometric properties. METHODS: We searched five different bibliographic databases (from 1985 to August 2017) and used several other search strategies (e.g., reference lists, forward citation) to obtain our data. We assessed the instruments, which were identified in an independent dual review process, using 12 psychometric rating criteria. Finally, we mapped the instruments' scales and subscales in regard to the constructs of the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcome Framework (IOF). RESULTS: We identified 31 unique instruments available for the assessment of implementation science constructs. Hospitals and other health care settings were the ones most often investigated (23 instruments), while education and childcare settings, workplace settings, and community settings lacked published instruments. Internal consistency, face and content validity, usability, and structural validity were the aspects most often described. However, most studies did not report on test-retest reliability, known-groups validity, predictive criterion validity, or responsiveness. Overall, the majority of studies did not reveal high-quality instruments, especially regarding the psychometric criteria internal consistency, structural validity, and criterion validity. In addition, we seldom detected instruments operationalizing the CFIR domains intervention characteristics, outer setting, and process, and the IOF constructs adoption, fidelity, penetration, and sustainability. CONCLUSIONS: Overall, a sustained and continuous effort is needed to improve the reliability and validity of existing instruments to new ones. Instruments applicable to the assessment of implementation constructs in public health and community settings are urgently needed. TRIAL REGISTRATION: The systematic review protocol was registered in PROSPERO on October 19, 2017, under the following number: CRD42017075208 .

Effects of a web-based follow-up intervention on self-efficacy in obesity treatment for women.

Obesity is a chronic disease requiring long-term care. The purpose of the current study was the evaluation of a web-based intervention (WBI), subsequent to an initial face to face life style treatment. In a randomized trial, 84 women received an introduction phase (4 months) and a training phase (2 months) where one group was trained in using WBI whereas the other arm received a printed manual (PMI). During the self-monitoring phase (6 months) participants either used the WBI or the PMI for follow-up support. Anthropometric parameters could be significantly reduced and self-efficacy was significantly increased in the first 6 months. At 12 months, values of self-efficacy of the WBI were not superior compared to results of the PMI; however, feedback on acceptability of the intervention did show higher ratings of the WBI and also facilitated contact with the program supervisor. No significant differences regarding the engagement in follow-up tools could be found between the intervention groups. Subgroup analysis indicated a positive effect of involvement in both forms of self-monitoring aftercare.

Effects of Rest-Break Intention on Rest-Break Frequency and Work-Related Fatigue.

OBJECTIVES: The present paper presents findings from two studies addressing the effects of the employee's intention to have rest breaks on rest-break frequency and the change of well-being during a workday. BACKGROUND: Rest breaks are effective in avoiding an accumulation of fatigue during work. However, little is known about individual differences in rest-break behavior. METHOD: In Study 1, the association between rest-break intention and the daily number of rest breaks recorded over 4 consecutive workdays was determined by generalized linear model in a sample of employees ( n = 111, 59% females). In Study 2, professional geriatric nurses ( n = 95 females) who worked over two consecutive 12-hour day shifts recorded well-being (fatigue, distress, effort motivation) at the beginning and the end of their shifts. The effect of rest-break intention on the change of well-being was determined by multilevel modeling. RESULTS: Rest-break intention was positively associated with the frequency of rest breaks (Study 1) and reduced the increase of fatigue and distress over the workday (Study 2). CONCLUSION: The results indicate that individual differences account for the number of breaks an employee takes and, as a consequence, for variations in the work-related fatigue and distress. APPLICATION: Strengthening rest-break intentions may help to increase rest-break behavior to avoid the buildup of fatigue and distress over a workday.

Inpatient smoking cessation therapy: truth or dare?

BACKGROUND: This study aims to answer the question to which extent even very heavy nicotine-dependent smokers can benefit from a 3-week inpatient smoking cessation program. A particular focus lies on analyzing the positive effects, which go above and beyond normally anticipated health benefits. METHODS: This is a descriptive study observing 270 patients over a 1-year period consisting of recruitment, therapy, and two post-therapy follow-up visits at 6-month interval. Gender differences, changes in body weight, and factors relating to addiction and the nicotine withdrawal process are analyzed. In comparing successful participants-post-therapy nonsmokers-with less successful ones, our analysis identifies benefits and advantages an inpatient smoking cessation therapy can bring to even the heaviest smokers. RESULTS: At the 12-month post-therapy follow-up visit, 42.6% of participants were identified as nonsmokers. A total of 34.0% of participants took up smoking again. No data is available on the remaining participants. Nonsmokers experienced significant reduction in nicotine craving and withdrawal symptoms. In terms of body weight, increases were found in both, men and women, nonsmokers and smokers. CONCLUSION: Successful quitters fail to report of an unbearable strong desire to smoke. Such unfounded fear should be communicated. Weight gain remains an undesired side effect. Hence, it is crucial to diagnose individuals more prone to weight gain and offer coping strategies thus reducing the risk of developing obesity. Nevertheless, the outcome of the study should be an encouragement to also heavy smokers and empower them to undertake smoking cessation.

An instrument to measure adherence to weight loss programs: the compliance praxis survey-diet (COMPASS-Diet).

Adherence to behavioral weight loss strategies is important for weight loss success. We aimed to examine the reliability and validity of a newly developed compliance praxis-diet (COMPASS-diet) survey with participants in a 10-week dietary intervention program. During the third of five sessions, participants of the "slim-without-diet" weight loss program (n = 253) completed the COMPASS-diet survey and provided data on demographic and clinical characteristics, and general self-efficacy. Group facilitators completed the COMPASS-diet-other scale estimating participants' likely adherence from their perspective. We calculated internal consistency, convergent validity, and predictive value for objectively measured weight loss. Mean COMPASS-diet-self score was 82.4 (SD 14.2) and COMPASS-diet-other score 80.9 (SD 13.6) (possible range 12-108), with lowest scores in the normative behavior subscale. Cronbach alpha scores of the COMPASS-diet-self and -other scale were good (0.82 and 0.78, respectively). COMPASS-diet-self scores (r = 0.31) correlated more highly with general self-efficacy compared to COMPASS-diet-other scores (r = 0.04) providing evidence for validity. In multivariable analysis adjusted for age and gender, both the COMPASS-diet-self (F = 10.8, p < 0.001, r² = 0.23) and other (F = 5.5, p < 0.001, r² = 0.19) scales were significantly associated with weight loss achieved at program conclusion. COMPASS-diet surveys will allow group facilitators or trainers to identify patients who need additional support for optimal weight loss.

Evaluation of the sustainability of the Public Health Program "Slim without Diet (Schlank ohne Diät)".

BACKGROUND: The prevalence of obesity and associated illnesses is continuously rising in industrialized countries. As a preventive measure, the Lower Austria Health Insurance Fund, together with the Institute of Social Medicine of the Medical University Vienna has launched the weight reduction program "Slim without Diet (SWD)". The Program's aim is to change the participants' eating and exercise habits. The methodical approach is to enhance the individual's self-control so that participants are able to identify, break, and modify false behavior patterns. During this project, the data from 4,053 individuals were descriptively evaluated by using the statistical program SPSS (Version 15). RESULTS: The scientifically recommended target group regarding Body Mass Index and age was reached and the weight reduction success rate is comparable to similar programs. Follow-up checks of the project carried out 6 and 12 months after the end of the intervention phase showed that participants were able to maintain an average weight loss of 4.26 kg compared to their weight at program-start. The participants who follow the therapy recommendations achieved significantly higher weight loss and weight reduction also correlates with the number of attended group sessions (p < 0.001). The attendance frequency at the follow-up checks, however, shows a decreasing tendency of up to 75 percent. CONCLUSION: The results show that there is need to develop new methods to increase motivation and compliance of the participants to achieve long-term success. A first trial in this direction was to implement an additional module - participants had the chance of ongoing contacts after the group sessions have finished. The results until now show that a possible participation in the follow-ups is not significantly affected by ongoing contacts.

[The influence of drug packaging on the drug-taking compliance of older patients living on their own]. / Einfluss der Medikamentenverpackung auf die Compliance bei älteren selbständig lebenden Patienten.

The present study is concerned with compliance and the possible influence thereon of drug packaging. Since most medications are prescribed for older persons, our target group was that of the over 70-year-olds otherwise usually excluded from participating as probands in clinical trials. Our method chose a study design that includes both the experience of a selected group of experts as well as the results of a field study. In the field study, 70 persons (18 male and 61 female), and 70-to-95 years of age participated in a face-to-face interview as well as in a test dealing with the handling of drug packaging. While the subjective patient responses provide a positive result with respect to compliance -- over 80% say that they take their medications regularly -- the data that were determined objectively within the framework of the test with selected medications showed deficiencies. The "medication test" carried out here shows impressively that child-proof packaging is also "age-proof" and, when used in the target group of older persons, can represent a considerable barrier to compliance.

Craving and other characteristics of the comorbidity of alcohol and nicotine dependence.

PURPOSE: In this cross-sectional study we compared alcohol-dependent smokers and non-alcohol-dependent smokers with respect to intensity of nicotine dependence, craving conditions, sleep disturbances, comorbidity with major depression, reasons for smoking, accompanying somatic diseases and patients' prolonged abstinence from smoking during the 3 years preceding the study. SUBJECTS AND METHODS: Fifty-one alcohol-dependent smokers and 327 non-alcohol-dependent smokers diagnosed as ICD-10 and DSM-IV-nicotine dependent, were investigated by means of the Fagerström Test for Nicotine Dependence, the Lübeck Craving-Recurrence Risk Questionnaire and the Lesch Alcohol Dependence Typology (both adapted to smoking). RESULTS: The intensity of nicotine dependence was more enhanced in alcohol-dependent smokers compared to non-alcohol-dependent smokers. Several variables of all factors of craving ("depressive mood", "stimulation", "relaxation", "socially triggered tension") were significantly increased in alcohol-dependent patients (P<0.05). Alcohol-dependent smokers showed depressive symptoms and sleep disturbances, whilst non-alcohol-dependent individuals mainly smoked for stress release and weight control. DISCUSSION: Our study demonstrates that the intensity of nicotine dependence, several conditions of craving for nicotine, sleep disturbances and symptoms of depression appear to be enhanced in alcohol-dependent smokers compared with non-alcohol-dependent smokers. Conclusions. - It is hoped that the factors of craving and reasons for smoking identified in this study will contribute to a better understanding of smoking temptation in alcohol-dependent smokers and non-alcohol-dependent smokers in future.

[Health campaign for atherosclerosis prevention]. / Gesundheitskampagne zur Atherosklerose-Prävention.

The goal of the campaign "plus leben", a project designed to run for at least 5 years, is to heighten the awareness of patients at risk of heart disease and to provide them with an appropriate prevention program. During the first two years of the campaign 20,000 visitors were registered on the homepage, 400,000 tests for risk of heart disease were distributed, and more than 3,000 health information brochures were requested. Thus, a survey of patients was designed to provide information on the extent to which preventive measures are effective. The survey, which was carried out by mail, had a response rate of 28%, or 230 participants. In the random sample, consisting of about 60% men and 40% women, only 16% are younger than 50 years of age. Thus the survey provides a representative picture of the affected target group. The test for risk of cardiac disease provided by "plus leben" led to an increase in awareness of preventive measures in more than two thirds of the respondents, and 60% also completed the test. Although only a fourth of the patients are regularly informed by their physician about preventive measures, the campaign has led about 90% of the respondents to make fundamental or at least partial changes in their lifestyle. In connection with the study it was shown that the media play an important role in providing information on preventive measures. Communication in the doctor's office as an important building block in raising consciousness about atherosclerosis prevention could be further improved.

The Austrian multicentre study on smoking: subgroups of nicotine dependence and their craving.

BACKGROUND: The misconception of tobacco smoking as a 'bad habit' has been replaced by a diagnosis of addiction. Although help to quit is offered by nicotine replacement, antidepressants and psychotherapeutic support, there is no cure yet. One cause of impediment might be psychiatric comorbidity. Therefore, we searched for smoker subgroups, needing different treatments. AIM OF THE STUDY: The study aimed at subtyping smokers in an attempt to better understand the phenomenon of resistant smokers and provide more information that could potentially become useful to treatment centres assuming the subtypes correlate directly with outcomes of different smoking cessation treatments, tailor-made according to subtypes. METHODS: 330 out of 430 recruited smokers were classified as nicotine dependent (ICD-10) and tobacco dependent (DSM-IV) and remained in the study. They were investigated with different diagnostic assessments: Fagerström Test (FT), Lübeck Craving Risk Relapse Questionnaire and Lesch Typology Questionnaire (the last two being modified for smoking). RESULTS: Dependence severity degree is reflected by the FT. FT scores >/=5 indicated higher conspicuousness. Four clusters for nicotine craving were found: (1) 'depressed', (2) 'stimulated', (3) 'relaxed mood state' and (4) 'socially triggered tensed mood'. In contrast to alcoholism, 'stimulation' was one of the major craving conditions in smokers. The decision tree, consisting of the FT and the Lesch Typology Questionnaire, distinguishes four subgroups of nicotine-dependent persons. CONCLUSION: The subgroups reflect different reinforcement and psychosocial disturbances. They match treatment and can be applied as outcome predictors in controlled treatment and relapse prevention studies.

[The status of atherosclerosis prevention in Austria]. / Stellenwert der Atherosklerose-Prävention in Osterreich.

Although atherosclerosis is today seen as presenting a distinct clinical picture, there are almost no data available about the impact this has on medical practice and about the point at which a patient is considered high-risk. As part of a larger project on the prevention of heart disease and atherosclerosis, "Aktion plus leben", 1,117 physicians were polled in a scientific survey. The study was carried out in some 100 hospitals throughout Austria, above all in departments of internal medicine, but also in neurological departments, and in a number of other units. The results showed that in fact over 90% of those questioned see atherosclerosis as a separate, treatable illness in the context of risk prevention. The most frequent methods of diagnosis were specified as ultrasound and the clarification of symptoms of coronary heart disease. Atherosclerosis prevention is initiated above all in patients with coronary heart disease, myocardial infarction and stroke, but also very frequently in those with diabetes, peripheral vascular occlusive disease, hyperlipidemia and hypertension. Of particular interest to us was the respondents' evaluation of the effect of ramipril, the angiotensin-converting enzyme (ACE) inhibitor used in the HOPE study. The majority of those questioned see a broad range of indications for this ACE inhibitor and ascribe to it a profibrinolytic, antiinflammatory and plaque-stabilising action. Although the survey sought assessment of just one particular medication as a possible treatment option, the study documents the importance of a more inclusive concept of atherosclerosis prevention.