Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial.

BACKGROUND: Smoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support. METHODS AND DESIGN: We examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date. DISCUSSION: There is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace. TRIAL REGISTRATION: Netherlands Trial Register Identifier: NL8463 . Date of registration: 17-03-2020.

Generation shifts in smoking over 20 years in two Dutch population-based cohorts aged 20-100 years.

BACKGROUND: Younger and older generations may differ substantially in their lifetime smoking habits, which may result in generation-specific health challenges. We aimed to quantify generation shifts in smoking over a period of 25 years. METHODS: We used the Doetinchem Cohort Study (baseline 1987-1991; 7768 individuals; 20-60 years; follow-up 1993-2012) and the Longitudinal Aging Study Amsterdam (baseline 1992-1993; 3017 individuals; 55-85 years; follow-up 1995-2009). Generation shifts were studied between 10-year generations (age range: 20-100 years). Generation shifts were examined graphically and by using logistic random effect models for men and women. RESULTS: Among men, significant generation shifts in current smoking were found between two non-successive generations: for instance men in their 40s at baseline smoked much more than men in their 40s at follow-up (33.6% vs. 23.1%, p < 0.05). Among women, the most recently born generation showed a favourable significant generation shift in current smoking (-7.3%) and ever smoking (-10.1%). For all other generations, the prevalence of ever smoking among women was significantly higher in every more recently born generation, whereas no other generation shifts were observed for current smoking. The unfavourable generation shifts were mainly found among the lower educated. CONCLUSIONS: The future burden of disease due to smoking is expected to be reduced among men, but not yet among women. Educational differences in smoking-related health problems are expected to increase.

A weak sense of coherence is associated with a higher mortality risk.

BACKGROUND: Sense of coherence (SOC) is a health-promoting resource within the salutogenic theory that reflects an individual's coping ability. The association between SOC and mental health has been confirmed, but its association with mortality is less clear. We examined the association between SOC and all-cause mortality in an adult Dutch population. METHODS: Between 1996 and 1998, a postal questionnaire, including the three-item SOC scale, was completed by 12 024 men and women aged 20-65 years, who had participated in a health examination (MORGEN project) 6 months to 3 years earlier. Vital status was recorded up to November 2011; in total, 603 deaths were registered (5%). The participants were divided into three groups with a weak (21.1%), intermediate (60.3%) or strong (18.6%) SOC. Cox proportional hazard models were used with an intermediate SOC as the reference group. Adjustments were made for sex, age, socioeconomic factors, indicators of health status and lifestyle. RESULTS: A weak SOC, as compared with an intermediate SOC, was associated with a higher all-cause mortality risk after, on average, 13.5 years of follow-up and adjusted for sex and age (HR=1.40, 95% CI 1.14 to 1.70). After additional adjustments, the higher all-cause mortality risk remained statistically significant (HR=1.27, 95% CI 1.01 to 1.59). Mortality risk for the strong SOC group did not differ from that for the intermediate group. CONCLUSIONS: A weak SOC was associated with a higher risk of all-cause mortality. Health promotion focusing on strengthening SOC may be a promising new strategy, potentially affecting not only mental health but also mortality.

Retirement and a healthy lifestyle: opportunity or pitfall? A narrative review of the literature.

BACKGROUND: Retirement is a life-course transition in late adult life that is marked by major changes that may affect healthy lifestyles. Our aim is to give an overview of the current knowledge on changes in smoking, alcohol consumption, physical activity and dietary habits during the transition to retirement. This may provide clues to a better targeting and timing of preventive activities at older age. METHODS: Literature search in Medline, Scopus, Embase, PsycInfo, Social SciSearch and SciSearch limited to English-language papers published between 2001 and May 2013. Results of 20 original papers are summarized in a narrative review. RESULTS: Some studies report an increase in alcohol consumption after retirement, whereas others found a decrease or no change at all. Those who retired involuntarily tended to increase their alcohol consumption, whereas retirees who quit voluntarily did not change their alcohol consumption. Leisure-time physical activity seems to increase slightly after retirement, especially moderately intensive physical activity. This increase does not compensate the loss of work-related physical activity such as the work itself or work-related transportation. The studies on changes in smoking and dietary habits were too limited to draw conclusions. CONCLUSIONS: The transition to retirement is accompanied with both favourable and unfavourable lifestyle changes, depending on the type of lifestyle, lifestyle indicator and the personal situation of the retiree. The (pre-)retirement period may well offer a suitable opportunity for preventive action, for example in pre-retirement programmes, planning or other retirement-related support.

Shared and individual medical appointments for children and adolescents with type 1 diabetes; differences in topics discussed?

OBJECTIVE: The purpose of this study was to examine differences in the type of topics discussed during shared medical appointments (SMAs) and traditional individual outpatient visits for children and adolescents with type 1 diabetes. In addition, differences between the conversational contributions of the participants were examined. METHODS: Videotapes of 42 individual outpatient visits and 5 SMAs with 31 children or adolescents were collected and observed using a checklist of topics adapted from the international consensus guideline for the management of type 1 diabetes in childhood and adolescents. Furthermore, patients reported about their experience with the information and support provided during an SMA. Data analysis was performed using one-way ANOVAs and univariate variance analysis. RESULTS: In SMAs, more diabetes-related topics were discussed. During SMAs, the conversational contributions of the different participants seemed to be more equally distributed than during traditional individual outpatient visits. Participants felt that they had learned most from the presence of other patients and their questions. CONCLUSION: More diabetes-related topics are covered in SMAs than in individual outpatient pediatric follow-up visits. PRACTICE IMPLICATION: SMAs seem to offer an appreciated variation on the regular diabetes care for children and adolescents.

[Shared Medical Appointments: experiences of patients and care givers]. / 'Gezamenlijk Medisch Consult': samen naar de dokter. Ervaringen van patiënten en zorgverleners.

OBJECTIVE: To examine the characteristics of patients participating in a shared medical appointment (SMA); to what extent SMAs fulfil patients' needs; to evaluate if patients are better informed after an SMA and how they evaluate meeting other patients at an SMA, and how health professionals experience SMAs. DESIGN: Descriptive. METHOD: Fourteen multidisciplinary teams participated in the study. The Dutch Institute for Healthcare Improvement (CBO) trained them in how to conduct an SMA. The experiences of patients participating in an SMA were compared with the experiences of patients who visited the doctor individually. Patients completed questionnaires before and after the SMA (n = 83) or the individual visit (n = 158). RESULTS: Patients who participated in an SMA did not differ significantly from the regular patient population in either demographic characteristics or in their experience of health and care uptake. Patients participated in an SMA primarily to share experiences with fellow patients, to learn from others and to obtain more information. Both patients and health professionals (n = 53) reported that patients received more information during an SMA. Patients valued the contact with their fellow patients. SMA offered care givers a different experience and opportunities to learn. CONCLUSION: For patients and health professionals, SMAs seem indeed to have added value. More research is needed to understand the working mechanism and the long-term effects of participation in SMAs.

Does burnout among doctors affect their involvement in patients' mental health problems? A study of videotaped consultations.

BACKGROUND: General practitioners' (GPs') feelings of burnout or dissatisfaction may affect their patient care negatively, but it is unknown if these negative feelings also affect their mental health care. GPs' available time, together with specific communication tools, are important conditions for providing mental health care. We investigated if GPs who feel burnt out or dissatisfied with the time available for their patients, are less inclined to encourage their patients to disclose their distress, and have shorter consultations, in order to gain time and energy. This may result in less psychological evaluations of patients' complaints. METHODS: We used 1890 videotaped consultations from a nationally representative sample of 126 Dutch GPs to analyse GPs' communication and the duration of their consultations. Burnout was subdivided into emotional exhaustion, depersonalisation and reduced accomplishment. Multilevel regression analyses were used to investigate which subgroups of GPs differed significantly. RESULTS: GPs with feelings of exhaustion or dissatisfaction with the available time have longer consultations compared to GPs without these feelings. Exhausted GPs, and GPs with feelings of depersonalisation, talk more about psychological or social topics in their consultations. GPs with feelings of reduced accomplishment are an exception: they communicate less affectively, are less patient-centred and have less eye contact with their patients compared to GPs without reduced accomplishment.We found no relationship between GPs' feelings of burnout or dissatisfaction with the available time and their psychological evaluations of patients' problems. CONCLUSION: GPs' feelings of burnout or dissatisfaction with the time available for their patients do not obstruct their diagnosis and awareness of patients' psychological problems. On the contrary, GPs with high levels of exhaustion or depersonalisation, and GPs who are dissatisfied with the available time, sometimes provide more opportunities to discuss mental health problems. This increases the chance that appropriate care will be found for patients with mental health problems. On the other hand, these GPs are themselves more likely to retire, or risk burnout, because of their dissatisfaction. Therefore these GPs may benefit from training or personal coaching to decrease the chance that the process of burnout will get out of hand.

The workload of general practitioners does not affect their awareness of patients' psychological problems.

OBJECTIVE: To investigate if general practitioners (GPs) with a higher workload are less inclined to encourage their patients to disclose psychological problems, and are less aware of their patients' psychological problems. METHODS: Data from 2095 videotaped consultations from a representative selection of 142 Dutch GPs were used. Multilevel regression analyses were performed with the GPs' awareness of the patient's psychological problems and their communication as outcome measures, the GPs' workload as a predictor, and GP and patient characteristics as confounders. RESULTS: GPs' workload is not related to their awareness of psychological problems and hardly related to their communication, except for the finding that a GP with a subjective experience of a lack of time is less patient-centred. Showing eye contact or empathy and asking questions about psychological or social topics are associated with more awareness of patients' psychological problems. CONCLUSION: Patients' feelings of distress are more important for GPs' communication and their awareness of patients' psychological problems than a long patient list or busy moment of the day. GPs who encourage the patient to disclose their psychological problems are more aware of psychological problems. PRACTICE IMPLICATIONS: We recommend that attention is given to all the communication skills required to discuss psychological problems, both in the consulting room and in GPs' training. Additionally, attention for gender differences and stress management is recommended in GPs' training.

Does the attention General Practitioners pay to their patients' mental health problems add to their workload? A cross sectional national survey.

BACKGROUND: The extra workload induced by patients with mental health problems may sometimes cause GPs to be reluctant to become involved in mental health care. It is known that dealing with patients' mental health problems is more time consuming in specific situations such as in consultations. But it is unclear if GPs who are more often involved in patients' mental health problems, have a higher workload than other GPs. Therefore we investigated the following: Is the attention GPs pay to their patients' mental health problems related to their subjective and objective workload? METHODS: Secondary analyses were made using data from the Second Dutch National Survey of General Practice, a cross sectional study conducted in the Netherlands in 2000-2002. A nationally representative selection of 195 GPs from 104 general practices participated in this National Survey. Data from: 1) a GP questionnaire; 2) a detailed log of the GP's time use during a week and; 3) an electronic medical registration system, including all patients' contacts during a year, were used. Multiple regression analyses were conducted with the GP's workload as an outcome measure, and the GP's attention for mental health problems as a predictor. GP, patient, and practice characteristics were included in analyses as potential confounders. RESULTS: Results show that GPs with a broader perception of their role towards mental health care do not have more working hours or patient contacts than GPs with a more limited perception of their role. Neither are they more exhausted or dissatisfied with the available time. Also the number of patient contacts in which a psychological or social diagnosis is made is not related to the GP's objective or subjective workload. CONCLUSION: The GP's attention for a patient's mental health problems is not related to their workload. The GP's extra workload when dealing in a consultation with patients' mental health problems, as is demonstrated in earlier research, is not automatically translated into a higher overall workload. This study does not confirm GPs' complaints that mental health care is one of the components of their job that consumes a lot of their time and energy. Several explanations for these results are discussed.

The workload of GPs: consultations of patients with psychological and somatic problems compared.

BACKGROUND: GPs report that patients' psychosocial problems play a part in 20% of all consultations. GPs state that these consultations are more time-consuming and the perceived burden on the GP is higher. AIM: To investigate whether GPs' workload in consultations is related to psychological or social problems of patients. DESIGN OF STUDY: A cross-sectional national survey in general practice, conducted in the Netherlands from 2000-2002. SETTING: One hundred and four general practices in the Netherlands. METHOD: Videotaped consultations (n = 1392) of a representative sample of 142 GPs were used. Consultations were categorised in three groups: consultations with a diagnosis in the International Classification of Primary Care chapter P 'psychological' or Z 'social' (n = 138), a somatic diagnosis but with a psychological background according to the GP (n = 309), or a somatic diagnosis and background (n = 945). Workload measures were consultation length, number of diagnoses and GPs' assessment of sufficiency of patient time. RESULTS: Consultations in which patients' mental health problems play a part (as a diagnosis or in the background) take more time and involve more diagnoses, and the GP is more heavily burdened with feelings of insufficiency of patient time. In consultations with a somatic diagnosis but psychological background, GPs more often experienced a lack of time compared to consultations with a psychological or social diagnosis. CONCLUSION: Consultations in which the GP notices psychosocial problems make heavier demands on the GP's workload than other consultations. Patients' somatic problems that have a psychological background induce the highest perceived burden on the GP.

The workload of GPs: patients with psychological and somatic problems compared.

BACKGROUND: GPs state that patients with mental problems make heavy demands on their available time. To what extent these perceived problems correspond with reality needs more investigation. OBJECTIVES: To investigate the effect of patients with psychological or social diagnoses on GP's workload, expressed in time investments. METHODS: Data were derived of a cross-sectional National Survey in General Practice, conducted in The Netherlands in 2000-2002. For a year, all patient contacts with a representative sample of 104 general practices were registered. Patients diagnosed with one or more diagnoses in ICPC (International Classification of Primary Care) chapter 'Psychological' or 'Social' (n = 37,189) were compared to patients with only somatic diagnoses (n = 189,731). A subdivision was made in diagnoses depression, anxiety, sleeping disorders, stress problems, problems related to work or partner and 'other psychological or social problems'. Workload measures are the consultation frequency, number of diagnoses and episodes of illness of the patients involved. RESULTS: Patients in all categories of psychological or social problems had almost twice as many contacts with their general practice as patients with only somatic problems. They received more diagnoses and more episodes of illness were shown. Patients with psychological or social diagnoses also contacted their general practice about their somatic problems more frequently, compared to patients with only somatic problems. CONCLUSION: Patients with psychological or social problems make heavy demands on the GP's workload, for the greater part due to the increase in somatic problems presented.