计划行为理论在吸烟男性戒烟行为干预中的应用

目的探讨计划行为理论(TPB)在吸烟男性戒烟行为干预研究中的应用效果,为不同人群控烟干预积累经验。方法应用TPB设计调查问卷,在生活环境、经济水平等因素相似的2个社区选取吸烟男性进行问卷调查,找出吸烟男性戒烟行为的影响因素,以此拟定干预策略和方案。对照组不进行任何干预,干预组接受半年的社区控烟宣传、戒烟讲座、家庭成员督促教育、社区戒烟公约制定等基于TPB的针对性干预。结果干预后干预组较对照组在戒烟相关行为态度、主观规范和知觉行为控制方面有明显改善,有戒烟意向者从20%提升至40%,认为自己戒烟能成功者从10%提升至26%,差异均有统计学意义(均P0.05)。结论 TPB是吸烟男性戒烟行为的主要影响因素,针对性的干预能有效提高吸烟男性戒烟行为的尝试。     

基于社会认知理论的小组戒烟干预效果的2年随访评价

目的评价社会认知理论指导下的"我能戒烟"小组式戒烟方法的长期效果。方法通过社区动员征集217名吸烟者进行以社会认知理论为指导的小组式戒烟干预,并在干预完成半年、2年后对研究对象进行随访,评价干预效果。结果干预2年后生化验证的戒烟率为32.3%,戒烟成功率为15.2%。患吸烟相关疾病、自我效能的变化以及家庭无烟政策与2年后是否戒烟有关。结论"我能戒烟"小组式戒烟法是一种有效的戒烟方法,适于在社区推行。     

“我能戒烟”培训干预效果评价

目的:探索社会认知理论指导下的“我能戒烟”小组式戒烟方法,评价干预效果。方法:通过社区动员征集119名吸烟者进行以社会认知理论为指导的小组式戒烟干预,并在干预完成半年、一年后对研究对象进行随访,评价干预效果。结果:一年后学员的戒烟率维持在37.3%,每日吸烟量平均减少了11支,学员的戒烟意愿普遍提高;自我效能有明显提高。对吸烟危害的认识和缺乏毅力分别为学员自我总结的戒烟成功和失败最重要的原因。Logistic回归分析显示,基线时对自己戒烟成功的预测成为是否戒烟的影响因素。结论:“我能戒烟”小组式戒烟法是一种行之有效的方法,值得在社区推广。     

北京市肿瘤防控示范社区患者戒烟干预研究

目的:探索社区门诊简短戒烟干预和热线戒烟干预相结合的戒烟模式。方法:社区医生采用2A+R模式对吸烟患者进行简短戒烟干预,并将患者转诊至北京12320卫生热线进行戒烟干预。结果:社区转诊患者烟龄较长、重型吸烟者多、成功戒烟者少,在过去一年尝试过戒烟的患者的2周戒烟率(34.0%)高于未尝试过戒烟的患者(23.2%),主动寻求戒烟干预服务患者的2周时点戒烟率(60.0%)高于被动接受戒烟干预服务的患者(27.2%),差异均有统计学意义(P0.05)。结论:可采用社区门诊简短戒烟干预和北京12320卫生热线戒烟干预模式为吸烟患者提供戒烟帮助。     

四城市开展戒烟热线服务的效果评价

目的评价戒烟热线的有效性。方法使用中国戒烟热线咨询方案在中国四城市中开展电话戒烟干预。共干预226例研究对象,成功评价137例。结果干预完成1个月后对研究对象进行效果评价。结果显示,通过电话戒烟干预的1个月戒烟率为27.4%,尝试戒烟率为70.2%。未戒烟者的吸烟行为变化显著,每日吸烟支数均值从19.4支下降到13.8支,干预前后变化差异有统计学意义(Z=4.807,P0.05);吸烟强度指数(HSI)均值由2.3下降1.6,干预前后变化差异有统计学意义(Z=8.148,P0.05)。结论戒烟热线能够有效地帮助吸烟者戒烟。     

中国／WHO控烟能力建设社区子项目上海地区一年效果评估

目的　评价中国/WHO控烟能力建设合作项目(社区控烟子项目)在上海市长宁区新华街道社区居民控烟能力建设实施一年的效果,探索今后社区的控烟方法。方法　按照中国/WHO控烟能力建设合作项目(社区控烟子项目)总体安排,统一问卷、统一时间,按照人口2 %的样本量随机抽取2 0～6 0岁社区居民,对其烟草使用和控烟方面的知识、态度和行为及对戒烟服务的需求和获得情况进行了调查与分析。结果　社区男性居民吸烟率高于女性,干预前后居民吸烟率分别为35 1%和4 2 8% ,干预期间社区居民男性吸烟人群戒烟成功率为10 6 % ,以5 5岁以上年龄段、离退休人员、大专以上学历、家庭人均月收入>2 5 0 0元人群中戒烟成功率最高。戒烟失败的主要原因是缺乏意志力,其次是来自周围吸烟者的影响;84 %以上的调查对象都认为吸烟、被动吸烟有害健康,且吸烟者、不吸烟者、戒烟者正确认知率依次增高;干预后男性调查对象劝阻朋友或家人吸烟、表示戒烟后永不吸烟比干预前有明显提高(P <0 0 1) ,且能主动寻求戒烟服务(P <0 0 5 ) ;去治疗机构就医时医务人员主动向男性调查对象介绍戒烟方法和技巧干预后多于干预前(P <0 0 1) ,有显著性差异。结论　对新华街道社区居民实施控烟教育与培训等综合性措施是有效的,提升了社区居民的控烟能     

三城市社区小样本吸烟行为的干预研究

为了减少城市社区人群的吸烟率 ,提高吸烟人群的KAP水平 ,1 997～ 1 999年在北京、上海和长沙三个城市社区小样本中开展吸烟行为干预的研究 ,以寻找预防心脑血管疾病更为有效的干预措施。在三城市社区筛查出的小样本中开展大众传播和人际传播等综合干预措施。对社区小样本每年进行 4次随访 ,并测定唾液中硫氰酸盐浓度来监测他们吸烟行为的改变。结果显示 :(1 )干预 2年后 ,北京、上海和长沙三城市社区小样本的戒烟率分别为 2 1 51 %、2 5 90 %和 1 8 56 %。 (2 )吸烟者的KAP水平较干预前有了明显的提高。因此 ,在三城市社区小样本中开展吸烟行为的强化干预措施和方法是有效而可行的     

组织改变理论在工厂戒烟干预中的应用研究

目的探索组织改变理论模型在中国工厂戒烟干预应用的可行性和效果。方法于2008～2009年对上海市两家工厂进行对照研究。对照组246人(男204,女42),平均年龄(34.7±13.2)岁,干预组233人(男203,女30),平均年龄(31.1±11.9)岁。将组织改变理论模型的4个阶段应用到干预组的戒烟干预中。分别在干预前和干预后,以问卷调查表的形式收集员工每日吸烟量、吸烟率、危害认知和戒烟意愿等方面的改变。在干预6个月后以戒烟者尿液中可的宁浓度的生物学检测判定是否成功戒烟。结果干预组的现在吸烟率由干预前的59.8%下降到干预后的39.1%(P<0.01),每日吸烟量由(15.0±8.6)支/天下降到(11.9±7.9)支/天(P<0.01)。对照组则无显著改变;干预组吸烟者中愿意接受同事戒烟帮助的比例由干预前的3.7%上升到干预后的15.6%(P<0.01),认为吸烟对健康有严重危害的比例也由干预前的36.5%上升到干预后的64.4%(P<0.05),对照组则均无显著改变(P>0.05);干预组吸烟者中打算在1个月内戒烟的比例由干预前的11.0%提高到干预后的41.5%(P<0.01),而对照组则无显著改变(8.5%vs9.5%);干预组和对照组6个月的戒烟成功率分别为24.6%和6.4%(P<0.01)。结论组织改变理论模型在中国工厂开展戒烟干预中的应用是可行的;该模型的应用对降低工人的吸烟率和每日吸烟量,提高吸烟者的戒烟意愿是显著的,6个月的戒烟成功率也显著提高。     

综合干预对杭州市社区医务人员提供戒烟咨询的效果及影响因素分析

目的 评价综合干预对社区医务人员提供戒烟咨询的短期效果及影响因素.方法 以杭州市下城区和拱墅区作干预区,开展为期2年的综合吸烟干预,西湖区为对照区,干预前后采用问卷调查戒烟资源、准备情况及实际行动,评价干预效果.采用logistic回归分析戒烟干预的影响因素.结果 干预区299人,对照区141人,吸烟率均约5％.(1)戒烟资源:干预前后,干预区获取种类分别为2、3种,利用种类分别为1、3种,干预前后差异有统计学意义(均P＜0.001),对照区获取及利用种类均呈下降趋势.(2)准备情况:干预区准备好戒烟咨询的比例在干预前后分别为35.5％、52.0％,干预前后差异有统计学意义(P＜0.001),对照区前后分别为28.1％、39.3％,干预前后无统计学意义(P=0.162).(3)实际行动,干预区能对≥90％的患者提供戒烟咨询的医务人员比例呈小幅上升趋势,而对照区呈下降趋势,差异均无统计学意义.准备情况的改善有助于提高医务人员询问患者吸烟状况的比例(调整OR=1.43,P=0.007).结论 综合干预可一定程度增加社区医务人员戒烟培训及戒烟资源的获取机会和利用水平,改善其提供咨询的准备心态,但并不能显著改善其提供戒烟咨询服务的行为,需考虑建立配套机制,切实促进行为改善.     

戒烟方法的循证医学证据

[目的]了解日前戒烟方法的实际效果,以供戒烟者及指导戒烟者参考. [方法]复习全世界所有戒烟方法的相关研究,对Coehrane系统评价进行总结. [结果]证实有效的戒烟方法有:尼古丁替代疗法、1月以上的住院干预、个体电话咨询、对青少年戒烟的多种方法联合使用.面醋酸银、催眠及针刺疗法、社区干预和单纯防止向未成年人出售烟草等对戒烟无效.另外,医护人员的劝导、社会药房提供的咨询、传媒干预、行为治疗、厌恶疗法、锻炼疗法、可乐定和美加明等也可能有效,但需要进一步研究证实.[结论]有效的戒烟,需要高质量的循证医学证据支持下的多方法联合应用,同时需要社会各部门共同的努力.     

General practitioners' views on and referral to NHS smoking cessation services

OBJECTIVES: Increasing the rate of smoking cessation remains a major public health goal. To help achieve this in the UK, National Health Service (NHS) smoking cessation services have been established to provide treatment for smokers wanting help with stopping. Referrals from general practitioners (GPs) are crucial to the success of these clinics. This study aimed to assess English GPs' self-reported interactions with, and attitudes towards, their local smoking cessation services. STUDY DESIGN: Postal survey assessing the attitudes of GPs in England towards, and formal interactions with, NHS smoking cessation services. METHODS: A questionnaire was posted to a random sample of 544 GPs in England (response rate 63%). GPs' self-reported interactions with smoking cessation services and their attitudes towards these clinics were assessed. GPs were also asked what factors determined whether they prescribed nicotine-replacement therapy (NRT) and Buproprion (Zyban), and what was the extent and nature of their smoking cessation interventions with their patients. RESULTS: Most GPs (94%) reported that they were aware of the specialist smoking cessation service in their area. Seventy percent of GPs supported the continuation of current funding for specialist smoking cessation services. Seventy percent reported that they referred patients to these services, and 55% had staff within their practices trained as community smoking cessation advisors. Most GPs (79%) reported 'clinical need' as a determinant of whether they prescribed NRT/Zyban, and a few GPs cited 'budgetary constraints' as a factor (15%). Ninety-eight percent of GPs reported that they record smoking status when new patients join their practice, and they advise smokers to stop 'at least every now and then'. CONCLUSIONS: GPs support the existence and continuation of specialist smoking cessation services, and most reported that they refer patients to them. Virtually every GP reported that they record smoking status when new patients join their practice, and they advise smokers to stop 'at least every now and then'.     

Minimal smoking cessation interventions in prenatal, family planning, and well-child public health clinics

OBJECTIVES: This study assessed the prevalence and effectiveness of smoking cessation interventions for women of childbearing age in public health clinics. METHODS: Smokers in prenatal, family planning, and well-child services in 10 public health clinics (n = 1021) were interviewed 5 to 8 weeks after a medical visit to assess their exposure to smoking cessation interventions and smoking cessation outcomes. RESULTS: Depending on clinic service and intervention component (poster, video segment, provider advice, booklet), 16% to 63% of women reported exposure to an intervention component during their visit. Women in prenatal services received more interventions and had better outcomes than those in the other services. CONCLUSIONS: Exposure to more interventions increased readiness and motivation to quit and the number of actions taken toward quitting.     

Quitting smoking and experience of smoking cessation interventions among UK Bangladeshi and Pakistani adults: the views of community members and health professionals

OBJECTIVE: To explore attitudes to quitting smoking and experience of smoking cessation among Bangladeshi and Pakistani ethnic minority communities. DESIGN: Qualitative study using community participatory methods, purposeful sampling, interviews and focus groups, and a grounded approach to data generation and analysis. SETTING: Newcastle upon Tyne, UK, 2000-2002. PARTICIPANTS: 53 men and 20 women aged 18-80 years, including smokers, former smokers, and smokers' relatives, from the Bangladeshi and Pakistani communities; and eight health professionals working with these communities. RESULTS: Motivation to quit was high but most attempts had failed. "Willpower" was the most common approach to quitting. For some, the holy month of Ramadan was used as an incentive, however few had been successful in quitting. Perceived barriers to success included being tempted by others, everyday stresses, and withdrawal symptoms. Few participants had sought advice from health services, or received cessation aids, such as nicotine replacement therapy (NRT) or buproprion. Family doctors were not viewed as accessible sources of advice on quitting. Health professionals and community members identified common barriers to accessing effective smoking cessation, including: language, religion and culture; negative attitudes to services; and lack of time and resources for professionals to develop necessary skills. CONCLUSIONS: High levels of motivation do not seem to be matched by effective interventions or successful attempts to quit smoking among Bangladeshi and Pakistani adults in the UK. There is a need to adapt and test effective smoking cessation interventions to make them culturally acceptable to ethnic minority communities. UK tobacco control policies need to give special attention to the needs of ethnic minority groups.     

Systematic review of the effectiveness of community pharmacy-based interventions to reduce risk behaviours and risk factors for coronary heart disease

BACKGROUND: The aim of the study was to provide a critical and comprehensive overview of the published peer-reviewed evidence relating to community pharmacy-based activity in the reduction of risk behaviours and risk factors for coronary heart disease (CHD). METHOD: Electronic databases were searched from 1 January 1990 to 1 February 2001. Hand searches for the same period were undertaken of specific journals and proceedings of peer-reviewed conference abstracts. Data abstracted from publications included: participants/setting; study designs intervention including training); outcome measures; key findings. RESULTS: Four randomized controlled trials (RCTs) were identified, two in smoking cessation and two in lipid management. All met review criteria and were included. Two (RCTs) involving 976 subjects and three non-randomized experimental studies were identified that evaluated the effectiveness of community pharmacy advice in smoking cessation. Two controlled trials and one before-and-after study investigated the effect of training on pharmacists' smoking cessation advice. One attitudinal survey collected data on reactive and proactive smoking cessation advice-giving by community pharmacists. Two RCTs involving 642 subjects, and two observational studies were identified for community pharmacy-based lipid management. The published studies provided evidence of clinical and cost-effectiveness of community pharmacy services from UK RCTs in smoking cessation, and from US and Canadian RCTs in lipid management in the prevention of heart disease. Although the role of the community pharmacy in disease detection and case finding has been widely discussed, only a small number of studies was found. The findings indicated that further investigation is warranted in these areas. CONCLUSION: The peer-reviewed literature demonstrates the contribution of community pharmacy-based services to the reduction of risk behaviours and risk factors for CHD. The evidence supports the wider provision of smoking cessation and lipid management through community pharmacies. Health commissioners and planners can use the findings of this review to incorporate community pharmacy based health development activities into local health services. Further research is needed into the contribution of community pharmacy to disease detection and case finding as part of local public health strategies.     

Development of Culturally Appropriate Support Strategies to Increase Uptake of Nicotine Replacement Therapy Among Russian- and Chinese-Speaking Smokers in New York City

Approximately 80,000 New York City smokers are Chinese or Russian speakers. To increase utilization of smoking cessation services among these populations, the Department of Health and Mental Hygiene developed linguistically and culturally tailored outreach strategies to promote and enhance its annual Nicotine Patch and Gum Program. In 2010, online web applications in Chinese and Russian were introduced. In 2011, input was sought from the community to develop Russian-language radio and newspaper ads, and a Russian-speaking liaison provided phone-assisted online enrollment support. In 2012, Chinese newspaper ads were introduced, and a Cantonese- and Mandarin-speaking liaison was hired to provide enrollment support. In 2010, 51 Russian speakers and 40 Chinese speakers enrolled in the program via web application. In 2011, 510 Russian speakers applied via the web application, with 463 assisted by the Russian-speaking liaison; forty-four Chinese speakers applied online. In 2012, 394 Russian speakers applied via the web application; 363 were assisted by the Russian-speaking liaison. Eighty-five Chinese smokers applied online via the web application; seventy were assisted by the Chinese-speaking liaison. Following the implementation of culturally tailored cessation support interventions, ethnic Russian smokers’ uptake of cessation support increased tenfold, while Chinese smokers’ uptake doubled. Although linguistically appropriate resources are an essential foundation for reaching immigrant communities with high smoking rates, devising culturally tailored strategies to increase quit rates is critical to programmatic success.     

Smoking cessation knowledge, attitudes, and practice among community health providers in China

BACKGROUND: The smoking prevalence is high (32.5%) among male providers in community health centers in Beijing, China. The majority of providers self reported that they advise patients to quit smoking, yet they have low expectations that their counseling is effective in helping patients to quit. Many have not received training on how to advise patients to quit, and half lack knowledge about nicotine replacement. These findings suggest that surveyed providers need more training in tobacco cessation services.     

Examining Smoking Cessation in a Community-Based Versus Clinic-Based Intervention Using Community-Based Participatory Research

Tobacco use remains a major public health problem in the U.S. disproportionately affecting underserved communities. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) initiative is an intervention to address the problem using a community-based participatory research (CBPR) approach. This study compares quit rates in a peer-led community-based intervention with those achieved in a clinical setting. The intervention consisted of three Phases. Phase I (n?=?404) was a clinic-based trial comparing two types of counseling. Phase II (n?=?398) and Phase III (n?=?163) interventions were conducted in community venues by trained Peer Motivators. Quit rates at 12-week follow-up increased from 9.4?% in Phase I (clinic-based) to an average of 23.7?% in Phases II and III combined (community-based). The main predictor of smoking cessation was delivery of services in community settings (OR 2.6, 95?% CI 1.7–4.2) while controlling for possible confounders. A community-based approach can significantly guide and improve effectiveness and acceptability of smoking cessation services designed for low-income urban populations. In addition, CBPR can result in better recruitment and retention of the participants.     

手机戒烟干预和网络戒烟干预的国际进展研究

提供戒烟帮助是控烟工作的重点之一。该文对国际上新显现的手机戒烟干预和网络戒烟干预的发展进行了总结,以期为我国的控烟工作提供借鉴支持。手机和网络戒烟干预方式的共同优势在于：无时间和地域性的限制,范围更广;规避了有些人不愿意面对面交流的忧虑,保护了咨询者的隐私;成本相对较低。二者在可及性、沟通效果、成本效益等方面则各有利弊。     

Tobacco Use and Interest in Smoking Cessation Among Latinos Attending Community Health Fairs

Health fairs are vital for reaching underserved Latinos providing access to health services including smoking cessation. The purpose of this study is to describe tobacco use and interest in smoking cessation among Latino smokers attending community health fairs. We surveyed 262 self-identified Latinos attending health fairs; we assessed smoking behavior and attitudes of 53 (20.2%) current smokers. Smokers were mostly uninsured (98.1%), male (54.7%), recent immigrants (96.2%) with limited English proficiency (60.4% spoke Spanish at home), and were mainly light (86.3%) and nondaily (58.7%) smokers. Although most participants attempted to quit smoking at least once in the past year, only 5.0% of current smokers reported ever using cessation medication and 94.3% were unaware of free-telephone counseling. The majority of smokers were ready to quit within 30 days and were interested in participating in cessation programs. Health fairs provide a unique opportunity to address smoking cessation among underserved Latinos with limited knowledge of access to, and use of effective cessation services.