国际戒烟热线综述

戒烟热线是国际上广为采用的一种有效咨询服务方式。本文就国际戒烟热线的建立、宣传和运作等进行综述,以期为建立符合我国国情的热线咨询模式提供借鉴。1戒烟热线的服务种类戒烟热线通过各种方式为吸烟者提供多种戒烟服务[1],包括人工和语音咨询服务,在回答电话时当场给予一次     

移动医疗在戒烟干预中应用的研究进展CSCD

我国烟草流行形势严峻, 已有的戒烟干预可及性低, 大多数吸烟者并未获得有效的戒烟支持。移动医疗技术具有干预覆盖面广、节约成本、功能多样等优势, 在控烟及临床戒烟领域展现出巨大的潜力。本文从移动戒烟的概述、类型及效果等方面进行总结, 回顾了短信、网络及智能手机应用程序在戒烟干预中应用的研究现状, 以期为今后的控烟探索与实践提供参考。     

青少年戒烟影响因素及戒烟干预

吸烟会严重损害青少年呼吸系统和心血管系统的发育,会加速其成年后慢性病的发生。帮助青少年吸烟者戒烟对于保护青少年健康及降低未来的人群吸烟率均具有重要现实意义。虽然国外对青少年戒烟的影响因素和干预措施已有较多研究探索,但国内研究相对较少,尤其是戒烟干预尚处于起步阶段,亟需加强研究与实践。本文从个人、家庭、学校和社会等多个层面综述了国内外影响青少年戒烟的因素,梳理了现有针对青少年的戒烟干预方法,以期为后续相关研究提供参考。     

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。     

简短戒烟干预知识

1．何谓“简短戒烟干预”简短戒烟干预是指在日常的诊疗服务中,医务工作者为吸烟者提供的简短的专业戒烟建议和帮助。简短戒烟干预的基本要点是根据吸烟者所处行为转变的不同时期分别给予不同的戒烟建议和帮助。如果吸烟者尚未开始戒烟,医务工作者主要是进行简短的戒烟动机干预,鼓励其考虑成烟。一旦吸烟者决定开始戒烟,医务工作者则为其提供简短的戒烟建议和帮助。医务工作者还可以根据吸烟者的具体情况。决定是否将其转诊到戒烟门诊或者戒烟热线,与戒烟门诊和戒烟热线构成立体的网络,帮助吸烟者戒烟。整个简短戒烟干预的过程持续3～5分钟。     

戒烟干预模式及方法研究的国内外进展

正吸烟是当今世界最严重的公共卫生问题之一,是癌症、心血管病和呼吸系统疾病第1位可预防的死亡危险因素。2008年世界卫生组织(WHO)全球烟草流行报告指出,20世纪已有1亿人死于烟草流行,每年因烟草导致的死亡达540万人,是结核、艾滋病和疟疾的总和,而戒烟可降低患病和死亡的风险[1-3]。由于烟草依赖是一种慢性、依赖性疾病,戒烟过程中,戒断症状重、复吸率高、常常需要反复干预和多种戒烟尝试。因此,除了积极宣传吸烟危害和戒烟益处、为吸烟者提供     

综合性医院开展戒烟干预方法研究的设计和初步结果

为探索综合性医院开展戒烟干预的方法并评价其效果,采用戒烟门诊专科干预、简单干预、义诊干预和集体干预等模式对不同吸烟人群进行包括健康咨询、心理干预和药物治疗等不同形式及内容的戒烟干预,以统一规范的指标和方法评价干预效果.在项目实施的20个月中,共对690名吸烟者进行干预,对其中402名完成6个月随访的干预对象进行的初步统计分析发现:目前已完成的戒烟门诊专科干预、集体干预和戒烟义诊时的简单干预3种模式均有一定干预效果,吸娴者的吸烟量有不同程度下降,吸烟者戒烟的动机、医生采用的干预模式及强度是影响干预效果的主要影响因素;戒烟门诊专科干预和集体干预的效果优于戒烟义诊的简单干预,其6个月随访时的时点戒烟率分别为31.6%、30.9%和15.1%.戒烟者的戒烟动机和医生的态度、戒烟方法的选择及干预技能水平对戒烟成功率影响较大,因此探索适合国情的戒烟服务模式及个体化干预方法十分必要.

Abstract：

To study the intervention programs on smoking cessation in a general hospital and to evaluate its effects of the programs. Four methods including: a) the intervention through specialists in the smoking cessation clinic, b) short-time intervention in the out-patient department,c) free medical intervention, d) group intervention, were adopted for different smokers, with health counseling, psychological intervention and drug treatment. Intervention effect was evaluated by standard methods. During the 20-month period of the project, we treated 690 cases and 402 completed 6-month follow-up. Preliminary results in 402 cases showed that the three methods of smoking cessation interventions could reduce the amount of cigarette smoking and increase the quitting rate. Motivation to quit smoking, intervention methods and intensity of intervention seemed cessation clinic (31.6%) and in the group intervention (30.9%) was higher than short-time intervention in free medical events (15.1%). The successful rate of smoking cessation depended on the motivation of quitters, and the attitude, methods and intervention skills of the physicians.Therefore, it is necessary to explore and develop smoking cessation service models suitable to national context and individual intervention methods in China.     

简短戒烟干预研究的Meta分析

目的 采用Meta分析评价简短戒烟干预的有效性.方法 计算机检索2000年1月至2014年9月中外生物医学数据库(The Cochrane Library、Medline、EMbase、中文期刊全文数据库、万方电子期刊数据库、维普中文科技期刊数据库和中国生物医学文献数据库)中有关简短戒烟干预随机对照试验,采用Revman 5.1软件进行Meta分析.结果 最终纳入9篇文献,随机效应模型合并RR值(95%CI)=1.57(1.01～2.44) .与未进行干预的吸烟者相比,接受了简短戒烟干预的吸烟者,其戒烟的可能性提高了57%.研究对象为孕妇和就诊患者,干预时间≤10 min的亚组更易戒烟,但各亚组分析结果之间的差异均无统计学意义.结论 简短戒烟干预可提高戒烟率,但该结论尚需纳入更多高质量大样本的随机对照试验加以证实.     

社区戒烟干预理论概述

通过对近几十年国内外以社区为基础开展戒烟干预研究的文献进行分析汇总,介绍根据不同理论框架开发的戒烟措施在社区应用的效果。针对中国严峻的烟草流行形势和现有戒烟服务的不足,探讨其在降低中国人群吸烟率中的应用前景,以期为国内开展社区戒烟干预研究的理论框架和实践应用提供参考。     

戒烟干预对吸烟者知识、态度和行为的影响

目的 评价戒烟干预对戒烟门诊求助者烟草相关知识、态度和行为(知、信、行)的影响。方法 以2008年10 月至2013 年8月解放军总医院戒烟门诊就医的未使用戒烟药物的吸烟者为研究对象,戒烟门诊医师首诊时为吸烟者进行≥30 min的面对面咨询和心理干预,之后1周、1个月、3个月和6个月时共进行4次随访电话干预(每次15～20 min).对照组为2012 年8月至2013 年8月解放军总医院健康医学中心某病区常规查体的吸烟者,基线和随访时均不进行干预。比较基线和1年随访时干预组和对照组烟草相关知、信、行的变化情况。结果 干预组和对照组分别纳入414例和213例研究对象。意向性分析显示,干预组1年随访烟草相关知、信方面共有5个变量的知晓/同意率高于基线。两组的1年随访时点戒烟率分别为4.7%和27.3%.logistic 多元回归分析显示,1年随访时戒烟率与暴露于戒烟干预、女性、尼古丁依赖评分低和烟草相关知识及态度正向变化(吸烟导致心脏病、应该禁止各种形式的烟草产品推广、吸烟浪费金钱和酒楼、饭店应该全面禁烟)共7个变量呈正相关,其OR值(95%CI)分别为2.85(2.00～4.07)、3.34(1.23～9.07)、2.78(1.64～4.72)、2.30(1.03～5.15)、5.33(1.47～19.32)、6.32(1.56～25.62)和10.47(2.25～48.84).结论 戒烟门诊求助者的烟草危害认知水平普遍较高,通过系统化戒烟干预,部分吸烟者知识及态度有了一定提高。烟草相关知识及态度的有益转变,有利于提高戒烟率。     

戒烟药物研究进展

烟草危害人类健康,戒烟已经迫在眉睫。国际公认的戒烟药物有7种,包括5种尼古丁替代制剂、安非他酮缓释剂和伐尼克兰。尼古丁替代疗法是用纯净医用尼古丁代替烟雾中吸入的尼古丁;安非他酮缓释剂是种氨基酮类抗抑郁剂。通过增加中枢NE、5-HT及DA含量,两者都可减少戒断症状。伐尼克兰是种选择性烟碱受体部分激动剂,可竞争性的与α4β2尼古丁乙酰胆碱受体结合但部分激活受体,引起减半的受体应答效应,从而起到降低吸烟渴求和减少戒断症状的发生。对目前的戒烟药物现状作一综述。     

天津市居民吸烟及戒烟状况调查分析

目的：了解天津市居民吸烟状况、戒烟想法及戒烟方法的应用,为有针对性地在居民中开展健康教育活动提供依据,同时为制定相关控烟政策提供基础数据。方法使用 PPS 法(按规模大小成比例的概率抽样)在每个区抽取3个街道,共计16个区。使用 PPS 在每个街道抽取2个居委会抽样单位,采用随机抽样方法在每个居委会抽取70个家庭户,每个家庭户采用 KISH 表抽取1名调查对象,每个居委会完成50份调查问卷。结果男性现在吸烟率为42.35%,女性现在吸烟率为10.32%,男性吸烟率高于女性(χ2=760.956,P <0.05),不同文化程度居民吸烟率差异有统计学意义(χ2=95.605,P <0.05)。男性与女性现在吸烟者戒烟意愿差异无统计学意义(χ2=2.959,P >0.05),不同吸烟量的现在吸烟者戒烟意愿差异有统计学意义(χ2=30.434,P <0.05),随着吸烟者吸烟量的增大,想戒烟的比例也在逐渐降低。89.18%现在吸烟者选择靠自己毅力戒烟,7.06%选择拨打戒烟热线。在过去12个月,有42.25%医护人员建议吸烟者戒烟。非吸烟者对主动吸烟及吸入二手烟的危害知晓率高于吸烟者,有戒烟想法的人主动吸烟及吸入二手烟的危害知晓率高于吸烟者。结论应积极开展控烟工作,有针对性地对男性、女性吸烟者开展控烟干预工作,加大戒烟门诊、戒烟热线的宣传,提高医务人员的戒烟知识和戒烟技巧,广泛宣传主动吸烟与被动吸烟的危害,同时政府部门加强控烟法律执行力度,保证人民群众不受二手烟的危害。     

The Effect of Cigarette Price Increases on Smoking Cessation in California

We investigated whether smoking cessation increased in California after a cigarette manufacturer’s retail price increase and an increase in the state cigarette excise tax. The sample for this study was drawn from the 1996 and 1999 California Tobacco Surveys. The rate of unsuccessful and successful quit attempts and the rate of abstinence were calculated for each month of the 14-month period preceding each survey administration. We combined the monthly rates for both surveys and used multiple regression modeling to test whether the proportion of smokers reporting a quit attempt and the proportion of smokers reporting abstinence increased during the period following the price increases. We included several covariates in our models to control for factors other than the price increases that could account for any increases observed in quit attempts and abstinence. Because smokers recall quits occurring closer to the date of the survey better than quits occurring further back in time, we included a term in the models representing the number of months elapsed between the survey administration and the reported quit. We also included terms in the models representing the months before and after the over-the-counter (OTC) availability of the nicotine patch and nicotine gum in 1996 to control for the increase in smoking cessation observed following the availability of OTC nicotine replacement therapy (NRT). Lastly, in order to control for increased quits made in January as a result of New Year’s resolutions, we included a term in our models for quit attempts and successful quits (abstinence) made during this month. Results of the regression analyses indicated a significantly greater proportion of smokers reported quit attempts (p < 0.05) in the months immediately following the cigarette price increases (after November 1998); however, a significant increase in abstinence was only observed from December 1998 through March 1999 (p < 0.05) relative to abstinence occurring before the price increases.     

The Chinese Community Smoking Cessation Project: A Community Sensitive Intervention Trial

This paper describes (1) the design, methods and baseline data of the first smoking cessation clinical trial for Chinese Americans with medical conditions - Chinese Community Smoking Cessation Project (CCSCP); (2) the collaborative process between researchers and the Chinese community; and (3) the barriers and facilitators of implementing the study. CCSCP was a culturally tailored, randomized, smoking cessation trial testing the efficacy of an intensive (physician advice, in-person counseling with nicotine replacement therapy, 5 telephone calls) compared to a minimal (physician advice and self-help manual) intervention. The study applied a community-sensitive research method involving community members in all phases of the research process in San Francisco Bay Area during 2001–2007. CCSCP recruited 464 smokers from health care facilities (79%) located in Chinese neighborhoods and through Chinese language media (21%). Baseline assessments and interventions were conducted in-person using translated and tested questionnaire and intervention materials. The majority of the participants were men (91%) with a mean age of 58.3 years, foreign born (98%), with less than high school education (58%), spoke no English (42%) and in non-skilled or semi-skilled occupations (60%) with <$20,000 household income (51%). Participants smoked regularly on an average 38.6 ± 17 years, smoked 9.1 ± 8 cigarettes per day and 85% smoked daily. Cultural tailoring of recruitment methods and intervention design led to successful enrollment and retention of participants, overcoming barriers faced by the participants. Community sensitive collaborative process facilitated implementation of study protocol in community health care settings.     

Predictors of Cigarette Smoking Cessation in Adolescents: A Systematic Review

PurposeTo update a systematic review published in 2012 that identified predictors of cigarette smoking cessation among adolescents.MethodsThe PubMed and Web of Science databases were searched for relevant articles published between September 2010 and January 2018, using the following keywords: smoking OR tobacco OR cessation; quit OR stop; longitudinal OR prospective OR cohort. Our search identified 3,399 articles. Inclusion criteria included longitudinal studies (intervention and cohort studies) evaluating cigarette smoking cessation in young people (aged 10–24 years). After screening, in total, 34 articles were included in the review.ResultsIn total, 63 predictors of smoking cessation among adolescents were identified, with 36 new predictors that were not identified in the previous review: nine sociodemographic factors, 13 psychosocial factors, five behavioral factors, 19 social influences factors, eight smoking related variables, six environmental factors, 2 health related variables, and one genetic factor.ConclusionsTo increase the probability of successful smoking cessation, strategies targeting young smokers should consider both individual and environmental predictors of cessation.     

Helping Smokers Quit: Understanding the Barriers to Utilization of Smoking Cessation Services

Context: Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost‐effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation. Methods: Review of literature and discussions with representatives of stakeholders. Findings: All stakeholders—health plans, employers, clinicians, smokers, and the government—face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places. Conclusions: Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.     

戒烟对慢性阻塞性肺疾病患者肺功能和生活质量的影响

目的探讨戒烟对慢性阻塞性肺疾病(COPD)患者肺功能和生活质量的影响。方法对2008年12月-2009年12月在承德医学院附属医院呼吸科接受诊治的吸烟的COPD患者实施医生"劝导戒烟干预",干预时间为2个月。根据戒烟成功与否,将其分为戒烟组(36人)、吸烟组(28人),同期接受诊治的有吸烟史但已戒烟2年以上的COPD患者为曾吸烟组(26人),每隔3个月检测其第一秒呼气容积(FEV1)、用力肺活量(FVC)、呼气峰值流速(PEF),12个月后采用CAT评定量表对其生活质量进行测定。结果随访3个月后,戒烟组一氧化碳血红蛋白结合百分比(COHb%)较入组(0个月)时显著降低(P<0.05)。FEV1、FVC在各时间点戒烟组和吸烟组均高于曾吸烟组,差异有统计学意义(P<0.05)。随访12个月时,戒烟组FEV1、FVC均高于吸烟组,但差异无统计学意义;PEF较0个月时增高37ml,差异有统计学意义(P<0.05)。CAT显示,吸烟组痰量高于戒烟组和曾吸烟组(P<0.05)。结论戒烟可以提高COPD患者FEV1、FVC、PEF及其生活质量。     

Smoking Cessation Counseling Practices of Texas Pharmacists

A cross-sectional study was conducted to determine pharmacists’ awareness and education about smoking cessation and their communication with patients about smoking cessation. A survey was mailed to East Texas pharmacists practicing in the areas of hospital or clinical, retail or community, managed care, consultant, or academic pharmacy. Outcome measurements included: measures of the awareness of the 5 A’s and 5 R’s of smoking cessation, training received in smoking cessation, and communication practices regarding smoking cessation. There were 320 respondents. Approximately 10% of the respondents indicated they had received tobacco cessation counseling education during their formal educational training, 36% during continuing education programs, and 9% during both formal training and continuing education. About 44% reported they had received no tobacco cessation counseling training. Among pharmacists surveyed, 5% responded that they usually or always ask their patients if they smoke cigarettes, pipe, or cigars, 43% reported they sometimes or half of the time ask, and 45% said they never ask. There is a clear relationship between pharmacists awareness and education of smoking cessation techniques and their communication with patients about them. Pharmacy education leaders must continue their movement to include public health in the pharmacy curricula to produce pharmacists who are prepared to better serve the community. This project was funded by a grant from the Texas Department of State Health Services.     

基质金属蛋白酶-9及其组织抑制因子在戒烟大鼠肺组织中的表达

目的　研究基质金属蛋白酶 -9(MMP -9)及其组织抑制因子 -1(TIMP -1)在戒烟大鼠肺组织中的表达及可能作用机制。方法　建立吸烟肺气肿大鼠模型 ,5 0只雄性Wistar大鼠 ,随机分为 4月、6月对照组和吸烟 4月、6月组、戒烟组 (每组 10只 ) ,用原位杂交和免疫组化等方法观察肺组织基质金属蛋白酶 -9(MMP -9)、金属蛋白酶组织抑制因子 -1(TIMP -1)的mRNA及蛋白的表达 ,用免疫组化法观察IV型胶原在肺内的表达。结果　与相应的对照组相比 ,吸烟 4、6月组MMP -9、TIMP -1在肺组织表达均显著上升 ( P <0 0 1) ;与吸烟 4月组相比 ,戒烟组肺组织MMP -9mRNA及蛋白的表达均明显减少 ( P <0 0 5 ) ,而TIMP -1表达明显上升 (P <0 0 5 ) ,IV型胶原表达增加 (P <0 0 5 ) ;与吸烟 4月组相比 ,戒烟组血气分析改善。结论　戒烟能阻止阻塞性肺气肿进一步发展 ,可能通过抑制MMP -9和增强TIMP -1表达发挥作用