Smoking, smoking cessation, and use of smoking cessation aids and support services in South Derbyshire, England

OBJECTIVES: To describe smoking behaviour, motivation to quit and quit rates, and the effect of advice and support for smoking cessation among smokers from more and less disadvantaged socio-economic groups in South Derbyshire, a mixed urban and rural area of central England. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study with a random, stratified sample of people aged 25-44 years and people aged 65-74 years with over-sampling of populations living in disadvantaged areas. Main outcome measures included the proportion of smokers wishing to quit and quitting in the last year; reported advice to quit from family and friends and health professionals; and awareness and use of NHS smoking-cessation services. RESULTS: Over half of smokers aged 25-44 years, about one-third of women smokers and 40% of male smokers aged 65-74 years wished to quit. This varied little by socio-economic status. Quit rates were generally lower among smokers of lower socio-economic status (SES), especially among people aged 25-44 years. Smokers of lower SES reported slightly less advice to quit from family and friends, and more so from health professionals. Awareness and use of cessation services was about 30% and 5%, respectively, among smokers and recent quitters. Awareness varied little but accessing services was generally higher among smokers of lower SES. CONCLUSIONS: Despite evidence that health professionals and cessation services were targeting smokers with lower SES and of similar motivation to quit, quit rates were lower. Broader tobacco control interventions targeting the social and environmental contexts that create and maintain socio-economic differentials in smoking are required.     

The effectiveness of covering smoking cessation services for medicare beneficiaries

Objective. To examine whether reimbursement for Provider Counseling, Pharmacotherapies, and a telephone Quitline increase smoking cessation relative to Usual Care. Study Design. Randomized comparison trial testing the effectiveness of four smoking cessation benefits. Setting. Seven states that best represented the national population in terms of the proportion of those ≥65 years of age and smoking rate. Participants. There were 7,354 seniors voluntarily enrolled in the Medicare Stop Smoking Program and they were followed‐up for 12 months. Intervention(s). (1) Usual Care, (2) reimbursement for Provider Counseling, (3) reimbursement for Provider Counseling with Pharmacotherapy, and (4) telephone counseling Quitline with nicotine patch. Main Outcome Measure. Seven‐day self‐reported cessation at 6‐ and 12‐month follow‐ups. Principal Findings. Unadjusted quit rates assuming missing data=smoking were 10.2 percent (9.0–11.5), 14.1 percent (11.7–16.5), 15.8 percent (14.4–17.2), and 19.3 percent (17.4–21.2) at 12 months for the Usual Care, Provider Counseling, Provider Counseling + Pharmacotherapy, and Quitline arms, respectively. Results were robust to sociodemographics, smoking history, motivation, health status, and survey nonresponse. The additional cost per quitter (relative to Usual Care) ranged from several hundred dollars to $6,450. Conclusions. A telephone Quitline in conjunction with low‐cost Pharmacotherapy was the most effective means of reducing smoking in the elderly.     

伐尼克兰辅助戒烟治疗有效性观察

目的评价伐尼克兰辅助戒烟治疗的有效性。方法研究对象为2008年12月—2012年12月在该院戒烟门诊就诊的吸烟者,将使用伐尼克兰治疗组56例与对照组68例做对照分析,观察开始治疗后6个月时持续戒烟率。结果 56例治疗组中1例因出现严重恶心、呕吐,1例出现胸闷、心率增快停止治疗,54例接受伐尼克兰治疗2~3个月,6个月随访结束时,29.6%的吸烟者已经持续戒烟;68例对照组6个月随访结束时,吸烟者持续戒烟率为10.3%。治疗组戒烟率为对照组的2.9倍,差异有统计学意义（χ^2=7.36,P〈0.01）。结论伐尼克兰能显著提高戒烟率,且安全性、耐受性好。     

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.     

2013-2014年安徽省成人吸烟和戒烟行为状况分析

目的 了解安徽省成人居民吸烟和戒烟行为状况,为制定烟草控制措施提供依据。方法 利用2013-2014年安徽省成人慢性病及其危险因素监测项目调查数据,使用事后分层权重调整和复杂抽样设计方法进行统计分析。结果 有效样本量为7 182人,现在吸烟率为26.2%（95% CI：23.9%~28.4%）,男性高于女性,分别为51.2%（95% CI：45.5%~56.8%）和1.4%（95% CI：0.5%~2.4%）;男性现在吸烟率随文化程度提高出现降低趋势（P<0.001）。现在每日吸烟率为23.7%（95% CI：21.4%~26.0%）,男性（46.5%,95% CI：41.7%~51.3%）高于女性（1.2%,95% CI：0.5%~1.9%）。现在吸烟者日均吸烟量为17.1（95% CI：16.5~17.6）支,男女分别为17.2（95% CI：16.7~17.8）支和10.5（95% CI：9.4~11.7）支,且男性日均吸烟量随着年龄升高而增加（P=0.048）,随文化程度升高而减少的趋势（P=0.003）。二手烟暴露率为57.6%（95% CI：51.2%~64.0%）。男性现在吸烟者中仅有37.6%（95% CI：25.0%~50.2%）打算戒烟,男性戒烟率为13.8%（95% CI：7.5%~20.1%）,成功戒烟率为9.1%（95% CI：5.1%~13.0%）。结论 安徽省成人居民吸烟行为普遍存在,二手烟暴露率较高,成年男性烟草使用率高,戒烟和成功戒烟率水平低。     

呼出气一氧化碳检测在戒烟门诊中的开展情况及对患者戒烟意愿和戒烟行为的影响

目的探索呼出气一氧化碳检测在我国戒烟门诊中的开展及对患者戒烟意愿和戒烟行为的影响情况。方法选取基本公共卫生项目戒烟门诊数据管理平台中, 2019-2021年在全国257家配备呼出气一氧化碳检测仪戒烟门诊戒烟的41 566名患者数据, 分析开展呼出气一氧化碳检测与患者戒烟意愿, 及完成随访患者戒烟率之间的关系。结果首诊时仅21 470名(51.7%)的患者开展了呼出气一氧化碳检测。通过logistic回归分析发现, 检测呼出气一氧化碳的患者有强戒烟意愿的可能性是未检测患者的1.87(95%CI:1.78～1.96)倍;首诊时检测呼出气一氧化碳的患者1个月随访时戒烟的可能性是未检测患者的1.10(95%CI:1.05～1.16)倍, 3个月随访时戒烟的可能性是未检测患者的1.22(95%CI:1.17～1.29)倍。结论呼出气一氧化碳检测能提高患者的戒烟意愿和戒烟率。但目前该检测仪在我国戒烟门诊中的配备和使用率均较低, 建议在戒烟门诊中继续推进该检测仪的配备和使用。     

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.     

拒烟自我效能在吸烟危害认知对戒烟成功影响的中介效应分析

目的 分析拒烟自我效能在吸烟危害认知对戒烟成功影响的中介效应。方法 采用以社区人群为基础的病例对照研究设计,以642例男性自发性戒烟成功者为病例组,700例男性自发性戒烟失败者为对照组。吸烟危害认知水平由12个评分项目的总分评估,拒烟自我效能由拒烟自我效能问卷评估。总效应被分解为直接效应和间接效应,通过基于KHB法的logistic回归分析探讨各效应。结果 调整潜在混杂因素(包括年龄、开始吸烟年龄、职业、教育水平、婚姻状况)后,拒烟自我效能的中介效应仅占吸烟危害认知对戒烟成功影响总效应的6.03%,吸烟危害认知对戒烟成功影响的直接效应占总效应的93.97%;在3种拒烟自我效能情境(包括积极、消极、习惯情境)下的中介效应占吸烟危害认知对戒烟成功总效应的比例分别为6.80%、3.08%和2.32%。结论 拒烟自我效能在吸烟危害认知对戒烟成功的影响具有部分中介效应。提高吸烟者的危害认知水平可直接促使其戒烟成功,并可通过增大拒烟自我效能促使其成功戒烟。     

中国戒烟门诊现状调查

目的 了解我国戒烟门诊运行现状和面临的挑战,为今后的控烟工作提供证据支持。方法 2013年采用电话调查的方式对我国201家戒烟门诊进行问卷调查,采用半结构式访谈的方法对6家戒烟门诊负责人进行访谈,并采用面对面调查方式对北京地区398名吸烟者进行问卷调查。使用SPSS 19.0软件进行统计学分析。结果 全国仍在正常运行的戒烟门诊有94家,51%的戒烟门诊设置在呼吸内科,平均配备出诊医生或护士3.24人,近一个月平均每周接诊量为6.92人。针对北京戒烟门诊和吸烟者调查显示,戒烟门诊病例的一个月戒烟成功率在50%以上;公众对戒烟门诊知晓率为48%;如果要戒烟,会选择去戒烟门诊的比例为21.9%;不选择的主要原因是认为吸烟不是“疾病”。结论 戒烟门诊就诊量少,导致戒烟门诊数量大幅下降,政府和医院应共同努力加大戒烟门诊的宣传力度,提高公众对戒烟门诊的认识和接受程度,建立良好的戒烟门诊转诊机制,提高医务人员戒烟咨询能力。     

天津市戒烟门诊158名就诊吸烟者戒烟状况调查

目的 了解天津市戒烟门诊就诊吸烟者的人群特点、吸烟情况、戒烟情况,为更有效的开展戒烟门诊服务提供科学依据。方法 调查前来三家戒烟门诊就诊的158名吸烟者,并于一个月后进行随访。结果 就诊吸烟者中50%(79/158)是通过医生推荐或转诊至戒烟门诊,47.5%(75/158)决定戒烟的原因是自身患病,59.5%(94/158)的人尝试过戒烟;就诊吸烟者的平均烟龄为19.5年,平均每日吸烟量为16.3支;一个月随访的应答率为86.7%(137/158),一个月随访的时点戒烟率为43.1%(59/137),未戒烟者的一个月时点减烟率为56.4%(44/78);27.0%(37/137)的人认为医生或药物对其戒烟帮助最大。结论 天津市戒烟门诊能提高吸烟者的戒烟率,但目前就诊人数较少,还应继续加大戒烟门诊的宣传力度。     

吸烟者戒烟意愿及影响因素分析

目的探讨沈阳市吸烟人群有戒烟意愿的人口学特征及影响因素,为有关部门制定有效的控烟措施提供科学依据。方法 2006年4～8月,在沈阳市内五区,采用多阶段分层随机整群抽样的方法 ,按照"街道→社区→家庭→调查对象"四个阶段进行抽样。其中,第一阶段使用按容量比例概率抽样法(PPS)抽取10个街道;第二阶段按PPS法在每个街道内抽取2个社区;第三阶段使用简单随机抽样法在每个社区抽取300户家庭;第四阶段使用简单随机抽样法在300户家庭中抽取100名成年吸烟者作为调查对象;每个居委会至少调查40名吸烟者;最终在沈阳市抽取调查了801名成年吸烟者。结果沈阳市吸烟者中有戒烟意愿者的比例为30.7%;男性有戒烟意愿者的比例(29.8%)远低于女性(46.7%);职业分布中,以国家机关党群组织负责人中有戒烟意愿的比例最高达47.5%,其次为离退休人员36.7%,以专业技术人员有戒烟意愿的比例最低为21.4%。影响因素分析发现:亲人反对、社会舆论、对健康的影响、控烟宣传的力度、健康警示信息的普及、对烟草相关疾病的知晓程度以及对戒烟产品和戒烟服务的接触均会影响吸烟者戒烟意愿的产生。结论通过普及烟草危害的健康教育,提倡亲人积极参与吸烟者戒烟活动,丰富烟草包装健康警示信息,提高控烟宣传力度以及推广戒烟产品和戒烟服务等措施可以很好地提高沈阳市吸烟者戒烟意愿的产生。     

吸烟原因与戒烟成功关系的优势分析

目的：研究吸烟原因与戒烟成功的关系。方法采用以社区人群为基础的病例对照研究设计,以642名男性自发性戒烟成功者为病例组,700名男性自发性戒烟失败者为对照组,应用Russell吸烟原因问卷（RRSQ）调查吸烟原因。运用优势logistic回归探讨吸烟原因对戒烟成功影响的相对重要性。结果在调整了潜在混杂因素（年龄、开始吸烟年龄、婚姻、职业、教育水平）后,戒烟成功组“镇静”和“刺激”的得分显著低于戒烟失败组;优势logistic分析显示,影响戒烟成功的前两项因素依次为“镇静”和“刺激”,其次为“心理意向”、“自动”、“手口活动”、“享乐”和“瘾”。结论成瘾依赖是影响戒烟成功的最主要因素,其作用大于社会心理因素。     

Response to an indigenous smoking cessation media campaign – It's about whānau

Objective: To assess any effects among Māori (the indigenous people of New Zealand) smokers and their whānau (the traditional Māori family unit) of a campaign designed to support Māori smokers to quit smoking. Method: New Zealand‐wide cross sectional population surveys between 2000 and 2002 of smokers and whānau pre‐ and post‐airing of the campaign. Measures included recall and awareness of the campaign; perceptions of the campaign; and campaign‐attributed changes in quitting‐related attitudes and behaviours. Results: Seventy‐eight per cent of smokers and 73% of whānau were able to recall the campaign one year following its launch. The television commercials (TVCs) were consistently rated very believable or very relevant by over half of the smokers who had seen them. More than half of smokers (54%) stated that the campaign had made them more likely to quit. Conclusion: This nationwide mass media cessation campaign developed to deliver a cessation message to indigenous people was received positively by Māori smokers and their whānau and played a role in prompting quit attempts. Implications: Social marketing campaigns have an important role as part of a tobacco control program to reduce high smoking prevalence among Māori and inequalities in health outcomes between Māori and other New Zealanders.     

Engaging nurses in smoking cessation: Challenges and opportunities in Turkey

This paper discusses the training of nurses in smoking cessation as part of routine patient care in Turkey. Formative research was carried out prior to training to identify challenges faced by smokers when trying to quit. Site visits to government hospitals and cessation clinics were conducted to observe health care provider-patient interactions involving behavior change.Four culturally sensitive cessation training workshops for nurses (n = 54) were conducted in Istanbul. Following training, nurses were debriefed on their experiences delivering cessation advice. Challenges to cessation counseling included lack of time and incentives for nurse involvement; lack of skills to deliver information about the harm of smoking and benefits of quitting; the medicalization of cessation through the use of pharmaceuticals; and hospital policy which devalues time spent on cessation activities. The pay-for-performance model currently adopted in hospitals has de-incentivized doctor participation in cessation clinics.Nurses play an important role in smoking cessation in many countries. In Turkey, hospital policy will require change so that cessation counseling can become a routine part of nursing practice, incentives for providing cessation are put in place, and task sharing between nurses and doctors is clarified. Nurses and doctors need to receive training in both the systemic harms of smoking and cessation counseling skills. Opportunities, challenges and lessons learned are highlighted.     

承德市医疗卫生人员吸烟及戒烟认知度调查分析

目的:了解承德市医疗机构人员吸烟和被动吸烟情况以及医务人员提供戒烟服务的现状,为制定针对性的戒烟干预措施提供依据。方法:采用随机抽样方法调查承德5个医疗机构医务人员,进行面对面问卷调查。结果:共调查485名(包括卫生行政人员),吸烟率19.6%,男性吸烟率显著高于女性(男性61.37%、女性1.8%),戒烟率为2.7%(男性1.6%,女性1.0%)。不同性别吸烟率差别有统计学意义(P0.01)。结论:承德市医务人员吸烟人群中以男性为重点人群,应加强对医务人员的健康教育和戒烟知识培训,以提高医务人员戒烟率和戒烟服务能力。     

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。     

香烟暴露与戒烟对大鼠肺组织组蛋白去乙酰化酶2的影响

目的 探讨香烟暴露及戒烟对大鼠肺组织组蛋白去乙酰化酶2(histone deacetylase2,HDAC2)的影响.方法 将40只健康雄性SD大鼠按随机数字表法分为5组,每组8只,对照组(A组)、吸烟1个月组(B组)、吸烟2个月组(C组)、戒烟1个月组(D组)、戒烟2个月组(E组).吸烟组及戒烟组大鼠每天上午、下午在自制熏烟盒中给予烟熏两次,吸烟组分别在吸烟1、2个月后取材;戒烟组在给予两个月烟熏后停止,分别正常饲养1、2个月取肺组织标本.正常对照组在正常饲养四个月后取肺组织标本.肺组织标本采用HE染色在镜下观察气道炎症改变、收集支气管肺泡灌洗液(BALF),用免疫组化方法检测肺组织HDAC2的表达.结果 与正常对照组相比,吸烟组肺组织HDAC2含量逐渐降低(吸烟2个月组＜吸烟1个月组);戒烟组肺组织HDAC2含量小于正常对照组(P＜0.05),但趋势是逐渐升高(戒烟2个月组＞戒烟1个月组).与吸烟组相比,戒烟组肺组织HDAC2含量有所回升(P＜0.05).结论 香烟暴露可使肺部组织中组蛋白修饰酶HDAC2减少,抑制炎症基因表达作用减弱,戒烟后有所改善.     

How place matters for smoking cessation: Barriers to smoking cessation among low-income Black women

African Americans start smoking later in life, yet they are less likely to quit smoking than other racial/ethnic groups. Drawing upon 40 in-depth interviews with former and current Black women smokers in the South Side of Chicago, this study examines external barriers to successful smoking cessation among socioeconomically disadvantaged Black women smokers. Beyond individual factors (e.g., stressors), this study finds interpersonal and structural factors that influence Black women's cessation efforts, including the high prevalence and normality of smoking and access to cheaper, loose cigarettes in their communities. Findings highlight the importance of considering local contexts for future tobacco research and policies.     

一氧化碳血红蛋白测定对无戒烟意愿ACS患者烟草戒断效果

目的探讨动脉血一氧化碳血红蛋白测定基础上充分告知吸烟危害,对无戒烟意愿ACS患者烟草戒断效果的影响。方法2013年10月至2014年2月,连续入选心脏中心住院的不愿意戒烟的吸烟ACS患者40例,将患者随机分为一氧化碳血红蛋白(COHb)组和对照组。对照组予常规5R干预,COHb组除常规5R干预,还行动脉血COHb测定,并结合患者COHb化验回报,充分告知患者吸烟的危害。随访24周,判断两组第24周戒断率及吸烟指数差异。结果两组患者尼古丁依赖性评分分别为7.5±1.5与7.7±1.5,两组差异无统计学意义(t=-0.433,P0.05)。COHb组患者动脉血COHb水平为(6.2±2.5)%,明显高于正常范围。随访24周时COHb组患者戒断率较对照组升高,为25%比15%,但尚未达到统计学差异(χ2=0.625,P0.05)。COHb组患者吸烟指数较对照组显著下降。结论动脉血COHb水平检测并结合COHb升高,充分告知吸烟危害可显著降低无戒烟意愿的ACS患者吸烟指数,并在一定程度上提高戒烟率。