• 【为土著卫生人员确定多层次的文化上适当的戒烟策略: 一种概念映射方法。】 复制标题 收藏 收藏
    DOI:10.1093/her/cys111 复制DOI
    作者列表:Dawson AP,Cargo M,Stewart H,Chong A,Daniel M
    BACKGROUND & AIMS: :Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.
    背景与目标: : 澳大利亚原住民,包括土著卫生工作者 (ahw),吸烟率是非土著人口的两倍。这项研究利用概念映射方法来确定和确定与文化相关的策略以促进ahw戒烟。利益相关者参与者包括AHWs,其他卫生服务员工和烟草控制人员。通过34次访谈,3个焦点小组和利益相关者研讨会,对戒烟策略 (n = 74) 进行了头脑风暴。利益相关者将策略分为有意义的组,并根据感知的重要性和可行性对其进行评分。使用多维缩放和分层聚类分析开发了概念图。描述了十种独特的戒烟策略,这些策略针对个人,家庭和同龄人,社区,工作场所和公共政策。除更广泛的策略外,还提供了戒烟资源和服务,以解决使吸烟永久化并使戒烟困难的社会和环境压力源。与社区控制相比,在政府协调的卫生服务中工作的参与者对集群的重要性和可行性的评价有所不同。对于弱势人群中的卫生服务工作者,这些发现显然暗示了除了传统的烟草控制策略之外,还需要有针对性的策略来减轻社会和环境压力。概念图已应用于知识翻译中,以指导ahw戒烟计划的开发。
  • 【烟草渴望预示着青少年吸烟者在戒烟治疗中会吸烟。】 复制标题 收藏 收藏
    DOI:10.1080/14622200701365178 复制DOI
    作者列表:Bagot KS,Heishman SJ,Moolchan ET
    BACKGROUND & AIMS: :Previous research indicates that tobacco craving predicts relapse to smoking among adult smokers attempting to quit. We hypothesized a similar relationship between craving and lapse (any smoking following a period of abstinence) among adolescent smokers during the treatment phase of a clinical trial. A visit was considered a lapse visit if the participant reported smoking or had a carbon monoxide level of 7 ppm or greater subsequent to an abstinent visit. A total of 34 participants (mean age = 14.9 years [SD = 1.3]; mean cigarettes/day = 18.0 [SD = 7.6]; mean Fagerström Test for Nicotine Dependence score = 6.8 [SD = 1.34]; 65% female), were included in the present analysis of 167 treatment visits. Logistic regression analyses showed a positive relationship between degree of craving, measured by the Questionnaire on Smoking Urges, and lapse during smoking cessation treatment (p = .013). Additionally, linear regression analyses demonstrated a strong positive association between cigarettes smoked per day and craving scores (p<.001). Taken together with other data, these findings suggest that degree of craving might influence tobacco abstinence for adolescent smokers. Thus monitoring and addressing craving appears useful to increase the success of adolescent smoking cessation.
    背景与目标: : 先前的研究表明,对烟草的渴望预示着试图戒烟的成年吸烟者的吸烟复发。我们假设在临床试验的治疗阶段,青少年吸烟者的渴望和戒烟 (禁欲一段时间后吸烟) 之间存在相似的关系。如果参与者报告吸烟或在禁欲访视后一氧化碳水平达到7 ppm或更高,则该访视被认为是短暂访视。共有34名参与者 (平均年龄 = 14.9岁 [SD = 1.3]; 平均香烟/天 = 18.0 [SD = 7.6]; 平均fagerstr ö m测试的尼古丁依赖性评分 = 6.8 [SD = 1.34]; 65% 名女性) 被包括在167治疗访问的当前分析中。Logistic回归分析显示,通过吸烟冲动问卷测量的渴望程度与戒烟治疗期间的失误之间存在正相关关系 (p = .013)。此外,线性回归分析表明,每天吸烟与渴望得分之间存在很强的正相关 (p<.001)。结合其他数据,这些发现表明,渴望程度可能会影响青少年吸烟者的戒烟。因此,监测和解决渴望似乎有助于提高青少年戒烟的成功率。
  • 【对评估坚持戒烟药物与治疗成功之间关系的研究的系统综述。】 复制标题 收藏 收藏
    DOI:10.1111/add.12319 复制DOI
    作者列表:Raupach T,Brown J,Herbec A,Brose L,West R
    BACKGROUND & AIMS: AIMS:Lack of adherence to smoking cessation medication regimens is assumed to play a significant role in limiting their effectiveness. This study aimed to assess evidence for this assumption. METHODS:A systematic search was conducted, supplemented by expert consultation, of papers reporting on randomized trials and observational studies examining the association between adherence to cessation medication and the success of quit attempts. To rule out reverse causality, only studies where adherence was assessed prior to relapse were included. Five studies met the inclusion criteria and results were extracted independently by two researchers. Heterogeneity between studies precluded a pooled analysis of the data. RESULTS:Studies varied widely with regard to both the definition of adherence and outcome measures. The included studies only addressed adherence to nicotine replacement therapy. One study of lozenge use found that the amount of medication used between 1 and 2 weeks after the quit date predicted abstinence at 6 weeks [adjusted odds ratio (OR) for 'high' versus 'low' lozenge use 1.25; 95% confidence interval (CI) = 1.05-1.50; P < 0.02]. Similarly, one study found a significant impact of oral nicotine consumption during the first week on abstinence at 4 weeks (adjusted OR per additional mg/day = 1.05; CI = 1.01-1.10). Another study found that participants using nicotine replacement therapy for at least 5 weeks were significantly more likely to self-report continuous abstinence at 6 months. The remaining two studies failed to find a significant effect of treatment duration on outcome at 1 and 2 years but had very low power to detect such an effect. CONCLUSIONS:There is modest evidence to support the assumption that lack of adherence to nicotine replacement therapy regimens undermines effectiveness in clinical studies.
    背景与目标:
  • 【全科医生对建议戒烟服务的有效性和意图的信念: 定性和定量研究。】 复制标题 收藏 收藏
    DOI:10.1186/1471-2296-8-39 复制DOI
    作者列表:Vogt F,Hall S,Marteau TM
    BACKGROUND & AIMS: BACKGROUND:General practitioners' (GPs) negative beliefs about smoking cessation services may act as barriers to them recommending such services to smokers motivated to stop smoking. METHODS:In Study 1, 25 GPs from 16 practices across London were interviewed in this qualitative study. Framework analysis was used to identify key themes in GPs' beliefs about smoking cessation services. In Study 2, a convenience sample of 367 GPs completed an internet-based survey. Path-analysis was used to examine relationships between beliefs identified in Study 1 and intentions to recommend smoking cessation services. RESULTS:In Study 1, GPs felt that smoking cessation assistance was best provided by others. GPs favoured local services (i.e. practice nurses offering stop smoking support) over central services (i.e. offered through the Primary Care Trust), mainly because these were seen as more personalised and accessible for patients. These beliefs appeared to influence GPs' beliefs about the effectiveness of services. In Study 2, GPs' beliefs had a large effect on their intentions to recommend both central services, (f2 = .79) and local services, (f2 = 1.04). GPs' beliefs about effectiveness and cost-effectiveness were key predictors their intentions to recommend central services and local services. Beliefs about the level of personalisation offered and smokers' likelihood of attending services had indirect effects on intentions to recommend services operating via beliefs about effectiveness. CONCLUSION:GPs vary in their perceptions of the effectiveness of smoking cessation services and their intentions to recommend these services vary in line with these beliefs. Interventions aimed at increasing the likelihood with which GPs recommend these services may therefore be more effective if they addressed these beliefs.
    背景与目标:
  • 【精神病理学与戒烟治疗反应的关系。】 复制标题 收藏 收藏
    DOI:10.1016/s0376-8716(00)00114-9 复制DOI
    作者列表:Gariti P,Alterman AI,Mulvaney FD,Epperson L
    BACKGROUND & AIMS: :The study evaluated the relationship of psychopathology to treatment response of 208 smokers prescribed transdermal nicotine (8 weeks). Participants were relatively high functioning (DSM-IV axis V score) outpatients in a university-based clinic. The primary study objective was to determine whether patients with a history of either a DSM-IV axis I or II diagnosis would have poorer during treatment response (patch adherence, smoking) and lower rates of smoking cessation at post-patch follow-up (study weeks 9, 26, 52) than those without a diagnosis. While there was some indication that patients with a history of psychopathology wore the patch less frequently, psychopathology was not associated with during- and post-treatment smoking.
    背景与目标: : 该研究评估了208吸烟者处方经皮尼古丁 (8周) 的心理病理学与治疗反应的关系。在大学诊所中,参与者的门诊患者功能相对较高 (dsm-iv axis V评分)。主要研究目标是确定具有dsm-iv轴I或II诊断史的患者在治疗反应 (贴片依从性,吸烟) 期间是否较差,并且在贴片后随访时戒烟率较低 (研究第9、26周,52) 比没有诊断的人。尽管有迹象表明有精神病理学史的患者较少佩戴该贴片,但精神病理学与治疗期间和治疗后吸烟无关。
  • 6 Exercise interventions for smoking cessation. 复制标题 收藏 收藏

    【戒烟运动干预。】 复制标题 收藏 收藏
    DOI:10.1002/14651858.CD002295.pub6 复制DOI
    作者列表:Ussher MH,Faulkner GEJ,Angus K,Hartmann-Boyce J,Taylor AH
    BACKGROUND & AIMS: BACKGROUND:Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain. OBJECTIVES:To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention. SEARCH METHODS:We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019. SELECTION CRITERIA:We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months. DATA COLLECTION AND ANALYSIS:We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. MAIN RESULTS:We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). AUTHORS' CONCLUSIONS:There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.
    背景与目标:
  • 【一种为戒烟量身定制药物疗法的算法: Delphi国际专家小组的结果。】 复制标题 收藏 收藏
    DOI:10.1136/tc.2008.025635 复制DOI
    作者列表:Bader P,McDonald P,Selby P
    BACKGROUND & AIMS: BACKGROUND:Evidence-based smoking cessation guidelines recommend nicotine replacement therapy (NRT), bupropion SR and varenicline as first-line therapy in combination with behavioural interventions. However, there are limited data to guide clinicians in recommending one form over another, using combinations, or matching individual smokers to particular forms. OBJECTIVE:To develop decision rules for clinicians to guide differential prescribing practices and tailoring of pharmacotherapy for smoking cessation. METHODS:A Delphi approach was used to build consensus among a panel of 37 international experts from various health disciplines. Through an iterative process, panellists responded to three rounds of questionnaires. Participants identified and ranked "best practices" used by them to tailor pharmacotherapy to aid smoking cessation. An independent panel of 10 experts provided cross-validation of findings. RESULTS:There was a 100% response rate to all three rounds. A high level of consensus was achieved in determining the most important priorities: (1) factors to consider in prescribing pharmacotherapy: evidence, patient preference, patient experience; (2) combinations based on: failed attempt with monotherapy, patients with breakthrough cravings, level of tobacco dependence; (3) specific combinations, main categories: (a) two or more forms of NRT, (b) bupropion + form of NRT; (4) specific combinations, subcategories: (1a) patch + gum, (1b) patch + inhaler, (1c) patch + lozenge; (2a) bupropion + patch, (2b) bupropion + gum; (5) impact of comorbidities on selection of pharmacotherapy: contraindications, specific pharmacotherapy useful for certain comorbidities, dual purpose medications; (6) frequency of monitoring determined by patient needs and type of pharmacotherapy. CONCLUSION:An algorithm and guide were developed to assist clinicians in prescribing pharmacotherapy for smoking cessation. There appears to be good justification for "off-label" use such as higher doses of NRT or combination therapy in certain circumstances. This practical tool reflects best evidence to date of experts in tobacco cessation.
    背景与目标:
  • 【与为癌症患者实施戒烟临床试验有关的问题。】 复制标题 收藏 收藏
    DOI:10.1007/s10552-008-9222-x 复制DOI
    作者列表:Martinez E,Tatum KL,Weber DM,Kuzla N,Pendley A,Campbell K,Ridge JA,Langer C,Miyamoto C,Schnoll RA
    BACKGROUND & AIMS: :Given high rates of smoking among cancer patients, smoking cessation treatment is crucial; yet limited data exist to guide integration of such trials into the oncologic context. In order to determine the feasibility of conducting smoking cessation clinical trials with cancer patients, screening and baseline data from a large randomized placebo-controlled pharmacotherapy trial were analyzed. Descriptive statistics and regression analyses were used to compare enrollees to decliners, describe program enrollees, and assess correlates of confidence in quitting smoking. Out of 14,514 screened patients, 263 (<2%) were eligible; 43 (16%) refused enrollment. Among the eligible patients, 220 (84%) enrolled. Enrollment barriers included smoking rate, medical history/contraindicated medication, lack of interest, and language. Compared to enrollees, decliners were more likely to have advanced cancer. The trial enrolled a sample of 67 (>30%) African Americans; participants had extensive smoking histories; many were highly nicotine dependent; and participants consumed about seven alcoholic beverages/week on average. Head and neck and breast cancer were the most common tumors. About 52 (25%) reported depressive symptoms. A higher level of confidence to quit smoking was related to lower depression and lower tumor stage. Integrating a smoking cessation clinical trial into the oncologic setting is challenging, yet feasible. Recruitment strategies are needed for patients with advanced disease and specific cancers. Once enrolled, addressing participant's depressive symptoms is critical for promoting cessation.
    背景与目标: : 鉴于癌症患者的吸烟率很高,戒烟治疗至关重要; 然而,有限的数据可以指导将此类试验纳入肿瘤学领域。为了确定对癌症患者进行戒烟临床试验的可行性,对一项大型随机安慰剂对照药物治疗试验的筛查和基线数据进行了分析。描述性统计和回归分析用于比较参与者与下降者,描述计划参与者并评估戒烟信心的相关性。在14,514名筛查患者中,263名 (<2% 名) 符合条件; 43名 (16% 名) 拒绝入组。在符合条件的患者中,220 (84%) 入组。入学障碍包括吸烟率,病史/禁忌用药,缺乏兴趣和语言。与参保人相比,下跌股更有可能患有晚期癌症。该试验纳入了67名 (>30% 名) 非裔美国人的样本; 参与者有广泛的吸烟史; 许多人高度依赖尼古丁; 参与者平均每周饮用约7种酒精饮料。头颈部和乳腺癌是最常见的肿瘤。约52例 (25%) 报告了抑郁症状。较高的戒烟信心水平与较低的抑郁和较低的肿瘤分期有关。将戒烟临床试验纳入肿瘤学环境是具有挑战性的,但可行的。晚期疾病和特定癌症患者需要招募策略。一旦入组,解决参与者的抑郁症状对于促进戒烟至关重要。
  • 【戒烟和痴呆症的荟萃分析: 性别重要吗?】 复制标题 收藏 收藏
    DOI:10.1093/geronb/gbw158 复制DOI
    作者列表:Baines N,Au B,Rapoport MJ,Naglie G,Tierney MC
    BACKGROUND & AIMS: Objectives:The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the prevalence and incidence of driving cessation among drivers with dementia and compares the pattern of sex differences in drivers with dementia to those without dementia. Method:MEDLINE, PsycINFO, Scopus, and CINAHL were searched in July 2015 for observational studies of sex differences in driving cessation. Meta-analyses were performed using a random-effects model. Results:Twenty studies provided data on sex differences in driving cessation in older adults with or without dementia. Driving cessation was significantly more prevalent in women with dementia than men (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.50-2.98), and the same pattern was found in women without dementia (OR = 2.74, 95% CI = 1.85-4.06). Discussion:Our findings suggest that the patterns of driving cessation differ between men and women with dementia, and this may have implications for sex-specific approaches designed to support drivers with dementia both before and after driving cessation.
    背景与目标:
  • 【用户对基于短信的戒烟计划NEXit干预的结构和内容的满意度。】 复制标题 收藏 收藏
    DOI:10.1186/s12889-016-3848-5 复制DOI
    作者列表:Müssener U,Bendtsen M,McCambridge J,Bendtsen P
    BACKGROUND & AIMS: BACKGROUND:Smoking is still the leading cause of preventable ill health and death. There is a limited amount of evidence for effective smoking cessation interventions among young people. To address this, a text messaging-based smoking cessation programme, the NEXit intervention, was developed. Short-term effectiveness, measured immediately after the 12-week intervention revealed that 26% of smokers in the intervention group had prolonged abstinence compared with 15% in the control group. The present study was performed to explore the users' experiences of the structure and content of the intervention in order to further develop the intervention. METHODS:Students participating in the main NEXit randomized controlled trial were invited to grade their experiences of the structure and content of the intervention after having completed follow-up. The participants received an e-mail with an electronic link to a short questionnaire. Descriptive analysis of the distribution of the responses to the questionnaire was performed. Free-text comments to 14 questions were analysed. RESULTS:The response rate for the user feedback questionnaire was 35% (n = 289/827) and 428 free-text comments were collected. The first motivational phase of the intervention was appreciated by 55% (158/289) of the participants. Most participants wanted to quit smoking immediately and only 124/289 (43%) agreed to have to decide a quit-date in the future. Most participants 199/289 (69%) found the content of the messages in the core programme to be very good or good, and the variability between content types was appreciated by 78% (224/289). Only 34% (97/289) of the participants thought that all or nearly all messages were valuable, and some mentioned that it was not really the content that mattered, but that the messages served as a reminder about the decision to quit smoking. CONCLUSIONS:The programme was largely perceived satisfactory in most aspects concerning structure and content by young people and most participants stated that they would recommend it to a friend who wants to quit smoking. The motivational phase might be worth shortening and the number of messages around the quit date itself reduced. Shorter messages seemed to be more acceptable. TRIAL REGISTRATION:ISRCTN75766527 .
    背景与目标:
  • 【在HIV阳性吸烟者中进行护士管理,同伴主导的戒烟干预的可行性。】 复制标题 收藏 收藏
    DOI:10.1016/S1055-3290(06)60353-1 复制DOI
    作者列表:Wewers ME,Neidig JL,Kihm KE
    BACKGROUND & AIMS: :The purpose of this pilot study was to examine the effectiveness of an 8-week, nurse-managed, peer-led smoking cessation intervention among HIV-positive smokers. The intervention was based on the Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline and was delivered by an ex-smoker who was HIV positive and had been trained by an advanced practice nurse to deliver cessation counseling. Eight male HIV-positive smokers were assigned to the intervention group and received (a) 21 mg nicotine patch therapy for 6 weeks, (b) weekly face-to-face or telephone counseling, and (c) skills training that included substitute strategies for dealing with not smoking. Those participants assigned to the control group received written self-help materials for smoking cessation. Abstinence rates at end of intervention and 8 months were compared between groups. At end of treatment, 62.5% of intervention group participants were biochemically confirmed as abstinent from smoking compared with 0% in the control group. Eight-month abstinence rates were 50% among the intervention group compared with 0% in the control group.
    背景与目标: : 这项初步研究的目的是研究在HIV阳性吸烟者中进行为期8周,由护士管理,由同伴主导的戒烟干预的有效性。该干预措施基于卫生保健政策和研究机构戒烟临床实践指南,由一名HIV阳性的前吸烟者提供,并接受了高级实践护士的培训,以提供戒烟咨询。8名男性HIV阳性吸烟者被分配到干预组,接受了 (a) 21 mg尼古丁贴片治疗6周,(b) 每周面对面或电话咨询,以及 (c) 包括替代策略的技能培训不吸烟。分配到对照组的参与者收到了书面的戒烟自助材料。比较两组干预结束和8个月的禁欲率。在治疗结束时,与对照组的0% 相比,干预组参与者的62.5% 被生化确认为戒烟。与对照组的0% 相比,干预组的8个月禁欲率50%。
  • 【医生在戒烟中的作用。现在和未来的议程。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Nett LM
    BACKGROUND & AIMS: :Medical views in the United States on the effects of smoking have shifted dramatically since the published evidence in 1958 established the link between smoking and fatal disease. Today's physician should be a nonsmoking role model, whose workplace both directly and indirectly teaches smoking cessation skills. Publications on smoking cessation techniques from the National Institutes of Health along with intervention tools such as patient smoking history questionnaires are available free of charge to physicians. Patient histories are critical to the intervention process, for they provide essential clues and information about which stage in cessation of smoking the patient has already reached: precontemplation, contemplation, action, and maintenance. Different approaches and techniques are required at each stage. The most important objective for the physician with a patient at the stage of contemplating quitting is to initiate a conversation leading to a directive to quit, with benefits of quitting stressed as reinforcement. Actively motivated patients committed to quit dates may need both educational and pharmacologic support; issues such as nicotine dependence and withdrawal symptoms must be addressed. Pharmacologic therapy at this time may consist of substitution of nicotine-containing gum (nicotine polacrilex) for cigarettes. Used in sufficient, regular dosages, the nicotine gum has been found to help diminish withdrawal symptoms following smoking cessation. Other drug therapies are currently under study. For now, nicotine replacement therapy (where indicated) is to be used for at least three months, the period of greatest chance of relapse. The physician should continue to encourage patients who have quit smoking to forestall relapses, while tacitly understanding that the incidence of relapse is high in first-time quitters. Hospital inpatients provide an opportunity to initiate bedside smoking cessation programs. The hope is that, in the future, hospitals will involve the entire health team in comprehensive smoking cessation programs.
    背景与目标: : 自从已发表的证据1958年吸烟与致命疾病之间的联系以来,美国对吸烟影响的医学观点发生了巨大变化。今天的医生应该是一个不吸烟的榜样,其工作场所直接和间接教授戒烟技能。美国国立卫生研究院关于戒烟技术的出版物以及干预工具,如患者吸烟史问卷,可免费提供给医生。患者病史对于干预过程至关重要,因为它们提供了有关患者已经达到戒烟阶段的基本线索和信息: 沉思,沉思,行动和维持。每个阶段都需要不同的方法和技术。对于在考虑戒烟的阶段有患者的医生来说,最重要的目标是发起对话,导致戒烟的指令,而戒烟的好处是加强。积极主动的戒烟患者可能需要教育和药物支持; 必须解决尼古丁依赖和戒断症状等问题。此时的药物治疗可能包括用含尼古丁的口香糖 (尼古丁polacrilex) 代替香烟。尼古丁胶以足够的常规剂量使用,已发现有助于减轻戒烟后的戒断症状。目前正在研究其他药物疗法。目前,尼古丁替代疗法 (如所示) 至少要使用三个月,这是复发机会最大的时期。医生应继续鼓励戒烟的患者预防复发,同时默许首次戒烟者的复发率很高。医院住院患者提供了启动床边戒烟计划的机会。希望将来,医院将使整个卫生团队参与全面的戒烟计划。
  • 【职业健康护士在戒烟干预中的自我效能: 文献综述。】 复制标题 收藏 收藏
    DOI:10.1177/2165079920925106 复制DOI
    作者列表:Thornberry A,Garcia TJ,Peck J,Sefcik E
    BACKGROUND & AIMS: :Background: Effective smoking cessation interventions (SCIs) are indicated, particularly among the working population, where a higher than expected prevalence of smoking continues. Occupational health nurses' (OHN) self-efficacy can affect SCI but current scientific literature is limited. The purpose of this integrative literature review was to determine factors that affect OHN self-efficacy and motivation for providing SCI and to guide research needed to enhance SCI programs. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted an integrative literature review. The strategy was an electronic data search of PubMed conducted between 2013 and 2018 and included peer-reviewed manuscripts written in English that addressed self-efficacy and its relationship to SCI. Findings: In total, 15 research articles met the inclusion criteria and two referred specifically to OHNs. Common themes revealed factors which positively and negatively influenced nurses' self-efficacy, including training, academic preparation, as well as nurse attitudes and personal/social influence. Studies specific to OHNs identify self-efficacy as the most influential factor affecting nurse implementation of SCI. Organizational support and theory-based training are more effective in overcoming personal and social barriers affecting OHN self-efficacy. Conclusion/Application to Practice: The results of this review revealed attitude, innovation, perceived social influence, and self-efficacy were factors for nurses' intention to implement SCI. Changes in the organizational environment supporting cessation programs and educational development, particularly theory-based training, should be further studied. Our findings suggest that designing programs utilizing these research findings to improve OHN self-efficacy could guide changes in clinical practice for motivating smokers to quit.
    背景与目标: 背景: 指出了有效的戒烟干预措施 (sci),尤其是在工作人群中,吸烟率持续高于预期。职业健康护士 (OHN) 的自我效能会影响SCI,但目前的科学文献有限。这篇综合文献综述的目的是确定影响OHN自我效能感和提供SCI动机的因素,并指导增强SCI计划所需的研究。方法: 遵循系统评价和荟萃分析 (PRISMA) 指南的首选报告项目,我们进行了综合文献综述。该策略是对PubMed进行的2013年和2018进行的电子数据搜索,其中包括用英语撰写的同行评审手稿,这些手稿涉及自我效能感及其与SCI的关系。研究结果: 总共有15篇研究文章符合纳入标准,其中两篇专门针对ohn。共同的主题揭示了积极和消极影响护士自我效能感的因素,包括培训,学术准备以及护士的态度和个人/社会影响。针对ohn的研究将自我效能感确定为影响护士实施SCI的最有影响力的因素。组织支持和基于理论的培训在克服影响OHN自我效能感的个人和社会障碍方面更有效。结论/实践应用: 本综述的结果表明,态度,创新,感知的社会影响力和自我效能感是护士实施SCI意图的因素。应进一步研究支持戒烟计划和教育发展的组织环境的变化,特别是基于理论的培训。我们的发现表明,利用这些研究结果来设计提高OHN自我效能的程序可以指导临床实践的变化,以激励吸烟者戒烟。
  • 【蒙大拿州的美洲印第安大学生使用手机和计算机促进健康和戒烟。】 复制标题 收藏 收藏
    DOI:10.22605/rrh4014 复制DOI
    作者列表:Dotson JA,Nelson LA,Young SL,Buchwald D,Roll J
    BACKGROUND & AIMS: INTRODUCTION:Cell phones and personal computers have become popular mechanisms for delivering and monitoring health information and education, including the delivery of tobacco cessation education and support. Tobacco smoking is prevalent among American Indians (AIs) and Alaska Natives (ANs), with 26% AI/AN adult men smoking compared to 19% of Caucasian adult males and 22% of African American adult males. Smoking is even more prevalent in Northern Plains AI populations, with 42% of men and women reporting current smoking. The literature on the availability and use of cell phones and computers, or the acceptability of use in health promotion among AIs and ANs, is scant. The authors report findings from a survey of AI students regarding their cell phone and computer access and use. The survey was conducted to inform the development and implementation of a text messaging smoking cessation intervention modeled on a program developed and used in Australia. METHODS:A 22-item paper and pencil survey was administered to students at tribal colleges in rural Montana. The survey questions included cell phone ownership and access to service, use of cell phones and computers for health information, demographics, tobacco use habits, and interest in an intervention study. The study was reviewed and determined exempt by the institutional review boards at the tribal colleges and the lead research university. The study was conducted by researchers at the tribal colleges. Survey respondents received $10 when the survey was completed and returned. Data analysis was performed with the Statistical Package for the Social Sciences. RESULTS:Among 153 AI respondents, the mean age was 29 years, range was 18-64 years. Overall, 40% reported smoking cigarettes with a mean age of 16 years at initiation. A total of 131 participants (86%) had cell phones and, of those, 122 (93%) had unlimited text messaging. A total of 104 (68%) had smart phones (with internet access), although 40% of those with smart phones reported that internet access on their phone was very slow or location limited. A total of 146 (95%) participants reported having access to a computer, although 32% of those did not have daily access. Students aged less than 23 years were more likely to have cell phones with internet access. Cell phone ownership differed by site (93% vs 77%, p=0.007). About 60% of the respondents who smoked indicated interest in participating in the intervention study. CONCLUSIONS:This study revealed that AI tribal college students in the rural communities surveyed had less cell phone, smart phone, and computer and internet access than that reported for undergraduate college students elsewhere in the USA. Research efforts and public health interventions must be culturally appropriate and technologically viable, therefore access to and acceptability of mobile technology must be evaluated when planning and implementing interventions for rural and other marginalized populations. The findings from this study contribute to the literature regarding the access to and acceptability of mobile technology for health promotion among AI/AN college students in rural and remote areas, and helped introduce the proposed study to the community and solicited useful data regarding tobacco prevalence and interest in tobacco research in the target population.
    背景与目标:
  • 【家庭医生和戒烟。实践、意见和障碍调查。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Mowat DL,Mecredy D,Lee F,Hajela R,Wilson R
    BACKGROUND & AIMS: OBJECTIVES:To assess what family physicians need to promote smoking cessation by looking at current knowledge, attitudes, and behaviours and to examine the barriers facing physicians in implementing an effective antismoking strategy. DESIGN:Cross-sectional study involving face-to-face interviews and mailed questionnaires. SETTING:Family practices in Kingston, Ont, and surrounding areas. PARTICIPANTS:All family physicians (n = 155) in the City of Kingston and the counties of Frontenac, Lennox, and Addington. MAIN OUTCOME MEASURES:Knowledge, attitudes, beliefs, and practices concerning smoking cessation; barriers and practices recommended in the literature. RESULTS:Response rate was 77%. Many physicians know about smoking cessation, and many actively counsel their patients to quit. Brief advice, nicotine replacement therapy, self-help materials, and follow-up appointments are the most common methods. Although many report that they are already knowledgeable, many are willing to learn more. Many physicians have unrealistically high estimates of the probability of success, and many find poor compliance among patients to be the greatest barrier. CONCLUSIONS:Family physicians in this are recognize the need to help their patients to quit and are identifying and counseling smokers in their practices. The main educational need could be to appreciate smoking as an addictive behaviour.
    背景与目标:

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