青少年戒烟的信息通信技术干预短期效果评价

目的了解信息通信技术对青少年戒烟干预的短期效果,为开展青少年戒烟干预活动提供参考。方法在上海市6所中专和职业高中募集179名吸烟青少年,以学校为单位随机分成干预组和对照组,进行为期3个月的干预研究。对干预组利用手机短信、即时通信和互联网等信息通信技术实施戒烟干预,而对照组接受戒烟宣传手册自行阅读。通过干预前后烟草相关知识、态度、吸烟行为、尼古丁和烟草依赖指数等的变化评价干预实施的短期效果。结果 12周后,干预组对于烟草的部分知识和态度增强程度高于对照组;干预组的7d和30d戒烟率分别达到14.1%和9.8%,高于对照组的8.0%和6.9%。干预组的日均吸烟量平均减少4.1支,而对照组平均减少1.9支,干预组减少吸烟率(66.3%)显著高于对照组(34.5%),尤其表现在与朋友相处时减少了吸烟行为;行为改变阶段分析显示,63.2%的干预组对象朝着成功戒烟方向前进,而对照组为34.8%。期间干预组的尼古丁依赖指数和烟草依赖指数分别下降了0.5和3.8,而对照组却分别上升了0.3和1.6。结论运用手机短信等现代信息通信技术进行双向、互动的青少年戒烟干预,可以有效提高对戒烟的认同感,减少吸烟量和对烟草的身心依赖。     

Consumer Acceptance of an SMS-Assisted Smoking Cessation Intervention: A Multicountry Study

This study assesses smokers' perceptions, motivations, and intentions towards using an SMS-assisted smoking cessation intervention in Australia, France, and Mexico through an extended technology acceptance model with mediating variables. Data was collected through online surveys. Results show that perceived usefulness and vicarious innovativeness predict use intentions for all three countries. Perceived ease of use is significant only for Mexico. Subjective norms are significant only for Mexico and Australia. Perceived monetary value and perceived annoyance are significant mediating variables for all three countries, whereas perceived enjoyment is significant only for Mexico and Australia. These results contribute to theory and practice.     

Predictors of Smoking Cessation in Pregnancy and Maintenance Postpartum in Low-Income Women

Objective: To describe factors associated with smoking status of low-income women during pregnancy and postpartum. Methods: Data from a randomized clinical trial were used to conduct separate analyses on 327 women who smoked at baseline (time at enrollment) and for whom smoking status was available at delivery, and on 109 women who reported not smoking at delivery (quit spontaneously or after study enrollment) and for whom smoking status was available at 6-months postpartum. Salivary cotinine was used to assess the accuracy of self-reported smoking status for the sample as a whole. Data were collected between May 1997 and November 2000. Results: 18% of the 327 baseline smokers stopped smoking before delivery. Cessation was less likely in older women, those reporting Medicaid coverage (vs. commercial or no insurance), who were at a later week of pregnancy at baseline, were more addicted, had a husband/partner who smoked, and did not receive the study intervention. 37% of the 109 women who reported not smoking at delivery maintained abstinence at 6-months postpartum. Factors associated with abstinence were later week of pregnancy at baseline and quitting spontaneously with pregnancy, while women who lived with a smoker were less likely to report abstinence. Spontaneous quitters were less likely to relapse by 6 months postpartum than women who quit smoking later in pregnancy. Conclusions: Partner participation in smoking cessation programs for pregnant and postpartum women merits exploration. Lower relapse rates among spontaneous quitters indicate a need to foster an environment that encourages quitting at pregnancy.     

Effectiveness of a Combined Prenatal and Postpartum Smoking Cessation Program

Women frequently quit smoking during pregnancy but then relapse postpartum. The BABY & ME—Tobacco Free program combines prenatal and postpartum smoking cessation counseling and biomarker feedback with monthly postpartum incentives. The settings included 22 sites (WIC offices and prenatal clinics) in upstate New York. A quasi-experimental design was used to evaluate this intervention, that included four face-to-face prenatal sessions with a counselor who did smoking cessation counseling, carbon monoxide testing and random saliva cotinine testing. For 1 year postpartum, mothers were biochemically tested every 3–4 weeks and, if negative, were issued a voucher for diapers. Three implementation models were studied: multi-tasking counselors at fixed sites (Models 1 and 2) versus itinerant smoking cessation specialists (Model 3). Outcomes included biochemically validated abstinence rates during pregnancy and postpartum. Logistic regression was used to identify predictors of postpartum abstinence and program dropout. Proportional hazards regression was used to compare implementation models. Of the 777 pregnant women who enrolled in the program, 588 were eligible for the postpartum program. The intention to treat pregnancy quit rate was 60%. Postpartum, Model 3 showed consistently better quit outcomes than the other models. Predictors of abstinence at 6 months postpartum are: older age (OR = 1.07, 95% C.I. 1.02–1.12), lower baseline carbon monoxide level (OR = 0.69, 95% C.I. 0.49–0.97), Model 3 (OR = 4.60, 95% C.I. 2.80–7.57) and attending more prenatal sessions (OR = 3.52; 95% C.I. 2.19–5.65). The BABY & ME—Tobacco Free program is an effective smoking cessation program for pregnant and parenting women.     

Teen Perceptions of Facilitator Characteristics in a School-Based Smoking Cessation Program

Background: Facilitators are often responsible for the implementation of public health programs, yet little is known about how they influence outcomes. Not‐On‐Tobacco (N‐O‐T) is a youth smoking‐cessation program implemented by trained facilitators. The purpose of this study was to investigate teens’ perceptions of facilitator characteristics and the relationship between those perceptions and program outcomes. Methods: Data were collected from N‐O‐T participants aged 14 to 19 who completed a survey about perceptions of facilitator characteristics that were linked to program outcomes 3 months post‐baseline (n = 769). Eight facilitator characteristics were ordered, based on importance to participants. Chi‐square tests measured differences in perceptions of facilitator characteristics according to race and sex, and an aggregate facilitator favorability score was created and analyzed in relation to program outcomes (smoking reduction or cessation vs increase/no change). Logistic regression was used to analyze facilitator characteristics’ relationship to outcomes, controlling for race and sex. Results: Participants rated facilitator characteristics of trustworthy, cares about students, and confidential as most important. Girls consistently ranked facilitator characteristics as more important than did boys. There were few significant differences based on race, except that white students rated nonjudgmental to be more important than did nonwhite students. There were no significant findings from the logistic regression, but there was a significant relationship between the aggregate facilitator favorability score and favorable changes in smoking outcomes (reduction or cessation). Conclusions: This study provides insights into the facilitator characteristics that are important to teen participants. It demonstrates that teens’ overall perceptions of facilitators contribute to their perception of how the program contributes to their success and program outcomes.     

Feasibility and Acceptability of a Text Messaging Program for Smoking Cessation in Israel

Text messaging programs on mobile phones have been shown to promote smoking cessation. This study investigated whether a text-messaging program for smoking cessation, adapted from QuitNowTXT, is feasible in Israel and acceptable to Israeli smokers. Participants (N = 38) were given a baseline assessment, enrolled in the adapted text messaging program, and followed-up with at 2 weeks and 4 weeks after their quit date. The authors used an intent-to-treat analysis and found that 23.7% of participants reported having quit smoking at the 4-week follow-up. Participants sent an average of 12.9 text replies during the study period, and the majority reported reading most or all of the texts. However, 34.2% of participants had unsubscribed by the 4-week follow-up. Moderate levels of satisfaction were reported; more than half agreed that they would recommend the program. Suggestions for improvement included adding advice by an expert counselor, website support, and increased customization. Results indicate that a text messaging smoking cessation program developed by modifying the content of QuitNowTXT is feasible and could be acceptable to smokers in Israel. The experience adapting and pilot testing the program can serve as a model for using QuitNowTXT to develop and implement such programs in other countries.     

The Impact of Quitting Smoking on Weight Among Women Prisoners Participating in a Smoking Cessation Intervention

Objectives. We examined the impact of smoking cessation on weight change in a population of women prisoners.Methods. Women prisoners (n = 360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement.Results. Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers.Conclusions. We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations.Smoking and obesity are the 2 major causes of mortality and morbidity in the United States.^1,2 Although smoking is the leading preventable cause of death, resulting in approximately 440 000 deaths each year,³ obesity is a growing epidemic and is the second leading cause of preventable death, resulting in more than 300 000 deaths annually.^4,5 Whereas smoking rates have declined from their peak in the 1960s, obesity rates have been steadily climbing each year, and obesity is expected to soon eclipse smoking as the most preventable cause of mortality in the United States.¹The relationship between smoking and weight is complex, and the mechanisms by which smoking influences weight are not fully understood. Smoking affects weight by increasing metabolic rate and decreasing caloric absorption, which is thought to help suppress appetite.⁶ Sympathoadrenal activation by nicotine is thought to be primarily responsible for the metabolic effect of smoking.⁷ Smoking is also associated with increased energy expenditure.⁸ Smoking a single cigarette also decreases caloric consumption by 3% within 20 minutes.⁹Compared with light smokers and nonsmokers, heavy smokers tend to have greater body weight, which likely reflects a clustering of risk behaviors (i.e., little physical activity and poor diet) and increased insulin resistance and accumulation of abdominal fat.^6,10,11 Overall, smokers tend to be less physically active than nonsmokers, which may confound explanations of weight differences between smokers and nonsmokers.¹²Most studies on weight and smoking have reported postcessation weight gain. Smoking cessation has been associated with approximately 10 pounds of weight gain after 1 year of abstinence,¹³ suggesting that health benefits from smoking cessation may be mitigated to some degree by increased health risks associated with weight gain.¹⁴ To prevent or reduce weight gain, those administering cessation programs are recommended to integrate follow-up support for weight control, provide regular body weight measurement, provide recommendations for dietary change, and encourage increased physical activity.¹⁴ Despite concerns about weight, few studies have systematically investigated weight gain following smoking cessation, particularly with underserved populations such as prisoners.Correctional populations especially are vulnerable to the negative health consequences of smoking. Smoking rates are 3 to 4 times higher among correctional populations than among the general population, and smoking is normative within the correctional environment.^15–17 Smoking prevalence is 70% to 80% among male and female prisoners,^15–20 while almost half (46%) of adolescents in juvenile justice are daily smokers.²¹ This compared to about 21% of adults in the general population who are current smokers.²² However, in the research literature, the emphasis on smoking prevalence, prevention, cessation, and policies is much greater among other populations than it is among criminal justice populations—despite the human, health, and economic costs that occur in prison and in the community.^20,23In addition to the larger prevalence of smoking in prisons, there is less access to interventions for smoking cessation in correctional facilities. Lack of resources amplifies the negative health risks associated with smoking, such as heart, circulatory, and respiratory problems. Over the past 2 decades, correctional facilities in the United States have implemented tobacco-control policies ranging from restrictions on indoor smoking to complete tobacco bans.²⁴ Tobacco restrictions and bans have not succeeded in suppressing smoking, and reduced access to programs and materials that might increase long-term smoking cessation have paralleled them.^16,17,24,25We recently conducted a randomized controlled trial of smoking cessation with women prisoners and found 7-day point prevalence cessation rates comparable to those seen in community smoking cessation interventions.¹⁵ The intervention combined nicotine replacement with a 10-week group therapy intervention.²⁶ The community-tested intervention was modified for the prison environment and included a discussion of weight gain and weekly monitoring of weight during the intervention and follow-up assessments.¹⁵ Point prevalence quit rates for intervention participants were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, compared with less than 1% at these same time points for control participants.¹⁵ We examined differences in weight change over time for (1) women in the intervention condition compared with women in the control condition and (2) women in the intervention condition who quit smoking compared with those who continued to smoke. To our knowledge, ours is the first study to conduct such a trial among women prisoners.     

Predicting Desire for a Child Among Low-Income Urban Adolescent Girls: Interpersonal Processes in the Context of Poverty

Although poverty is a well-established risk factor for adolescent motherhood, little is known about the interpersonal processes that influence reproductive-decision making within this broader context. An important factor appears to be the adolescent's desire to have a child. In the present study, interpersonal influences on the desire to have a child were examined in a sample of pregnant low-income urban adolescents. Specifically, we hypothesized that adolescent girls who report poorer relationships with their parents would report greater emotional reliance on their boyfriends and greater reliance on boyfriends would predict greater desire for a child. Results of structural equation modeling provide support for this hypothesis.     

齐鲁晚报读者吸烟与戒烟状况调查

目的了解山东省《齐鲁晚报》读目前的吸烟与戒烟状况,借以制定良好的控烟策略。方法在《齐鲁晚报》上刊登问卷,对读进行调查。结果《齐鲁晚报》读现吸烟率为５４．１％,被动吸烟率为８２．３５％,吸烟率在５０岁之前随年龄增加而升高,５０岁之后随年龄增加而下降,开始吸烟率的年龄多在１５～２０岁之间;９７．９％的被调查认为吸烟,但烟害知识知晓率却仅为５２．１１％;７３．４％被调查戒过烟,２６．９％戒烟     

The Gap Between Attitudes and Use in Prediction of Effect of an Online Smoking Cessation Program

This article describes an investigation of the effect of attitude toward and use of different components of an online smoking cessation program on stage transition based on the Transtheoretical Model. Participants were 299 users of the StopSmokingCoach, an online smoking cessation program, who completed an online questionnaire concerning their attitudes toward the program and its components within 6 months after registration. These attitude measurements and participants’ actual use of the program components were linked to stage transitions of these users. Attitudes toward the StopSmokingCoach and its components were positive; however, only one of these attitude measurements (instructiveness of e-mail tips) predicted actual stage transitions. In contrast, frequency/intensity of use of the coach and 3 of its components (advices, forum, and personal charts, but not the diary, tips, or decisional balance) was significantly related to stage transitions. These results suggest that users do not need to have positive attitudes toward a health program in order to achieve behavioral change. Use of some, but not all program components appears to be more important.     

Characteristics Associated with Exposure to and Participation in a Televised Smoking Cessation Intervention Program for Women with High School or Less Education

OBJECTIVES: This paper estimates the prevalence of exposure to and participation in a televised smoking cessation intervention targeting women with high school or less education and describes characteristics related to exposure and participation. METHODS: A random sample of the population of female smokers with high school or less education in the Chicago metropolitan area was used to estimate the prevalence of exposure to a targeted smoking cessation intervention with television and booklet components (n = 722). Multiple logistic regression analysis was used to examine characteristics related to exposure to each component and participation, defined as simultaneous use of both components, in a sample of population and registrants combined (n = 1,727). RESULTS: About one of every four women in the target population either saw the television series or called for the booklet (24.5%); 17.5% saw the television series, 9.4% called for the booklet, and 2.4% both saw the television series and called for the booklet. Independent predictors of booklet exposure were black, older age, annual income $40,000 or less, heavier smoking, and higher stage of readiness to quit. Adjusting for booklet exposure, independent predictors of television exposure were older age and nonblack. Independent predictors of participation were black, older age, and higher stage of readiness to quit. CONCLUSIONS: The intervention reached a substantial portion of low-educated female smokers. Women who were older, black, or at higher stages of readiness to quit were most likely to be exposed and to participate. Heavier smokers or lower income women were most likely to be exposed but not necessarily to participate.     

Practice-Based Evidence of Effectiveness in an Integrated Nutrition and Parenting Education Intervention for Low-Income Parents

Research identifying associations between parental behaviors and children's food and activity choices and weight suggests that the integration of parenting and nutrition education holds promise for promoting healthful eating and activity in families. However, translational research leading to sustainable interventions lags behind. Development and testing of interventions within actual program contexts is needed to facilitate translation to full-scale implementation. Therefore, the goal of this pilot study was to develop and test an integrated nutrition and parenting education intervention for low-income families within the Expanded Food and Nutrition Education Program in New York State. During a 21-month period, low-income parents of 3- to 11-year-olds were recruited through usual programmatic channels by nutrition program staff to participate in a series of eight workshops delivered to small groups. A validated self-administered questionnaire was used to assess behavior change outcomes among 210 parents who completed the program. Mean scores improved significantly for most behaviors, including adult fruit and vegetable intake; adult and child low-fat dairy and soda intake; and child fast-food intake, activity, and screen time (P<0.001). Many parents reported eating together with children at program entry, leaving little room to improve, but about 20% reported at least a 1-point improvement (on a 5-point scale). The most frequent change was reducing how often children ate fast food and was reported by >50% of parents. Design and testing through practice-based research can facilitate development of interventions that are both feasible and likely to improve eating and activity behaviors among low-income families.     

北京市区医院医务人员吸烟状况及参与控烟干预态度调查

目的 了解目前我市医务人员的吸烟状况及对参与控烟的态度及其成因，为有针对性地对医务人员这一专业群体进行戒烟培训，提高其控烟意识，促使其在日常工作中积极参与控烟工作提供依据。方法 1999年对北京市4所医院的300名医务人员进行问卷调查。结果 男性医务人员吸烟率48．1％，其中40－49岁年龄组的吸烟率明显低于其它年龄组。医务人员对有关吸烟的心脏病，糖水病，溃疡病等危害认识率不足50％。认为医务人员的戒烟建议会有效的比例占61．6％。有73．6％的医务人员愿意工作中加入戒烟内容，不吸烟者与吸烟者的态度存在显著差异。不愿意参与控烟的原因主要有：工作忙，忘记和自己本身吸烟。结论 必须加强对所有卫生专业人员进行基本的专业戒烟培训，引导医务工作者正控烟态度，把控烟视为一种职责。     

Evaluation of a Mindfulness-Based Intervention Program to Decrease Blood Pressure in Low-Income African-American Older Adults

Hypertension affects a large proportion of urban African-American older adults. While there have been great strides in drug development, many older adults do not have access to such medicines or do not take them. Mindfulness-based stress reduction (MBSR) has been shown to decrease blood pressure in some populations. This has not been tested in low-income, urban African-American older adults. Therefore, the primary purpose of this pilot study was to test the feasibility and acceptability of a mindfulness-based program for low income, minority older adults provided in residence. The secondary purpose was to learn if the mindfulness-based program produced differences in blood pressure between the intervention and control groups. Participants were at least 62 years old and residents of a low-income senior residence. All participants were African-American, and one was male. Twenty participants were randomized to the mindfulness-based intervention or a social support control group of the same duration and dose. Blood pressure was measured with the Omron automatic blood pressure machine at baseline and at the end of the 8-week intervention. A multivariate regression analysis was performed on the difference in scores between baseline and post-intervention blood pressure measurements, controlling for age, education, smoking status, and anti-hypertensive medication use. Effect sizes were calculated to quantify the magnitude of the relationship between participation in the mindfulness-based intervention and the outcome variable, blood pressure. Attendance remained >80% in all 8 weeks of both the intervention and the control groups. The average systolic blood pressure decreased for both groups post-intervention. Individuals in the intervention group exhibited a 21.92-mmHg lower systolic blood pressure compared to the social support control group post-intervention and this value was statistically significant (p = 0.020). The average diastolic blood pressure decreased in the intervention group post-intervention, but increased in the social support group. Individuals in the intervention group exhibited a 16.70-mmHg lower diastolic blood pressure compared to the social support group post-intervention, and this value was statistically significant (p = 0.003). Older adults are at a time in life when a reflective, stationary intervention, delivered in residence, could be an appealing mechanism to improve blood pressure. Given our preliminary results, larger trials in this hypertensive study population are warranted.     

Pilot of a Diabetes Primary Prevention Program in a Hard-to-Reach,Low-Income,Immigrant Hispanic Population

An immigrant Hispanic population in the Texas-Mexico border region urgently requested assistance with diabetes. The project team implemented an exploratory pilot intervention to prevent type 2 diabetes in the general population through enhanced nutrition and physical activity. Social networks in low-income rural areas (colonias) participated in an adaptation of the Diabetes Empowerment Education Program. The program had a pre-post-test design with a comparison group. The intervention had a small but significant effect in lowering body mass index, the biological outcome variable. The process evaluation shows that the participants valued the pilot project and found it culturally and economically appropriate. This program was the first primary prevention program in diabetes to address a general population successfully. The study shows that low-income, rural Mexican American families will take ownership of a program that is participatory and tailored to their culture and economic situation.     

Smoking Cessation and Quality of Life: Insights From Analysis of Longitudinal Australian Data,an Application for Economic Evaluations

ObjectivesA number of studies have shown an association between smoking habit and quality of life, but these have mainly involved cross-sectional data. This study takes advantage of longitudinal panel data to estimate the effect of the transition from “smoker” to “ex-smoker” status (smoking cessation) on health-related quality of life (HRQoL), measured by SF-36, in an Australian general population sample.MethodsPanel data from 13 waves (2001-2013) of a nationally representative longitudinal survey of Household Income and Labour Dynamics of Australia (HILDA) were used; 1858 respondents (5% of total HILDA sample) who experienced only 1 cessation event in their HILDA life were selected. HRQoL trajectories elicited by SF-36 (0-100 scale, worst to best health) were modeled before and after cessation events using a piecewise (segmented) 2-way fixed-effect linear regression, adopted to capture within-person differences. This enabled measurement of changes of regression slopes and intercept while controlling time-invariant characteristics (eg, country of birth, gender) and time-varying changes in health status.ResultsAnnual pre-post intervention improvements were estimated for the following dimensions: role physical 0.65 (95% CI 0.62-1.24), bodily pain 0.48 (95% CI 0.10-0.86), general health 0.55 (95% CI 0.2-0.9), and the physical component summary score 0.22 (95% CI 0.01-0.04). Immediate effects (discontinuity at the time of cessation) of smoking cessation existed for bodily pain –1.5 (95% CI –2.52 to –0.40) and general health 1.82 (95% CI 1.01-2.62). The effects for mental health domains were not significant.ConclusionsAdjusting for all unmeasured time-invariant confounders and controlling the effect of time, this study revealed the varied effects of smoking cessation on HRQoL; it has positive effect on physical and general health but nonsignificant effect on mental aspects. Preference-based utility measures based on SF-6D capture changes that can be measured in several of the domains of the SF-36.     

Menthol Brand Switching Among Adolescents and Young Adults in the National Youth Smoking Cessation Survey

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes; by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes.Following enactment of the Family Smoking Prevention and Tobacco Control Act in June 2009,1 fruit, candy, and clove characterizing flavorings in cigarettes were banned to reduce youth smoking initiation. Menthol is the only characterizing flavor that was not banned outright by the act. Nationally representative surveys have shown an age gradient in menthol use, with the youngest smokers (aged 12–17 years) most likely to smoke mentholated cigarettes.2^,3 Studies of adolescents report that middle school smokers and recent initiates are more likely to use mentholated cigarettes than high school smokers and those smoking longer than 1 year, respectively.4 With other studies,5–7 these results argue that menthol facilitates smoking initiation and that mentholated cigarettes serve as starter tobacco products for youths.4Although these nationally representative studies document an age gradient in menthol use, they do not address smoking patterns in the same individuals over time and whether there is a disproportionate shift from early use of mentholated cigarettes to nonmentholated cigarette use later on. The current study assesses patterns in menthol and nonmenthol cigarette use over time in young smokers, aged 16 to 24 years.