尼古丁疫苗进行戒烟治疗的新进展

烟草是目前全球人类健康所面临的最大危险因素之一,通过合理正规的戒烟治疗是完全可以降低相关疾病发生的。吸烟可以成瘾,称为烟草依赖。许多吸烟者存在不同程度的烟草依赖。烟草依赖者一旦停止吸烟,可出现吸烟渴求、焦虑、抑郁、头痛等一系列戒断症状,导致再度吸烟,戒烟困难。烟草依赖是一种慢性疾病,有其相应的临床诊断标准。同时,烟草依赖具有高复发性,其治疗往往需要专业人士及科学方法的辅助。     

重视文化程度对戒烟治疗效果的影响

目的 探讨文化程度对戒烟治疗效果的影响,提高戒烟率,减少吸烟相关疾病的发病率,提高生活质量.方法 于2012年3月~2012年10月在本院内科住院的吸烟患者,同意配合戒烟行动的209人选为研究对象,均为男性,年龄45~65岁,平均（55.2±5.2）岁,按文化程度分为小学文化以下（低）、中学和中专文化（中）、大专以上（高）三组,每组人员都采用尼古丁贴片加心理行为干预加戒烟日志综合方法戒烟,并进行严格的跟踪和督导,对实验结果进行统计分析.结果 文化程度低者成功戒烟23例,中等文化程度者成功戒烟30例,文化程度高者成功戒烟33例,三组间差异有统计学意义（χ2=8.491,P＜0.01）.结论 文化程度高的吸烟患者戒烟效果好,如果重视文化程度,并根据文化程度给予针对性戒烟指导,可提高戒烟成功率.     

昆明市男性烟草使用与戒断现状研究

目的了解昆明市常见使用烟草所致的精神与行为障碍的流行强度及分布情况。方法按容量比例和随机抽样原则,采用人户调查的方法,使用CID12-1为调查工具,ICD-10作为诊断标准。结果共调查样本5033户,随机抽得有吸烟行为男性2416例,终生吸烟行为63．53％。在吸烟行为人群中,有戒烟意识51．27％,有戒烟行为49．32％,成功戒烟5．34％,有害性使用33．81％,依赖综合征12．25％。结论本次调查达到了预期目的,使用烟草问题发生率高,对健康影响大,戒烟成功率低,应立即提高防治力度。     

中重度烟草依赖患者文化程度对戒烟干预策略选择的影响

目的观察文化程度对中重度烟草依赖患者戒烟效果的影响, 探讨个体化有效戒烟方法, 提高戒烟率。方法选取2020年1-12月在胜利油田中心医院呼吸与危重症医学科及戒烟门诊就诊有戒烟意愿的患者480例, 按文化程度分为四组, 每组120例, A组为小学及以下, B组为初中及高中, C组中专或大专, D组为大学及以上。每组随机给予"5A"干预和"5A"联合伐尼克兰戒烟干预(联合干预)措施。观察四组患者对吸烟危害认知度及不同干预措施在各时间点戒烟率的差异。结果 D组、C组、B组、A组吸烟危害认知度评分分别为(806.5±35.7)分、(710.8±26.2)分、(643.6±43.4)分、(512.4±30.1)分, 文化程度高的患者有较高的烟草危害认识度, 组间差异有统计学意义(F=1 543.26, P < 0.001)。四组1个月、3个月、6个月戒烟率比较, 联合干预均高于"5A"干预(A组:χ2=3.85、4.23、4.10, B组:χ2=4.30、4.09、4.60, C组:χ2=6.81、4.30、4.03, D组:χ2=6.71、6.51、4.73, 均P < 0.05...     

影响糖尿病药物治疗依从性的相关因素及护理干预对策

目的探讨影响糖尿病患者服药依从性的相关因素及护理干预对策。方法回顾性分析480例糖尿病患者的临床资料,以服药依从性差者作为观察组,服药依从性好者作为对照组,对影响服药依从性的因素进行比较。结果480例患者中服药服药依从性好33．3％,服药依从性差者占66．7％,服药依从性差的因素：年龄大、文化程度低、服降血糖药种类及次数多、糖尿病认知差、医疗费自费（P〈0．05）。结论诸多因素的影响糖尿病患者药物治疗依从性,应通过健康教育、提高低文化程度群体健康信念、给予简单化个体化给药方案、加强老年患者家庭支持可改善依从性。     

住院精神病人吸烟状况调查分析

目的：了解精神病人的吸烟及依赖情况和态度。方法：采用自制吸烟状况调查表和戒断症状调查表，对住院４１２名精神病人进行普查，并筛选出符合烟草依赖者９０例进行分析。结果：精神病人吸烟率占总住院病人７３．５％，依赖率为２１．８％。多元回归分析显示，病程、住院、时间、环境、疾病的转归差与吸烟的易感因素对戒烟认识不足、缺乏自信、态度较为消极成正比。结论：改善单调住院环境是控制精神病人吸烟关键因素。     

武汉市吸烟者的烟草依赖性及相关因素的分析

目的:了解吸烟者的吸烟习惯、描述其烟草依赖程度的分布及相关因素,为有效开展控烟工作提供科学依据。方法:对武汉市各区的1310名吸烟者就吸烟情况、控烟认识、吸烟习惯等问题进行问卷调查。对与吸烟者烟草依赖有关的问题进行量化赋分,评估依赖程度。结果:单因素分析的结果表明:不同技术职称、收入、职业、受教育程度、人际关系以及工作紧张程度的吸烟者对烟草的依赖水平存在着显著的统计学差异;累计吸烟时间长(OR=2.539,P=0.000)及对吸烟危害认识欠缺(OR=3.436,P=0.003)的吸烟者容易产生尼古丁高依赖,而经济条件好(OR=0.867,P=0.024)、受教育程度高(OR=0.818,P=0.017),表明技术职称高(OR=0.599,P=0.044)是吸烟者不易产生尼古丁高依赖。结论:受教育程度低、工作环境紧张、对烟草危害认识低和累计吸烟时间长是烟草依赖性的危险因素。     

5A戒烟法联合电话热线进行社区戒烟干预效果评价

<正>作为一种慢性疾病,烟草依赖(tobacco dependence)目前已经被世界卫生组织列入国际疾病分类[1]。众多的研究结果均表明,吸烟人群罹患心血管系统疾病如冠心病、高血压,呼吸系统疾病如慢性阻塞性肺疾病、肺气肿,以及多种癌症如肺癌的相对危险度(RR)与非吸烟人群相比显著升高[2,3]。作为全球最大的烟草产销国家,目前我国有3亿的吸烟人口,其中男性烟民占到一半以上的比例[4],吸烟和二手烟所致的严重疾病负担、环境污染和经济负担,不利于中国全民健康目标的达成[5]。因此禁烟、控烟和戒烟工作迫在眉睫。本文拟就5A戒烟     

护理干预在冠心病慢性心力衰竭患者中的应用效果分析

目的探讨护理干预对冠心病慢性心力衰竭患者的护理效果。方法选择本院慢性心力衰竭患者共100例,上述患者随机分为观察组和对照组。对照组给予常规慢性心力衰竭护理干预,观察组在常规护理基础上实施综合性护理干预。观察两组患者不良生活方式改变情况。通过自设问卷调查表对护理干预后患者对医嘱等执行情况进行调查,观察两组患者依从性。结果观察组患者低盐饮食、低脂饮食、合理休息和运动、戒烟戒酒所占比例均高于对照组,差异有统计学意义。观察组依从性好所占比例为90.0%,对照组患者中依从性好所占比例为62.0%,观察组依从性好所占比例高于对照组,差异有统计学意义（P〈0.05）。结论综合性护理干预有助于改善冠心病心力衰竭患者不良生活方式,提高治疗依从性,护理效果显著。     

PDCA循环模式对医院工作人员控烟干预效果评价

目的 探讨PDCA循环模式对医院工作人员控烟干预效果.方法 运用PDCA循环模式对河北省某综合性三甲医院的98名工作人员(包括临床、医技、行政管理及后勤科室),实施为期180 d的控烟干预,采用问卷式调查法,比较干预前后医院工作人员对控烟知识、态度、行为的变化.结果 干预后工作人员对烟草危害、吸烟和被动吸烟相关疾病知识的认知,较干预前明显提高,对控烟的态度和行为均发生了较大转变.认为室内应全部禁烟的比例由干预前的64.28%上升到干预后86.73%,认为"可以在自己办公室吸烟"的比例由干预前的20.41%下降到干预后的6.12%,赞同香烟可以当作礼物互赠由干预前的53.06%,下降到干预后的16.33%,2组之间比较差异有统计学意义(P<0.05);同时提高了对就诊者询问和提供戒烟服务的主动性.主动推荐戒烟药物的比例,由干预前的12.90%上升到干预后的24.19%,2组之间比较差异有统计学意义(P<0.05);干预后,26人成功戒烟,戒烟率达26.53%;每人每日平均吸烟支数由干预前12支降低到干预后的8支,准备未来1年戒烟人数由干预前的13.26%上升到45.83%;对PDCA控烟模式的满意度达91.84%.结论 运用PDCA循环模式对医院工作人员实施控烟干预,不仅能提高工作人员对烟草危害、吸烟和被动吸烟相关疾病知识的认知,显著降低工作人员吸烟量、提高戒烟成功率;而且能转变他们的控烟态度和行为,提高对就诊者吸烟的主动询问率及提供戒烟服务的能力,有利于推动全社会控烟工作的发展.     

Cigarette smoking and interest in quitting in methadone maintenance patients

OBJECTIVES: To examine tobacco use, readiness to quit, and interest in smoking cessation interventions among methadone maintenance patients. METHODS: Cross-sectional survey of outpatients enrolled in four urban methadone maintenance clinics. Stage of readiness to quit was determined for all smokers, and factors associated with both readiness to quit and interest in attending an on-site smoking cessation program were determined. RESULTS: Among 389 patients, 83% were current smokers. Nearly half (48%) of smokers were contemplating quitting, and an additional 22% were in the preparation stage of readiness to quit. In multivariate analyses, lower nicotine dependence, prior use of smoking cessation pharmacotherapy, and lower methadone dose were associated with being in the preparation stage. Patients with more education, Hispanics/Latinos, and patients who had used smoking cessation pharmacotherapy or were in the preparation or contemplation stages of behavior change were more interested in attending an on-site smoking cessation program. CONCLUSIONS: Tobacco use is highly prevalent among methadone maintenance patients, but we also observed a high level of readiness to quit and interest in smoking cessation. Targeted smoking cessation interventions, including on-site programs, should be developed for methadone maintenance patients.     

Adolescents' rationalizations to continue smoking: The role of disengagement beliefs and nicotine dependence in smoking cessation

Adult smokers were found to reduce cognitive dissonance regarding their smoking behaviour by adhering to rationalizations or justifications to continue smoking, also known as disengagement beliefs. These beliefs were found to be an important barrier with regard to smoking cessation practices. Neither the occurrence of disengagement beliefs, nor its effect on motivation to quit and actual smoking cessation have been studied among adolescent smokers. Therefore, this prospective study among a sample of 363 adolescents examined the extent to which adolescents adhere to disengagement beliefs, and the relations between disengagement beliefs and adolescents' motivation to quit smoking, motivation change and smoking cessation. The association and interplay between disengagement beliefs and level of nicotine dependence was also assessed. Results showed that the degree to which adolescent smokers adhere to disengagement beliefs was similar to that of adults, if not stronger. Higher levels of dependence coincided with stronger adherence to disengagement beliefs. Further, when controlling for nicotine dependence, disengagement beliefs were strongly negatively associated with motivation to quit, but only marginally inversely associated with smoking cessation one year later. Nicotine dependence was the strongest barrier for smoking cessation at follow-up.     

Motivation of trauma patients to stop smoking after admission to the emergency department

Every smoker should be offered smoking cessation treatment when they present for clinical care. The Readiness to Change-Smokers (RTC-S) questionnaire and the Heidelberg Smoking History (HSH) are brief questionnaires that divide patients into three stages. The purpose of this study was to prospectively compare the performance of each questionnaire at identifying patients who will successfully quit smoking within one year of Emergency Department (ED) discharge. Out of 1292 injured ED patients nearly half (n = 599, 46.4%) were identified as current smokers. Both questionnaires were given to all 599 subjects, and used to divide patients into three stages. At 12-months postdischarge 306 patients (51.1%) were contacted to determine smoking status. Patients were similarly classified by both tests in only 36% of cases. Concordance between tests was poor (kappa = 0.33). The RTC-S classified fewer patients as ready to quit (A = 13% vs. 22.2%). At 12 month follow-up, 55 patients (17.9%) had stopped smoking. The HSH was more successful to predict quitters. Multivariate logistic regression with respect to smoking cessation resulted in significant impact of HSH (p = 0.024).     

Sleep duration and smoking cessation in student nurses

STUDY OBJECTIVES: To assess predictors of smoking cessation in young adults. DESIGN: Prospective study of smoking cessation. SETTING: 32 Schools of Nursing in Southwest Germany. PARTICIPANTS: 500 student nurses, 82% female, median age 19.9 years, who smoked at baseline. MEASUREMENTS AND RESULTS: Smoking status and potential predictors of smoking cessation were assessed by two questionnaires within a median time interval of 13.1 months. At follow-up, 10.6% of the participants had stopped smoking. Sleep duration was positively associated with smoking cessation. One hour additional sleep per night at baseline increased the relative probability to stop smoking by 1.48 (95% CI 1.14-1.93). The number of cigarettes per day and the 'self-assessment of smoking behaviour in 5 years' were additional factors predicting smoking cessation. CONCLUSIONS: Sleep duration may influence smoking cessation and may have relevance for advising people who want to quit smoking.     

Alcohol consumption and quitting smoking in the International Tobacco Control (ITC) Four Country Survey

Although greater alcohol consumption has been associated with decreased odds of quitting smoking in prospective studies, the aspects of drinking most strongly associated with quitting have not been fully explored and examination of potential confounder variables has been limited. Further studies are needed to inform efforts to enhance smoking cessation among the substantial portion of smokers who drink alcohol. The present study examines: (a) drinking frequency, average weekly quantity of alcohol consumption, and frequency of heavy drinking as prospective predictors of quit smoking behaviors, (b) difference across countries in this prediction, and (c) third variables that might account for the association between alcohol consumption and quitting smoking. Data were drawn from the International Tobacco Control Four Country Survey, a prospective cohort study of smokers in Australia, Canada, the UK, and the US. A total of 4831 participants provided alcohol data at one study wave and were re-interviewed 1 year later. Individuals who drank heavily (4+/5+ drinks for women and men, respectively) more than once a week had significantly lower rates of quitting smoking than all other participants, in part due to the fact that a significantly lower proportion of those making a quit attempt remained quit for more than 1 month at follow-up. The role of frequent heavy drinking did not differ by country or sex and was not accounted for by demographics, smoking dependence, or attitudes regarding quitting smoking. Neither drinking frequency nor weekly quantity of consumption showed robust associations with quitting behaviors. Results indicate further study of interventions to address heavy drinking among smokers is warranted.     

Reciprocal effects of alcohol and nicotine in smoking cessation treatment studies

Objective

Smoking and alcohol use are highly related; as such the present study investigated whether alcohol use is associated with failure in tobacco cessation attempts. We first examined the self-reported drinking behavior and smoking over the course of a year at a basic level. Next, we addressed two hypotheses to characterize this relationship at a deeper level: (Hypothesis 1) Alcohol use would be lower for those who attempted to quit smoking (quit for one or more days) during the year compared to those who never quit, and (Hypothesis 2) for those who relapsed to smoking after a quit increases in alcohol consumption would be positively associated with increases in smoking.

Method

Subjects were participants in two smoking cessation programs. One group of participants (N = 139) was part of a smoking cessation study in alcohol dependent smokers in early recovery and the other group of participants (N = 163) was drawn from a smoking cessation study for HIV positive smokers.H1 was tested using t-tests. For H2, a time series analysis examined relationships between smoking and alcohol use within person over a one year period. For H1 and for H2, the analyses utilized bivariate time series procedures. Timeline follow-back data allowed for detailed daily reports of both tobacco and alcohol use.

Results

In the overall sample, there was no difference in alcohol use between those who stopped smoking and those who never stopped. However, when broken up by study, a difference was found in the alcohol dependent sample such that mean drinks were higher for those who stopped compared to those who never stopped smoking (H1). The results indicated a high number of positive significant cross-correlations between tobacco and alcohol use such that one substance predicted current, as well as past and future use of the alternate substance. Same-day cross-correlations were the most common, and dissipated with time (H2).

Conclusions

This analysis provided insights into the proximal influence of one substance on the other. Alcohol is related to relapse in smoking cessation attempts. It is important that smoking cessation efforts in alcohol using populations consider alcohol use in treatment.     

The influence of message framing, intention to quit smoking, and nicotine dependence on the persuasiveness of smoking cessation messages

This study explores the combined effect of message framing, intention to quit smoking, and nicotine dependence on the persuasiveness of smoking cessation messages. Pre- and post-message measures of quit intention, attitude toward smoking cessation, and perceived behavioral control were taken in two separate waves from current cigarette smokers with varying levels of nicotine dependence (N=151). In the second wave, participants were randomly assigned to one of two groups. In the first group, participants read a smoking cessation message which emphasized the benefits of quitting (positive frame). In the second group participants read a message which emphasized the costs of not quitting (negative frame). Results show that smokers' intentions to quit smoking and their level of nicotine dependence jointly influence the persuasiveness of positive and negative message frames. When nicotine dependence and quitting intention are both high, a negative frame works best. Conversely, a positive frame is preferable when nicotine dependence or quitting intention is low. Smokers' level of processing is proposed as the underlying mechanism explaining the different effects of message frames.     

The Heaviness of Smoking Index as a predictor of smoking cessation in Canada

Nicotine addiction is believed to be a major impediment for many people in quitting smoking, but measures of nicotine dependence such as the Heaviness of Smoking Index (HSI) have had mixed success in predicting cessation. Using the National Population Health Survey, the relationship between HSI at baseline in cycle 2 (1996-1997) and successful smoking cessation at cycle 3 (1998-1999) and cycle 4 (2000-2001) was examined in 2938 Canadian adult smokers. A logistic regression model was developed for HSI as a predictor of smoking cessation, and then tested for interaction and confounding. The odds ratio of not smoking in cycle 3 was 2.08 (95% CI: 1.51, 2.86; p<0.001) for low HSI (<2) compared to medium HSI. When the period of follow-up was extended, individuals with both high (>4) HSI scores (OR 2.16; 95% CI: 1.11, 4.21; p=0.02) and low scores (OR 2.22; 95% CI: 1.41, 3.49) had higher odds of not smoking at both cycle 3 and cycle 4 than those with medium HSI scores. The likelihood of reporting cessation was higher than expected in the Canadian population among highly dependent smokers, particularly among older smokers, those with middle or greater income adequacy, and those with no intention to quit smoking. There were no substantial changes to the results when those lost-to-follow-up were treated as continuing smokers. These findings indicate that nicotine dependence is only one factor in succeeding at a quit attempt. Individual and population strategies for smoking cessation may need to consider other influences such as cognitive, affective and environmental factors.     

Influence of phase-related variability in premenstrual symptomatology, mood, smoking withdrawal, and smoking behavior during ad libitum smoking, on smoking cessation outcome

Emerging evidence suggests that women have a more difficult time quitting smoking than men-possibly due, in part, to sex hormones. The present study characterized mood, premenstrual symptomatology, and smoking withdrawal, as well as smoking behavior, in the follicular and luteal phases during ad libitum smoking in 25 women intending to quit. We also investigated the possible influence of phase-related variability in these measures on likelihood of study adherence and smoking cessation. We found that premenstrual symptomatology, as well as some measures of mood and smoking withdrawal, were significantly higher during the luteal phase than in the follicular phase. Cigarettes/day did not vary by menstrual cycle phase. Phase-related variability in premenstrual symptomatology [F(3, 20)=2.82, p=0.0650)] and urge to smoke [F(2, 21)=4.85, p=0.0186)] were associated with relapse. These data support the inference that sex hormones influence smoking cessation outcome. This knowledge may contribute to the development of more rational and effective smoking cessation interventions for women.     

History of smoking and postcessation weight gain among weight loss surgery candidates

Smoking cessation often results in weight gain. Although smoking cessation frequently is recommended to patients presenting for weight loss surgery (WLS), the relationship between smoking cessation and weight gain among WLS candidates is poorly understood. Thus, we sought to document the history and prevalence of smoking and smoking-related weight gain among WLS candidates. Subjects (N=67) presenting for bariatric surgery provided demographic information, were interviewed about smoking, and were weighed and measured prior to operation. Sixty-seven percent of patients reported a lifetime history of smoking, and 26.9% were current smokers. Among lifetime smokers who had attempted to quit, the average maximum amount of weight gained following smoking cessation was 28.1 lb, but there was wide variability in postcessation weight gain. These data suggest that smoking among candidates for bariatric surgery is prevalent and that previous cessation attempts were associated with considerable weight gain. Because patients often receive recommendations to quit smoking and lose weight prior to surgery, additional information on the impact of presurgical smoking cessation on long-tem weight control in this population is needed.