Smoking behavior and secondhand smoke exposure among university students in northern Portugal: Relations with knowledge on tobacco use and attitudes toward smoking.

OBJECTIVES: To assess the prevalence of active smoking and secondhand smoke (SHS) exposure among college students in the north of Portugal, and analyze the relationship between knowledge about tobacco use and attitudes toward smoking. MATERIALS AND METHODS: This a cross-sectional study with a representative sample of college students (n=840) in one university in Portugal. A validated self-reported questionnaire was administered to a proportional stratified random sample during the academic year of 2018/2019. We evaluated associations between smoking status, SHS exposure, smokers peers, knowledge and attitudes toward smoking and sociodemographic variables. RESULTS: The results showed that 20.1% of the students surveyed were current smokers (7.3% occasional smokers, 2.9% regular smokers and 9.9% daily smokers). Most current smokers started smoking before the age of 17 (61.4%) and reported never having tried to quit smoking (59.7%). Only 34.4% of students reported (almost) not having been in enclosed spaces with smokers in the past 7 days. Exposure to SHS and having smoker friends contributes to the prevalence of tobacco use. In general, students showed favorable attitudes toward smoking, especially those who are smokers, have smoking friends and are more exposed to SHS. The level of knowledge about tobacco was moderate, with a higher number of correct responses by former smokers. CONCLUSIONS: These results suggests an urgent need for socio-educational programs for counseling on smoking cessation. In addition, is also strongly recommended that, throughout academic training, students develop personal and social skills for dealing with the tobacco epidemic.

Clinical guideline for the treatment of dual pathology in the adult population.

Editorial del vol 28-1.

Prevalence of secondhand smoke exposure in asthmatic children at home and in the car: A cross-sectional study.

OBJECTIVE: To compare secondhand smoke exposure (SHSe) prevalence at home and inside the car between asthmatic and non-asthmatic Portuguese children. MATERIALS AND METHODS: This is a cross-sectional study that assessed children's SHSe in a representative sample of nine Portuguese cities. A validated self-reported questionnaire was administered to a random sample of 4th grade students during the school year of 2010/2011. The asthma prevalence was defined by the answers to three questions regarding asthma symptoms, medication and inhaler use. We performed chi-square tests and analysed frequencies, contingency tables, confidence intervals, and odd-ratios. RESULTS: The self-reported questionnaire was administered to 3187 students. Asthma prevalence was 14.8% (472 students). Results showed that 32.3% of non-asthmatic children and 32.4% of asthmatic children were exposed to secondhand smoke as at least one of their household members smoked at home. The prevalence of parental smoking, smoking among fathers and smoking among mothers at home was also similar in both groups (asthmatic and non-asthmatic children). SHSe inside the car was 18.6% among non-asthmatic children and 17.9% among asthmatic children. CONCLUSIONS: Asthmatic and non-asthmatic children were equally exposed to secondhand smoke, because no significant differences were found between the two groups concerning the prevalence of SHSe at home and inside the car. These findings highlight the need to include SHSe brief advice in paediatric asthma management.

Nightlife, verbal and physical violence among young European holidaymakers: what are the triggers?

OBJECTIVES: There is an established relationship between nightlife, substance use and violence. This study investigated this relationship when people are on holiday, and explored the differences in experiences between physical and verbal violence. STUDY DESIGN: A survey of young tourists at seven airport departure areas in Southern European resorts. METHODS: Questionnaires from 6502 British and German tourists were analysed exploring demographics, violence (verbal and physical), substance use, and reasons for resort and venue selection. RESULTS: Over two-thirds of respondents reported being drunk on their holiday, 12.4% had been involved in arguments and 2.9% had been involved in fights. Logistic regression highlighted more violence amongst visitors to Mallorca [arguments: adjusted odds ratio (AOR) 2.7; fights: AOR 2.0] compared with those visiting Portugal, males (arguments: AOR 1.3; fights: AOR 1.7), those who had used illicit drugs (arguments: AOR 1.5; fights: AOR 2.9), those who had been in fights at home in the last 12 months (arguments: AOR 2.2; fights AOR 2.9), and those who had frequently been drunk abroad (arguments: AOR 2.4; fights: AOR 2.5). Those aged 16-19 years, visiting Italy or Crete, who were drunk for fewer than half of the days of their stay, and who chose bars because they were frequented by drunk people were more likely to report having an argument. Fights were associated with cannabis use and were negatively associated with choosing bars with a friendly atmosphere. Economic status or frequency of visiting bars had no relationship with arguments or fights. CONCLUSIONS: Understanding and addressing the variables involved in violence when holidaying abroad is critical in targeting appropriate health promotion and harm reduction measures.

Effectiveness of personalized written feedback through a mail intervention for smoking cessation: a randomized-controlled trial in Spanish smokers.

This study evaluated the effects of written feedback adapted to a self-help mail intervention. The efficacy of the standard mail intervention treatment was 37% at the end of treatment, 22% at the 3-month follow-up, 19% at the 6-month follow-up, and 13% at the 12-month follow-up. In contrast, the standard mail program combined with personalized written feedback resulted in an efficacy of 51% at the end of treatment, 37% at the 3-month follow-up, 32% at the 6-month follow-up, and 27% at the 12-month follow-up. Both groups were significantly different from the control group at the end of treatment (0%), at the 3-month follow-up (1%), and at the 6-month follow-up (1%). There was a significant reduction in the number of cigarettes smoked daily among continuing smokers under both experimental conditions. The authors conclude that written feedback substantially increases abstinence rates when it is applied following similar guidelines to those used in clinical settings.

Evaluation of the amount of therapist contact in a smoking cessation program.

This research tested a multicomponent self-help manual that contained nicotine fading and some behavioral techniques. It also evaluated the incremental effects of using higher amounts of therapist contact on quitting rates. 114 smokers were randomly assigned to one of four treatment groups: (1) A 10-session multicomponent program (n = 25); (2) a 5-session multicomponent program (n = 31); (3) a 5-session multicomponent plus a self-help manual program (n = 25); and (4) a self-help-manual-only program (n = 33). A control group (n = 48) did not receive any treatment. The distinctive characteristic of the treatments was the different amount of therapist contact. Common components of the programs were a refundable deposit, self-monitoring, information on smoking, stimulus control, CO feedback, nicotine fading, and strategies to avoid withdrawal symptoms. End-of-treatment quit rates ranged from 36% (self-help manual) to 68% (10-session multicomponent program). At 12-month follow-up there were significant differences between groups, and the most effective group was the 5-session plus manual group, with an abstinence rate of 48%.

Depression and smoking in a smoking cessation programme.

BACKGROUND: The aim of this study has been to investigate the effect of depressive symptoms on the results of a smoking cessation programme. METHOD: 186 received a multicomponent behavioural programme. At 12-month follow-up 160 subjects were contacted. Depression symptoms pretreatment and at the 12-month follow-up were evaluated using the Beck Depression Inventory (Beck et al., 1979. Cognitive Therapy of Depression. Guilford Press, New York.). RESULTS: Smokers at 12-month follow-up had a mean score of 7.1 (S.D. = 5.8) and abstainers had a score of 5.2 (S.D. = 5.4). Depressive symptoms at 12 month follow-up were associated with smoking cessation at 12 month follow-up (t(1,158) = 1.98, P < 0.05), but depressive symptoms at baseline and smoking cessation end of treatment were not. LIMITATIONS: The most important limitation in study has been the size of the sample (particularly in abstainers). CLINICAL RELEVANCE: Depressive symptoms have an influence on efficacy at the 12-month follow-up, but not at the end of treatment. It does not seem necessary, for the moment, to introduce specific interventions targeted at the modification of negative mood.

Self-reported smoking and measurement of expired air carbon monoxide in a clinical treatment.

In this study was evaluated the relationship between self-reported smoking rate and expired air carbon monoxide in 208 smokers who had attended a behavioral program for smoking cessation. A close relationship between carbon monoxide levels and self-reports was found at the end of treatment and in all follow-ups (6 and 12 mo.), around 100% concordance. Thus, support was found for the use of an expired air carbon monoxide measure as a valid and easy way of corroborating self-report data when required.

Smoking cessation and weight gain in smokers participating in a behavioral treatment at 3-year follow-up.

This study assessed the weight gain for the short- and long-term (36 mon. follow-up) in a sample of 158 smokers (71 men and 87 women), who participated in a multicomponent behavioral smoking-cessation program. Weight was evaluated with a self-reported questionnaire, with a over-all mean pretreatment weight of 65.3 Kg (SD = 12.6). All individuals tended to gain weight. Afterwards, the mean of nonquitters (n = 116) by 0.6 Kg. Among abstinent people no significant differences were found by sex at 36 mon. but significant mean difference were found in those subjects (quitters) older than 35 yr. who gained 4.1 Kg compared with 1.2 Kg in the group 35 yr or younger.

The course of relapse across 36 months for smokers from a smoking-cessation program.

The aim of this study is to examine relapse of 72 smokers who stopped smoking with a behavioral smoking cessation program and relapse in the period from the end-of-treatment to the 36-mo. follow-up. The relapse occurred fundamentally between the end-of-treatment and the 6- (53.7% relapse) and the 12-mo. follow-up (61.1% relapse), and more slowly beyond 12-mo. follow-ups with 72.2% and 70.4% relapse at the 24- and 36-mo. follow-up.

Treatment of major depression associated with smoking cessation.

A number of clinicians have reported cases of major depression associated with smoking cessation. We report here a case of major depression in a 27-year-old woman who abruptly reduced cigarette consumption from 35 to 8 cigarettes per day during the baseline period. A multi-component behavioural programme was applied to stop smoking, together with pharmacotherapy and Beck's cognitive therapy for depression. Twelve months after ending treatment, the patient was still abstaining from smoking, and she showed no signs of depressive symptomatology.

The Fagerström Test for Nicotine Dependence in a Spanish sample.

The Fagerström Test for Nicotine Dependence was developed to improve the reliability and validity of the Fagerström Tolerance Questionnaire. In this study, we examined the applicability of the Spanish version of such test as well as its relationship to sex, age, and consumption of cigarettes, in a representative sample of smokers from Galicia, Spain (N = 646).

Pathological gambling in Spanish children and adolescents: an emerging problem.

Several studies have shown a high prevalence of pathological gamblers among adults in Spain (between 1.5% and 1.7%) of the population (18 years and older). In other countries the prevalence of pathological gambling in children and adolescents has been higher than in adults. Here some results of the first studies conducted in Spain concerning the prevalence of pathological gambling in school children and adolescents (11-16 years) are presented for two cities located in different northern regions of Spain, A Coruña (Galicia) and Gijon (Asturias), with representative samples of school children. The prevalence was 2.2% (n = 1,200) and 1.6% (n = 2,185), respectively, for the use of slot machines, using the 1993 DSM-IVJ Questionnaire of Fisher, and 2.4% in the first city with the South Oaks Gambling Screen-Revised Adolescent for all types of gambling. The analyses suggest there is an emerging problem among children and adolescents in Spain perhaps leading to an increased number of pathological gamblers as adults.

Does using relapse prevention increase the efficacy of a program for smoking cessation?: An empirical study.

The aim of this study was to assess the effectiveness of relapse prevention taught as a problem-solving procedure in increasing the efficacy of a behavioral program for smoking cessation at short- and longer-term, 12-mo. follow-up. 75 smokers were assigned randomly to two treatment groups, using an additional 40 smokers who attended an information session but did not receive any treatment session as a control group. The first group (n = 40) received the standard behavioral multicomponent program of Becoña. The program included motivational contract, self-monitoring, information on smoking, nicotine fading, stimulus control, avoidance of withdrawal symptoms, physiological feedback, and progressive self-control. The second group (n = 36), the relapse prevention group, were given the above program and an additional component of relapse prevention using a problem solving procedure. Both groups had 8 sessions of treatment. Analysis showed that at the end of treatment abstinence in the two groups was 80.0% and 61.1%, respectively, at the 12-mo. follow-ups 30.0% and 36.1%. These differences were not significant; however, both groups were significantly different from the control group at the end of treatment (0% abstinence) and at 12-mo. follow-ups (2.5% abstinence). These results show that the addition of this relapse prevention does not increase the number of smokers who quit or decrease the number who relapse. Further research should focus on the process of relapse and develop more effective procedures to help maintain abstinence.

The age of stopping smoking: the Spanish example.

In this study we analysed the average age at which smokers in Spain seek treatment. The sample of 485 smokers who sought to participate in a smoking cessation program by mail had a mean age of 37.5 yr, and the mean reported number of cigarettes smoked per day was 26.3. Subjects' age was significantly associated with gender, marital status, and the number of cigarettes smoked before treatment.

Pathological gambling and depression.

A number of previous studies have indicated that pathological gambling is often associated with depression. Equally, a number of theoretical models of pathological gambling have included depression as a key variable. Here we report a study of depression in pathological gamblers identified within a random sample of 1,615 adults living in the major cities of Galicia (northwest Spain). Pathological gamblers were identified on DSM-IV diagnostic criteria. Depression was evaluated with the Beck Depression Inventory, subjects being classified 'depressive' if they obtained a score of 18 or more. Of 19 pathological gamblers who completed the Beck Depression Inventory, 21% were depressive; by contrast, only 9% of the other subjects were depressive. The Beck scores of pathological gamblers were positively correlated with the severity of their addiction as indicated by the number of DSM-IV-specified symptoms reported.

Relation between the Tolerance Questionnaire (nicotine dependence) and assessment of carbon monoxide in smokers who participated in treatment for smoking.

It is very important to have objective measurements of nicotine dependence or tobacco addiction, especially in the treatment of smokers. The most utilized physiological assessment is the carbon monoxide (one of the components of tobacco smoke) in expired air. A noninvasive measure of nicotine dependence is the Fagerström's Tolerance Questionnaire. In our study we compared responses on the Tolerance Questionnaire of 217 smokers who participated in a treatment to stop smoking and also measurements of carbon monoxide in expired air (evaluated with a Mini Smokerlyzer EC-50). Analysis showed the utility of the Tolerance Questionnaire in the discrimination of number of cigarettes smoked prior to and after treatment and at follow-up.

Nicotine fading and smokeholding methods to smoking cessation.

We tested a multicomponent behavioural package to stop smoking that contained nicotine fading and smokeholding techniques. 73 smokers were randomly assigned to one of five treatment programmes: (1) nicotine fading and cigarette fading, (2) nicotine fading and concurrent smokeholding, (3) nicotine fading and subsequent smokeholding, (4) a nonintensive smokeholding programme, and (5) an intensive smokeholding programme (daily sessions). Common components of the programmes were self-monitoring, information on smoking, stimulus control, CO feedback, and strategies to avoid withdrawal symptoms. Each treatment was carried out during a total of 10 sessions over 4 weeks (Treatments 1-4) or 2 weeks (Treatment 5). End-of-treatment quit rates ranged from 85% to 91%. At 12-mo. follow-up, the most effective package proved to have been nicotine fading and cigarette fading, with an abstinence rate of 57% as against 25 to 37% for the other treatments.

Scores of Spanish smokers on Fagerström's Tolerance Questionnaire.

Nicotine may be the agent responsible for tobacco addiction. A non-invasive, easy measure for evaluating addiction is Fagerström's 1978 Tolerance Questionnaire. Present results are based on responses of 732 Spanish smokers to the Spanish version of the questionnaire. The questionnaire has a moderate reliability, and some items are more important than others. Among the Spanish smokers, the questionnaire differentiated the groups of 327 light, 275 normal, and 130 heavy smokers.