Smokers' expectations toward the engagement of their general practitioner in discussing lifestyle behaviors.

Barriers associated with the sparse engagement of general practitioners (GPs) in lifestyle counseling are well investigated. The aim of the study was (a) to explore to what extent smoking patients want to discuss about lifestyle; and (b) to investigate whether patient characteristics might influence the expectations to discuss smoking, alcohol, nutrition, or physical activity. Data were collected during the 24-month follow-up of a smoking cessation efficacy study. Participants were 1,029 patients. More than half of the patients expected that their GP should address smoking, alcohol, and nutrition in a proactive way. Patients who preferred to address the issue of smoking, alcohol, nutrition, and physical activity only for themselves were more likely to be female. Older patients were more likely to reject a discussion concerning these three lifestyle habits in general. Regarding smoking and alcohol, higher age predicted a lower readiness to use an extra appointment. There are some reservations among several patient groups to accept a GP-initiated offer for a discussion about lifestyle habits. Therefore, the improvement of skills and a high sensitivity to address lifestyle habits conveniently can have a large effect on public health.

Reasons for not using smoking cessation aids.

BACKGROUND: Few smokers use effective smoking cessation aids (SCA) when trying to stop smoking. Little is known why available SCA are used insufficiently. We therefore investigated the reasons for not using SCA and examined related demographic, smoking behaviour, and motivational variables. METHODS: Data were collected in two population-based studies testing smoking cessation interventions in north-eastern Germany. A total of 636 current smokers who had never used SCA and had attempted to quit or reduce smoking within the last 12 months were given a questionnaire to assess reasons for non-use. The questionnaire comprised two subscales: "Social and environmental barriers" and "SCA unnecessary." RESULTS: The most endorsed reasons for non-use of SCA were the belief to be able to quit on one's own (55.2%), the belief that help is not necessary (40.1%), and the belief that smoking does not constitute a big problem in one's life (36.5%). One quarter of all smokers reported that smoking cessation aids are not helpful in quitting and that the aids cost too much. Smokers intending to quit agreed stronger to both subscales and smokers with lower education agreed stronger to the subscale "Social and environmental barriers". CONCLUSION: Main reasons for non-use of SCA are being overly self-confident and the perception that SCA are not helpful. Future interventions to increase the use of SCA should address these reasons in all smokers.

[Improving Health Care for Patients with Somatoform and Functional Disorders: A Collaborative Stepped Care Network (Sofu-Net)]. / Verbesserte Versorgung von Patienten mit somatoformen und funktionellen Störungen: Ein koordiniertes gestuftes Netzwerk (Sofu-Net).

The management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy and overuse of health care. To address these difficulties, this study aimed to establish a collaborative stepped health care network (Sofu-Net). Sofu-Net was established among 41 primary care physicians, 35 psychotherapists and 8 mental health clinics. Baseline assessment in primary care showed elevated psychopathology and deficits in health care among patients with somatoform symptoms. Network partners provided positive evaluations of Sofu-Net.

Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices: a three-arm cluster randomized trial.

BACKGROUND: Brief advice for smoking patients has not been sufficiently integrated in routine care. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting. METHOD: 151 practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions. We assessed three dimensions of population impact: (1) adoption, i.e., the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within 7 months; (3) effectiveness, measured as smoking abstinence at 12-months follow-up. RESULTS: Among the practices, 70% adopted the program with no significant differences across study groups. Treatment was provided to 3086 adult smokers. Negative binomial regression analysis revealed that the number of interventions provided was higher in practices allocated to the tailored letter and combination intervention groups by 215% (p<.01) and 127% (p=.02), respectively, compared to the brief advice intervention group. Among the patients who received the combination of both intervention, the odds of point abstinence from smoking was increased by 65% (p=.02) and 32% (p=.01) compared to the brief advice and tailored letters intervention respectively. Comparing the number of abstinent patients at follow-up revealed that the tailored letter and combination interventions were superior to the brief advice intervention. CONCLUSIONS: Computer-based interventions alone or in addition to conventional practitioner-delivered advice can foster the participation of general medical practices in tobacco control.

Need for cognition as a predictor and a moderator of outcome in a tailored letters smoking cessation intervention.

OBJECTIVE: To analyze whether baseline need for cognition (NFC) was a predictor or a moderator of treatment outcome in a tailored letters intervention for smoking cessation. DESIGN: A total of 1,499 daily smokers were recruited from general medical practices in Germany within a quasi-randomized trial testing the efficacies of two brief interventions for smoking cessation: (a) computer-generated tailored letters and (b) physician-delivered brief counseling versus assessment-only. For this study, we used data from 1,097 daily smokers who were assigned to the tailored letters or the assessment-only condition. MAIN OUTCOME MEASURES: self-reported 6-month prolonged abstinence from tobacco smoking assessed at 12-, 18-, and 24-month follow-ups, and smoking cessation self-efficacy assessed at 6- and 24-month follow-ups. RESULTS: Baseline NFC predicted 6-month prolonged smoking abstinence (p = .01) and smoking cessation self-efficacy (p < .01). When compared to assessment only, NFC did not moderate the effect of the tailored letters intervention on smoking abstinence (p > .05) but on smoking cessation self-efficacy (p = .05). Tailored letters resulted in higher smoking cessation self-efficacy only for persons with higher NFC. CONCLUSION: Higher levels of NFC are required to increase smoking cessation self-efficacy in computer-tailored interventions for smoking cessation. Considering an individual's NFC might improve the efficacy of written interventions for smoking cessation.

Effects of practitioner-delivered brief counseling and computer-generated tailored letters on cigarettes per day among smokers who do not quit--a quasi-randomized controlled trial.

BACKGROUND: It is still unclear how brief counseling for smoking cessation, combined with proactive recruitment of participants, impacts on those smokers not reaching the primary treatment goal of tobacco abstinence. Thus, within a quasi-randomized controlled trial, we examined the effects of (1) practitioner-delivered brief advice and (2) computer-generated tailored letters on cigarettes per day (CPD) among participants not succeeding in quitting. METHODS: A total of 34 general practices (participation rate 87%) were randomly selected in a German region. Within these practices, 1499 daily smoking patients aged 18-70 years (participation rate 80%) agreed to participate in a smoking cessation intervention trial. Allocation to study condition was based on time of practice attendance. Latent growth analyses were performed on the subsample of 1334 (89%) smokers who did not reach 6-month prolonged abstinence within the 2-year follow-up period. CPD was assessed at baseline and at 6-, 12-, 18-, and 24-month follow-ups. RESULTS: Both interventions led to small but significant reductions in CPD, and they did not differ in efficacy. Treatment effects occurred within the first 6 months and could be sustained by the continuing smokers until the 24-month follow-up. CONCLUSIONS: Present results complement earlier findings of increased abstinence rates in the total sample. It can be concluded that, even if applied to unselected samples of smokers, from which only a minority initially intends to change, both brief counseling strategies are able to significantly decrease tobacco consumption. They hence appear to provide a means to reducing tobacco-related disease among general medical practice patients.