Difficulties of smoking cessation in diabetic inpatients benefiting from a systematic consultation to help them to give up smoking.

AIM: To assess the value of systematic smoking cessation consultations for diabetic smokers admitted to hospital. METHODS: All diabetic smokers admitted to the Diabetes Department of Georges Pompidou European Hospital between February 2003 and February 2004 were systematically offered a consultation with a physician specialised in tobacco cessation. Follow-up visits at three, six and nine months were planned. RESULTS: Of the 306 diabetic patients admitted, 38 (12.4%) were smokers. There were more men than women in the group of smokers and the diabetic smokers were younger than the non-smokers. The smokers had fewer micro-angiopathic complications than the non-smokers, but there was no difference in the frequency of macro-angiopathic complications. The level of nicotine physical dependence was moderate or high for 60% of the smokers. Although all the smokers agreed to the consultation, less than half agreed to drug-based treatments to help them to give up smoking and only 15% returned for the six-month visit. Only one patient had stopped smoking at the six-month visit. CONCLUSION: This study demonstrates the difficulties in systematic interventions to help diabetic patients to stop smoking. Diabetic smokers probably constitute a specific population for which the barriers to giving up smoking should be explored.

[Feasibility of systematic screening for addictive behaviours of hospitalized patients]. / Faisabilité du dépistage systématique des comportements addictifs chez les patients hospitalisés.

BACKGROUND: The national policy against addiction led to the establishment of specialized units with liaison teams trained in addiction specifically to work with the in-patients. The aim of this study has been established within the context of the implementation of one of these addiction liaison units in a Parisian Hospital, the Georges Pompidou European Hospital (HEGP), that is namely to evaluate the feasibility of a systematic screening procedure concerning tobacco and alcohol dependence among inpatients in two of the hospital's specialization departments between December 6, 2001, and March 6, 2002. METHODS: Self-administered questionnaires on addictive behaviours were distributed to each patient admitted to the vascular health department and to the hypertension department They included the Fagerström Test for Nicotine Dependence and the AUDIT for evaluating levels of alcohol abuse. RESULTS: The response rate was 30.2% (110/364). Twenty-nine smokers were identified. Among them, 72.5% presented a low level of physical nicotine dependence. Nearly half of them (14/29) were not interested in participating in a smoking cessation intervention with the assistance of relevant hospital staff. Among eleven patients at risk of excessive alcohol abuse, only one accepted to be referred to a specialist. CONCLUSION: This study highlights the difficulties of the systematic screening for addictive behaviours in hospitalized patients. Nevertheless, the obstacles faced in terms of the acceptability of the screening, but the patients as well as by the hospital staff, do not lean against the development of this trend or oppose this type of approach. New methods of individual screening for addictive behaviours should be explored.

[Epidemiology of tobacco smoking]. / Epidémiologie du tabagisme.

INTRODUCTION: The aim of this review is to give an overview on tobacco consumption in France and to describe the mortality and the morbidity related to smoking. STATE OF ART: Following the increase of tobacco prices in 2002-2003, the prevalence of smoking was estimated to 30% in 2004 in France. Tobacco smoking leads to 66,000 deaths annually in France: 59,000 among men and 7 000 among women. Three groups of diseases are linked with smoking: cancers, cardio-vascular diseases and chronic lung diseases. A relation was also established with gravidic or osteoporotic complications. Passive smoking is also involved in numerous diseases such as lung cancer, coronary diseases and strokes. PERSPECTIVES: Smoking cessation conducts to a progressive decrease in morbidity risk. A functional improvement is obtained for patients suffering from chronic lung diseases. CONCLUSIONS: Effective smoking cessation treatments are available and should be systematically offered to smokers.

[Characteristics of smokers seeking smoking cessation services: the CDT programme]. / Caractéristiques des fumeurs s'adressant aux consultations de tabacologie. Analyse de la base nationale CDT.

INTRODUCTION: The development of smoking cessation clinics in France since 1999 has been accompanied by the setting up of an electronic database to evaluate the appropriateness of these services to the needs of smokers. The aim of this paper is to analyse the characteristics of smokers registered in the smoking cessation services national database. METHODS: A cross-sectional population-based study was conducted in 40 smoking cessation centres from 20 French regions. The study population included 14,574 smokers attending the smoking cessation centres that participated in building a national computerised database during the period 2001-2003. RESULTS: A significant proportion of the study population was female (51.4%), middle-aged (42.8 years), more highly educated (34% had received further education) and employed (68%). Almost half of the population was considered to be highly dependent on tobacco. Thirty-four percent of smokers had a past medical history of cardiovascular or lung disease. A history of depression was found in nearly one third of the population. CONCLUSIONS: Young people and individuals from deprived backgrounds were underrepresented, but smoking cessation services were being accessed by highly-dependent smokers and smokers with tobacco-related diseases services. More targeted smoking cessation strategies should be considered in order to improve access to smoking cessation services by more deprived groups.

[Comparison of insurance coverage of tobacco cessation pharmacotherapies in five countries from the Organisation for Economic Co-operation and Development]. / Comparaison des systèmes de couverture assurantielle des traitements pharmacologiques d'aide au sevrage tabagique dans cinq pays de l'Organisation de Coopération et de Développement Economiques.

BACKGROUND: Reports in the literature demonstrate effectiveness and cost-effectiveness of tobacco treatments including drug and behavioral therapies. The health insurance coverage of smoking cessation treatments could lower financial barriers which limit the access to these services. The purpose of this paper was to compare health insurance coverage for pharmacotherapies for smoking cessation in five countries from the Organisation for Economic Co-operation and Development. METHODS: A literature review was performed using Medline, official websites and Google. A grid was used to analyse articles and reports in order to identify: the public or private coverage of smoking cessation pharmacotherapies; the population groups who were covered; the extent and content of the insurance coverage as well as the practical ways to obtain it and the training and certification of the health staff to prescribe these treatments. RESULTS: Australia, Quebec, the United States, New Zealand and the United Kingdom provide financial coverage for some of the drugs prescribed to stop smoking. The financial coverage depends on the organization of the health care system: universal coverage in Australia, Quebec, New Zealand, and the United Kingdom and private coverage in the United States except for the Medicaid public program. In the United States as well as in the United Kingdom the first population group to benefit from financial coverage of smoking cessation therapy were socially precarious persons. Prescription schemes are recommended in the present programs and persons who receive the treatment are generally requested to attend follow-up visits. All countries studied encourage training of health professionals in tobacco cessation, but except for Australia and New Zealand there is no mandatory registration of physicians who prescribe smoking cessation drugs. CONCLUSION: The financial coverage of smoking cessation pharmacotherapies is often the result of a political decision. Taking into consideration the situation of developed countries, France should first consider the financial coverage of smoking cessation pharmacotherapies for socially precarious persons and populations with tobacco-related diseases. In addition, a population-based study should be conducted in France to measure the efficacy of financial coverage on smoking cessation.