[Predictive factors of smoking behaviour in secondary school children]. / Factores predictores de la conducta fumadora en alumnos de enseñanza secundaria.

INTRODUCTION: Many factors have been reported as being responsible for starting smoking during school age, but it is still not well known which cognitive determinants may be used as predictive factors of tobacco use. SUBJECTS AND METHODS: A prospective, longitudinal, study, including 417 pupils from 12 to 17 years, was carried out over three years in two rural Secondary Education Institutes in Castilla y León. The ESFA questionnaire was used, which included scales on attitudes and beliefs, social influences, self-efficacy, intention to smoke in the future and smoker behaviour. RESULTS: Of the 417 pupils studied, 36.7 % were smokers (38.6 % females and 34.4 % males). The mean of starting smoking was 12 years (11.83-12.15). In the initial analysis there was a clear relationship between cognitive determinants and smoker behaviour. The advertising and peer pressure lost predictive value after 3 years. The multivariate analysis showed that the determining factors of tobacco use are, besides age (OR = 3.85; 95 % CI, 1.27-11.64), to have a favourable attitude to smoking, (OR = 4.47; 95 % CI, 2.15-9.32), and the conduct perceived among peers (OR = 5.05; 95 % CI, 2.50-10.19). CONCLUSIONS: The determining factors that demonstrates a clear relationship with smoker behaviour are, age, favourable attitude of pupils towards smoking, and the perceived behaviour by smoker friends. Smoking prevention programs should take these factors into accounts when designing their activities.

[Teenagers and smoking: prevalence, patterns and attitudes]. / Jóvenes y tabaco: prevalencia, patrón y actitud ante el consumo de tabaco.

OBJECTIVES: To determine the prevalence of smoking among 12 to 14-year-olds in the province of Salamanca and to identify their knowledge of and attitudes to smoking as well as the impact of information provided on the subject in comic strip form. MATERIAL AND METHOD: We performed a descriptive study (n = 4907). The variables analyzed were: age, sex, place of residence, school, smoking, and degree of awareness of the consequences of smoking before and after being given the comic book. Statistical analysis was carried out using measures of central tendency, the chi-squared test and Student's t-test T (p < 0.05). RESULTS: Of the teenagers surveyed, 45.4 % of the boys and 39 % of the girls had smoked at some time and 20.5 % reported they were current smokers, with no differences between sexes. In both sexes the first cigarette was offered by a friend (59.8 % of boys and 66.5 % of girls). The teenagers began to smoke at a mean age of 11.1 years. Most of these adolescents smoked between 1 and 5 cigarettes a day. Most (91.8 %) considered tobacco to be a drug and after reading the comic strip this percentage rose to 99.1 %. A total of 70.1 % knew what passive smoking was, and after reading the comic strip this figure increased to 88.2 %. More than half (64.9 %) associated tobacco consumption with cancer, bronchitis and heart attack and 44.4 % considered mild cigarettes to be less harmful; after reading the comic strip these percentages changed to 95.3 % and 1.4 % respectively. Before reading the comic strip 84.2 % associated addiction with nicotine whereas after reading the comic this figure was 97.8 %. CONCLUSIONS: Children have contact with tobacco at a relatively early age. Current information on smoking is acceptable but could be improved. Information provided through comic strips can be an effective way of reaching adolescents and of preventing them from taking up the habit.

[Smoking cessation in primary and specialized care: a real opportunity and a public health necessity]. / El abordaje del tabaquismo en atención primaria y especializada, una oportunidad real y una necesidad de salud pública.

AIM: To determine whether primary care provides a suitable framework for integrated treatment aimed at smoking cessation with systematic minimal intervention or pharmacological treatment with nicotine replacement therapy (NRT). To compare the results with those obtained in a specialized pneumology unit. DESIGN: Prospective, quasi-experimental study. SETTING: Primary and specialized care services. PARTICIPANTS: 357 smokers who were followed at a health center (166) or a specialized clinic (191) during a 6-month period. INTERVENTIONS: Two types of intervention were used depending on the patients' degree of nicotine dependence: systematic minimal intervention for those with low dependence or who were still in the contemplation or precontemplation phase, and NRT for those with high dependence, in the preparation phase. MAIN OUTCOME MEASURES: Twelve months after the start of the study, abstinence among participants who received systematic minimal intervention was 36.5% in primary care patients and 41.8% in specialized care patients (P>.05). Among participants who received NRT abstinence was 37.1% in the former group and 35.5% in the latter (P>.05). The percentage of patients lost to follow-up was 8.6% in specialized care and 6.3% in primary care. CONCLUSIONS: The results lead us to recommend smoking cessation treatment integrated in the primary care setting, either with systematic minimal intervention or NRT.

[Tobacco detoxication at a primary care clinic: efficacy of medical counseling, minimal intervention and nicotine replacement therapy at the one-year follow-up]. / Deshabituación tabáquica en una consulta de atención primaria: eficacia del consejo médico, la intervención mínima y la terapia sustitutiva con nicotina al año de seguimiento.

OBJECTIVE: The main objective was to compare the efficacy of one-off tobacco counselling and of the systematic minimum intervention on making people give up smoking. A secondary aim was to evaluate the efficacy of nicotine replacement therapy (NRT) in the context of a primary care consultation. DESIGN: Controlled and randomised clinical trial. SETTING: Primary care. PARTICIPANTS: Smokers who over 12 months attended a primary care clinic at an urban health centre (304 patients). INTERVENTIONS: Two kinds of intervention were conducted at random on patients with low nicotine dependence (one-off medical counselling and counselling integrated into what is known as the minimal intervention, but conducted systematically). NRT was administered through nicotine patches (11% nicotine) to patients with moderate-to-high nicotine dependence. MEASUREMENTS AND MAIN RESULTS: Short-term cessation a year after the minimal intervention was 39% (29.4-49.3%), and maintained cessation 30.9% (29.4-49.3%), as against 11% (5.6-18.8%) short-term cessation in the group that received one-off counselling (p < 0.0001). Short-term tobacco cessation in the NRT group was 35.3% (24.1-47.8%), and maintained cessation 30.8%. CONCLUSIONS: Primary care is a suitable context for an intervention against tobacco dependency, through the use of any of the established interventions: one-off medical counselling, systematic minimal intervention, or specialist drug treatment through NRT. Therefore, these kinds of intervention must form part of PC clinics' daily activity.