Gender differences in success at quitting smoking: Short- and long-term outcomes. / Diferencias de género en el éxito al dejar de fumar: resultados a corto y largo plazo.

Smoking cessation treatments are effective in men and women. However, possible sex-related differences in the outcome of these treatments remain a controversial topic. This study evaluated whether there were differences between men and women in the success of smoking cessation treatment, including gender-tailored components, in the short and long term (> 1 year). A telephone survey was carried out between September 2008 and June 2009 in smokers attended in a Smoking Cessation Clinic. All patients who have successfully completed treatment (3 months) were surveyed by telephone to determine their long-term abstinence. Those who remained abstinent were requested to attend the Smoking Cessation Clinic for biochemical validation (expired CO ≤10 ppm). The probability of remaining abstinent in the long-term was calculated using a Kaplan-Meier survival analysis. The treatment success rate at 3-months was 41.3% (538/1302) with no differences by sex 89% (479/538) among those located in the telephonic follow-up study and 47.6% (256/479) were abstinent without differences by sex (p = .519); abstinence was validated with CO less than 10 ppm in 191 of the 256 (53.9% men and 46.1% women). In the survival analysis, the probability of men and women remaining abstinent in the long-term was not significant. There are no differences by sex in the outcome of smoking cessation treatment that included gender-tailored components in the short and long term (> 1 year).

Los tratamientos para dejar de fumar son eficaces en hombres y mujeres. Sin embargo, las posibles diferencias encontradas en los resultados del tratamiento aún son objeto de controversia. Este estudio analiza si existen diferencias entre hombres y mujeres en el éxito al dejar de fumar a corto y largo plazo (> 1 año) con un programa de tratamiento que incluye la perspectiva de género. Se realizó una encuesta telefónica en fumadores atendidos en una unidad de tabaquismo. Los pacientes que completaron con éxito el tratamiento (3 meses), fueron encuestados telefónicamente para determinar su abstinencia a largo plazo; se validó la abstinencia mediante cooximetría (CO espirado ≤10 ppm) en los que se mantenían abstinentes. La probabilidad de permanecer abstinentes a largo plazo se calculó utilizando un análisis de supervivencia de Kaplan-Meier. La tasa de éxito del tratamiento fue de 41,3% (538/1302), sin diferencias por sexo. El 89% (479/538) fue localizado por teléfono y el 47,6% (256/479) se mantenía abstinente sin diferencias por sexo (p = ,519); la abstinencia fue validada en 191 de 256 (53,9% hombres y 46,1% mujeres). En el análisis de supervivencia, la probabilidad de que los hombres y las mujeres mantuvieran la abstinencia a largo plazo no fue significativa. No hay diferencias por sexo en el resultado del tratamiento para dejar de fumar, que incluyan aspectos de género, a corto y largo plazo (> 1 año).

Experience with using second life for medical education in a family and community medicine education unit.

BACKGROUND: The application of new technologies to the education of health professionals is both a challenge and a necessity. Virtual worlds are increasingly being explored as a support for education. AIM: The aim of this work is to study the suitability of Second Life (SL) as an educational tool for primary healthcare professionals. DESIGN: Qualitative study of accredited clinical sessions in SL included in a continuing professional development (CPD) programme for primary healthcare professionals. LOCATION: Zaragoza I Zone Family and Community Medicine Education Unit (EU) and 9 health centres operated by the Aragonese Health Service, Aragon, Spain. METHOD: The EU held two training workshops in SL for 16 healthcare professionals from 9 health centres by means of two workshops, and requested them to facilitate clinical sessions in SL. Attendance was open to all personnel from the EU and the 9 health centres. After a trail period of clinical sessions held at 5 health centres between May and November 2010, the CPD-accredited clinical sessions were held at 9 health centres between February and April 2011. PARTICIPANTS: 76 healthcare professionals attended the CPD-accredited clinical sessions in SL. MAIN MEASUREMENTS: Questionnaire on completion of the clinical sessions. RESULTS: Response rate: 42-100%. Questionnaire completed by each health centre on completion of the CPD-accredited clinical sessions: Access to SL: 2 centres were unable to gain access. Sound problems: 0% (0/9). Image problems: 0% (0/9). Voice/text chat: used in 100% (10/9); 0 incidents. Questionnaire completed by participants in the CPD-accredited clinical sessions: Preference for SL as a tool: 100% (76/76). Strengths of this method: 74% (56/76) considered it eliminated the need to travel; 68% (52/76) believed it made more effective use of educational resources; and 47% (36/76) considered it improved accessibility. Weaknesses: 91% (69/76) experienced technical problems, while; 9% (7/76) thought it was impersonal and with little interaction. 65.79% (50/76) believed it was better than other distance learning methods and 38.16% (29/76) believed it was better than face-to-face learning. CONCLUSIONS: SL is a tool that allows educational activities to be designed that involve a number of health centres in different geographical locations, consequently eliminating the need to travel and making more effective use of educational resources.

[Evolution of anxiety during the smoking cessation process at a Smoking Cessation Clinic]. / Evolución de la ansiedad en el proceso de dejar de fumar en fumadores que acuden a una Unidad de Tabaquismo.

OBJECTIVE: To assess the evolution of anxiety during the smoking cessation process (3 months) and early smoking relapse, in a group of smokers seeking treatment for giving up smoking. METHOD: Analytical, prospective and longitudinal study. STUDY VARIABLES: sex, age, marital status, educational level, anxiety and depression background, use of psychopharmacological drugs, cigarettes smoked per day, co-oximetry, nicotine dependence (Fagerström Test for Nicotine Dependence) and state and trait anxiety (State-Trait Anxiety Inventory). Trait anxiety was assessed at the same time as medical history and state anxiety over the following sessions: Medical history session, day prior to stopping smoking, the day after, and at one week, one month and three months. Continuous abstinence was assessed by self-report and confirmed by co-oximetry ≤ 10 ppm. RESULTS: 569 patients, 288 men (50.6%) and 281 women (49.4%), mean age 43 years, mean cigarettes per day 23, average score on Fagerström Test 6. State anxiety levels decreased during the smoking cessation process, and these levels were maintained three months later. Women scored higher on state and trait anxiety, and so did smokers who took psychopharmacological drugs. Relapsing patients had higher levels of state anxiety in the session prior to relapse. CONCLUSIONS: State anxiety decreases during the smoking cessation process, remaining at the same level after 3 months. There is a need to incorporate behavioural strategies in smoking cessation treatment.

[Weight gain and anxiety levels in recent ex-smokers]. / Ganancia ponderal al dejar de fumar y su relación con la ansiedad.

OBJECTIVE: To evaluate weight gain and its relation to anxiety in a group of smokers after 3 months of cessation treatment. PATIENTS AND METHODS: The target population for this prospective, analytical, longitudinal study was smokers being treated in a specialist smoking cessation clinic who were still abstinent at the conclusion of a 3-month treatment program. The following variables were analyzed: age, sex, nicotine dependence (Fagerström test), daily cigarette consumption, number of pack-years, pharmacological treatment (nicotine replacement/bupropion), use of nicotine gum (yes/no), weight gain, body mass index, and degree of state and trait anxiety. Successful cessation was defined as self-reported abstinence confirmed by measurement of expired carbon monoxide (CO) level (< or = 10 ppm). Anxiety was evaluated using the State-Trait Anxiety Inventory. The state anxiety and weight variables were measured on 5 occasions: before smoking cessation, and at the end of week 1, month 1, month 2, and month 3 after cessation. Results for the quantitative variables were expressed as means (SD), and results for the qualitative variables were expressed as percentages and absolute frequencies. RESULTS: The study population consisted of 122 individuals, 76 of whom were men (62%) and 46 of whom were women (38%). The mean age was 43.9 (9.9) years, and mean nicotine dependence according to the Fagerström scale was 6.2 (2.2) points. Average weight gain was 2.6 kg (3.6%), with no significant difference between the sexes. Weight gain in 25% of this population was greater than 4.2 kg, and maximum weight gain was 9.2 kg. Levels of state anxiety fell progressively as weight increased, although there was no evident relationship between the 2 variables. CONCLUSIONS: Weight gain is moderate as smokers quit. Anxiety levels, which are greater in the first few weeks after cessation, do not explain weight variation, which is more related to the metabolic effects of nicotine rather than to psychological variables.

[Results of smoking cessation therapy in a specialist unit]. / Resultados del tratamiento del tabaquismo en una unidad especializada.

OBJECTIVE: The aim of this study was to assess the results of smoking cessation therapy in a specialist unit by calculating the probability of continued abstinence at 6-month follow-up and analyzing differences according to the characteristics of the individuals. PATIENTS AND METHODS: A prospective longitudinal study was undertaken in smokers who received multicomponent smoking-cessation therapy over a period of 3 months. Continued abstinence was assessed on the basis of self-report by participants and confirmed by measurement of exhaled carbon monoxide levels. Kaplan-Meier survival analysis was performed to assess the probability of continued abstinence. Log-rank tests were used to analyze differences in continued abstinence according to different qualitative variables. RESULTS: The 1120 patients who participated in the study (56% men and 44% women) had a mean (SD) age of 44.1 (9.5) years. The mean score on the Fagerström test was 6.3 (2.1). Nicotine replacement therapy was provided in 70.8% of patients while 29.2% received bupropion. The probability of continued abstinence at 6 months was 62.2%. Individuals with a high dependence had a lower probability of continued abstinence at 6 months, as did those in whom treatment adherence was poor. No differences were observed in the probability of abstinence according to sex or type of pharmacological treatment. CONCLUSIONS: Individuals with a high nicotine dependence can benefit from intensive smoking-cessation treatment in a specialist unit to achieve continued abstinence.

Can we modify the enrollment in a postpartum smoking cessation intervention in Spain?

OBJECTIVE: it is known that very few women who continue to smoke at the time of delivery stop smoking during the postpartum period. Discovering strategies that can be incorporated during pregnancy to help improve women's participation in postpartum interventions could increase the number of women non-smokers. The aim of this study is to identify the predictors of participation by pregnant women smokers in a postpartum smoking cessation intervention. DESIGN: a cross-sectional study was carried out amongst women smokers who had attended to give birth. SETTING: women attended the University Clinical Hospital 'Lozano Blesa' of Zaragoza (Spain) who were smokers before pregnancy and reported at delivery to have continued smoking during pregnancy were eligible and were invited to participate in the study. FINDINGS: 2044 women completed the questionnaire 24 hours after giving birth. The smoking prevalence during pregnancy was 18.2% (n=372) and 62.9% of them (n=234) participated. The logistic regression model provided five significant predictors for women who participated: intention to breast feed, having less of an urge to smoke the first cigarette of the day before pregnancy, having reduced consumption during pregnancy by 50% or more, having received advice and being willing to get help. CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: the factors associated with participation show aspects that can be modified by maternal and child health professionals. Advice to stop smoking, received during pregnancy, encourages participation in a postpartum intervention. From the point of view of public health, the huge increase in the prevalence of smoking women poses the need to take advantage of the pregnancy as an opportunity for giving up smoking definitely. It would be necessary to identify what programmes of smoking cessation have better results in pregnant women and to know how to motivate health professionals to implement them.

[Predictors of outcome of a smoking cessation treatment by gender]. / Factores predictores de éxito según género en el tratamiento del tabaquismo.

OBJECTIVE: To identify factors predictive of the outcome of a smoking cessation program by gender. METHODS: A cross-sectional study of smokers starting treatment in a smoking cessation clinic from 2002 to 2007 was conducted. The variables consisted of data on sociodemographic factors, smoking habits, the social context of smoking and psychiatric comorbidity prior to or during the smoking cessation process. All patients received multicomponent treatment consisting of psychological and pharmacological interventions. Success was defined as self-reported continuous abstinence confirmed by cooximetry (CO ≤10 ppm). Logistic regression was used to analyze the factors predictive of success. RESULTS: A total of 1302 persons (52.1% men and 47.9% women), with a mean age of 43.4 (10.2) years, were included. The mean number of cigarettes smoked per day was 25.3 (10.4) and the mean Fagerström test score was 6.2 (2.2) points. The success rate was 41.3% (538) with no differences by gender. Positive predictors were lower nicotine dependence and having a non-smoking partner in men and older age, smoking fewer cigarettes per day, having fewer smoking friends and not experiencing depression or anxiety during the treatment in women. CONCLUSIONS: Men and women have similar tobacco abstinence outcomes although gender factors play a role in determining abstinence. The gender perspective should be incorporated in smoking prevention and cessation programs.

A proactive smoking cessation intervention in postpartum women.

OBJECTIVE: to analyse the efficacy of a proactive intervention during the postpartum period to prevent a relapse in recent quitters and to promote progress in the behavioural process of change in smokers. DESIGN: randomised controlled trial designed for women at the end of the pregnancy using a proactive intervention. Motivational Interviewing (MI) and relapse prevention served as principles for the programme. In the intervention group, four telephone supporting sessions were performed in weeks 3, 6, 9 and 12. For the control group only two check calls in weeks 3 and 12. SETTING: women who attended the University Clinical Hospital 'Lozano Blesa' of Zaragoza (Spain) to give birth between January 2009 and March 2010. The intervention began after delivery, lasted for 3 months, and finished with a visit to validate abstinence biochemically. FINDINGS: a total of 2,044 women were studied, 30.6% (n=626) smoked before pregnancy; 65.8% (n=412) of them agreed to participate. The results for recent quitters by self-report showed that the probability of remaining abstinent after 12 weeks was 74% for the intervention group and 37% for the control group. Only the half of the sample attended the visit at 3 months to confirm the abstinence biochemically. For smokers, 90.7% of the intervention group said that they would be ready to try to quit in the following 6 months, vs. 18.3% for the control group. CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: a proactive intervention in the postpartum period may reduce the probability of relapse in recent quitters and helps female smokers to make progress in the behavioural process of change. Such interventions should be included systematically in mother-child health services.