Preventing tobacco in vocational high schools: study protocol for a randomized controlled trial of P2P, a peer to peer and theory planned behavior-based program.

BACKGROUND: In France, the issue of youth smoking remains a major challenge for public health. School failure, socio-economic and socio-cultural backgrounds influence the initiation and maintenance of smoking behavior in adolescents. Vocational students are at particularly high risk of using psychoactive substances, including tobacco. One of the most important factors is the environment, whether family, friends or peers. Therefore, peer education has a positive potential to change smoking behavior of adolescents. It has also been demonstrated that the Theory of Planned Behavior (TPB) has yielded the best prediction of intentions and behavior, in several health domains, including on tobacco. However, it is usually confined to the measurement of processes by which interventions change behavior, rather than to the development of these interventions. The objective of this paper is to describe the protocol for a randomized controlled trial of a peer intervention based on the TPB on a highly exposed young population. METHODS/DESIGNS: This is a cluster randomized controlled trial comparing an intervention group to a control group, randomized into clusters (professional schools and classes) and stratified in three departments (Hérault, Aude and Gard) in the Languedoc-Roussillon region. The primary issue is the prevalence of daily smoking at 24 months, defined by a daily tobacco use of at least 1 cigarette, validated by CO levels in exhaled air. The primary hypothesis is that intervention will lead to decrease the daily smoking prevalence of 10% between the intervention group and the control group during a 2-year follow-up. DISCUSSION: The results from this trial will provide evidence on the effectiveness of an innovative peer-to-peer intervention based on the TPB. TRIAL REGISTRATION: ISRCTN: 37336035 , Retrospectively registered 11/12/2015.

Feasibility and Efficacy of an Addiction Treatment Program in Patients With Upper Aerodigestive Tract Cancer.

BACKGROUND: Continuing to smoke or to drink after the treatment of an upper aerodigestive tract (UADT) cancer is known to worsen the prognosis. We assessed the feasibility and efficacy of an addiction treatment program integrated into the cancer treatment. METHOD: In four units devoted to UADT tumors, we proposed an addiction treatment to all patients still drinking or smoking at the end of the cancer treatment; the abstinence rate was assessed 6 and 12 months later. RESULTS: One hundred and sixteen patients were included. Among the 73 patients still drinking and/or smoking at the end of the cancer treatment, 46.6% accepted an addiction treatment. In the latter, abstinence rate was increased, 52.2% versus 31.03% ( p = .07) at M12. In patients both drinking and smoking, addiction treatment doubled the rate of abstinence of both products (31% vs. 14%). CONCLUSION: Offering addiction treatment to patients with UADT cancer improves abstinence rate and helps maintain long-term withdrawal.

Efficacy of a physiotherapy, yoga and patient education programme for patients with breast cancer and hormone therapy-induced pain: a multicentre randomised study protocol (SKYPE 2).

INTRODUCTION: Osteoarticular pain is experienced by approximately 50% of patients with breast cancer under hormone therapy and can increase the risk of therapy discontinuation. Among complementary therapies, yoga has shown efficacy regarding reduction of fatigue, anxiety, pain due to hormone therapy and inflammation. Personalised patient education programmes increase engagement and motivation, and induce effective behavioural changes. The SKYPE programme, an integrated intervention combining physiotherapy, yoga and patient education, showed promising efficacy on hormone therapy-induced pain in a previous pilot study. In this study, we hypothesised that using theory-based patient education favour learning and practising 15 min of at-home yoga every day to decrease hormone therapy-induced pain. METHODS AND ANALYSIS: This multicentre randomised study will assess the efficacy of the SKYPE programme on pain reduction compared with standard care in patients with breast cancer reporting osteoarticular pain due to hormone therapy. Main secondary objectives will describe pain evolution and characteristics, patient adhesion to yoga sessions and home practice, forward flexibility, quality of life, fatigue, anxiety and compliance to hormone therapy. Patients in the intervention group will participate in 1 weekly educational yoga session of 90 min for 6 weeks, supervised by physiotherapists (period 1). They will also perform daily at-home 15 min yoga sessions for 12 weeks, the total duration of the intervention (periods 1 and 2). Pain will be evaluated during physiotherapy check-ups at baseline (T0), at 6 weeks (T1) and at 12 weeks (T2). ETHICS AND DISSEMINATION: This study was approved by the ethics committee (CPP Ile de France 8 on 22 June 2020). The results will be disseminated to patients and healthcare professionals, and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT04457895.

Trismus Occurrence and Link With Radiotherapy Doses in Head and Neck Cancer Patients Treated With Chemoradiotherapy.

BACKGROUND: Chemoradiotherapy (CRT) for head and neck cancer (HNC) induces side-effects, including trismus, which impairs quality of life by causing difficulty to eat, speak, and maintain good oral hygiene, and by altering social life. Given the wide variation of reported trismus prevalence and as a first mandatory step for the preventive physiotherapy OPEN program (NCT03979924) this study evaluated trismus occurrence and its link with radiation doses. METHODS: Study population was non-larynx HNC patients with epidermoid carcinoma treated with CRT, with or without surgery. A physiotherapist measured maximal interincisal distance before, during and after CRT, at 10 weeks and 6 months. The proportion of patients with trismus (with a 95% confidence interval) was estimated. Irradiation doses were analyzed between patients with and without trismus using non-parametric Kruskal-Wallis test. RESULTS: We included 45 patients (77.8% male), median age 61 years (range 41-77). The proportion of trismus at baseline was 24.4%, 26.8% at 10 weeks and 37.1% at 6 months. During radiotherapy, it was 27.9% at week 3 and increased to 41.9% at week 6. Trismus occurrence at 10 weeks was higher when the radiation dose to the ipsilateral lateral pterygoid muscle was above the median value, that is, 36.8 grays. CONCLUSION: Trismus occurrence differed according to radiation dose and cancer location. These findings highlight the necessity of early preventive physiotherapy programs to reduce trismus occurrence. The second step, of the interventional multicenter OPEN program, is currently evaluating the impact of preventive physiotherapy and patient education on trismus in a sample of 175 patients.

Importance of Patient Education for At-home Yoga Practice in Women With Hormonal Therapy-induced Pain During Adjuvant Breast Cancer Treatment: A Feasibility Study.

BACKGROUND: Osteo-articular pain (OAP) is experienced by approximately 50% of women under hormonal therapy (HT) for breast cancer (BC), which increases the risk for therapy discontinuation. This study was aimed to assess benefits of yoga practice combined with patient education (PE) for at-home practice by evaluating feasibility among BC patients under HT and measuring OAP, flexibility and satisfaction. METHODS: Feasibility was evaluated by patient adherence as accomplishment of at least 4 out of 6 supervised yoga-PE sessions along with 70% or more at-home yoga sessions. Intervention (12 weeks) included two 6-weeks periods: P1 comprising one 90-minutes supervised yoga-PE session/week and 15-minutes daily at-home yoga and P2, daily autonomous at-home yoga sessions. Evaluations (at inclusion and by the end of each period) consisted in assessment of OAP on Visual Analog Scale (VAS), forward flexibility (cm) and patient satisfaction on Likert (0-10 points) scale. RESULTS: Between September 2018 and May 2019 we included 24 patients of median 53 years (range 36-72). Feasibility was validated by 83% successful adherence rate. Pain was significantly reduced from median VAS of 6 [range 4-10] to 4 [range 0-7] at the end of both P1 and P2 (p < 0.01), albeit with no difference between P1 and P2. Forward flexibility improved by a median gain of 8 cm (end of P2) and median satisfaction score of 10/10 [range 8-10]. CONCLUSION: Combined physiotherapy-yoga-PE intervention is a feasible strategy to increase at-home yoga practice with potential benefit on pain, flexibility, and satisfaction, thus prompting further evaluations in larger randomized multicenter trials. CLINICALTRIALS.GOV: NCT04001751.

[Educational methods in the prevention of smoking, among students of the Department of Herault, France]. / Métodos educativos en la prevención del tabaquismo, en escolares del Departamento del Herault, Francia.

OBJECTIVE: To evaluate the efficacy of two educational strategies to prevent tobacco addiction in schoolchildren living in Herault, France. MATERIAL AND METHODS: A study was conducted to deliver an intervention and make a concurrent comparison, among elementary school, fifth-grade students, during school years 1992 to 1995, in Herault Department, Montpellier, France. Three observation groups were included: Group 1 was subject to a cross-sectional educational intervention; Group 2 was only subject to a single health activity on World Day Against Smoking; and Group 3 or control was not subject to any intervention. RESULTS: The prognostic role of peers and the family setting on tobacco consumption was confirmed; after three years, the Group subject to the sustained cross-sectional intervention showed a prevalence of smokers significantly lower than that of the other two groups. CONCLUSIONS: Even though tobacco consumption seems to begin earlier in boys than in girls, in the former the prevalence increases from 0.7 to 7% after three years. Preventive educational interventions should be maintained and reinforced to be effective on the initiation and cessation of tobacco smoking among children.

Métodos educativos en la prevención del tabaquismo, en escolares del Departamento del Herault, Francia / x

Objetivo. Evaluar la eficacia de dos estrategias educativas para la prevención del tabaquismo en jóvenes de edad escolar. Material y métodos. Estudio de intervención, de comparación concurrente, con alumnos del quinto grado de primaria durante los cursos de 1992 a 1995, efectuado en el Departamento del Herault, Montpellier, Francia. Se incluyeron tres grupos de observación: grupo I, sometido durante el año escolar a un programa educativo transversal; grupo II, sometido el "Día Mundial sin Fumar" a una acción puntual, y el grupo III, testigo, no sometido a intervención, cuyos resultados se compararon con ji cuadrado y se hizo regresión logística. Resultados. Se confirma el papel pronóstico de sus iguales y del entorno familiar sobre el consumo de tabaco. Transcurridos tres años, el grupo sometido a la intervención transversal sostenida muestra una prevalencia de fumadores significativamente inferior a la de los otros dos grupos. Conclusiones. Aunque el consumo de tabaco parece iniciar más tardíamente en las niñas que en los niños, en este estudio la prevalencia aumenta al cabo de tres años, de 0.7 a 7 por ciento. Deben mantenerse y reforzarse en tiempo y lugar las acciones educativas de prevención para que tengan influencia y eficacia en la iniciación y disminución del consumo de tabaco en los niños.

Abstract Objective. To evaluate the efficacy of two educational strategies to prevent tobacco addiction in schoolchildren living in Herault, France. Material and Methods. A study was conducted to deliver an intervention and make a concurrent comparison, among elementary school, fifth-grade students, during school years 1992 to 1995, in Herault Department, Montpellier, France. Three observation groups were included: Group 1 was subject to a cross-sectional educational intervention; Group 2 was only subject to a single health activity on World Day Against Smoking; and Group 3 or control was not subject to any intervention. Results. The prognostic role of peers and the family setting on tobacco consumption was confirmed; after three years, the Group subject to the sustained cross-sectional intervention showed a prevalence of smokers significantly lower than that of the other two groups. Conclusions. Even though tobacco consumption seems to begin earlier in boys than in girls, in the former the prevalence increases from 0.7 to 7 percent after three years. Preventive educational interventions should be maintained and reinforced to be effective on the initiation and cessation of tobacco smoking among children.