Smoking cessation and the effect of nicotine dependence on relapse rate in Izmir, Turkey.

BACKGROUND/AIM: Smoking is the leading preventable cause of death in the world. There is growing evidence of the need for community- based programs on smoking cessation. The main purpose of this study is to establish the rate of smoking cessation and restarting in 1 year at the Balçova Smoking Cessation Center. MATERIALS AND METHODS: This is a prospective study with a study group of 359 individuals who quit smoking at the Balçova Smoking Cessation Center for at least 4 weeks between October 2009 and April 2010. The outcomes of the study were 1-year cessation rate and relapse rate. Individuals who reported restarting and/or had CO measurements above 6 ppm were accepted as quitters who had relapsed. RESULTS: The 1-year rate of smoking cessation was 30.1% for the study group. Of the subjects who quit smoking, 50.1% started smoking again during the 1-year follow-up. Relapse rate was also higher in nicotine addicts. Pharmacological treatment was associated with increased success rates in smoking cessation. CONCLUSION: Nicotine dependency was shown to be associated with lower rates of smoking cessation and higher rates of relapse. Therefore, it is important to begin smoking cessation attempts before individuals become serious addicts.

Determinants of inpatient costs of angina pectoris, myocardial infarction, and heart failure in a university hospital setting in Turkey.

OBJECTIVE: This study aimed to determine the correlates of in-hospital costs for angina pectoris (AP), myocardial infarction (MI), and heart failure (HF) in a university hospital setting. METHODS: This is a retrospective cost-of-illness study using data from the records of patients who were admitted with AP, MI, or HF to Dokuz Eylül University Hospital during 2008. Direct medical costs were calculated from the Social Security Institute perspective using a bottom-up approach. Socio-demographic and clinical information was abstracted from patient files. Costs were presented in Turkish lira (TL). A generalized linear model was used in the multivariate analysis. RESULTS: We included 337 in-patients in total in the study. AP was present in 26.4% (n=89), MI was present in 55.8% (n=188), and HF was present in 17.8% (n=60) of patients. MI was the most costly disease (2760 TL), followed by HF (2350 TL) and AP (1881 TL). The largest proportion of the total cost was formed by medical interventions (27.5%), followed by surgery (22.2%). Presence of DM, smoking, diagnosis of MI, HF, need for intensive care, and resulting in death were strong predictors of treatment costs. CONCLUSION: Both preadmission characteristics of patients (diabetes mellitus, smoking, use of anti-aggregant before admission) and in-patient characteristics (diagnosis, coronary artery bypass grafting, intensive care need, death) predicted the hospital cost of cardiovascular diseases (CVDs) independently. Our results may be used as input for health-economic models and economic evaluations to support the decision-making of reimbursement and the cost-effectiveness of public health interventions in healthcare.

Smoking habits and cessation success. What differs among adults and elderly?

OBJECTIVE: To determine factors affecting smoking cessation success in different age groups. METHODS: This was an intervention study consisting of 761 patients attending the Balcova Municipality, Smoke Cessation Center, Izmir, Turkey, between November 2009 and December 2011. Variables were successful smoking cessation for one year, socio-demographic features, previous attempts at smoking cessation, a smoking spouse, nicotine dependency level, risk of depression, method of smoking cessation, presence of chronic disease, and decreasing smoking in the last year. Data was analyzed by logistic regression. RESULTS: Approximately 43.8% of the elderly, and 62.7% of the adults reduced the number of cigarettes smoked in the past year. Approximately 83.6% of the elderly and 90.6% of the adults reported previously smoking 11 or more cigarettes daily. Two-thirds of the participants in both groups had tried smoking cessation. Smoking cessation was 49% in the elderly group and 33.4% in the adult group. The logistic regression test showed that moderate and less nicotine dependency level increased the success of cessation in the elderly group (odds ratio [OR]=2.39, 95% confidence interval [95% CI] 1.11-5.17, p=0.026), while in the adult group: increasing age (OR=1.02, 95% CI: 1.01-1.04, p=0.044), male gender (OR=1.69, 95% CI: 1.07-2.68, p=0.025), moderate and less nicotine dependency level (OR=1.65, 95% CI: 1.09-2.49, p=0.018), and the use of medication (OR=1.70, 95% CI: 1.13-2.56, p=0.011) increased the success. CONCLUSION: Different variables in different age groups may affect successful smoking cessation. These should be taken into consideration in efforts at smoking cessation.