[Smoke-free psychiatry in Germany: A closer look]. / Rauchfreie Psychiatrie: Eine Bestandsaufnahme.

OBJECTIVE: In order to protect non-smokers, the federal states of Germany have adopted a law that provides for extensive smoking bans. In many of these federal laws, acute psychiatric facilities are treated as an exception. Therefore, it is often up to the institutions themselves to develop and enforce regulations. The aim of this study was to evaluate the situation in acute psychiatric facilities. METHODS: The survey was created on the basis of previously evaluated questionnaires and consisted of 53 questions. A total of 289 hospitals were contacted. Participants were invited to take part in the survey via e-mail. RESULTS: 59 hospitals (20.4 %) participated in the survey. Binding regulations were in place in 48 (81.4 %) hospitals, in 26 (44.1 %), smoking was prohibited on open wards. Three hospitals (5.1 %) strictly prohibited smoking on locked wards. Stop-smoking medication was available in 31 (55.3 %) hospitals. 19 (32.2 %) offered smoking cessation interventions. 22 (37.3 %) hospitals have set up a working group on the subject. CONCLUSION: Currently, the issue of smoking in psychiatric facilities does not receive enough attention. The physical and mental health of psychiatric patients would benefit from a smoke-free policy. In order to achieve this, psychiatric staff and patients need appropriate support.

Evaluation of the cognitive behavioral smoking reduction program "Smoke_less": a randomized controlled trial.

The vast majority of smokers are unable or unwilling to quit, but many are open to reducing smoking. No treatment options exist for these smokers besides medication-based therapies. Thus, this study investigated the efficacy of a cognitive behavioral therapy (CBT) smoking reduction program, Smoke_less. A sample of 155 outpatient smokers aged 18-70 years was recruited at the Tobacco Dependence Outpatient Clinic of the Medical Center of the University of Munich, Germany, and randomly assigned to the experimental group (Smoke_less: four weekly CBT group sessions and two telephone calls over 5 weeks, n = 51), active comparator group (one 15-minute counseling session, n = 49), or waiting control group (no intervention during the study, n = 55). The primary endpoint was a ≥50% smoking reduction in the intention-to-treat group 1 week and 6 months after the intervention. We evaluated also abstinence rates at follow-up. Significantly more participants in the Smoke_less group had reduced smoking ≥50% compared to the waiting group at 1 week [OR 7.59 (2.59-22.19)] and 6 months [OR 5.00 (1.68-14.84)] and compared to the active comparison group at 1 week [OR 8.58 (2.67-27.31)] but not at 6 months [OR 1.73 (0.71-4.20)]. We found no significant effects on abstinence rates. The CBT smoking reduction program Smoke_less is effective for smoking reduction but is superior to brief counseling only in the short term. Further research is required to improve its efficacy in long-term smoking reduction to provide a valid, non-medication-based alternative to smokers unable or unwilling to quit. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02337400.

Smoking Cessation Program for Inpatients with Substance Use Disorder: A Quasi-Randomized Controlled Trial of Feasibility and Efficacy.

AIMS: The present study investigated the feasibility, acceptance and efficacy of a newly developed cognitive behavioral program for smoking cessation/reduction ('Rethink your Smoking' program, RSP) in inpatients with substance use disorder (SUD). METHOD: One hundred ninety-nine inpatients with SUD were randomly assigned to either the RSP (n = 101) or a minimal intervention (MI) program (n = 98). In addition, participants were offered optional nicotine replacement therapy. Data from a group of patients with SUD without any intervention (control group, n = 78) were included in the analyses for comparison. Assessments were performed at admission, discharge and follow-up after 3 and 6 months. RESULTS: RSP proved to be feasible and was well accepted by participants. Patients in both interventions showed lower scores for physical nicotine dependence and number of cigarettes smoked per day and higher scores for various motivational parameters at discharge and 3 months later. Both interventions were superior to no intervention, but no differences were found between the RSP and MI. CONCLUSION: A smoking cessation/reduction program is feasible for substance-dependent in-patients undergoing detoxification. Although the RSP appears to be effective in terms of harm reduction in in-patients with SUD, more cost- and time-efficient programs might also be suitable for this population.

Electronic Cigarettes-Attitudes and Use in Germany.

INTRODUCTION: Smoking is the leading preventable cause of death and disease. Previous studies on electronic cigarette (e-cigarette) use have reported reduction and cessation of conventional cigarette smoking; however, health effects are still a matter of discussion. This cross-sectional study investigated the attitudes of adults in Germany towards using e-cigarettes instead of or in addition to cigarettes. Furthermore, it examined the extent to which e-cigarettes are used as a smoking cessation tool. METHODS: In 2012, we recruited a sample of 319 participants comprising e-cigarette users (vapers, 33%), cigarette smokers (smokers, 37%) and smokers of both cigarette types (dual users, 30%). The Integrated Model for Change (I-Change Model) was used as a theoretical framework and a modified Fagerström Test of Nicotine Dependence was used to assess nicotine dependence. Data were collected by means of a questionnaire and smoking status was substantiated by measuring exhaled carbon monoxide. RESULTS: The vapers were more often men, were less addicted to nicotine and had a higher motivation to stop smoking than the smokers. In addition, vapers reported better health and had a lower carbon monoxide concentration than smokers. Furthermore, vapers had a more positive attitude towards e-cigarettes and higher self-efficacy in terms of abstaining from cigarettes in certain situations. CONCLUSIONS: This is the first study to report on the use of e-cigarettes in Germany. Our results support those of previous studies in other populations. Further research is still needed on the potential health effects of e-cigarettes and their efficacy as a smoking cessation aid. IMPLICATIONS: The study is the first description of attitudes and use of e-cigarettes in Germany.