Barriers and facilitators for oral health screening among tobacco users: a mixed-methods study.

OBJECTIVES: Tobacco consumption adversely affects general and oral health and is considered one of the significant public health burdens globally. The present study aims to assess the barriers and facilitators for attending oral and dental health screening among tobacco users who seek cessation advice. METHODOLOGY: The present mixed-methods study used group concept mapping (GCM) to identify the facilitators/barriers to attending oral health screening among young adults attending face-to-face and virtual Tobacco Cessation Clinic at King Saud University (Riyadh, Saudi Arabia) between September 2022 and April 2023. Study investigators included healthcare social workers, dental interns, and oral and maxillofacial medicinists. Information about demographics, general health, oral/dental health and tobacco use were collected using self-completed questionnaires. The barriers and facilitators were assessed following GCM by brainstorming, sorting, rating, and interpretation activities. Descriptive, multidimensional scaling and hierarchical cluster analysis were used to describe the study participants and produce concept maps of the generated statements. RESULTS: The study included 148 participants who generated 67 statements summarised into 28 statements as facilitators or barriers. Based on a 5-point importance scale, the participants indicated the importance of facilitators under health-related cluster [e.g. when I feel pain] as the highest, followed by personal [e.g. to maintain my mouth hygiene], social [e.g. the quality of treatment] and financial clusters [e.g. the reasonable cost]. Concerning barriers, financial factors [e.g. high cost] acted as the highest-rated barrier, followed by personal [e.g. lack of dental appointments] and health-related [e.g. worry that dental problems will worsen]. The social factors were the least considerable barrier [e.g. lack of time]. Clustering these facilitators/barriers on the concept map indicated their conceptual similarity by an average stress value of 0.23. CONCLUSION: Pain was the most important facilitator to attending oral health screening by young adults seeking tobacco cessation advice. Notable barriers included the high cost of dental treatment and the lack of scheduled appointments. Thus, oral health care providers need to consider scheduling periodic and timely dental check-ups to prevent and reduce the burden of tobacco-associated and pain-causing oral diseases.

Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model.

INTRODUCTION: Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes. Guided by the Information-Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking. METHODS: A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June 2021, with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals. The interview transcriptions were analyzed using applied thematic analysis. RESULTS: Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation. Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics. The provision of information on tobacco-associated diabetic complications, by using video messages featuring former smokers' stories was also suggested. CONCLUSIONS: To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition. Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential. Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit.

Lifestyle Intervention for the Prevention of Cardiovascular Disease.

Lifestyle medicine is a cornerstone of cardiovascular disease prevention and early disease intervention. A leading cause of death in developed countries, modifiable risk factors of cardiovascular disease like diet, exercise, substance use, and sleep hygiene have significant impacts on population morbidity and mortality. One should address these amendable risks in all patients, independently, and stress the importance of intervention adherence while avoiding the sacrifice of patient trust. One must also understand a patient's psychological well-being can be compromised by organic chronic disease states, and poor psychological well-being can have a negative impact on patient compliance and overall health.

[Self-perception of smoking cessation skills among Cardiology residents in Argentina]. / Autopercepción de las habilidades para la cesación del tabaquismo entre los residentes de cardiología en Argentina.

Objective: To evaluate the self-perception of cardiology residents in Argentina regarding their abilities to help their patients stop smoking, as well as their opinions about their knowledge and skills in this area. Materials and methods: A cross-sectional study was carried out using secondary data from a study carried out in five Latin American countries and Spain, focusing on the information provided by cardiology residents in Argentina. Discrete variables were expressed as median and interquartile range, and categorical variables were expressed as percentages, and were analyzed using the chi-square test or Fisher's exact test, depending on the relative frequency of the expected values. Results: 447 residents participated; 87.5% routinely provided brief advice to quit smoking, and 11.6% used validated questionnaires to assess the degree of addiction. Furthermore, 32.1% stated that they prescribed pharmacological treatment, but 53.1% were only familiar with a single drug. When asked about their self-perception of getting their patients to stop smoking, the median response was 5 (scale from 1 to 10); only 13.7% responded with a score of 8 or more. Conclusions: The present study suggests that cardiology residents in Argentina recognize the importance of carrying out smoking cessation interventions, but a high proportion of them do not feel qualified to do so.

Comparison of in-person versus telephonic interview on tobacco cessation in an Indian dental setting.

Oral health professionals in the dental office settings have a distinctive opportunity to increase tobacco abstinence rates among tobacco users as tobacco use has significant adverse effects on oral health. This review assesses the effectiveness of tobacco cessation interventions offered to cigarette smokers and smokeless tobacco users in the dental office setting. The following electronic retrieval systems and databases were searched for the identification of studies, The Cochrane Central Register of Controlled Trials, PUBMED, GOOGLE SCHOLAR, SCIENCE DIRECT and TRIP. The review included randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office setting. Seven clinical trials met the criteria for inclusion in this review. All the studies have employed behavioral therapy, telephonic counseling's and pharmacotherapy as interventional component. The rate of abstinence and biochemical validation were the outcome measurements. Since all the studies included were randomized clinical trials, the level of evidence was II. Available evidence suggests that telephonic interventions for tobacco use conducted by oral health professionals in the dental office setting may increase tobacco abstinence rates among smokers and smokeless tobacco users. This review data suggests that telephone has a pragmatic effect on interactional aspects of psychological therapy. Further research should be carried out to make conclusive recommendations regarding the intervention components that can be incorporated in the dental office settings.

Weighing cessation: Rising adiposity of current smokers in NHANES.

BACKGROUND: Rising rates of obesity may have interacting effects with smoking given associated cardiovascular risks and cessation-associated weight gain. This study aimed to assess the change in body mass index (BMI) magnitude and prevalence of obesity and central adiposity over time among current smokers and to compare with that of former and never smokers to describe how the obesity and tobacco epidemics interrelate. METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES) 1976-2018, survey-weighted, internally standardized analyses were used to look at outcomes of BMI, BMI category, and central adiposity by smoking status. A nonparametric test assessed trend over time. RESULTS: The standardized proportion of current smokers with obesity increased from 11.6% in NHANES II to 36.3% in continuous NHANES 2017-2018; at the latest assessment this proportion was significantly lower than for former smokers. Mean BMI among current smokers also increased, from 24.7 kg/m2 to 28.5 kg/m2 among current smokers, which is significantly lower than among former smokers and never smokers at the latest time point. The standardized proportion of current smokers with central adiposity also increased, from 34.3% to 54.1%; again, at the latest time point the proportion was lower than for former smokers or never smokers. CONCLUSION: Between 1976 and 2018, smoking rates decreased while adiposity increased among current, former, and never smokers. Over a third of current smokers meet BMI criteria for obesity and over half have an elevated waist circumference. It is imperative that weight management strategies be incorporated into smoking cessation approaches.

Associations between the Frequency and Quantity of Heated Tobacco Product Use and Smoking Characteristics among Korean Smoking Adolescents.

PURPOSE: Although heated tobacco product (HTP) use among adolescents is an emerging public health problem, little is known about the frequency and quantity of HTP use. Thus, we investigated the associations between the frequency and quantity of HTP use and smoking characteristics (i.e., combustible cigarette [CC] and electronic cigarette [EC] use, and attempts to quit smoking) among CC-smoking adolescents. METHODS: We analyzed nationally representative data from 2,470 Korean adolescents who were current CC smokers. To investigate our aim, we conducted multinomial logistic and logistic regression analyses. RESULTS: We found that daily and heavier CC users had greater likelihoods of more frequent and heavier HTP use. In addition, dual users of CCs and ECs were more likely to use HTPs more frequently and heavily than CC users who did not use ECs. Moreover, daily EC users had the highest risk of frequent and heavy HTP use. The frequency and quantity of HTP use were not associated with attempts to quit smoking. Compared to CC-only use, dual use of CCs and HTPs was not associated with quitting attempts, and triple use of CCs, ECs, and HTPs was associated with a lower likelihood of quitting attempts. CONCLUSION: HTP use was less likely to displace CC use and promote attempts to quit smoking. Thus, strict regulations are required to prevent the promotion of HTPs as a substitute for CCs or as a means of quitting smoking. Additionally, health professionals should consider preventive interventions for HTP, as well as CC and EC use among adolescents.

Addressing nutrition and physical activity in substance use disorder treatment: Client reports from a wellness-oriented, tobacco-free policy intervention.

Introduction: Interest in wellness interventions in substance use disorder (SUD) treatment is growing although evidence remains limited. This study evaluated nutrition, physical activity, nutrition and physical activity counseling, and relationships of counseling with wellness behavior before and after a wellness-oriented, tobacco-free policy intervention in 17 residential SUD programs. Methods: Clients completed cross-sectional surveys reporting sugar-sweetened beverage consumption, physical activity, and receipt of nutrition and physical activity counseling before (n= 434) and after (n = 422) an 18-month intervention. Multivariable regression models assessed pre-post-intervention differences in these variables and examined associations of nutrition counseling with sugar-sweetened beverage consumption and physical activity counseling with physical activity. Results: Post-intervention clients were 83% more likely than pre-intervention clients to report nutrition counseling (p = 0.024). There were no pre-post- differences for other variables. Past week sugar-sweetened beverage consumption was 22% lower among clients reporting nutrition counseling than for those who did not (p = 0.008) and this association did not vary by time (pre/post). There was a significant interaction of physical activity counseling receipt by time on past week physical activity (p = 0.008). Pre-intervention clients reporting physical activity counseling had 22% higher physical activity than those who did not; post-intervention clients reporting physical activity counseling had 47% higher physical activity. Conclusion: A wellness policy intervention was associated with increased nutrition counseling. Nutrition counseling predicted lower sugar-sweetened beverage consumption. Physical activity counseling predicted higher physical activity, an association that was greater post-intervention. Adding wellness components to tobacco-related interventions may promote health among SUD clients.

Effectiveness of smoking cessation interventions among persons with cancer: A systematic review.

OBJECTIVES: Continued smoking after cancer diagnosis is associated with worse outcomes, however, many persons diagnosed with cancer who smoke are unable to quit successfully. Effective interventions are needed to promote quitting in this population. The purpose of this systematic review is to understand the most effective interventions for smoking cessation among persons with cancer and to identify gaps in knowledge and methodology to suggest directions for future research. METHODS: Three electronic databases (The Cochrane Central Register of Controlled trials, MEDLINE, and EMBASE) were searched for studies of smoking cessation interventions among persons with cancer, published up to 1 July 2021. Title and abstract screening, full-text review, and data extraction was completed by two independent reviewers, via Covalence software, with any discordance resolved by a third reviewer. A quality assessment was completed using the Cochrane Risk of Bias Tool Version 2. RESULTS: Thirty-six articles were included in the review, including 17 randomized-controlled trials (RCTs) and 19 non-RCT studies. Of the 36 studies, 28 (77.8%) utilized an intervention that included both counseling and medication, with 24 (85.7%) providing medication to participants at no cost. Abstinence rates in the RCT intervention groups (n = 17) ranged from 5.2% to 75%, while the non-RCTs found abstinence rates ranging from 15% to 46%. Overall, studies met a mean of 2.28 out of seven quality items, ranging from 0 to 6. CONCLUSIONS: Our study highlights the importance of utilizing intensive combined behavioral and pharmacological interventions for persons with cancer. While combined therapy interventions seem to be the most effective, more research is needed, as current studies have several quality issues, including the lack of biochemical verification for abstinence.

Cambios en el abandono del consumo de tabaco en España, 1987-2020 / Changes in smoking cessation in Spain, 1987-2020

Introducción: El objetivo del estudio fue estimar y describir la evolución del abandono del consumo de tabaco en España desde 1987 hasta 2020, según las principales características sociodemográficas.Material y métodoAnálisis de la serie histórica de la Encuesta Nacional de Salud y la Encuesta Europea de Salud en España. Se definió la proporción de abandono (PA) como el número de exfumadores entre el total de personas que fuman o han fumado alguna vez en su vida. Otras variables de estudio fueron: año de la encuesta, edad, sexo y nivel de estudios. Se elaboraron modelos de regresión de Poisson ajustados simultáneamente por las características sociodemográficas, estimando para cada año la PA estandarizada y sus intervalos de confianza al 95%.ResultadosLa diferencia absoluta de la PA estandarizada aumentó desde 1987 a 2017 un 18,6% (IC95%: 16,8-20,4), siendo moderadamente superior en los hombres (19,2%; IC95%: 17,1-21,4) que en las mujeres (16,5%; IC95%: 13,3-19,7). Se observó un incremento del abandono en todos los grupos etarios, pero de mayor magnitud según aumentaba la edad, estimando una diferencia de PA entre 1987 y 2017 del 22,4% (IC95%: 17,7-27,1) en los ≥65años. Las personas con estudios universitarios mostraron un mayor incremento durante el periodo (32,7%; IC95%: 27,5-38,0), especialmente si se compara con los de menor nivel de estudios (9,0%; IC95%: 4,8-13,2).ConclusiónLa PA se ha incrementado intensamente y de forma sostenida desde 1987, pero se detectan importantes diferencias según la edad y el nivel de estudios, destacando el gran incremento de la inequidad observada en estos 33 años de evolución. (AU)

Introduction: The goal of this study was to estimate and to describe the smoking cessation changes in Spain from 1987 to 2020, according to the main sociodemographic characteristics.Material and methodAnalysis of the historical series of the Spanish National Health Survey and the European Health Survey in Spain. Quit rate (QR) was defined as the number of former smokers among the total number of people who are smokers or have smoked at some time in their life. Other included variables were year of survey, age, gender and educational level. Poisson regression models were simultaneously adjusted for sociodemographic characteristics, estimating QR and its 95% confidence intervals (CIs) for each year.ResultsThe absolute difference in standardized QR increased from 1987 to 2017 by 18.6% (95%CI: 16.8-20.4), being moderately higher in men (19.2%; 95%CI: 17.1-21.4) than in women (16.5%; 95%CI: 13.3-19.7). An increase in QR was observed in all age groups, but its magnitude increased with age, estimating a difference in QR between 1987 and 2017 of 22.4% (95%CI: 17.7-27.1) in those aged over 64. People having university studies showed a higher QR during the period, 32.7% (95%CI: 27.5-38.0), especially when compared to those with a lower level of education (9.0%; 95%CI: 4.8-13.2).ConclusionQR has increased sharply and steadily since 1987, however important differences were detected according to age and educational level, highlighting the large increase in inequity observed in these 33 years of evolution. (AU)

Addictions, Social Deprivation and Cessation Failure in Head and Neck Squamous Cell Carcinoma Survivors.

AIM: To evaluate the evolution of addictions (tobacco and alcohol) and social precarity in head and neck squamous cell carcinoma survivors when these factors are addressed from the time of diagnosis. METHODS: Addictions and social precarity in patients with a new diagnosis of HNSCC were assessed through the EPICES score, the Fagerström score, and the CAGE questionnaire. When identified as precarious/dependent, patients were referred to relevant addiction/social services. RESULTS: One hundred and eighty-two patients were included. At the time of diagnosis, an active tobacco consumption was associated with alcohol drinking (Fisher's exact test, p < 0.001). Active smokers were more socially deprived (mean EPICES score = mES = 36.2 [±22.1]) than former smokers (mES = 22.8 [±17.8]) and never smokers (mES = 18.9 [±14.5]; Kruskal-Wallis, p < 0.001). The EPICES score was correlated to the Fagerström score (Kruskal-Wallis, p < 0.001). Active drinkers (mES = 34.1 [±21.9]) and former drinkers (mES = 32.7 [±21]) were more likely to be socially deprived than those who never drank (mES = 20.8 [±17.1]; Krukal-Wallis, p < 0.001). A Fagerström score improvement at one year was associated to a CAGE score improvement (Fisher's exact test, p < 0.001). Tobacco and alcohol consumption were more than halved one year after treatment. Patients who continued to smoke one year after diagnosis were significantly more likely to continue to drink (Fisher's exact test, p < 0.001) and had a significantly higher initial EPICES score (Kruskal-Wallis, p < 0.001). CONCLUSIONS: At one year, addictions and social deprivation tend to improve when taken care of from the diagnosis. The most dependent patients and those with multiple frailties are at highest risk of cessation failure.

Changes in Substance Use Treatment Providers' Delivery of the 5A's for Non-Cigarette Tobacco Use in the Context of a Comprehensive Tobacco-Free Workplace Program Implementation.

Tobacco use treatment is not prioritized in substance use treatment centers (SUTCs), leading to tobacco-related health inequities for patients with substance use disorders (SUDs) and necessitating efforts to enhance providers' care provision. Training providers on how to treat tobacco use increases their intervention on patients' smoking, but limited work addresses its effects on their non-cigarette tobacco use intervention provision. This study redressed this gap using data from 15 unaffiliated SUTCs in Texas (serving 82,927 patients/year) participating in a tobacco-free workplace program (TFWP) that included provider education on treating tobacco use, including non-cigarette tobacco use. SUTC providers completed surveys before (n = 259) and after (n = 194) TFWP implementation. Past-month screening/intervention provision for non-cigarette tobacco use (the 5A's; ask, advise, assess, assist, arrange) and provider factors theoretically and practically presumed to underlie change [i.e., beliefs about concurrently treating tobacco use disorder (TUD) and other SUDs, self-efficacy for tobacco use assessment (TUA) delivery, barriers to treating tobacco dependence, receipt of tobacco intervention training] were assessed. Generalized linear or linear mixed models assessed changes over time from before to after TFWP implementation; low vs. high SUTC-level changes in provider factors were examined as moderators of changes in 5A's delivery. Results indicated significant improvement in each provider factor and increases in providers' asking, assisting, and arranging for non-cigarette tobacco use over time (ps < 0.04). Relative to their counterparts, SUTCs with high changes in providers' beliefs in favor of treating patients' tobacco use had greater odds of advising, assessing, assisting, and arranging patients, and SUTCs with greater barrier reductions had greater odds of advising and assisting patients. Results suggest that TFWPs can address training deficits and alter providers' beliefs about treating non-tobacco TUD during SUD care, improve their TUA delivery self-efficacy, and reduce intervention barriers, ultimately increasing intervention provision for patients' non-cigarette tobacco use. SUTCs with the greatest room for improvement in provider beliefs and barriers to care provision seem excellent candidates for TFWP implementation aimed at increasing non-cigarette tobacco use care delivery.

Sex differences in smoking cessation: a retrospective cohort study in a psychosocial care unit in Brazil.

INTRODUCTION: Despite the results of epidemiological and psychometric studies reporting comparable levels of tobacco dependence among males and females, some clinical studies have detected disparities. Some smoking cessation studies based on clinical setting programs reported poorer outcomes among women than men. METHODS: This retrospective cohort study aimed to compare treatment success and retention between men and women on a smoking cessation program (n = 1,014) delivered at a CAPS-AD unit in Brazil. The psychological intervention lasted 6 weeks for each group of 15 patients. Each patient had to participate in weekly group cognitive-behavioral therapy (CBT) sessions and individual medical appointments during this period. These appointments were focused on the possibility of prescribing pharmacological treatment (i.e., nicotine replacement therapy, bupropion, or nortriptyline) as adjuvants to group therapy. RESULTS: The women had lower smoking severity at baseline, more clinical symptoms, and lower prevalence of alcohol and drug use disorders and were older than the men. Females had significantly higher levels of success (36.6% vs. 29.7%) and retention (51.6% vs. 41.4%) than males. Sensitivity analysis showed that female gender was significantly associated with both retention and success, among those without drug use disorders only. CONCLUSION: Depending on the smoking cessation setting (i.e., low and middle-income countries and mental health and addiction care units), females can achieve similar and even higher quit rates than males. Previous drug use disorder was an important confounding variable in the gender outcomes analyses. Future studies should try to replicate these positive smoking cessation effects of CBT-based group therapy plus pharmacotherapy in women.

[Changes in smoking cessation in Spain, 1987-2020]. / Cambios en el abandono del consumo de tabaco en España, 1987-2020.

INTRODUCTION: The goal of this study was to estimate and to describe the smoking cessation changes in Spain from 1987 to 2020, according to the main sociodemographic characteristics. MATERIAL AND METHOD: Analysis of the historical series of the Spanish National Health Survey and the European Health Survey in Spain. Quit rate (QR) was defined as the number of former smokers among the total number of people who are smokers or have smoked at some time in their life. Other included variables were year of survey, age, gender and educational level. Poisson regression models were simultaneously adjusted for sociodemographic characteristics, estimating QR and its 95% confidence intervals (CIs) for each year. RESULTS: The absolute difference in standardized QR increased from 1987 to 2017 by 18.6% (95%CI: 16.8-20.4), being moderately higher in men (19.2%; 95%CI: 17.1-21.4) than in women (16.5%; 95%CI: 13.3-19.7). An increase in QR was observed in all age groups, but its magnitude increased with age, estimating a difference in QR between 1987 and 2017 of 22.4% (95%CI: 17.7-27.1) in those aged over 64. People having university studies showed a higher QR during the period, 32.7% (95%CI: 27.5-38.0), especially when compared to those with a lower level of education (9.0%; 95%CI: 4.8-13.2). CONCLUSION: QR has increased sharply and steadily since 1987, however important differences were detected according to age and educational level, highlighting the large increase in inequity observed in these 33years of evolution.

Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs.

Background: Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients. Objective: We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams. Methods: We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT. Results: Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams. Conclusion: TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.

Effects of educational level on the choice of intervention strategies for smoking cessation in patients with moderate to severe tobacco dependence / 中国基层医药

Objective:To investigate the effects of educational level on smoking cessation in patients with moderate to severe tobacco dependence, explore effective individualized smoking cessation methods, and increase smoking cessation rate.Methods:A total of 480 patients with moderate to severe tobacco dependence who were willing to quit smoking and received treatment in the Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital from January to December 2020 were included in this study. They were divided into four groups ( n = 120/group) according to their educational level: group A (elementary school and below), group B (junior high school and senior high school), group C (technical secondary school or college), and group D (university and above). All patients were randomly assigned to undergo "5A" intervention alone or "5A" intervention combined with varenicline intervention (combined intervention). Patients' awareness of the health risks of tobacco smoking was compared among the four groups. The smoking cessation rate measured at different time points was compared between different intervention strategies. Results:The scores of health risk of tobacco smoking in groups D, C, B, and A were (806.5 ± 35.7) points, (710.8 ± 26.2) points, (643.6 ± 43.4) points, and (512.4 ± 30.1) points, respectively. Patients with high education levels had high awareness of the health risk of tobacco smoking ( F = 1 543.26, P < 0.001). At 1, 3, and 6 months, the smoking cessation rate of combined intervention was higher than that of "5A" intervention alone in each group (group A: χ2 = 3.85, 4.23, 4.10, group B: χ2 = 4.30, 4.09, 4.60, group C: χ2 = 6.81, 4.30, 4.03, group D: χ2 = 6.71, 6.51, 4.73, all P < 0.05). The smoking cessation rate after 6 months of "5A" intervention alone or combined intervention in group D was 60.0% and 78.3% respectively, which were significantly higher than 41.7% and 60.0% in group C, 23.3% and 41.7% in group B, and 20.0% and 36.7% in group A ( χ2 = 26.59, 26.12, both P < 0.001). At different time points, the smoking cessation rates of the "5A" intervention alone in group D were significantly higher than those of combined intervention in groups A and B ( χ2 = 9.25, 25.04, 7.29, all P < 0.05). Conclusion:Awareness of the health risks of tobacco smoking is related to a patient's educational level, and affects smoking cessation. Individualized smoking cessation interventions based on a patient's educational level can increase the rate of smoking cessation.

Libres de humo: efectividad de un programa de cesación tabáquica en un Centro de Salud Comunitario de la Ciudad Autónoma de Buenos Aires / Smoke-free: effectiveness of a smoking cessation program in a Community Health Center of the Autonomous City of Buenos Aires

Introducción. El consumo de tabaco representa un importante desafío para la salud pública debido a su alta incidencia y mortalidad, y es el principal factor de riesgo modificable para desarrollar enfermedades crónicas no transmisibles. La Residencia de Medicina General y Familiar del Hospital General de Agudos Dr. Teodoro Álvarez desarrolló un programa de cesación tabáquica en el Centro de Salud y Acción Comunitaria N◦34, que forma parte desde 2012 del Programa de Prevención y Control del Tabaquismo del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, Argentina. Objetivo. Documentar los resultados de la eficacia de este programa y explorar las variables relacionadas con la probabilidad de éxito y recaída. Materiales y métodos. Estudio cuantitativo, de corte transversal analítico, con datos obtenidos de historias clínicas electrónicas entre 2017 y 2020. Fueron incluidos los pacientes que consultaron al menos en dos ocasiones al programa de cesación tabáquica y establecieron un día D al menos 30 días antes del abandono del consumo de tabaco. La eficacia terapéutica fue definida como haber permanecido al menos seis meses sin fumar, y la recaída, como el reinicio de consumo del tabaco luego de haber logrado 24 horas de abstinencia con fecha posterior al día D.Resultados.De 59 pacientes, 24 (40,7 %) lograron la eficacia terapéutica, de los cuales 5 (20,8 %) presentaron recaídas.De los 35 pacientes que no lograron alcanzar la etapa de mantenimiento, 30 (85,7 %) recayeron durante las primeras ocho semanas. El sexo masculino y el consumo de tabaco superior a 20 paquetes-año mostraron una mayor correlación con las recaídas. Conclusiones. El programa presentó una eficacia terapéutica del 40,7 % en el periodo evaluado. Se encontraron asociaciones entre una mayor eficacia terapéutica y ciertas características de los pacientes, pero se requieren más estudios para confirmar esta hipótesis. (AU)

Background. Tobacco consumption represents an important challenge for public health due to its high incidence and mortality and is the main modifiable risk factor for developing chronic non-communicable diseases. The General and Family Medicine Residence of the Hospital General de Agudos Dr. Teodoro Álvarez developed a smoking cessation program in Health and Community Action Centre N◦34. Since 2012 it has been part of the Program for the Prevention and Control of Smoking of the Ministry of Health of the Government of Buenos Aires, Argentina. Objective. To document the results of the effectiveness of the program and explore the variables related to the probability of success and relapse. Materials and methods. Quantitative, analytical cross-sectional study, with data obtained from electronic medical records between 2017 and 2020. Patients who consulted the smoking cessation program at least twice and established a D-day 30 days before quitting tobacco consumption were included. Therapeutic efficacy was defined as having remained at least six months without smoking, and relapse, as the resumption of tobacco consumption after having achieved 24 hours of abstinence with a date after day D. Results. Of 59 patients, 24 (40.7 %) achieved therapeutic efficacy, of which 5 (20.8 %) presented relapses. Among the35 patients who failed to reach the maintenance stage, 30 (85.7 %) relapsed during the first eight weeks. Male sex and tobacco consumption of more than 20 pack per year showed a greater correlation with relapses. Conclusions.The program presented a therapeutic efficacy of 40.7 % in the evaluated period. Associations were found between greater therapeutic efficacy and certain patient characteristics but more studies are required to confirm this hypothesis. (AU)

Efeito do Programa de Cessação do Tabagismo: uma revisão dessa política pública para dependência tabágica / Effect of Smoking Cessation Program: a review of this public policy for tobacco dependence

Objetivo Entre as diretrizes do Ministério da Saúde para controle do tabagismo está o Programa de Cessação do Tabagismo, desenvolvido pelo Instituto Nacional do Câncer. Esta revisão objetiva descrever as pesquisas que aplicaram o Programa de Cessação do Tabagismo, analisando seus procedimentos, efeitos, potencialidades e limitadores. Método Foram avaliados artigos das bases PubMed, PsycINFO, Biblioteca Virtual da Saúde e Biblioteca Eletrônica Científica Online publicados entre 2002 e 2019 e encontrados através de busca que usou os descritores: "Programa Nacional de Controle do Tabagismo" e "cessação do tabagismo" em português, espanhol e inglês. Foram pré-selecionados 1670 artigos, dos quais 15 foram elegíveis para análise final. Resultados Os resultados mostraram taxas de adesão ao tratamento de 33% a 100%, taxas de sucesso de 15% a 85% após a intervenção e de 21% a 51% seis meses após o final do tratamento. Essa variabilidade pode estar relacionada à falta de padronização e baixa fidelidade na aplicação do Programa, que propõe tratar as dependências física, psicológica e comportamental. Conclusão Recomenda-se investimento em capacitação técnica e monitoramento dos registros.

Objective Brazil Health Ministry's guidelines for tobacco control include the Smoking Cessation Program, developed by the Instituto Nacional de Câncer of Brazil. This review aims to describe the studies in which this Program has been applied, reviewing its procedures, effects, potential and limitations. Method Articles from PubMed, PsycINFO, Virtual Health Library and Scientific Electronic Library Online, published between 2002 and 2019, were evaluated, using the descriptors "Smoking Cessation Program" and "smoking cessation" in Portuguese, Spanish and English. A total of 1670 articles were pre-selected, of which 15 resulted eligible for final assessment. Results The results showed adherence rates from 33% to 100%, success rates from 15% to 85% after the intervention and 21% to 51% six months after treatment completion. This variability may be related to the lack of standardization and poor fidelity in the application of the Program, which intends to treat physical, psychological and behavioral dependence. Conclusion Investment in technical training and record monitoring is suggested.

Análise situacional do programa de cessação tabágica em uma capital brasileira na pandemia da COVID-19 / Situational analysis of the smoking cessation program in a Brazilian capital during the COVID-19 pandemic

Resumo O tabagismo é um problema de saúde pública, está associado a uma elevada morbimortalidade. Os serviços de saúde vigentes para a cessação tabágica, apesar de efetivos, apresentam alcance limitado e foram comprometidos pela pandemia. O estudo teve como objetivo analisar o cuidado com a pessoa tabagista em João Pessoa (PB), na pandemia de COVID-19. Foi realizado um estudo descritivo, exploratório e quantitativo com duas fases: levantamento dos indicadores de saúde e avaliação dos perfis sociodemográficos dos profissionais e usuários dos serviços nos anos do estudo. Participaram da pesquisa sete profissionais, coordenadores de grupo de tabagismo e 20 usuários. Os resultados apontaram para uma baixa cobertura do programa, além de revelar queda no número de fumantes atendidos na pandemia, de 419 em 2019 para 129 em 2020. As entrevistas identificaram pontos positivos e limitações do programa, boa efetividade e baixo acesso, especialmente na APS, e que as estratégias utilizadas para conter o consumo do tabaco e seus riscos durante a pandemia partiram dos serviços e dos profissionais envolvidos. É possível concluir que, nessa região, o Programa Nacional de Controle do Tabagismo (PNCT) apresenta implantação incipiente na APS e que, durante a pandemia, o número de serviços ofertados foi reduzido, diminuindo a procura e as ações realizadas.

Abstract Smoking is a public health problem associated with high morbimortality. Smoking cessation services, although effective, have limited reach and have been compromised by the pandemic. This study aimed to analyze the care for smokers in João Pessoa (PB), Brazil, during the COVID-19 pandemic. A descriptive, exploratory, and quantitative study was conducted in two phases: a survey of health indicators and an evaluation of sociodemographic profiles of professionals and service clients during the study years. Seven professionals, smoking group coordinators, and 20 clients participated in the research. The results showed low program coverage, with a declining number of smokers treated during the pandemic, down from 419 in 2019 to 129 in 2020. Interviews identified the program's positive aspects and limitations, good effectiveness, and low access, especially in primary health care. Tobacco consumption and risk reduction strategies during the COVID-19 pandemic originated from services and professionals involved. We can conclude that the National Tobacco Control Program has an incipient implementation in primary health care in this region and that the number of services offered was reduced during the pandemic, decreasing demand and actions.

Smoking cessation for peripheral arterial disease: systematic review protocol / Cessação do tabagismo para doença arterial periférica: protocolo de revisão sistemática

ABSTRACT Background: peripheral arterial disease has smoking as its main avoidable vascular risk factor. However, most studies do not focus on smoking as the main exposure variable. Objectives: to assess the impact of smoking cessation interventions versus active comparator, placebo or no intervention, on peripheral arterial disease outcomes. Methods: we will use the Cochrane Handbook for Systematic Reviews of Interventions to guide whole this review process. We will consider parallel or cluster-randomised controlled trials (RCTs), quasi-RCTs, and cohort studies. We will search CENTRAL, MEDLINE, Embase, PsycINFO, LILACS and IBECS. We will also conduct a search of ClinicalTrials.gov and the ICTRP for ongoing or unpublished trials. Each research step will involve at least two independent reviewers. We will create a table, using GRADE pro GDT software, reporting the pooled effect estimates for the following outcomes: all-cause mortality, lower limb amputation, adverse events, walking distance, clinical severity, vessel or graft secondary patency, and QoL. Conclusions: we will assess these outcomes according to the five GRADE considerations to assess the certainty of the body of evidence for these outcomes, and to draw conclusions about the certainty of the evidence within the review.

RESUMO Introdução: a doença arterial periférica tem o tabagismo como principal fator de risco vascular evitável. Entretanto, a maioria dos estudos não destaca o tabagismo como principal variável de exposição. Objetivos: avaliar o impacto das intervenções de cessação do tabagismo versus comparador ativo, placebo ou nenhuma intervenção, nos desfechos da doença arterial periférica. Métodos: usaremos o Cochrane Handbook for Systematic Review of Interventions para orientar todo este processo de revisão. Consideraremos ensaios controlados paralelos ou randomizados por cluster (ECRs), quase-ECRs e estudos de coorte. Buscaremos no CENTRAL, MEDLINE, Embase, PsycINFO, LILACS e IBECS. ClinicalTrials.gov e ICTRP serão consultados para ensaios em andamento ou não publicados. Criaremos uma tabela, usando o software GRADE pro GDT, relatando as estimativas de efeito agrupado para os seguintes desfechos: mortalidade por todas as causas, amputação de membro inferior, eventos adversos, distância percorrida, gravidade clínica, permeabilidade secundária do vaso ou enxerto e qualidade de vida. Avaliaremos esses resultados de acordo com as cinco considerações GRADE para avaliar a certeza do corpo de evidências para esses resultados e tirar conclusões sobre a certeza das evidências na revisão.