Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.546
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-33435462

RESUMO

The consequences of the COVID-19 pandemic on behavioral health, including tobacco use, are not fully known. The current study sought to measure the perceived impact of COVID-19 and the resulting stay-at-home orders in Philadelphia, Pennsylvania and Buffalo, New York on smokers enrolled in four smoking cessation trials between March 2020 and July 2020. The survey collected quantitative data regarding life changes due to COVID-19, health/exposure status, and the impact on their cessation attempt (e.g., motivation to quit, change in triggers). The questionnaire collected qualitative data to better understand how such changes could explain changes in smoking behavior. Of the 42 participants surveyed, approximately half indicated that COVID-19 changed their motivation and ability to quit or remain quit. Among those who reported that it was easier to quit following the stay-at-home orders (n = 24), most attributed this to concerns regarding the severity of COVID-19 among smokers. Among those who reported more difficulty quitting (n = 15), most attributed this to their increased stress due to the pandemic and the inability to access activities, places, or people that could help them manage triggers. Given public health warnings of continued surges in COVID-19, these data provide insight into who may benefit from further smoking cessation support should existing restrictions or new stay-at-home orders be enacted.


Assuntos
Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fumantes , Abandono do Hábito de Fumar/estatística & dados numéricos , Humanos , New York/epidemiologia , Pandemias , Philadelphia/epidemiologia , Inquéritos e Questionários
2.
Rev Mal Respir ; 37(9): 722-734, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33129612

RESUMO

Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.


Assuntos
Neoplasias Pulmonares/diagnóstico , Abandono do Hábito de Fumar , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , França/epidemiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Programas de Rastreamento/métodos , Mortalidade , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33202764

RESUMO

Tobacco use is a possible risk factor for contracting and spreading COVID-19. We aimed to describe the impact of the COVID-19 pandemic on the Youth Quitline service and quitting behaviors of its users in Hong Kong. We conducted a telephone survey involving 201 participants of the Youth Quitline service, and retrospectively analyzed the operation and use of Quitline since the COVID-19 outbreak in Hong Kong. The number of incoming calls to the Youth Quitline and the participants' quit rate has increased since the COVID-19 outbreak in Hong Kong. Many participants (68%) did not realize that tobacco use potentially increased their risk for developing and spreading COVID-19; however, 43% agreed that the pandemic motivated their intention to quit, and 83% changed their smoking habits during the pandemic. These changes were mainly due to wearing masks (30%), closure of bars/pubs (25%), suspension of classes (14%), and being unable to socialize with friends (24%). Overall, 58% reduced their tobacco use; of these participants, 66% reported a ≥50% reduction in daily cigarette consumption. The participants reduced their smoking during the COVID-19 pandemic despite lacking knowledge about the potentially increased risk for contracting COVID-19 from continued smoking. The pandemic could create new opportunities to motivate young smokers to quit smoking, especially those seeking support for smoking cessation, and may further contribute to reducing the risks posed by COVID-19.


Assuntos
Infecções por Coronavirus , Linhas Diretas/estatística & dados numéricos , Pandemias , Pneumonia Viral , Abandono do Hábito de Fumar/estatística & dados numéricos , Betacoronavirus , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
4.
Cochrane Database Syst Rev ; 10: CD010216, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33052602

RESUMO

BACKGROUND: Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e-liquid. People who smoke report using ECs to stop or reduce smoking, but some organisations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This review is an update of a review first published in 2014. OBJECTIVES: To evaluate the effect and safety of using electronic cigarettes (ECs) to help people who smoke achieve long-term smoking abstinence. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO for relevant records to January 2020, together with reference-checking and contact with study authors. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and randomized cross-over trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. To be included, studies had to report abstinence from cigarettes at six months or longer and/or data on adverse events (AEs) or other markers of safety at one week or longer. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, AEs, and serious adverse events (SAEs). Secondary outcomes included changes in carbon monoxide, blood pressure, heart rate, blood oxygen saturation, lung function, and levels of known carcinogens/toxicants. We used a fixed-effect Mantel-Haenszel model to calculate the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data from these studies in meta-analyses. MAIN RESULTS: We include 50 completed studies, representing 12,430 participants, of which 26 are RCTs. Thirty-five of the 50 included studies are new to this review update. Of the included studies, we rated four (all which contribute to our main comparisons) at low risk of bias overall, 37 at high risk overall (including the 24 non-randomized studies), and the remainder at unclear risk. There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In absolute terms, this might translate to an additional four successful quitters per 100 (95% CI 2 to 8). There was low-certainty evidence (limited by very serious imprecision) of no difference in the rate of adverse events (AEs) (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs occurred rarely, with no evidence that their frequency differed between nicotine EC and NRT, but very serious imprecision led to low certainty in this finding (RR 1.37, 95% CI 0.77 to 2.41: I2 = n/a; 2 studies, 727 participants). There was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.71, 95% CI 1.00 to 2.92; I2 = 0%; 3 studies, 802 participants). In absolute terms, this might again lead to an additional four successful quitters per 100 (95% CI 0 to 12). These trials used EC with relatively low nicotine delivery. There was low-certainty evidence, limited by very serious imprecision, that there was no difference in the rate of AEs between these groups (RR 1.00, 95% CI 0.73 to 1.36; I2 = 0%; 2 studies, 346 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.25, 95% CI 0.03 to 2.19; I2 = n/a; 4 studies, 494 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.50, 95% CI 1.24 to 5.04; I2 = 0%; 4 studies, 2312 participants). In absolute terms this represents an increase of six per 100 (95% CI 1 to 14). However, this finding was very low-certainty, due to issues with imprecision and risk of bias. There was no evidence that the rate of SAEs varied, but some evidence that non-serious AEs were more common in people randomized to nicotine EC (AEs: RR 1.17, 95% CI 1.04 to 1.31; I2 = 28%; 3 studies, 516 participants; SAEs: RR 1.33, 95% CI 0.25 to 6.96; I2 = 17%; 5 studies, 842 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate over time with continued use. Very few studies reported data on other outcomes or comparisons and hence evidence for these is limited, with confidence intervals often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that ECs with nicotine increase quit rates compared to ECs without nicotine and compared to NRT. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the degree of effect, particularly when using modern EC products. Confidence intervals were wide for data on AEs, SAEs and other safety markers. Overall incidence of SAEs was low across all study arms. We did not detect any clear evidence of harm from nicotine EC, but longest follow-up was two years and the overall number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up-to-date information for decision-makers, this review is now a living systematic review. We will run searches monthly from December 2020, with the review updated as relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Nicotina , Agonistas Nicotínicos , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Viés , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Nicotina/administração & dosagem , Agonistas Nicotínicos/administração & dosagem , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Fumar/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Dispositivos para o Abandono do Uso de Tabaco , Vaping
6.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33000953

RESUMO

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Assuntos
Tomada de Decisão Compartilhada , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Neoplasias Pulmonares/diagnóstico , Fumar/etnologia , Definição da Elegibilidade , Grupos Étnicos/estatística & dados numéricos , Custos de Cuidados de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Cobertura do Seguro , Marketing de Serviços de Saúde/métodos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Sexuais , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Classe Social , Estados Unidos
7.
S Afr Med J ; 110(8): 796-801, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880309

RESUMO

BACKGROUND: Smoking cessation is a complex process influenced by factors such as smokers' nicotine dependence levels, socioeconomic status (SES) and other lifestyle behaviours. Little is known about these relationships in South Africa (SA). OBJECTIVES: To explore the relationship between nicotine dependence, SES, lifestyle behaviours and lifetime quit attempts among adult smokers in SA. METHODS: This study used data from 2 651 participants aged ≥16 years in the 2011 South African Social Attitudes Survey. Information on SES (measured by asset ownership), binge drinking, physical activity, fruit and vegetable intake, intention to quit smoking and lifetime quit attempts was extracted. Nicotine dependence was measured using the Heaviness of Smoking Index (HSI). All data were weighted to account for the complex survey design and to yield nationally representative estimates. Data analysis included binary logistic regression with high nicotine dependence (HND) defined as HSI ≥4 and lifetime quit attempts as separate outcomes. RESULTS: The prevalence of smoking was 20.1% (31.6% for males and 9.5% for females), and was highest in the mixed-ancestry group (37.0%). Overall, 14.5% of smokers had HND, with a higher proportion in the high-SES group. The odds of HND increased with every 10  years of smoking history (odds ratio (OR) 2.05; 95% confidence interval (CI) 1.40 - 3.00) but decreased among participants who reported frequent physical activity (OR 0.4; 95% CI 0.18 - 0.86) and those who planned to quit (OR 0.37; 95% CI 0.19 - 0.75). Quit attempts were more likely among participants who reported frequent fruit and vegetable intake (OR 1.8; 95% CI 1.07 - 2.98) and less likely among those reporting binge drinking (OR 0.31; 95% CI 0.16 - 0.59) or assessed as having HND (OR 0.32; 95% CI 0.17 - 0.58). CONCLUSIONS: Most adult smokers in SA have low nicotine dependence. However, the association of HND with high SES in this study suggests that although cessation treatment based on an integrated lifestyle behavioural intervention package may suffice for most smokers, a more intense cessation treatment package is needed for smokers of higher SES.


Assuntos
Abandono do Hábito de Fumar/estatística & dados numéricos , Tabagismo/epidemiologia , Adulto , Bebedeira/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Dieta , Exercício Físico , Feminino , Frutas , Humanos , Estilo de Vida , Masculino , Distribuição por Sexo , Classe Social , África do Sul/epidemiologia , Inquéritos e Questionários , Verduras
8.
BMC Public Health ; 20(1): 1478, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993598

RESUMO

BACKGROUND: Four decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively. METHODS: Using the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014-15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011-13 Australian Health Survey. RESULTS: The results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation. CONCLUSIONS: Targeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.


Assuntos
Promoção da Saúde/estatística & dados numéricos , Expectativa de Vida/tendências , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Austrália/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Dinâmica Populacional , Prevalência , Fatores de Risco , Distribuição por Sexo , Prevenção do Hábito de Fumar
9.
Ann Epidemiol ; 49: 61-67, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32951805

RESUMO

PURPOSE: Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers. METHODS: The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design. RESULTS: After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. < 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [>high school vs.

Assuntos
Hispano-Americanos/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco/etnologia , Tabagismo/psicologia , Aculturação , Adolescente , Adulto , Distribuição por Idade , Idoso , Ansiedade , Depressão , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fumantes/psicologia , Fumar Tabaco/psicologia , Tabagismo/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
PLoS One ; 15(8): e0236559, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817636

RESUMO

Chronic obstructive pulmonary disease (COPD) poses a significant but heterogeneous burden to individuals and healthcare systems. Policymakers develop targeted policies to minimize this burden but need personalized tools to evaluate novel interventions and target them to subpopulations most likely to benefit. We developed a platform to identify subgroups that are at increased risk of emergency department visits, hospitalizations and mortality and to provide stratified patient input in economic evaluations of COPD interventions. We relied on administrative and survey data from Ontario, Canada and applied a combination of microsimulation and multi-state modeling methods. We illustrated the functionality of the platform by quantifying outcomes across smoking status (current, former, never smokers) and by estimating the effect of smoking cessation on resource use and survival, by comparing outcomes of hypothetical cohorts of smokers who quit at diagnosis and smokers that continued to smoke post diagnosis. The cumulative incidence of all-cause mortality was 37.9% (95% CI: 34.9, 41.4) for never smokers, 34.7% (95% CI: 32.1, 36.9) for current smokers, and 46.4% (95% CI: 43.6, 49.0) for former smokers, at 14 years. Over 14 years, smokers who did not quit at diagnosis had 16.3% (95% CI: 9.6, 38.4%) more COPD-related emergency department visits than smokers who quit at diagnosis. In summary, we combined methods from clinical and economic modeling to create a novel tool that policymakers and health economists can use to inform future COPD policy decisions and quantify the effect of modifying COPD risk factors on resource utilization and morality.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Formulação de Políticas , Doença Pulmonar Obstrutiva Crônica/mortalidade , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco/efeitos adversos , Idoso , Análise Custo-Benefício , Feminino , Recursos em Saúde/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , não Fumantes/estatística & dados numéricos , Ontário , Estudos Retrospectivos , Fatores de Risco , Fumantes/estatística & dados numéricos
11.
Aust N Z J Public Health ; 44(5): 397-403, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32776634

RESUMO

OBJECTIVE: Smoking is a major cause of preventable illness for Aboriginal and Torres Strait Islander people, with most commencing in adolescence. Understanding trends in youth tobacco use can inform prevention policies and programs. METHODS: Logistic regression models examined smoking trends among Aboriginal and Torres Strait Islander and all students aged 12-17 years, in five nationally representative triennial surveys, 2005-2017. Outcomes measured lifetime, past month, past week tobacco use and number of cigarettes smoked daily (smoking intensity). RESULTS: Aboriginal and Torres Strait Islander students' never smoking increased (2005: 49%, 2017: 70%) with corresponding declines in past month and week smoking. Smoking intensity reduced among current smokers (low intensity increased 2005: 67%, 2017: 77%). Trends over time were similar for Aboriginal and Torres Strait Islander students as for all students (8-10% annual increase in never smoking). CONCLUSIONS: Most Aboriginal and Torres Strait Islander students are now never smokers. Comparable declines indicate similar policy impact for Aboriginal and Torres Strait Islander and all students. Implications for Public Health: Comprehensive population-based tobacco control policies can impact all students. Continued investment, including in communities, is needed to maintain and accelerate reductions among Aboriginal and Torres Strait Islander students to achieve equivalent prevalence rates and reduce health inequities.


Assuntos
Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudantes/psicologia , Fumar Tabaco/tendências , Adolescente , Austrália/epidemiologia , Criança , Pesquisa Participativa Baseada na Comunidade , Feminino , Humanos , Masculino , Grupo com Ancestrais Oceânicos/psicologia , Estudos Prospectivos , Abandono do Hábito de Fumar/estatística & dados numéricos
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1009-1013, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741162

RESUMO

Carrying out standardized diagnosis, treatment, intervention, management, surveillance and evaluation of COPD is an important part of the special action for the prevention and treatment of chronic respiratory diseases in the "Healthy China Initiative (2019-2030)" . The surveillance of COPD among Chinese residents provides basic data for assessing the level of standardized diagnosis, treatment, intervention and management of patients with COPD. Based the data of all COPD patients found in the surveillance of COPD (2014-2015), the key series articles report the awareness rate of COPD among patients aged ≥40 years in China, and analyze the spirometry examination rate, medicine treatment rate, inhalation therapy rate, respiratory rehabilitation rate, smoking cessation rate, successful smoking cessation rate, and pneumococcal vaccination rate in COPD patients aged ≥ 40 years and their associated factors, providing a scientific reference for China to carry out special action for the prevention and treatment of chronic respiratory diseases represented by COPD.


Assuntos
Vigilância da População , Doença Pulmonar Obstrutiva Crônica , Adulto , China/epidemiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Espirometria
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1021-1027, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741164

RESUMO

Objective: To understand the smoking cessation behaviors in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention. Methods: COPD patients with post-bronchodilator FEV(1)/FVC<70% were selected from COPD surveillance (2014-2015) of China, in which 5 791 current or former smokers defined by questionnaire survey were included in the study. The smoking cessation rate/ratio and the successful smoking cessation rate in COPD patients, the successful smoking cessation rate in COPD patients who ever smoked daily and the rate of attempting to quit smoking in current smokers with COPD were estimated using data adjusted by complicated sampling method. Results: The smoking cessation rate was 25.0% and the successful smoking cessation rate was 19.1% in COPD patients aged 40 years or older who ever smoked. The smoking cessation ratio was 23.1% and the successful smoking cessation ratio was 17.6% in COPD patients who ever smoked daily. The rate and ratio were higher in urban area than rural area (P<0.05) and increased with age (P<0.05). Patients who were aware of smoking being a risk factor for COPD had higher rate and ratio than patients who were not aware (P<0.05). Patients with more severe airflow limitation and patients smoking less had higher rate and ratio (P<0.05). Conclusions: The smoking cessation rate and ratio were low in COPD patients in China. More health education for COPD patients about smoking cessation needs to be strengthened. It is suggested for healthcare workers to actively advise smoking cessation and suggest smoking cessation ways for patients who smoke in their routine clinical service to increase the successful smoking cessation rate/ratio in COPD patients.


Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Adulto , China/epidemiologia , Humanos , Fumar/epidemiologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-32854185

RESUMO

Tobacco use is exceedingly high among those who are homeless or at risk of homelessness but not commonly addressed by clinicians. Taking Texas Tobacco Free (TTTF) is a tobacco control program that addresses known clinician barriers to intervention (e.g., low training receipt, limited resources). Here, we examine the process and outcomes of TTTF's adaptation within four agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N = 68) to assess changes in training receipt, knowledge, and intervention behaviors, relative to program goals. Results indicated significant gains in clinicians' receipt of training in 9 (of 9) target areas (p's ≤ 0.0042) and a 53% knowledge gain (p < 0.0001). From pre- to post-implementation, there were mean increases in the use of the 5As (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen in assisting residents/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (p's ≤ 0.0491). All program goals, except gains related to advising smokers to quit and the use of specific interventions (behavioral counseling), were met. Overall, TTTF improved clinicians' capacity to address tobacco use among homeless and vulnerably housed individuals and can serve as a model for tobacco control efforts in similar agencies.


Assuntos
Fortalecimento Institucional , Fumar Cigarros/efeitos adversos , Pessoas em Situação de Rua/psicologia , Habitação , Abandono do Hábito de Fumar/estatística & dados numéricos , Abandono do Uso de Tabaco , Tabagismo/prevenção & controle , Fumar Cigarros/prevenção & controle , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Desenvolvimento de Programas , Abandono do Hábito de Fumar/métodos , Texas , Local de Trabalho
15.
BMC Public Health ; 20(1): 1124, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680475

RESUMO

BACKGROUND: Among food pantry users there is a high prevalence of both smoking and food insecurity, which may be related to one another. This study aims to evaluate the impact of a smoking cessation program carried out in food pantries on the smoking status and the food security status of food pantry users. METHODS / DESIGN: Before starting the cluster randomised controlled trial, stakeholders will be engaged to adapt a behavioural group counselling program for smoking cessation to the needs of the food pantry users in a pre study. Food pantry users and workers as well as other experts, such as smoking cessation trainers, social workers, and psychologists, will be involved, using the world café technique and telephone interviews and a qualitative thematic analysis for data analysis to design the concept of the intervention program will be applied. In the second phase, the impact of the intervention on the smoking status and on food insecurity will be investigated by a cluster randomised controlled trial. A total of 416 food pantry users across 32 clusters (food pantries) in Berlin, Germany, should be recruited and randomly assigned to either the intervention group or the waiting list control group. The intervention will consist of a behavioural group counselling program for smoking cessation, specially tailored for food pantry users, as well as optional nicotine replacement therapy and the implementation of environmental smoking reduction measures in the food pantries. The primary outcomes 6 months after the treatment will be self-reported continuous smoking abstinence, validated by exhaled carbon monoxide (< 10 ppm of carbon monoxide), and increased food security level (the percentage of participants with an improved food security level). DISCUSSION: This study will be the first long-term investigation into the effect of a smoking cessation program on smoking status and food insecurity. The results of this study will inform the implementation of smoking cessation programs in food pantries throughout Germany. TRIAL REGISTRATION: Prospectively registered DRKS00020037 . Registered 29 April 2020.


Assuntos
Aconselhamento/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/terapia , Adolescente , Adulto , Berlim/epidemiologia , Análise por Conglomerados , Aconselhamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Fumar/epidemiologia , Abandono do Hábito de Fumar/métodos , Participação dos Interessados/psicologia , Resultado do Tratamento , Adulto Jovem
16.
PLoS One ; 15(7): e0235276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673331

RESUMO

Smoking cessation reduces the cardiovascular risk but increases body weight. We investigated the risk of subsequent myocardial infarction and ischemic stroke according to weight gain after smoking cessation, using a nationwide population based cohort. We enrolled 3,797,572 Korean adults aged over 40 years who participated in national health screenings between 2009 and 2010. Subjects who quit smoking were classified into three subgroups according to the weight change between baseline and 4 years prior. Myocardial infarctions and ischemic strokes were followed until the end of 2015. We compared the hazard ratios among smoking cessation subgroups, non-smokers, and current smokers. The mean changes in weight (1.5 ± 3.9 kg) of the smoking cessation group were higher than those of the other groups (p < 0.0001). A total of 31,277 and 46,811 subjects were newly diagnosed with myocardial infarction and ischemic stroke, respectively. Regardless of weight change, all subgroups of smoking cessation had significantly less risk than current smokers. The subgroup of smoking cessation with weight gain over 4kg showed the lowest risk for myocardial infarctions (hazard ratio 0.646, 95% confidence interval 0.583-0.714, p < 0.0001) and ischemic strokes (hazard ratio 0.648, 95% confidence interval 0.591-0.71, p < 0.0001) after multivariable adjustment. In conclusion, weight gain after smoking cessation did not adversely affect the cardiovascular protective effect.


Assuntos
Infarto Encefálico/epidemiologia , Infarto do Miocárdio/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/efeitos adversos , Ganho de Peso , Adulto , Idoso , Infarto Encefálico/etiologia , Infarto Encefálico/prevenção & controle , Ex-Fumantes/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , não Fumantes/estatística & dados numéricos , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Fumantes/estatística & dados numéricos
17.
JAMA Netw Open ; 3(6): e203826, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32501490

RESUMO

Importance: Several states have banned sales of flavored e-cigarettes, but evidence on the association between vaping flavors and subsequent smoking initiation and cessation is limited. Objective: To evaluate whether new uptake of flavored e-cigarettes is more strongly associated with subsequent smoking initiation and cessation than uptake of unflavored e-cigarettes, separately for youths (12-17 years), emerging adults (18-24 years), and prime-age adults (25-54 years). Design, Setting, and Participants: This cohort study conducted secondary data analyses of longitudinal survey data from waves 1 to 4 of the Population Assessment of Tobacco and Health Study (collected from 2013 to 2018). The analytic sample was limited to 17 929 respondents aged 12 to 54 years at wave 1 who completed at least 3 consecutive waves of the survey and did not use e-cigarettes at baseline. Data were collected from 2013 to 2018 and analyzed in February 2020. Exposures: Flavored vs unflavored e-cigarette use reported in wave 2 of the Population Assessment of Tobacco and Health Study. Main Outcomes and Measures: Binary indicators captured wave 3 smoking among 7311 youths and 4634 emerging adults who did not smoke at baseline (ie, initiation) and not smoking at wave 3 among 1503 emerging adults and 4481 prime-age adults who smoked at baseline (ie, cessation). Smoking status was based on having smoked in the past 30 days for youths and established smoking (ie, current smoking among those who smoked at least 100 cigarettes in their lifetime) for emerging and prime-age adults. Results: The youths who did not smoke at baseline, emerging adults who smoked at baseline, and prime-age adults who smoked at baseline consisted of 51.4% to 58.0% male participants and 66.9% to 77.0% white individuals. Vaping uptake was positively associated with smoking initiation in youth (adjusted odds ratio [AOR], 6.75; 95% CI, 3.93-11.57; P < .001) and in emerging adults (AOR, 3.20; 95% CI, 1.70-6.02; P < .001). Vaping uptake was associated with cessation in adults (AOR, 1.34; 95% CI, 1.02-1.75; P = .03). Vaping nontobacco flavors was no more associated with youth smoking initiation than vaping tobacco-flavors (AOR in youth, 0.66; 95% CI, 0.16-2.76; P = .56) but was associated with increased adult smoking cessation (AOR in adults, 2.28; 95% CI, 1.04-5.01; P = .04). Conclusions and Relevance: In this study, adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors. More research is needed to establish the relationship between e-cigarette flavors and smoking and to guide related policy.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Aromatizantes , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Vaping/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
18.
JAMA Netw Open ; 3(6): e204207, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32501491

RESUMO

Importance: e-Cigarette use among individuals who quit smoking more than 1 ago in England is highest among those with lower socioeconomic position and may affect smoking-related health inequalities, depending on whether the devices protect against relapse to tobacco smoking. Objectives: To assess trends in current e-cigarette use by socioeconomic position among individuals who have quit smoking for at least 1 year, to capture postcessation initiation among those who quit within the past year and did not use an e-cigarette in their most recent quit attempt (representing recent initiation), and to capture postcessation initiation among those who quit smoking before e-cigarettes became popular in 2011 (representing late initiation). Design, Setting, and Participants: This cross-sectional study of 34 442 adults (≥16 years) who formerly smoked used data from the Smoking Toolkit Study (conducted 2014-2019), a nationally representative, monthly, repeated, cross-sectional, household survey of smoking and smoking cessation in England. Data analysis was conducted in December 2019. Exposures: Socioeconomic position based on occupation. Main Outcomes and Measures: Current self-reported e-cigarette use. Results: Weighted samples consisted of 19 297 individuals who had quit smoking for at least 1 year (mean [SD] age, 59.2 [17.0] years; 9024 [46.8%] women), 904 who quit in the past year and did not use an e-cigarette in their most recent quit attempt (mean [SD] age, 41.6 [17.1] years; 445 [49.3%] women), and 14 241 who quit before 2011 (mean [SD] age, 63.6 [14.6] years; 6619 [46.5%] women). Among those who had quit smoking fot at least 1 year, e-cigarette use increased from 3.3% (95% CI, 2.7%-4.0%) in 2014 to 10.4% (95% CI, 9.2%-11.6%) in 2019 among all socioeconomic groups. Use was more common among those with lower socioeconomic position than those with higher socioeconomic position (odds ratio, 1.59; 95% CI, 1.05-2.40; P = .03). Regarding postcessation initiation of e-cigarettes, among those who quit smoking in the past year and did not use an e-cigarette in their most recent quit attempt, 7.1% (95% CI, 5.9%-9.3%) initiated e-cigarette use after smoking cessation, and there was no clear trend over time or any difference according to socioeconomic position. Among those who quit before 2011, there was an overall increase in use of e-cigarettes (0.8% [95% CI, 0.5%-1.2%] in 2014 to 2.1% [95% CI, 1.4%-2.8%] in 2019), but there were no apparent differences in use across socioeconomic position. Conclusions and Relevance: In this study, e-cigarette use increased among all participants from 2014 to 2019 but was highest among those with lower socioeconomic position. Continued monitoring of this socioeconomic patterning is important because if e-cigarettes do not confer the public health benefit of protection against relapse to smoking, then equity-negative disadvantages of long-term usage are more likely. Late, but not recent, postcessation initiation of e-cigarettes has increased over time but is not likely to affect smoking-related health inequalities because there were no differences by socioeconomic position.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fatores Socioeconômicos , Vaping/tendências , Adolescente , Adulto , Idoso , Estudos Transversais , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Abandono do Hábito de Fumar/métodos , Fatores de Tempo , Fumar Tabaco , Adulto Jovem
19.
JAMA Netw Open ; 3(6): e206436, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32492162

RESUMO

Importance: An increasing proportion of US smokers smoke at low intensity and not every day. Some nondaily smokers have always had this pattern, whereas others previously smoked daily. The effect of reducing the level of smoking from daily to nondaily smoking and the dose response at low smoking levels are poorly understood. Objective: To evaluate risk of all-cause and cause-specific mortality among nondaily and daily cigarette smokers, by cigarettes per month, years after reducing from daily to nondaily smoking, and years since quitting. Design, Setting, and Participants: A prospective cohort study using harmonized data from multiple cycles of the Tobacco Use Supplements to the Current Population Survey (TUS-CPS), linked to the National Death Index, were analyzed during the period from 2018 to 2020. Adults completed the 1992-1993, 1995-1996, 1998-1999, 2000, 2001-2002, 2003, 2006-2007, or 2010-2011 TUS-CPS. Cigarette smokers were classified as daily or nondaily users; current nondaily smokers were further categorized by whether they previously smoked every day. Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for risks of mortality vs never smoking. Age was the underlying time metric, adjusted for sex, race/ethnicity, education, survey year, and household income. Results: Among 505 500 participants (aged 18-103 years), approximately 47 000 deaths occurred. The median number of cigarettes smoked per month was 600 (interquartile range, 300-600) (20 cigarettes per day [interquartile range, 10-20 cigarettes per day]) for daily cigarette smokers and 40 (interquartile range, 15-90) for lifelong nondaily smokers. Nevertheless, both current daily (HR, 2.32; 95% CI, 2.25-2.38) and lifelong nondaily (HR, 1.82; 95% CI, 1.65-2.01) smokers had higher all-cause mortality risks than never smokers. Associations were observed for 6 to 10 cigarettes per month and increased with greater-intensity use. Nondaily smokers who previously smoked every day had lower mortality risks than daily smokers, with similar HRs after 10 or more years of nondaily smoking as lifelong nondaily smokers (HR vs never smokers, 1.73; 95% CI, 1.56-1.92). Yet, their risks were higher than former smokers who quit 10 or more years before (HR vs never smokers, 1.18; 95% CI, 1.15-1.22). Conclusions and Relevance: Although reducing smoking from daily to nondaily was associated with decreased mortality risk, cessation was associated with far greater benefit. Lifelong nondaily smokers have higher mortality risks than never smokers, even among those smoking 6 to 10 cigarettes per month. Thus, all smokers should quit, regardless of how infrequently they smoke.


Assuntos
Fumantes/educação , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/mortalidade , Uso de Tabaco/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos Prospectivos , Medição de Risco , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Fumar/tendências , Abandono do Hábito de Fumar/métodos , Inquéritos e Questionários , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia
20.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(6): 890-895, 2020 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-32564555

RESUMO

Objective: To evaluate the effect of smoking cessation project run by the Central Subsidy Smoking Cessation Clinic and to explore the related influencing factors on smoking cessation, in order to improve related services and provide better guidance to these smoking cessation clinics. Methods: Practitioners who had been trained to run smoking cessation projects were recruited to conduct face-to-face interview with the smokers. Questionnaires were completed to provide information on related psychological, social and behavioral issues. In these clinics, medications were provided to the patients by the health care takers in the clinic. One month after the first visit, smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) was counted. Results: The overall smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) appeared as 34.1%. Results from the multivariate logistic regression showed that patients over the age of 60 were the ones most likely to quit smoking. Smokers who showed higher possibility of quitting would include those: not on the daily base, intend to quit within 30 days, with other diseases, or taking varenicline and bupropion. Factors as unemployment, longer history of smoking, bigger quantity of cigarettes consumption per day, dependence on nicotine and urgency on taking up the first cigarette in the early morning etc., were related to the less likelihood of giving up smoking. However, histories of cessation did not seem to affect the possibility of quitting. Conclusions: Data from self-reported 7-day point prevalence abstinence at 30-day follow-up study showed that the smoking cessation intervention programs run by the central subsidy smoking cessation clinic project had been effectively implemented. Advocacy on quit smoking at early stage seemed to have better outcomes, thus should be called for. Since medications as varenicline tartrate and bupropion hydrochloride can increase the possibility of stop smoking, we would suggest that all the hospitals which are with smoking cessation clinics be equipped with these medicines. Professional assistance provided by practitioners is of key importance to help overcome the withdrawal symptoms during the periods of cessation, on these smokers.


Assuntos
Pacientes Ambulatoriais/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Bupropiona/uso terapêutico , China , Seguimentos , Humanos , Pacientes Ambulatoriais/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Vareniclina/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA