Alexandra Kmetova

THE ELECTRONIC CIGARETTE: WHAT PROPORTION OF SMOKERS HAVE TRIED IT AND HOW MANY USE IT REGULARLY?

We read with interest the article by Wagener et al. [1], which calls for a balanced analysis of the risks and benefits of e-cigarettes (EC). There currently exist very few data on smokers’ reactions to EC to help guide relevant policy. Three internet surveys reported that many users consider the product a satisfactory replacement for cigarettes [2–4]. In all surveys, most EC users either stopped smoking conventional cigarettes completely or reduced their consumption substantially. However, user surveys are much more likely to attract EC enthusiasts than smokers who found the product disappointing, and so they do not provide an indication of a typical user reaction and the potential EC uptake by smokers. We conducted a survey that may add to the available information by establishing the proportion of first-time users who find the product acceptable and satisfying, and continue to use it. We approached people who bought cigarettes at five locations across Prague between 10 and 19 October 2011 and conducted brief structured interviews to establish whether the respondents had ever heard about electronic cigarettes; whether they had ever tried one; if so, what was their reaction to it; and what was their subsequent EC use. A total of 973 smokers (average age = 32, 54% men) were interviewed. A total of 86% (n = 837) of respondents had heard about EC, 26% (n = 253) had tried them at least once, and 7% (n = 69), i.e. 27% of those who had ever tried them, were using them regularly. Of the 253 respondents who had tried EC at least once, 245 provided information about their reaction, with 43% disappointed with the experience, 33% finding it as expected, and 24% finding EC better than expected. The respondents who tried EC but did not continue using them were asked for the reasons for their decision (multiple reasons were allowed). Of the 262 responses, 33% reported lack of satisfaction, 32% did not like the taste, 13% did not continue to use EC because of the cost, 9% found it embarrassing to use and 4% gave other reasons, such as technical difficulties with the product and missing the natural timing of finishing a cigarette. EC start to deliver nicotine only after a number of puffs and it is possible that some of the disappointed smokers did not puff on their first EC long enough, but this is only conjecture. The fact that more than 50% had a positive first response suggests that, overall, EC are sufficiently easy to use. Our study has limitations due to the simplicity of the project (e.g. no data were collected on smoke intake), but it provides the first information on the proportion of smokers who have tried EC and found them satisfactory enough to use them regularly. The key result suggests an unexpectedly high rate of adoption of the product, with about a quarter of smokers who tried EC once progressing to regular use. Further surveys are needed to confirm our findings.

Factors associated with weight changes in successful quitters participating in a smoking cessation program.

OBJECTIVE To identify possible predictors of post-cessation weight gain in smoking abstainers. PATIENTS AND METHODS A sample of 607 successful abstainers seen at the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2005 and 2010, was included in this analysis. This sample was followed up for 1year and included 47.9% women (N=291) with the mean age of 48years (18-85). FINDINGS Post-cessation weight gain occurred in 88.6% of the 607 abstainers. The mean weight gain after one year post-quit was 5.1kg (95% confidence interval 4.7-5.5kg). Baseline characteristics associated with increased weight gain included a higher baseline smoking rate (p<0.001), more severe cigarette dependence (p=0.003), less physical activity (p=0.008), and a report of increased appetite on the baseline assessment of withdrawal symptoms (p<0.001). CONCLUSIONS Smokers who are more dependent and have minimal physical activity are at increased risk for post-cessation weight gain. For these smokers, incorporating interventions targeting the weight issue into tobacco dependence treatment is recommended. Further research should be done to identify reasons for this important quitting complication.

Tobacco Treatment Outcomes in Patients With and Without a History of Depression, Czech Republic, 2005-2010

Introduction Higher prevalence of smoking among depressed patients, as well as the risk of depression in smokers, is well documented. The proportion of patients with a history of depression among those seeking intensive treatment of tobacco dependence is also high. In contrast, evidence of treatment success in this subgroup of patients is controversial. The aim of this study was to compare smoking abstinence rates after tobacco treatment in smokers with and without a history of depression. Methods We reviewed retrospective data from 1,730 smokers seeking treatment in Prague, Czech Republic. History of depression was defined as past diagnosis of depression or current treatment of depression. After a 1-year, self-reported smoking status was validated by expired-air carbon monoxide. We used logistic regression to analyze associations between abstinence rates, history of depression, and other factors (eg, age, sex, tobacco dependence). Results Of 1,730 smokers treated, 289 (16.7%) had a history of depression. The smoking abstinence rate at 1 year was 32.5% for smokers with a history of depression and 38.7% for those with no history (P = .048). Among women, abstinence did not differ between groups (35.0% vs 35.7%; P = .86). However, among men, those with a history of depression had lower rates of abstinence (27.4% vs 41.3%; P = .009). After adjustment for baseline covariates, history of depression was not significantly associated with smoking abstinence in men or women. Conclusion Intensive outpatient tobacco treatment programs can achieve abstinence rates among smokers with a history of depression similar to rates among the general population.

Tobacco Cessation Practices and Attitudes Among Nurses in the Czech Republic.

Background: Tobacco is the leading cause of cancer in the Czech Republic. More than one-third of the population older than 15 years smokes, including many nurses. Most smokers want to quit, but the extent of nurses’ involvement in tobacco cessation is unknown. Objective: The purposes of this study are to describe the frequency of nurses’ interventions in helping smokers quit, examine their attitudes and skills, and explore the relationship of nurses’ smoking status to level of intervention. Methods: A convenience sample of nurses in the Czech Republic completed a survey about their frequency of interventions according to the 5As for tobacco dependence treatment (ie, ask, advise, assess, assist, arrange), their attitudes and perceived skills, and their smoking status (never, former, current). Results: A total of 157 nurses completed the survey; 26% “always” or “usually” assisted patients with smoking cessation. Few (22%) reported that nurses could play an important role in helping patients quit, and 65% rated their ability to help smokers quit as “fair/poor.” Nurse who smoked (30%) were less likely to consistently assess smoking status or arrange for follow-up support. Conclusion: Few nurses in the Czech Republic consistently provide smoking cessation support to patients, have the skills to do so, or view this role as an important part of their role. Implications for Practice: To reduce tobacco-related cancers in the Czech Republic, capacity-building efforts are needed to enhance nurses’ skills and confidence in providing smoking cessation interventions. Support is also need to help nurses who smoke quit.

Czech adolescent smokers: unhappy to smoke but unable to quit.

OBJECTIVE To assess the prevalence of tobacco dependence among adolescents in the Czech Republic in 2010, their willingness to quit and knowledge about quitting options. METHODS Primary, intermediate and secondary school students completed an anonymous questionnaire on tobacco use during a smoking prevention class, with a response rate of 100%. RESULTS Of 1420 anonymous questionnaires analysed, 66.8% (n = 949) of respondents had ever tried smoking. More were from smoking (50.4%) than non-smoking (49.6%) families; there were no differences in sex. Most student smokers had experimented with cigarettes (94.6%), cigars (8%), marihuana cigarettes (4.6%) and water pipes (1.9%). At the time of the survey, 52.9% (520/949) of those who had ever tried smoking were current smokers, 30.3% smoked daily, 18.3% weekly and 4.2% less frequently. Only 20.5% of smokers had not considered quitting, and 66.9% had tried unsuccessfully to quit. Withdrawal symptoms were experienced by 24.5% (123/502) of the current smokers, indicating a high level of nicotine dependence in this age group. The majority (346/467, 74.1%) of the current smokers said they would stop smoking immediately on their own. Only a few would seek help at a pharmacy (4.9%), 3.4% would ask their doctor and 1.7% their parents. CONCLUSIONS Tobacco dependence is prevalent among Czech adolescents. The majority of smokers wanted to stop, but knowledge about smoking cessation and quitting assistance offered to smokers was low.

The Czech Republic SimSmoke: The Effect of Tobacco Control Policies on Smoking Prevalence and Smoking Attributable Deaths in the Czech Republic

Background. The Czech Republic has a weak tobacco control record. This paper describes a simulation model examining the effect of future tobacco control policies in the Czech Republic on smoking prevalence and associated future premature mortality. Methods. The model is developed using the SimSmoke simulation model of tobacco control policy. The model uses population, smoking rates and tobacco control policy data for the Czech Republic. It assesses, individually and in combination, the effect of taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth access policies. Results. With a comprehensive set of policies, smoking prevalence can be reduced by as much as 22% in the first year, by 35% in 20 years, and up to 40% in 30 years. By 2040, 5,873 deaths can be averted in that year alone. Without these policies, 113,004 people in the Czech Republic will die prematurely in the next 30 years. Conclusions. The model shows that significant inroads to reducing smoking prevalence and premature mortality can be achieved through tax increases, a high intensity media campaign, a comprehensive cessation treatment program, strong health warnings, stronger smoke-free air laws and marketing bans, and well-enforced youth access laws.