Anja Schumann

Association of smoking and nicotine dependence with trauma and posttraumatic stress disorder in a general population sample.

This study is aimed at investigating the association between trauma, posttraumatic stress disorder (PTSD), smoking, and nicotine dependence. Data were collected in a representative population sample of 4075 adults aged 18 to 64 with the Composite International Diagnostic Interview. Findings show increased odds ratios (ORs) for smoking (OR: 1.28; 95% CI: 1.09–1.51) and nicotine dependence (OR: 1.52; 95% CI: 1.26–1.82) in traumatized persons, independent of PTSD. Persons with PTSD tended to have higher odds for smoking (OR: 2.12; 95% CI: 1.16–3.90) and nicotine dependence (OR: 2.70; 95% CI: 1.57–4.65), but also had lower rates for quitting smoking (OR: 0.38; 95% CI: 0.17–0.84) and for remission from nicotine dependence (OR: 0.18; CI: 0.05–0.63). We conclude that persons suffering from PTSD might need comprehensive aid in smoking cessation.

Proactive interventions for smoking cessation in general medical practice: a quasi-randomized controlled trial to examine the efficacy of computer-tailored letters and physician-delivered brief advice*

Aims To test the efficacy of (i) computer-generated tailored letters and (ii) practitioner-delivered brief advice for smoking cessation against an assessment-only condition; and to compare both interventions directly. Design Quasi-randomized controlled trial. Setting A total of 34 randomly selected general practices from a German region (participation rate 87%). Participants A total of 1499 consecutive patients aged 18–70 years with daily cigarette smoking (participation rate 80%). Interventions The tailored letters intervention group received up to three individualized personal letters. Brief advice was delivered during routine consultation by the practitioner after an onsite training session. Both interventions were based on the Transtheoretical Model of behaviour change. Measurements Self-reported point prevalence and prolonged abstinence at 6-, 12-, 18- and 24-month follow-ups. Findings Among participants completing the last follow-up, 6-month prolonged abstinence was 18.3% in the tailored letters intervention group, 14.8% in the brief advice intervention group and 10.5% in the assessment-only control group. Assuming those lost to follow-up to be smokers, the rates were 10.2%, 9.7% and 6.7%, respectively. Analyses including all follow-ups confirmed statistically significant effects of both interventions compared to assessment only. Using complete case analysis, the tailored letters intervention was significantly more effective than brief advice for 24-hour [odds ratio (OR) = 1.4; P = 0.047] but not for 7-day point prevalence abstinence (OR = 1.4; P = 0.068) for prolonged abstinence, or for alternative assumptions about participants lost to follow-up. Conclusions The study demonstrated long-term efficacy of low-cost interventions for smoking cessation in general practice. The interventions are suitable to reach entire populations of general practices and smoking patients. Computer-generated letters are a promising option to overcome barriers to provide smoking cessation counselling routinely.

Stage of Change Transitions and Processes of Change, Decisional Balance, and Self-Efficacy in Smokers: A Transtheoretical Model Validation Using Longitudinal Data.

Interactions were examined between stage of change transitions and intraindividual increases or decreases in the processes of change, pros and cons of smoking, and situational temptations longitudinally. A total of 786 ever smokers was assessed 2 times, 6 months apart, with respect to the transtheoretical model (TTM) constructs. Two significant discriminant functions within initial precontemplators and 1 significant function within initial contemplators were found. Ten out of 15 TTM variables contributed to at least 1 function. The functions mainly distinguished between preabstinence (precontemplation, contemplation, or preparation) and abstinence (action or maintenance) stages of change, that is, between current and former smokers. This is one of the few studies providing a longitudinal validation of the postulates of the TTM.

The Fagerström test for nicotine dependence in two adult population samples—potential influence of lifetime amount of tobacco smoked on the degree of dependence

BACKGROUND The Fagerström test for nicotine dependence (FTND) has been widely used in clinical samples but seldom in population samples. Data are particularly lacking for a large range of ages. The goal was to describe the FTND sum score distribution in the adult population and to show potential variation according to the number of years of smoking. METHODS Random adult population samples from two northern areas in Germany were used. Sample 1 included 1460 current smokers aged 20-64 years and sample 2 included 1135 current smokers aged 20-79 years. One cross-sectional and longitudinal and one cross-sectional study were conducted. The FTND was administered during face-to-face computer-aided interviews. RESULTS The mean FTND sum score for those aged 20-64 was 3.2 among sample 1 and 2.5 among sample 2. The number of years of smoking and age did not affect the FTND sum score whereas it was positively correlated with the lifetime amount of tobacco smoked. CONCLUSIONS Dependence according to the FTND does not increase with the number of years of smoking. Population-based interventions addressing the needs of dependent smokers across all age groups are needed.

Relation between awareness of circulatory disorders and smoking in a general population health examination

BackgroundLittle is known about proportions of smokers who maintain smoking after they are aware of a circulatory disorder. The goal was to analyze the extent to which the number of circulatory disorders may be related to being a current smoker.MethodsCross-sectional survey study with a probability sample of residents in Germany investigated in health examination centers. Questionnaire data of 3,778 ever smoking participants aged 18 – 79 were used, questions included whether the respondent had ever had hypertension, myocardial infarction, other coronary artery disease, heart failure, stroke, other cerebrovascular disease, peripheral vascular disease, and venous thrombosis. Logistic regression was calculated for circulatory disorders and their number with current smoking as the dependent variable, and odds ratios (OR) are presented adjusted for physician contact, inpatient treatment, smoking cessation counseling, heavy smoking, exercise, overweight and obesity, school education, sex and age.ResultsAmong ever smokers who had 1 circulatory disorder, 52.1 % were current smokers and among those who reported that they had 3 or more circulatory disorders 28.0 % were current smokers at the time of the interview. The adjusted odds of being a current smoker were lower for individuals who had ever smoked in life and had 2 or more central circulatory disorders, such as myocardial infarction, heart failure or stroke, than for ever smokers without central circulatory disorder (2 or more disorders: adjusted OR 0.6, 95 % confidence interval, CI, 0.4 to 0.8).ConclusionAmong those with central circulatory disorders, there is a substantial portion of individuals who smoke despite their disease. The data suggest that only a portion of smokers among the general population seems to be discouraged from smoking by circulatory disorders or its accompanying cognitive or emotional processes.

Prevalence, Characteristics, Associated Mental Disorders and Predictors of DSM-IV Nicotine Dependence

Objective: Focussing on ever-smokers and comparing nicotine-dependent with nondependent subjects, we examined the characteristics, associations of nicotine dependence with other mental disorders as well as predictors of nicotine dependence. Never-smokers were not included in the reference group of the nondependent subjects, but were analyzed as a third group. Methods: Data of 1,636 never-smokers and 2,437 ever-smokers (i.e. 1,520 current smokers, 917 former smokers) were taken from the German Transitions in Alcohol Consumption and Smoking Study. Assessments were made using the Composite International Diagnostic Interview. Results: About a third of the ever-smokers met the criteria for nicotine dependence in some point in their lives. Nicotine-dependent smoking was significantly associated with various substance use disorders, affective disorders and anxiety disorders using nondependent smoking as a reference group. Comparing never-smokers and nondependent ever-smokers, significant associations were found for substance use disorders only. Smoking behavior variables, alcohol abuse or dependence and anxiety disorders but not sociodemographic variables and affective disorders were predictors for nicotine dependence. Conclusion: Nicotine-dependent smoking is distinct from smoking alone and nicotine-dependent smokers are a characteristically different subgroup within the smoking population.

Does the smoking status of general practitioners affect the efficacy of smoking cessation counselling

OBJECTIVE To examine the association between the smoking status of general practitioners (GPs) and abstinence rates among patients receiving GP-delivered brief advice for smoking cessation. METHODS A quasi-experimental multilevel study with follow-up assessments at 6, 12, 18, and 24 months after baseline was conducted using a random sample of 39 general practices in a defined area (participation rate=87.2%). Patients aged 18-70 were consecutively screened for smoking status (n=11,560) over the course of 3 weeks and were assigned to a control group (week 1), a computer expert system intervention (week 2), or a personal counselling intervention with the GP (week 3). For the current analysis, patients participating in study week 2 were excluded. A total of 1260 patients fulfilled the inclusion criteria and 80.2% took part: 609 patients in study week 1 and 402 patients from study week 3. GPs participated in a training session concerning smoking counselling, which was held between study weeks 2 and 3. Self-reported 4-week and 6-month prolonged abstinence measures at the 6-, 12-, 18-, and 24-month follow-ups were assessed. RESULTS The smoking status of the GP was neither significantly related to 4-week prolonged abstinence nor 6-month prolonged abstinence among patients in a main effects model. Further modelling revealed that the intervention group modified the effect of the non-smoking status of the GP on the likelihood to quit smoking. A significant interactive effect was found between the non-smoking status of the GP and the intervention group on both abstinence measures. CONCLUSION The non-smoking status of the GP had a positive effect among counselled patients. PRACTICE IMPLICATIONS The consideration of lifestyle behavioural variables such as the smoking status of the GP will be essential for further research concerning the efficacy of smoking interventions.

Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults

OBJECTIVE To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. DESIGN By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. MAIN OUTCOME MEASURES Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. RESULTS LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate = 64%, control rate = 42%). CONCLUSION The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population.

Predictors of Increased Body Mass Index Following Cessation of Smoking

The objective of this study was to explore nicotine withdrawal symptoms as predictors of increased body mass index (BMI) after an attempt to quit or reduce tobacco smoking. The authors used a survey study, with a probability sample of 4,075 18-64-year-old residents. The participation rate was 70.2%, which included 1,545 current daily smokers. Follow-ups were carried out for current smokers after thirty and 36 months. The authors found that smokers who experienced increased appetite or weight gain (IAW) as a nicotine withdrawal symptom had a higher BMI than smokers without IAW. They concluded that IAW after quitting might be a specific determinant of the BMI increase following smoking cessation in a subgroup of smokers.

Computer-tailored smoking cessation intervention in a general population setting in Germany: outcome of a randomized controlled trial.

This study reports the outcome of a randomized controlled trial testing a computer-tailored smoking cessation intervention based on the transtheoretical model in a general population setting in Germany. Participants of the smoking intervention study were recruited from an existing general population health examination survey in a university hospital. The sample consisted of 611 current and former smokers at baseline, and of 485 participants in the core group of baseline daily cigarette smokers. Follow-ups were conducted 6, 12, 18, and 24 months after baseline. The intervention was designed for both current and former smokers, involved up to three individualized feedback letters, and was created using expert-system technology. Based on 7-day point-prevalence abstinence and 6-month prolonged abstinence as the outcome measures, the study identified no significant differences between the intervention and control groups. Modeling the full longitudinal data in generalized estimation equation analyses, using different nonresponse procedures, and adjusting for covariates did not alter the results. We conclude that the computer-tailored transtheoretical model-based smoking cessation intervention, as delivered in this study and in this special setting, was ineffective.