Eva Kralikova

Determinants of smoking initiation among women in five European countries: a cross-sectional survey.

BackgroundThe rate of smoking and lung cancer among women is rising in Europe. The primary aim of this study was to determine why women begin smoking in five different European countries at different stages of the tobacco epidemic and to determine if smoking is associated with certain characteristics and/or beliefs about smoking.MethodsA cross-sectional telephone survey on knowledge and beliefs about tobacco was conducted as part of the Women in Europe Against Lung Cancer and Smoking (WELAS) Project. A total of 5 000 adult women from France, Ireland, Italy, Czech Republic, and Sweden were interviewed, with 1 000 from each participating country. All participants were asked questions about demographics, knowledge and beliefs about smoking, and their tobacco use background. Current and former smokers also were asked questions about smoking initiation. Basic statistics on the cross-sectional data was reported with chi-squared and ANOVA p-values. Logistic regression was used to analyze ever versus never smokers. Linear regression analyses were used to analyze age of smoking initiation.ResultsBeing older, being divorced, having friends/family who smoke, and having parents who smoke were all significantly associated with ever smoking, though the strength of the associations varied by country. The most frequently reported reason for initiation smoking was friend smoking, with 62.3% of ever smokers reporting friends as one of the reasons why they began smoking. Mean age of smoking initiation was 18.2 years and over 80% of participants started smoking by the age of 20. The highest levels of young initiators were in Sweden with 29.3% of women initiating smoking at age 14-15 and 12.0% initiating smoking younger than age 14. The lowest level of young initiators was in the Czech Republic with 13.7% of women initiating smoking at age 14-15 and 1.4% of women initiating smoking younger than age 14. Women who started smoking because their friends smoked or to look cool were more likely to start smoking at a younger age. Women who started smoking to manage stress or to feel less depressed were more likely to start smoking at an older age.ConclusionsIn all five participating countries, friends were the primary factor influencing ever smoking, especially among younger women. The majority of participants began smoking in adolescence and the average reported age of smoking initiation was youngest in Sweden and oldest in the Czech Republic.

A Randomized Placebo-Controlled Trial of Varenicline for Smoking Cessation Allowing Flexible Quit Dates

Introduction: Current smoking cessation guidelines recommend setting a quit date prior to starting pharmacotherapy. However, providing flexibility in the date of quitting may be more acceptable to some smokers. The objective of this study was to compare varenicline 1 mg twice daily (b.i.d.) with placebo in subjects using a flexible quit date paradigm after starting medication. Methods: In this double-blind, randomized, placebo-controlled international study, smokers of ≥10 cigarettes/day, aged 18–75 years, and who were motivated to quit were randomized (3:1) to receive varenicline 1 mg b.i.d. or placebo for 12 weeks. Subjects were followed up through Week 24. Subjects were instructed to quit between Days 8 and 35 after starting medication. The primary endpoint was carbon monoxide–confirmed continuous abstinence during Weeks 9–12, and a key secondary endpoint was continuous abstinence during Weeks 9–24. Results: Overall, 493 subjects were randomized to varenicline and 166 to placebo. Continuous abstinence was higher for varenicline than for placebo subjects at the end of treatment (Weeks 9–12: 53.1% vs. 19.3%; odds ratio [OR] 5.9; 95% CI, 3.7–9.4; p < .0001) and through 24 weeks follow-up (Weeks 9–24: 34.7% vs. 12.7%; OR 4.4; 95% CI, 2.6–7.5; p < .0001). Serious adverse events occurred in 1.2% varenicline (none were psychiatric) and 0.6% placebo subjects. Fewer varenicline than placebo subjects reported depression-related adverse events (2.3% vs. 6.7%, respectively). Conclusions: Varenicline 1 mg b.i.d. using a flexible quit date paradigm had similar efficacy and safety compared with previous fixed quit date studies.

Fifty-two-week continuous abstinence rates of smokers being treated with varenicline versus nicotine replacement therapy.

BACKGROUND AND AIMSnCross-study comparisons of effect sizes suggest that varenicline is more effective than nicotine replacement therapy (NRT) in aiding smoking cessation, but evidence from direct comparisons is limited. This study compared biochemically verified 52-week sustained abstinence rates in smokers attending the same clinical service according to whether they used varenicline or NRT in their quit attempt.nnnMETHODSnThis was a prospective cohort study of 855 smokers attending a large smoking cessation clinic who used their choice of NRT product or varenicline in their quit attempt. All received the same behavioural support programme and chose their medication option (nu2009=u2009519 varenicline; nu2009=u2009336 NRT). The primary outcome measure was self-report of 52 weeks abstinence following the target quit date confirmed by expired air carbon monoxide concentration. Baseline measures included socio-demographic variables, mental health diagnoses, measures of smoking, cigarette dependence and past use of NRT or varenicline.nnnRESULTSnThe 52-week abstinence rates were 42.8% versus 31.0% in those using varenicline versus NRT, respectively (Pu2009<u20090.001). After adjusting for all baseline variables, the odds of remaining abstinent for 52 weeks were 2.03 (95% CI 1.46-2.82), Pu2009<u20090.001 times higher in those using varenicline than those using NRT.nnnCONCLUSIONSnSmokers in the same behavioural support programme who use varenicline appear to have a greater probability of achieving long-term abstinence than those using their choice of nicotine replacement therapy options, even after adjusting for potentially confounding smoker characteristics.

Home and workplace smoking bans in Italy, Ireland, Sweden, France and the Czech Republic

The purpose of this study was to report predictors and prevalence of home and workplace smoking bans in five European countries. We conducted a population-based telephone survey of 4,977 females, ascertaining factors associated with smoking bans. Odds ratios and 95% confidence intervals were derived using unconditional logistic regression. A complete home smoking ban was reported by 59.5% of French, 63.5% of Irish, 61.3% of Italian, 74.4% of Czech and 87.0% of Swedish females. Home smoking bans were associated with younger age and being bothered by secondhand smoke, and among smokers, inversely associated with greater tobacco dependence. Among nonsmokers, bans were also related to believing smoking is harmful (OR 1.20, 95% CI 1.11–1.30) and having parents who smoke (OR 0.62, 95% CI 0.52–0.73). Workplace bans were reported by 92.6% of French, 96.5% of Irish, 77.9% of Italian, 79.1% of Czech and 88.1% of Swedish females. Workplace smoking bans were reported less often among those in technical positions (OR 0.64, 95% CI 0.50–0.82) and among skilled workers (OR 0.53, 95% CI 0.32–0.88) than among professional workers. Workplace smoking bans are in place for most workers in these countries. Having a home smoking ban was based on smoking behaviour, demographics, beliefs and personal preference.

Knowledge and Beliefs about Smoking and Cancer among Women in Five European Countries

Background: Lung cancer mortality in women is increasing across Europe, reflecting the alarming increase in smoking prevalence. Understanding womens perception of smoking may help to identify ways to reduce its prevalence and prevent uptake of smoking. The aim of this study was to examine factors associated with knowledge and beliefs about smoking and cancer among European women. Methods: A cross-sectional landline telephone survey on health attitudes and knowledge was conducted in five European countries: France, Ireland, Italy, the Czech Republic, and Sweden. A general linear modeling was used to explore the factors related to knowledge and beliefs about smoking and cancer. Results: A total of 5,000 women were interviewed (1,000 women from each country). The mean knowledge and belief scores about smoking and cancer were lower in current smokers than those of never and former smokers (P < 0.05). Women with above-the-median income (P = 0.001) and women who held skilled occupations seemed to be more knowledgeable about tobacco health risks (P < 0.001). The number of friends and family who smoked was inversely associated with knowledge on the harmful effects of tobacco (P = 0.001). Swedish women were the most knowledgeable about tobacco-related cancer risk, whereas in France and Italy, current smokers were less knowledgeable. Conclusions: Knowledge and beliefs about cancer and smoking varied significantly by smoking status. Impact: Results emphasize the need to develop health education programs that enhance cancer knowledge among women who currently smoke and are in low socioeconomic groups. Cancer Epidemiol Biomarkers Prev; 19(11); 2811–20. ©2010 AACR.

Postgraduate medical education on tobacco and smoking cessation in Europe

ISSUESnSmoking prevalence in European countries is high. Adequately trained physicians can play a key role in reducing smoking rates in Europe. This paper provides an overview of postgraduate smoking cessation training for physicians in Europe.nnnAPPROACHnTwo methods were used: (i) a review of the Europe-based published and grey literature between 1999 and 2009 on postgraduate education programs for physicians in smoking cessation; and (ii) a survey of key informants identified through two European tobacco control list serves.nnnKEY FINDINGSnA total of nine relevant articles were identified through the literature search which showed over 170 postgraduate training programs offered in Europe in smoking cessation. The survey resulted in a 100% response rate from 38 key informants from 28 European countries. Respondents from all countries except Latvia reported knowledge of the existence of smoking cessation training programs. Course content included brief intervention training (93%), pharmacotherapy (96%), motivational interviewing skills (85%) and training in the stages of change (89%). Participation by physicians in these courses was reported to be low (ranging in total participation estimates from 15 to 1100 per country).nnnIMPLICATIONSnThe study showed numerous training opportunities for physicians in Europe. However, postgraduate training in smoking cessation might not be reaching physicians and might not be rigorously evaluated.nnnCONCLUSIONSnIt is imperative that the effectiveness of the programs in changing provider practices and patient smoking outcomes is adequately evaluated. Further research is also indicated for methods of disseminating effective educational activities throughout Europe with the intention of increasing participation.

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

OBJECTIVEnTo identify possible predictors of post-cessation weight gain in smoking abstainers.nnnPATIENTS AND METHODSnA 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).nnnFINDINGSnPost-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).nnnCONCLUSIONSnSmokers 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.

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up

BackgroundSmoking is more prevalent among people with depression. Depression may make cessation more difficult and cessation may affect depression symptoms.PurposeThe aims of this study were to assess the associations between (1) baseline depression and 1-year smoking abstinence and (2) abstinence and change in depression.MethodsObservational study using data collected routinely in a smoking cessation clinic in the Czech Republic from 2008 to 2014. Aim 1: Nxa0=xa03775 patients; 14.3% reported mild and 15.4% moderate/severe baseline depression levels measured using Beck’s Depression Inventory (BDI-II). Logistic regressions assessed if depression level predicted 1-year biochemically verified abstinence while adjusting for patient and treatment characteristics. Aim 2: Nxa0=xa0835 patients abstinent at 1xa0year; change in depression was analysed using Chi-square statistics, t test and mixed method analyses of variance.ResultsRate of abstinence was lower for patients with mild (32.5%, ORxa0=xa00.68; 95% CI: 0.54 to 0.87, pxa0=xa00.002) and moderate/severe depression (25.8%; ORxa0=xa00.57, 95% CI: 0.45 to 0.74, pxa0<xa00.001) compared with patients without depression (40.5%).Across abstinent patients, the majority with baseline depression reported lower depression levels at follow-up. Overall mean (SD) BDI-II scores improved from 9.2 (8.6) to 5.3 (6.1); t(834)xa0=xa014.6, pxa0<xa00.001. There were significant main effects of time (F(1832)xa0=xa0880.8, pxa0<xa00.001, partial η2xa0=xa00.51) and baseline depression level (F(2832)xa0=xa0666.4, pxa0<xa00.001, partial η2xa0=xa00.62) on follow-up depression and a significant depressionxa0*xa0time interaction (F(2832)xa0=xa0296.5, pxa0<xa00.001, partial η2xa0=xa00.42).ConclusionsIn this effective smoking cessation clinic, depression at the start of treatment predicted reduced smoking abstinence 1xa0year later. Patients abstinent from smoking experienced considerable improvement in depression.

Impact of tobacco control policy on quitting and nicotine dependence among women in five European countries

Objective To describe differences in and factors associated with former smoking and nicotine dependence among women in Ireland, Sweden, France, Italy and the Czech Republic. Methods A cross-sectional, random digit dial telephone survey of 5000 women, aged 18u2005years and older, conducted in 2008. Analyses were conducted using logistic regression models. Results Respondents from Ireland and Sweden had statistically significantly higher odds of having quit smoking within the 5u2005years before survey administration compared with respondents from the Czech Republic. Current smokers from Ireland, Sweden, France and Italy are more nicotine dependent than those from the Czech Republic. Conclusions Respondents from countries with stronger tobacco control policies were more likely to have quit smoking compared with those living in the Czech Republic. However, respondents in countries with some of the strongest policies (Ireland, Sweden, France and Italy) had higher odds of smoking within 30u2005min of waking, an established indicator of nicotine dependence. More research in this area is warranted, but this study suggests that now that the Czech Republic is beginning to implement strong tobacco control policy, they will probably achieve a rapid decline in population-level smoking. Ireland, Sweden, France, Italy and other countries with established, strong tobacco control policies would do well to consider what additional programmes they can put in place to help their highly nicotine-dependent population of smokers successfully quit.