Lieke C.A. Christenhusz

Cost-effectiveness of an Intensive Smoking Cessation Intervention for COPD Outpatients

INTRODUCTION To determine the cost-effectiveness of a high-intensity smoking cessation program (SmokeStop Therapy; SST) versus a medium-intensity treatment (Minimal Intervention Strategy for Lung patients [LMIS]) for chronic obstructive pulmonary disease outpatients. METHODS The cost-effectiveness analysis was based on a randomized controlled trial investigating the effectiveness of the SST compared with the LMIS with 12-month follow-up. The primary outcome measure was the cotinine-validated continuous abstinence rate based on intention to treat. A health care perspective was adopted, with outcomes assessed in terms of (incremental) additional quitters gained, exacerbations prevented, and hospital days prevented. Health care resource use, associated with smoking cessation, was collected at baseline and 12 months after the start of the interventions. Monte Carlo simulations were performed to evaluate the robustness of the results. RESULTS The average patient receiving SST generated €581 in health care costs, including the costs of the smoking cessation program, versus €595 in the LMIS. The SST is also associated with a lower average number of exacerbations (0.38 vs. 0.60) and hospital days (0.39 vs. 1) per patient and a higher number of quitters (20 vs. 9) at lower total costs. This leads to a dominance of the SST compared with the LMIS. CONCLUSIONS The high-intensive SST is more cost-effective than the medium-intensive LMIS after 1 year. This is associated with cost savings per additional quitter, prevented exacerbations, and hospital days at lower or equal costs.

Well-Being Therapy in the Netherlands

ternative interpretations (e.g. ‘I have no reason to expect being rejected by others’, ‘There are no signs my wife wants to leave me, because she is nice to me’) and had positive experiences when he stayed in contact with others instead of avoiding contact. The PWS showed that he had impaired levels on the domains ‘purpose in life’ and ‘self-acceptance’. After the first 2 sessions, he decided to work 3 sessions on the domain ‘self-acceptance’ by writing about his talents (e.g. intelligent, reliable) and discussed his past (positive) life experiences with the therapist to become more self-compassionate. The last 3 sessions he worked on the domain ‘purpose in life’. He described important changes he wanted to reach in his life to make it more meaningful (e.g. socialize more in daily work, be active in positive relations) and made plans for the near future (e.g. visit friends weekly, spend more time with his wife during the weekends). At the end of the treatment he felt more selfconfident and fully recovered. Furthermore, he became more active, resumed playing football and working full time. He still remained well after 6 months of follow-up.

Can deceiving COPD smokers be detected by measuring exhaled CO to determine smoking status? A validation of three Co monitors

In alphabetical order by first author Validation of short-form scales for measuring depression in health-survey context *Aalto, A.-M., Kivimäki, M., Pirkola, S.; *Stakes (National Research and Development Centre for Welfare and Health), Helsinki, Finland Depression is highly relevant and associated with various physical illnesses. Therefore a valid measure of depression in health-related surveys is well-grounded. However, conventional measures of depression such as BDI21, are often burdensome for respondents in extensive surveys. This study examines validity and usability of short-form measures of depression in a survey context. Methods The data (n1⁄4 6005) was derived from the Finnish population based ‘‘Health 2000’’ – study, which included questionnaires and health examination. The scales under validation were BDI13, GHQ12 and GHQ12 depression & anxiety subscale (GHQad; Graez, 1991). The criterions for convergent-discriminant validity were BDI21 and CIDI-diagnosis (depressive or anxiety disorder). Also other psychometric properties as well as sociodemographic, personality and health-related correlates of depression scales were examined. Results The Cronbach alpha was highest for GHQ12 (0.90) and lowest for GHQad (0.79). Correlations with BDI21 were: 0.96 (BDI13), 0.69 (GHQ12) and 0.59 (GHQad). Depressive disorder explained clearly more of variance in all scales than anxiety disorder, though this pattern was less clear among women. Sociodemographic differences (age, gender & education) were found mainly in BDI scales. Correlations of BDI21, BDI13, GHQ12 and GHQad with cynical hostility were 0.31, 0.31, 0.18 and 0.19, with handicapping chronic illness 0.40, 0.34, 0.28 and 0.22, and with use of mental health services 0.26, 0.26, 0.22 and 0.21 respectively. Conclusions All scales showed acceptable reliability and convergent – discriminant validity in terms of CIDI classification, but the sociodemographic patterning of GHQ12 scores differed from that of BDI scales. Particularly the 13-item version of BDI seems to perform equally well as the longer form and can be recommended as an alternative to questionnaire surveys. Sequencing and prioritising of intentions in planned behaviour Abraham, C.; University of Sussex, UK Objectives This paper will demonstrate that social cognition models can be enhanced by looking beyond single intentions to the multiple, conflicting, congruent and interdependent intentions from which planned behaviour emerges. Method and Results Results from a number of surveys will be presented demonstrating that consideration of multiple intentions can enhance the predictive utility of the theory of planned ISSN 0887-0446 print/ISSN 1476-8321 online 2005 Taylor & Francis Group Ltd DOI: 10.1080/14768320500221275 behaviour and help clarify the nature of intention–behaviour discrepancies. Many health behaviours (e.g., studying or using a condom) involve sequences of actions so that the strength of a behavioural intention depends on the establishment of intentions to undertake prerequisite actions. For example, in a cross sectional survey of 2120 Scottish 16 year olds, after controlling for TPB predictors, measures of preparatory intentions (e.g., the intention to suggest condom use to a sexual partner) added 10% to the variance explained in the intention to always use condoms. Moreover, the strength of conflicting intentions may moderate intention-behaviour relationships. For example, in a survey of 419 students who had intended to use a condom during their last sexual intercourse with a new partner, the relative importance of having sex versus using a condom during sex discriminated most effectively between those who had and had not used a condom on that occasion. Finally, results form intervention evaluations focusing on physical activity will be reviewed, demonstrating the efficacy of goal setting as a behavioural intervention technique. Conclusion Predictive models should assess congruent, competing and prerequisite intentions as well as behavioural intentions matched to target behaviours. Simple explanations increase comprehension of terms used in oncology consultations *Abraham, C., Dudley, J.; *University of Sussex, UK Objectives To assess and enhance understanding of terms used in oncology consultations reported to be difficult to understand by patients. Methods Two street surveys were conducted. In the first survey phrases and terms were presented as recorded in consultations. In the second short, simple explanatory phrases were added to statements used in the consultations. Identical comprehension assessments were employed. Results In line with previous findings, the first survey (N1⁄4 101) demonstrated that understanding of terms and phrases used to describe cancer screening, diagnoses, prognoses, and treatment is poor. For example, less than 40% of participants understood terms such as: ‘‘spots within the liver’’, ‘‘seedlings’’ and ‘‘in remission’’. Even common terms were not understood by all with 30% of respondents failing to understanding that ‘‘metastasise’’ meant spreading of cancer. There were no significant demographic differences between the first and second survey samples (N1⁄4 101). Both samples were recruited in the same manner. In survey two simple explanations were added to oncologists original statements. For example, in the case of ‘‘spots within the liver’’, the explanation ‘‘This means that you have cancer in your liver’’ was added. These additions improved comprehension so that the same statements referring to ‘‘spots within the liver’’, ‘‘seedlings’’, ‘‘in remission’’ and ‘‘metastasise’’ were understood correctly by 93, 83, 73 and 98%, respectively. Conclusions Simple clarifications which would take only seconds to add to a consultation can substantially alter the proportion of lay people who understand statements made in oncology consultations. Changes in HAPA–model constructs predict type 2 diabetes risk factor reduction in life-style counselling *Absetz, P., Heinonen, H., Valve, R., Talja, M., Uutela, A, Nissinen, A., Fogelholm, M.; *National Public Health Institute, Finland Objective To study clinical risk factor changes among participants of a theoryand evidence-based life-style counselling program, and the effect of social-cognitive predictors on the change. Methods Subjects were Finnish men (N1⁄4 102) and women (N1⁄4 286, age 50–65) at an increased risk for type 2 diabetes recruited from primary care centres to participate in the GOAL life-style 10 Abstracts426 students aged 17–22 (m=18) completed a questionnaire, based on Ajzens Theory of Planned Behavior and its following developments, designed to study the determinants leading to accept a lift from a drunk driver. The data have been subjected to multiple regression Discussion Social norms (p <.05) and particularly peers norms (p<.001) seem to significatively predict the intention to get into a car with a drunk friend. Also perceived behavior control (p <.001) and risk perception (p<.01) seem to motivate the intentions. In licensed young adults also self-esteem (p <.01) influences intentions. The To Drink and to Drive: The Passengers PerspectiveSocial cognitive techniques work on both the task-oriented and emotion-oriented level focusing on enhancement of perceived capability, creating a role model environment and opportunities for mastery experience. There is no analysis system that addresses implementation of selfefficacy oriented interventions. To fill in the gap an analysis system for the coding of selfefficacy related interventions in training programs (ASSET: Analysis System for Self-Efficacy Training) has been developed. Four super categories have been deductively derived from Social Cognitive Theory: Mastery Experience, Role Model, Verbal Persuasion, and Physical and Affective State (Bandura, 1997). In the next step, the materials from self-management program manuals (DESMOND, 2004; Lorig, 1996) were used to inductively identify particular interventions as subcategories. Finally, the subcategories have been extended and refined on the basis of observation of self-management education programs run in local health care services. In the next step, ASSET will be validated. Participants’ behavioural, cognitive and emotional change, derived from self-report questionnaires, will be related to the frequency of utilized self-efficacy enhancing strategies. Having considered the high predictability of self-efficacy belief on behaviour change, it is expected that programs with high numbers of utilized selfefficacy oriented interventions will result in better illness adjustment. The validation study results will be presented in this poster.