Hintergrund / Ziel der Studie: Im Bereich der Tabakentwöhnung existieren mittlerweile zahlreiche erprobte therapeutische Maßnahmen und Medikamente. Dennoch ist die Inanspruchnahme vorhandener Entwöhnungsangebote sehr dürftig. Es besteht die begründete Hoffnung, dass durch eine stärkere Einbeziehung der Hausärzte in den Bereich der Tabakentwöhnung eine Versorgungslücke geschlossen werden könnte. Die Studie soll Durchführbarkeit und Erfolg einer solchen Ausweitung des Anbieterkreises von Tabakentwöhnungsmaßnahmen im Hausarztbereich untersuchen. Unterschiedliche bereits vorhandene Therapieansätze werden hierbei hinsichtlich Effektivität und Effizienz in der allgemeinärztlichen Routineversorgung miteinander verglichen. Methoden: In Phase I der Studie werden bundesweit Patienten in mehr als 800 Arztpraxen an einem Stichtag per Fragebogen zu ihrer Gesundheit und ihrem Rauchverhalten befragt. In Phase II werden die in Phase I identifizierten entwöhnungswilligen Raucher in ausgewählten Arztpraxen für die Intervention rekrutiert und randomisiert vier Gruppen mit (idealerweise) jeweils 250 Personen zugeteilt: einer Bupropion SR (Zyban®)-Gruppe, einer Nikotinersatzmittel-Gruppe, einer Verhaltenstherapie-Gruppe und einer Kontrollgruppe. Die Behandlung erfolgt jeweils durch die Ärzte in ihren Praxen unter Supervision und mit Unterstützung durch Studienmonitore. Erwartete Ergebnisse: In Abhängigkeit von Merkmalen des Arztes und seiner Praxis auf der einen Seite sowie Merkmalen der betroffenen Patienten auf der anderen, sollte die Akzeptanz, Durchführbarkeit und Wirksamkeit der ausgewählten Therapieansätze unterschiedlich ausfallen. Insgesamt sollte jedoch jede Therapiebedingung gegenüber der Kontrollbedingung hinsichtlich ihrer Effektivität überlegen sein. Im 6-Monats Follow-up sollte die Zyban-Gruppe gegenüber allen anderen Gruppen die höchste Abstinenzquote aufweisen. Schlussfolgerung: Die Ergebnisse sollten Hinweise auf Möglichkeiten einer bedarfsgerechten, optimierten Allokation vorhandener Maßnahmen zur Tabakentwöhnung in der allgemeinärztlichen Versorgung liefern. / Background / aim of the study: Although a number of efficacious smoking cessation measures and medications do exist, only a small number of smokers (tobacco users) make use of them. A stronger engagement of general practitioners (GPs) in the field of smoking cessation might help to improve health care in this important area. The study will investigate feasibility and effectiveness of different readily available smoking cessation measures under routine conditions in primary health care practices. Method: In phase I of the study patients' health status and tobacco consumption are assessed by means of questionnaires provided on a nationwide appointed date in more than 800 general practices in Germany. In phase II selected practices offer smoking cessation treatments to identified smokers. Participants recruited will be randomly assigned to four groups ideally consisting of 250 subjects each: A bupropion SR (Zyban©) condition, a nicotine replacement therapy (NRT) group, a cognitive-behavioural treatment (CBT) group and a control condition. Treatments will be conducted by GPs in their practices under supervision of study monitors offering therapeutical and organisational support. Expected results: Acceptance, feasibility, and effectiveness of smoking cessation treatments offered will differ depending on GP and patient characteristics. Overall, success-rates (while success is primarily defined as abstinence from tobacco use) should be higher in all therapeutic conditions as compared to controls. In the 6-month follow-up abstinence rates are expected to be highest in the bupropion SR group. Conclusion: Results should yield indications for an improved allocation of available smoking cessation measures in primary care.

Background and Rationale: There is a well-documented practice gap in the rates at which evidence-based smoking cessation treatments are delivered to patients in primary care settings. Multi-component intervention that combine practice, provider, and patient-level supports have been shown to increase the rates at which primary care providers deliver smoking cessation treatments to patients and increase rates of smoking abstinence amongst patients. The incremental value of adjunct telephone-based smoking cessation counselling when delivered as part of a multi-component intervention has not been examined. Aim: The primary objective of this study was to determine whether adjunct telephone-based smoking cessation follow-up counselling (FC), when delivered as part of a multi-component intervention program within primary care clinics is associated with increases in (a) the delivery of evidence-based smoking cessation treatments, (b) patient quit attempts, and (c) patient smoking abstinence when compared to the provision of practice and provider supports (PS) alone. The secondary objective of this study was to determine whether the introduction of a multi-component smoking cessation program is associated with increased delivery of evidence-based smoking cessation treatments by primary care providers and patient smoking outcomes, compared to pre-intervention rates. The study also sought to examine the association between patient, provider, clinic and implementation factors, and study outcomes. Methods: A two-group, pre-post cluster randomized controlled trial was conducted. Eligible clinics were randomly assigned to the PS group or FC group. Both groups were supported with implementing a multi-component intervention program that involved outreach facilitation visits, provider training, real time provider prompts and patient tools, and performance feedback. Clinics assigned to the FC group were also able to refer patients who smoke to a telephone-based follow-up support program for supplemental counselling support. An exit survey was completed with a cross-sectional sample of patients who smoked daily at each study clinic before and after the introduction of the intervention program, and all patients were contacted 4 months later to complete a brief telephone-based interview. Outcome measures included the rate at which evidence-based smoking cessation treatments (5As: ask, advise, assess, assist, arrange) were delivered to patients, the number of patients who made a quit attempt, and patient smoking abstinence at the 4-month follow-up. All data was analyzed using multi-level hierarchical modelling. Results: Seven family medicine clinics and 115 providers were enrolled in the study. A total of 12,585 patients were screened, and 835 eligible patients (mean age 45.8 SD± 14.6, 41% male) who smoke participated in the study. Contrary to the study hypothesis, a higher and statistically significant 7-day point prevalence abstinence (OR 6.8, 95% CI 2.1-21.7; p=<0.01) and continuous abstinence (OR 13.7, 95% CI 2.1-128.3; p=<0.05) rate was observed in the PS group compared to the FC group at the post-assessment after controlling for differences in smoking cessation rates between intervention groups during the baseline period. The introduction of the multi-component intervention program was associated with higher rates of provider 5As delivery and patient quit attempts compared to baseline, with no differences between groups documented. The odds ratios (OR) and 95% confidence intervals (CI) for 5As delivery between the pre- and post-intervention assessments for both intervention groups combined were: “ask” (OR 1.5; 95% CI 1.1, 2.0); “advise” (OR 2.0; 95% CI 1.5, 2.7); “assess” (OR 2.1; 95% CI 1.6, 2.9); “assist” with cessation (OR 2.30; 95% CI 1.70, 3.12); “arrange” (OR 1.9; 95% CI 1.2, 3.0); and “patient quit attempts” (OR 1.4; 95% CI 1.04, 1.94). Differences in 7-day point prevalence abstinence were not statistically significant between the pre- and post-intervention assessments (OR 1.5; 95% CI 0.94, 2.5). The study documented intra-provider variability in the rates at which evidence-based smoking cessation treatments are delivered to patients. Patient characteristics (readiness to quit, time to first cigarette, previous quit attempt in the last year), and the purpose of the clinic visit being for an annual health exam were associated with higher rates of 5As delivery. Conclusion: This is the first study to evaluate a multi-component smoking cessation intervention within the primary health care setting in Canada. The study findings demonstrate that the introduction of a multi-component intervention program in primary care settings was associated with significant improvements in the rates at which providers deliver evidence-based smoking cessation treatments, and increase patient quit attempts. The added value of adjunct telephone counselling was not evident at the 4-month follow-up. The conclusions that can be drawn from the present study are limited by the study design and sample size. A larger trial is required to conclusively determine the impact of the program on long-term smoking abstinence and examine the importance of clinic-level variables in explaining observed differences between study clinics.

Tobaksanvändning är ett av de största hoten mot vår hälsa. Det finns mycket att vinna på att sluta röka cigaretter och det är aldrig för sent för att sluta. På arbetsplatsen är det viktigt att fokusera på arbetsmiljön då denna påverkar individens välbefinnande och hälsa. Syfte: Syftet med studien var att kartlägga vilka åtgärder som satts in inom rökavvänjning med inriktning på arbetsplatsen som arena. Metod: För att besvara syftet har en systematisk litteraturstudie gjorts. De databaser som använts vid sökningen av vetenskapliga artiklar var PubMed och PsycInfo. Antal artiklar som använts i resultatet var 11 och dessa har blivit kritisk granskade. En temaananlys har gjorts för att analysera artiklarna till studien. Resultat: De åtgärder för rökavvänjning som framkom genom studien var policy mot rökning, rökavvänjning i grupp, internetbaserade rökavvänjningsprogram samt motiverande åtgärder. Ett införande av en policy mot rökning minskade antalet anställda som rökte. Genom att studera rökavvänjning i grupp framkom det att motivation till att sluta röka var viktigt i ett tidigt stadie av rökavvänjningen och socialt stöd en viktig faktor gällande att hålla sig rökfri på längre sikt. Det som framkom om internetbaserade rökavvänjningsprogram var att de anställda som använde programmen mer frekvent hade störst chans att uppnå rökstopp. De motiverande åtgärder som hittades var tävlingar, pengar, gratisbiljetter till fitnesscenter samt att sätta ett datum för tänkt rökstopp. Dessa hjälpte de anställda på vägen till att bli rökfria. Implikation: En interventionsstudie kan göras där deltagarna fokuserar på att ge varandra stöd och råd gällande rökavvänjning. Fortsatt forskning kan handla om att finna nya sätt att uppnå rökstopp på längre sikt. / Tobacco use is one of the greatest threats to our health. There is much to gain by quitting smoking cigarettes and it's never too late to quit. In the workplace it is important to focus on the work environment as it affects individual well-being and health. Aim: The aim of this study was to identify the measures put in place in smoking cessation, focusing on the workplace as an arena.Method: To answer the question, a systematic literature rewiev has been made. The databases used in the search of scientific articles was PubMed and PsycInfo. Number of articles used in the results was 11 and these have been critically examined. A thematic analysis have been made to analyze the articles of the study. Result: The measures for smoking cessation that emerged were a non-smoking policy, groupcounseling, Internet-based smoking cessation programs and motivating actions. The introduction of a non-smoking policy reduced the number of employees who smoked. By studying smoking cessation groups it was shown that motivation to stop smoking was important in the early stages of smoking cessation and social support was an important force to stay smoke-free in the long run. What was found on Internet-based smoking cessation program was that the employees who used the programs more frequently had the best chance of achieving smoking cessation.The motivational measures that were found to be effective were competitions, money, free tickets to a fitness center as well as setting a date for the planned cessation of smoking. These incentives helped the employees on the road to becoming smoke-free. Implication: An intervention study can be done where the participants focus on giving each other support and advice regarding smoking cessation. Further research may be able to find new ways to achieve smoking cessation in the longer term.

Abstrakt Tobak har varit den mest lönsamma konsumentprodukten i världen under mycket lång tid. Nikotinet medför att människor blir beroende både fysiologiskt och psykologiskt. Rökning har relaterats till olika sjukdomstillstånd och är idag den enskilt största orsaken till för tidig död. I Sverige leder rökningen varje år till ett betydande antal för tidiga dödsfall. Rökning är ett stort folkhälsoproblem. De flesta har dock en vilja att sluta röka. Motivation och vilja har visat sig vara nödvändigt för att nå ett rökstopp. Syftet var att beskriva före detta rökares tankar om motivation för att göra rökstopp och att sedan vidmakthålla detta rökstopp. Metoden som användes var en kvalitativ intervjustudie. Tio före detta rökare intervjuades och en ostrukturerad intervjumetod valdes. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultatet visade att rökstoppet var en process där motivationen sågs i tre olika faser. De olika faserna var motivation för att förebereda beslut om rökstopp, motivation för att ta beslut om rökstopp samt motivation för att vidmakthålla rökstopp. I de olika faserna identifierades känslor som osäkerhet där exempelvis behovet av stöd framkom. Egenmakt handlade om att bestämma sig och frihetskänslor visade bland annat stolthet och oberoende. Slutsatsen blev att motivationen för att nå ett rökstopp grundades på flera olika faktorer och varierade från individ till individ och över tid.          Nyckelord: folkhälsoproblem, motivation, rökstopp, tobak. / Abstract Tobacco has been the most profitable consumer product in the world for a very long time. Nicotine makes people addicted, both physiologically and psychologically. Smoking has been related to various diseases and is today the single largest cause of premature death. In Sweden, a significant number of premature deaths are caused each year due to smoking. Smoking is a major public health problem. Most people have a desire to stop smoking. Motivation and willingness have been shown to be necessary to reach a smoking cessation. The aim was to describe the former smokers' views on motivation to quit and then maintain that smoking cessation. The method used was a qualitative interview study. Ten former smokers were interviewed and an unstructured interview method was chosen. The interviews were analyzed with qualitative content analysis. The results showed that smoking cessation was a process in which motivation was seen in three different phases. The different phases were motivation to prepare a decision on quitting smoking, motivation to make decisions about smoking cessation, and motivation for maintaining smoking cessation. The various phases were identified feelings of uncertainty, where for example the need for support was found. Empowering was about how to determine their freedom and how feelings were revealed and among other things, pride and independence. Conclusion was that the motivation to reach a smoking cessation was based on several factors, varying from individual to individual and over time. Keywords: motivation, public health problem, smoking cessation, tobacco.

Syftet med studien var att jämföra livskvalitet, kunskap om KOL och antal patienter som inlett ett rökstopp där en grupp erhöll standard vård och en annan grupp förutom standard vård även fick ett strukturerat omhändertagande på en distriktssköterskeledd KOL- mottagning med undervisning i egenvård.Studien genomfördes med kvasiexperimentell design. Urvalet var 52 patienter från primärvården med diagnosen KOL. Patienterna matchades utifrån kön, sjukdomens svårighetsgrad och slumpades sen till två grupper, en interventionsgrupp och en jämförandegrupp. Jämförandegruppen erhöll standardvård medan interventionsgruppen utöver standardvård erhöll två utbildningsbesök i egenvård hos astma KOL-sjuksköterskan på en vårdcentral i mellansverige.Som datainsamlingsmetod har två enkäter använts. En enkät som innehöll frågor om kön, ålder, civilstånd, utbildning, upplevd kunskap om KOL och rökstatus samt en enkät som hade till syfte att ge information om hur andningsbesvären påverkar patientens livskvalitet. Båda grupperna har svarat på enkäterna vid två tillfällen, vid det första besöket och vid det sista besöket efter tre månader. Interventionsgruppen har däremellan fått två utbildningsbesök.Resultaten visade statistiskt säkerställda skillnader mellan grupperna gällande livskvalitet, rökstopp och kunskaper om KOL. Interventionsgruppen hade fått minskade andningsbesvär, hade ökat sin fysiska aktivitet och fått en bättre psykosocial hälsa. Medan jämförande gruppen hade försämrats något i alla dessa avseenden. I interventionsgruppen hade sex av sexton rökande patienter slutat att röka, medan ingen hade slutat av de fjorton rökande patienterna i jämförandegruppen. Patienterna i interventions- gruppen hade också väsentligen större kunskaper om sin sjukdom jämfört med patienterna i jämförandegruppen.

Syfte: Syftet var att beskriva hur sjukvårdspersonal kan hjälpa vuxna patienter att sluta röka, en kortare eller längre tid, inför en elektiv operation.Metod: Studien genomfördes som en litteraturöversikt. Genom sökning i databaserna Pubmed och Cinahl erhölls 10 vetenskapliga artiklar. Sökningar genomfördes med både MeSH-termer och fritextsökning. Artiklarna kvalitetsgranskades, analyserades och samanställdes. Resultat: Metoder som kan användas för att hjälpa patienter att sluta röka är olika former av rådgivning och utbildning: hälsoutbildning, program för livsstilsförändringar, sluta-röka-linje. Att erbjuda rådgivning och stöd i kombination nikotinersättningspreparat är fungerande metoder: motiverande samtal och nikotinersättning, regelbunden rådgivning och nikotinersättning, rökavvänjning med hjälp av interaktivt dataprogram, information och hjälp med planering, nikotinersättning och uppmuntrande telefonsamtal. Effekten av nikotinplåster, läkemedel och akupunktstimulering som ensamma metoder var begränsad. Slutsatser: Olika former av rådgivning eller utbildning kan användas när patienter behöver sluta röka inför en elektiv operation. Metoder som kombinerar nikotinersättning och rådgivning eller stöd var mest effektiva. Använder sig sjukvårdspersonal av detta kan lidande minskas, undvika förlängd vårdtid och pengar sparas.

The aim of the present study was to assess the effectiveness of a cognitive-behavioral smoking cessation program combined with nicotine patches in a university student sample. Moreover, changes in self-efficacy judgments of both experimental and control group participants were examined. 37 students from various departments of Middle East Technical University participated in the study. Participants in the experimental group received a 6-week group based multicomponent smoking cessation program combined with nicotine patches, whereas those in the control group were provided with self-help booklets. Point prevalence abstinence was used as the main outcome measure, which was verified by CO-measurement in exhaled air both at post-treatment and follow-ups. Separate one-way ANOVAs and repeated measures ANOVAs were used in data analysis. Results showed that there were no significant differences between the experimental and control group in terms of their degree of motivation, readiness and decision to quit smoking, nicotine dependence, depression, self-efficacy, and perceived social support at pre-treatment. Results of the repeated measures ANOVA with CO-values showed that the CO-levels of experimental groups significantly declined from pre-treatment to post-treatment and to follow-ups. Abstinence rates for the experimental group were found to be 66.67%, 55.55% and 45.44% at post-treatment, 1-month follow-up and 2-months follow-up respectively. On the other hand, abstinence rates for the control group were found to be 11.76%, 5.88% and 5.88% at post-treatment, 1-month follow-up and 2-months follow-up respectively. Moreover, it was found that self-efficacy scores of experimental group participants significantly increased at post-treatment, whereas those of control group participants significantly decreased from pre-treatment to post-treatment. The findings were discussed in the light of the relevant literature. After discussing the limitations and implications of the study, directions for future studies were suggested.

This study prospectively examined the timing and predictors of returning to smoking after pregnancy in a group of women who quit smoking cigarettes during pregnancy. We interviewed women during the postpartum hospital stay and at their infants 2-week and 2-month health supervision visits. Urine cotinine levels were measured at each interview. Fifty-three women were interviewed during the postpartum stay, 37 women at the 2-week and 36 women at the 2 month visits. At the 2-week visit, 40.5% had returned to smoking, and at the 2-month visit, 47.2% had returned to smoking. Factors associated with a return to smoking at 2 weeks included a lower level of education (high school graduate/GED vs. some college education; 13/37 vs. 2/37, p=0.02), the presence of someone else in the household who smoked (14/37 vs. 1/37, p=0.001), formula-feeding their infant at the time of interview (14/37 vs. 1/37, p=0.003), having smoking discussed with a doctor or nurse during pregnancy (12/37 vs. 3/27, p=0.009), and being African-American vs. Caucasian or Hispanic (10/37 vs. 5/37, p=0.008). Predictors of a return to smoking at 2 months included the presence of someone else in the household who smoked (17/36 vs. 0/36, p<0.001) and smoking at least 1 cigarette during pregnancy after initially quitting (12/36 vs. 5/36, p=0.02). Women who quit smoking cigarettes during pregnancy are likely to resume in the days immediately after delivery. The presence of household smokers and formula feeding are the strongest predictors of resuming smoking within 2 weeks.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing