Durch eine stärkere Einbeziehung deutscher Hausärzte in die Raucherentwöhnung soll die Versorgung von Rauchern flächendeckend verbessert werden. Inwiefern dieser Anspruch realisierbar ist, wird im Rahmen der "Smoking and Nicotine Dependent Awareness and Screening" (SNICAS) Studie überprüft. SNICAS ist eine zweistufige epidemiologische Punktprävalenzstudie [Stufe I (Vorstudie): Charakterisierung einer repräsentativen, bundesweiten Stichprobe von n = 889 Hausärzten; Stufe II: Stichtagserhebung an n = 28 707 unselektierten konsekutiven Patienten], an die sich eine regionale klinische Interventionskomponente anschließt. In diesem Beitrag werden Prävalenzraten des Rauchens, Aufhörmotivation und bisherige Aufhörversuche von Primärarztpatienten berichtet. Dargestellt werden Erkennens- und Interventionsraten von Rauchern durch Hausärzte, das ärztliche Interventionsverhalten sowie deren Einschätzung der Chancen und Barrieren von Raucherentwöhnung im Praxisalltag. Die Ergebnisse der Studie belegen ein großes Interesse der Hausärzte am Thema Raucherentwöhnung. Dennoch weisen niedrige hausärztliche Interventionsraten bei gleichzeitig hohen Prävalenzraten von Rauchen und Nikotinabhängigkeit auf ein beträchtliches Versorgungsdefizit. Als Ursachen hierfür werden neben ambivalenter Aufhörmotivation der Patienten strukturelle Barrieren diskutiert. Die Autoren fordern neue klinische Versorgungsmodelle, die ein abgestimmtes Zusammenspiel von Hausärzten mit anderen, auf Raucherentwöhnung spezialisierte Berufsgruppen fokussieren. / Through smoking cessation interventions, primary care physicians could play an important part in the treatment of smokers in Germany. In the "Smoking and Nicotine Dependent Awareness and Screening" (SNICAS) study, we examined whether this increased involvement of primary care physicians might be implemented. SNICAS is a two-stage epidemiological point prevalence study. In stage I (pre-study), a nationwide sample of 889 primary care doctors was characterized; in stage II, 28 707 unselected consecutive patients were assessed on the target day. The investigation was followed by regional clinical interventions. The present article contains our findings on the prevalence of smoking, the motivation to quit, and the history of quit attempts among primary care patients. Information will be provided on how frequently physicians recognize and treat smokers; what kind of interventions they offer; as well as how they judge the opportunities and obstacles for smoking cessation in routine care. Despite the high prevalence of smoking and nicotine dependence and the primary care doctors’ interest in treating smokers, insufficient interventions are provided. Reasons for this situation include, but are not limited to the patients’ ambivalent motivation to quit and structural barriers. Hence, new clinical models of health care with an improved cooperation between primary care physicians and other specialists in the field of smoking cessation seem necessary.

Introduction: Despite advances in evidence-based smoking cessation approaches, quit rates in people with mental health conditions who smoke have not increased over the past decade. This research explored the role of family or peers in promoting smoking cessation in this population, using three specific aims; 1) examine the association between family or peer views on tobacco use and smoking cessation, 2) identify pathways through which family or peer factors influence smoking cessation, and 3) identify social barriers and facilitators to seeking cessation support when quitting. Methods: We used data from the Population Assessment of Tobacco and Health Study and collected qualitative data from people with mental health conditions who currently smoke or quit within the last five years. Data were analyzed using logistic regression modeling, structural equation modeling, and rapid qualitative analysis. Results: Having family or peers with positive or neutral views on tobacco use significantly reduced the odds of quitting smoking. Higher intentions to quit and changes in smoking behavior mediated the relationship between supportive family or peer behaviors and quitting smoking. Quitting together and encouragement from family or peers were perceived as supportive, while nagging the individual undermined quitting success. Except for individuals who regarded autonomy highly or were not ready to stop smoking, stronger social relationships and tailored support increased willingness to involve family members in cessation interventions. Conclusions: Supportive family or peer attitudes and behaviors can positively influence smoking cessation in people with mental health conditions who smoke. Ways to identify ideal family or peer support partners to involve in cessation interventions are proposed.

Nicotine dependence is hypothesized to be due to neuroadaptations that ultimately drive compulsive nicotine use. The studies in this thesis aim to understand how the “upregulation” of nicotinic acetylcholine receptors (nAChRs) caused by chronic exposure to nicotine contributes to nicotine reward and nicotine withdrawal. Previous studies have shown that chronic nicotine induces upregulation of nAChRs containing the α4 subunit (α4* nAChR) within the Ventral Tegmental Area (VTA), a brain region critical for the rewarding properties of all illicit drugs. Curiously, α4* nAChR upregulation occurs specifically in the inhibitory GABAergic neuronal subpopulation of the VTA. To determine if increased expression and activation of α4* nAChRs in VTA GABAergic neurons contributes to nicotine dependence behaviors, I devised a viral-mediated, Creregulated gene expression system that selectively expressed α4 nAChR subunits containing a “gain-of-function” point mutation (a leucine mutated to a serine residue at the TM2 9´ position: Leu9´Ser) in VTA GABAergic neurons of adult mice. Sub-reward doses of nicotine were sufficient to activate VTA GABAergic neurons in mice expressing Leu9´Ser α4 nAChR subunits in VTA GABAergic neurons (Gad2VTA: Leu9´Ser mice) and exhibited acute hypolocomotion upon initial injection of low doses of nicotine that developed tolerance with subsequent nicotine exposures compared to control animals. In the conditioned place preference procedure, nicotine was sufficient to condition a significant place preference in Gad2VTA: Leu9´Ser mice at low nicotine doses that failed to condition control animals. I conclude from these data that upregulating α4* nAChRs on VTA GABAergic neurons increases sensitivity to nicotine reward. In a separate study testing the hypothesis that overexpression of Leu9´Ser α4* nAChRs in VTA GABAergic neurons disrupts baseline behavior and promotes anxiety-like behaviors, I found that overexpressing Leu9´Ser α4* nAChRs in VTA GABAergic neurons had a minimal effect on unconditioned anxiety-like behaviors. Drug naïve Gad2VTA: Leu9´Ser and control mice failed to exhibit any behavioral differences in the open-field, marble burying test and elevated plus maze compared to control. Together, these data indicate that overexpression of the “gain-of-function” α4* nAChRs in VTA GABAergic neurons contributes to reward sensitivity without increasing susceptibility to nicotine withdrawal symptoms. My data indicates that nAChRs expressed in VTA GABAergic neurons may be a suitable target for the development of better smoking cessation aids.

Die Ziele der Dissertation sind es, die Effektivität von Rauchentwöhnungsprogrammen in der stationären Behandlung von berufsbedingten Hauterkrankungen zu prüfen und den Forschungsstand zum Einfluss des Rauchens auf berufsbedingte Handekzeme zu beleuchten. In einer Längsschnittstudie wurden dazu zwei Rauchentwöhnungsprogramme in der stationären Behandlung für berufsbedingte Hauterkrankungen evaluiert. Das Rauchentwöhnungsprogramm „Rauchfrei nach Hause!?“ der IFT-Gesundheitsförderung wurde hinsichtlich der Bewertung der Teilnehmer, der Steigerung der Motivation und Zuversicht, das Rauchverhalten aufzugeben, und der Abstinenz vom Rauchen mit dem bisher durchgeführten Rauchentwöhnungsprogramm verglichen. Zudem wurde die Ausprägung des berufsbedingten Handekzems von Rauchern und Nichtrauchern während und bis zu sechs Monate nach dem stationären Aufenthalt analysiert. Die Ergebnisse bestätigen, dass sich die Implementierung des zeitlich und inhaltlich intensiveren Rauchentwöhnungsprogramms „Rauchfrei nach Hause!?“ in die stationäre Behandlung von berufsbedingten Handekzemen als effektiv erweist. Dieses Programm führt zu einer höheren Motivation und Zuversicht, das Rauchverhalten zu ändern, sowie zu einer höheren Abstinenzquote drei Wochen nach dem Aufenthalt im Vergleich zum bisherigen. Auch der negative Einfluss des Rauchens auf die Ausprägung des berufsbedingten Handekzems bestätigt sich zu bestimmten Messzeitpunkten. Mit den Ergebnissen wird die Diskussion um den schädigenden Einfluss des Rauchverhaltens auf die Ausprägung des Handekzems vorangebracht und sie regen zu weiterer Forschung auf bspw. ambulanter Behandlungsebene von berufsbedingten Hauterkrankungen an.

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Schönherr Qwick, R-M Öronakupunktur. Upplevelser och känslor av öronakupunktur isamband med rökavvänjning. Examensarbete i omvårdnad 15 högskolepoäng, D-nivå.Malmö högskola: Hälsa och samhälle, Utbildningsområde omvårdnad, 2009.Bakgrund Tobaksbruket medför stora hälsorisker och för många en för tidig död. Mångarökare önskar inget hellre än att sluta. Att sluta röka är ofta svårt, då nikotinet är en starkdrog och abstinserna kan vara svåra, även om evidens baserad hjälp finns i form avmetoder och hjälpmedel. Allt fler patienter önskar hjälp med akupunktur menkunskaperna och erfarenheterna om hur metoden fungerar och upplevs av rökare är få.Metod Åtta kvinnliga rökare, anställda inom Vård och Omsorg i Malmö, intervjuades dåde som frivilliga deltog i rökslutarbehandling med öronakupunktur under tre veckorvåren 2009. Intervjuerna analyserades enligt Burnards innehålls analys och resultaten hardiskuterats i relation till folkhälsoteorierna av Ajzen ”The Theory of Planned Behavior”och Prochaska & Di Clemente “The stage of Change Model.” Vårdgivarens upplevelserhar diskuterats i relation till omvårdnadsteorin av Jean Watson och Barbara Carper.Syftet Med denna studie har varit att undersöka upplevelser och känslor avöronakupunktur i samband med rökavvänjning. Vidare att se om behandlingen skullekunna ge lindring av abstinens och undersöka vilka bakomliggande motiv som ligger tillgrund för beslutet att sluta röka. Syftet var också att undersöka vårdgivarens upplevelserav att ge denna behandling.Resultat Presenteras utifrån olika kategorier av känslor och upplevelser som framkommithos deltagarna under behandlingen med öronakupunktur. Deltagarna rapporteradepositiva effekter av behandlingen. Samtliga deltagare var från början väl motiverade attsluta röka och till metoden. De ansåg att det var en verksam behandlingsmetod somhjälpte dem att sluta röka eller minska på nikotin behovet. De uttryckte lindring iabstinensen till följd av behandlingen samt känslor av välbefinnande och harmoni.Vårdgivaren upplevde arbetet givande och metoden som ett bra verktyg.Konklusion Mottagaren av öron akupunktur i samband med rökavvänjning upplever enlindring av abstinens. Den upplevs lugnande och rogivande. Vårdgivaren upplevdemetoden som ett effektivt, förtroende ingivande hjälpmedel. Mera forskning behövs föratt vidare utforska behandlingens effektivitet när det gäller den procentuella andelen sompå sikt slutar röka helt. / Schönherr Qwick, R-M. Earacupuncture. Experience and feelings of ear acupuncture inconjunction to quit smoking. Degree Project, 15 Credit Points, Advanced level. MalmöUniversity and Society, Department of Nursing, 2009.Background The use of tobacco smoking has severe health hazards and for many anincreased risk of premature death. Many smokers have a strong wish to quit tobacco.However smoking cessations is difficult, since nicotine is a strong addictive drug, and hasmany with- drawl symptoms, even if evidence based methods and nicotine replacementsare used. Many quitters wants to try alternative methods in smoking cessation asacupuncture but knowledge and experience about effect and sensations combined withthe treatment of smokers is scarce among caregivers.Aim Of this study was to explore the experiences and feelings of ear acupuncture inconjunction with smoking cessation. Further to examine if the treatment were able toreduce abstinences, to examine motives for smoking cessation and to examine thecaregivers experiences in providing this form of treatment.Method Eight women from the health care sector in Malmö volunteered to participate inthis tobacco cessation project by ear acupuncture during three weeks in spring 2009 inMalmö, Sweden. This qualitative interview study were analyzed using content analysisby Burnard and the findings have been analyzed in relation and people health theory ofAjzen “Theory of planned behavior” and Prochaska & Di Clemente” The stage ofChange Model.” The experiences from the caregiver in providing the treatment wereanalysed in relation to the caring theory by Jean Watson, Barbara Carper.The results All participants were motivated to quit smoking using ear acupuncture.Participants reported positive effects of ear acupuncture as a treatment reducing“crawings” for nicotine associated with in smoking cessation. The results also show thatparticipants were relived in main abstinences and they felt comfort and harmony in thecontext of the individual treatments. The caregiver experienced the method as efficient,rewarding and as a good tool.Conclusion The patient who receives ear acupuncture feels relief in symptoms ofwithdrawal associated with smoking cessation. The treatment perceives as calming andsoothing. More research is needed to further explore the efficiency of the treatment insuccess rate of smoking cessation.

Pregnant and parenting young women rarely access community-based smoking cessation interventions. Targeted cessation interventions have been laden with challenges and have produced suboptimal outcomes. There is a paucity of qualitative research specific to young women that explores the context of their tobacco use, as well as their attitudes towards and experiences with smoking cessation supports in pregnancy and postpartum. To bridge this gap, an interpretive descriptive design was used to explore the personal and contextual factors influencing young women’s smoking behaviour during and after pregnancy. Factors were identified by analyzing influences at the multiple levels of McLeroy’s social ecological model of health promotion. Data were collected via in-depth, semi-structured interviews with young women aged 16-24 years (n=13) who smoked regularly preconception and were pregnant or parenting. Transcripts were analyzed using qualitative content analysis. Findings highlighted the complexity and chronicity of issues young women faced and emphasized the interplay of social determinants that influenced their smoking. Smoking was a crutch that helped them to relieve psychological distress stemming from exposure to adverse or traumatic experiences; and persistent stress in the context of socioeconomic hardship, neighborhood disadvantage and limited social support. Smoking also was influenced by young women’s understanding of the harms related to smoking during pregnancy and their reconceptualization of risk for smoking-related consequences postpartum. Young women described having limited discussions regarding smoking with maternity care providers and found their passive approach to cessation counselling unhelpful. They desired more comprehensive cessation support from providers. They expressed interest in a tailored group cessation program and offered suggestions for improving cessation supports for young women in pregnancy and postpartum. Study findings bridge gaps in the literature and identify appropriate next steps in addressing the issue of smoking in pregnancy and postpartum amongst young women by suggesting a multi-level approach to cessation. / Thesis / Master of Science (MSc)

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