Rökning är ett utbrett samhällsproblem världen över och sjukdomar relaterade till rökning leder till mer än åtta miljoner dödsfall årligen. Effektiva rökavvänjningsmetoder spelar därför en viktig roll i samhället då de besparar samhället sjukvårdskostnader och främjar folkhälsan. I detta arbete genomförs en hälsoekonomisk utvärdering av ett SMS-baserat stöd för rökavvänjning. Syftet med arbetet är att fylla en kunskapslucka vad det gäller kostnadseffektivitet av digitala rökavvänjningsinsatser och samtidigt ge ett underlag tillbeslutsfattare som ansvarar för att prioritera folkhälsofrämjande insatser. Den hälsoekonomiska utvärderingen använder sig av kostnadseffektivitetsanalys som metod och baseras på en klinisk studie, där långsiktiga kostnader och hälsoeffekter skattas med hjälpav en beslutsanalytisk modell primärt baserad på en Markovmodell. De tre vanligaste följdsjukdomarna av rökning; KOL (kronisk obstruktiv lungsjukdom), lungcancer och hjärt- och kärlsjukdom modelleras mot bakgrund av hur många som slutar röka med hjälp av SMS-stödet. Data från olika källor används i modellen och i de fall data saknas görs antaganden baserade på tidigare studier för att kunna skatta kostnader och hälsoeffekter. Arbetet påvisar att en implementering av ett SMS-baserat stöd skulle generera ökade hälsoeffekter till lägre kostnader i jämförelse med att inte implementera ett sådant stöd. Resultatet från grundscenariot visar att interventionen skulle leda till kostnadsbesparingar på 63 539 kr per individ som tar del av interventionen och 0,30 vunna år i perfekt hälsa, sett över ett livstidsperspektiv. Resultaten bör tolkas med viss försiktighet då de är förknippade med osäkerheter, men kan användas som en del av det underlag beslutsfattare behöver för att fattabeslut om hur hälso- och sjukvårdens resurser ska prioriteras. Trots osäkerheterna i underlagetförefaller ett SMS-baserat stöd för rökavvänjning ha positiva hälsoeffekter och samtidigt spara resurser och därmed framstår metoden som en potentiellt viktig insats i framtida folkhälsoarbete. / Smoking is a globally widespread societal problem and diseases related to smoking account for more than eight million deaths annually. Effective smoking cessation methods therefore play an important role in society as they save society´s healthcare resources and promote public health. In this work, a health economic evaluation of an SMS-based smoking cessation is performed. The purpose of the work is to fill a knowledge gap in terms of cost-effectiveness of digital smoking cessation initiatives and at the same time provide a basis for decision-makers who are responsible for prioritizing public health promotion initiatives. The health economic evaluation uses cost-effectiveness analysis as a method and is based on a clinical study, where long-term costs and health effects are estimated using a decision-analytical model with a Markov structure. The three most common sequelae of smoking; COPD (chronic obstructive pulmonary disease), lung cancer and cardiovascular disease are modeled based on how many people stop smoking with the help of the SMS support. Data from different sources are used in the model and required assumptions based on previous studies are used to be able to estimate costs and health effects. The work shows that the implementation of an SMS-based support would generate increased health effects at lower costs in comparison with not implementing such support. The results from the basic scenario show that the intervention would lead to cost savings of SEK 63,539 per individual who takes part in the intervention and a gain in 0.30 years in full health, seen over a lifetime perspective. The results should be interpreted with some caution as they are associated with uncertainties but can be used as part of the basis on which decision-makers need to make decisions about how health care resources should be prioritized. Despite these uncertainties the SMS-based support for smoking cessation appears to save resources and lead to positive health effects and the method should be considered a potentially important addition in future public health policy.

Yes / Payment incentives are known to influence healthcare but little is known about the impact of paying directly for achieved outcomes. In England, novel purchasing (commissioning) of National Health Service (NHS) stop smoking services, which paid providers for quits achieved whilst encouraging new market entrants, was implemented in eight localities (primary care trusts (PCTs)) in April 2010. This study examines the impact of the novel commissioning on these services. Accredited providers were paid standard tariffs for each smoker who was supported to quit for four and 12 weeks. A cluster-controlled study design was used with the eight intervention PCTs (representing 2,138,947 adult population) matched with a control group of all other (n=64) PCTs with similar demographics which did not implement the novel commissioning arrangements. The primary outcome measure was changes in quits at four weeks between April 2009 and March 2013. A secondary outcome measure was the number of new market entrants within the group of the largest two providers at PCT-level. The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention PCTs compared to a decrease of 1.1% in the control PCTs (incident rate ratio 1108, p<0001, 95% CI 1059 to 1160). Eighty-five providers held 'any qualified provider' contracts for stop smoking services across the eight intervention PCTs in 2011/12, and 84% of the four-week quits were accounted for by the largest two providers at PCT-level. Three of these 10 providers were new market entrants. To the extent that the intervention incentivized providers to overstate quits in order to increase income, caution is appropriate when considering the findings. Novel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services.

No / Observational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers. This was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N = 58) using a modified visual probe task from one week prior to quit day. Both groups received 21 mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence. No attentional bias towards smoking cues was found in the sample at baseline (mean difference = 3 ms, 95% CI = -2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference = -9 ms, 95% CI = -20, 2). There was no difference between groups in change in craving (p = 0.89) and prolonged abstinence at four weeks (risk ratio = 1.00, 95% CI = 0.70, 1.43). Taken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective. CLINICAL TRIAL REGISTRATION: UK Clinical Trials ISRCTN 54375405.

Bakgrund: Rökning står för mer än vart tionde dödsfall i Sverige och hälften av alla långsiktiga rökare avlider av rökrelaterade sjukdomar. Lungcancer är den femte vanligaste cancersjukdomen i Sverige och orsakas i första hand av rökning. Kronisk obstruktiv lungsjukdom (KOL) orsakas också i första hand av rökning och är den tredje vanligaste dödsorsaken i världen. Fler kvinnor än män dör av KOL i Sverige men förklaringen till detta är oklar. Den komplexa kemiska blandningen som inhaleras vid förbränning av tobak orsakar negativa hälsoresultat, särskilt cancer och lungsjukdomar. Risken för och svårighetsgraden av många negativa hälsoeffekter orsakade av rökning kan variera beroende på om man själv är rökare eller bara exponeras för tobaksrök. Rökavvänjningen är potentiellt den mest effektiva av alla förbyggande åtgärder. Rökning påverkar också metabolisering av olika läkemedel. Nikotin är den beroendeframkallande substansen i tobak som orsakar abstinensbesvär. Rökfri tobak t.ex. snustobak orsakar också sjukdomar men i mycket mindre utsträckning än cigaretter. Syfte: Syftet med detta examensarbete var att ytterligare belysa kända hälsoproblem med rökning samt att beskriva eventuella ytterligare, tidigare okända, hälsoproblem. Metod: Detta arbete är en litteraturstudie baserat på 6 vetenskapliga artiklar. Resultat: Rökning ökar mortalitet och förkortar därmed livslängd. En stor del av dessa dödsfall orsakas av hjärt-kärl sjukdomar, kronisk obstruktiv lungsjukdom och många olika cancersjukdomar. Det finns ingen riskfri nivå av exponering för tobaksrök. Slutsats: Rökning ökar risken för alla typer av hjärt-kärl sjukdomar, låg födelsevikt för barn och många olika typer av cancer. Risken för pankreascancer i samband med rökning är relaterat till mängden av tobak som rökts dagligen. Minskning av antal rökta cigaretter per dag eller förpackningar per år har annars ingen större effekt på att minska risken för sjukdomar eller minska mortaliteten.

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients&#8217; quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George&#8217;s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients&#180; perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients&#8217; reasons for change, fostered collaboration and supported patients&#8217; autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients&#8217; utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients&#8217; knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients&#8217; fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients&#8217; perceived QoL, on the number of patients who quit smoking and on patients&#8217; knowledge about COPD.

No description available.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

Tobacco use is closely related to changes in body weight. Undesired weight gain following smoking cessation occurs in most patients. The mechanism responsible for changes in body weight post cessation are only partially understood. Several hypotheses have suggested a temporary increase in blood pressure following smoking cessation. In addition, weight concerns after quitting are common, and may affect tobacco dependence treatment outcomes. The aim of our study was to monitor changes in body weight, blood pressure, incretins and selected hormonal parameters among ex-smokers after three months of abstinence. We also examined factors associated with smoking-related weight concerns. We monitored and evaluated selected parameters (personal history, questionnaires, anthropometric, biochemical, hormonal) and compared before and after tobacco dependece treatment, if patients underwent such treatment. We found that smoking cessation was associated with weight gain. Smokers who were more tobacco dependent or more sedentary were at increased risk. The prevalence of diagnosis hypertension did not differ among non-smokers, former smokers and smokers adjusting for age and BMI. In the pilot phase of our study we demonstrated that three months of smoking abstinence was associated with an increase in serum leptin...

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-06T15:58:37Z No. of bitstreams: 1 henriquepintogomide.pdf: 4886533 bytes, checksum: ebecd2fd03722fac5b23835abb7cf2d9 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-02T13:29:17Z (GMT) No. of bitstreams: 1 henriquepintogomide.pdf: 4886533 bytes, checksum: ebecd2fd03722fac5b23835abb7cf2d9 (MD5) / Made available in DSpace on 2016-07-02T13:29:17Z (GMT). No. of bitstreams: 1 henriquepintogomide.pdf: 4886533 bytes, checksum: ebecd2fd03722fac5b23835abb7cf2d9 (MD5) Previous issue date: 2014-02-10 / Intervenções para tabagismo mediadas por internet disponíveis em língua portuguesa não cobrem todos os conteúdos das diretrizes de tratamento do tabagismo. Não existem intervenções de código-aberto na internet, isto é, que divulgam todo o código-fonte para sua adaptação e replicação para outros contextos e populações. O objetivo do estudo foi descrever uma metologia de desenvolvimento e avaliar a intervenção para tabagismo mediada por internet de código-aberto - “Viva sem Tabaco”. O desenvolvimento aconteceu nas seguintes etapas:(1) desenvolvimento do protótipo, (2) realização de um grupo focal fumantes e correção do protótipo e (3) avaliação da cobertura, precisão e interatividade do conteúdo com base nos 12 componentes das diretrizes de tratamento para tabagismo, e (4) revisão do conteúdo. Com os resultados do grupo focal e na revisão teórica das diretrizes, o protótipo foi desenvolvido e corrigido. Após as correções, o protótipo foi avaliado pelos especialistas e corrigido. O conteúdo da intervenção foi avaliado por dois pesquisadores de forma independente, 9 dos 12 tópicos apresentaram cobertura considerada adequada e 3 com cobertura mínima. Quanto à precisão, 8 tópicos foram avaliados como corretos e 4 como maior parte correto. Dois dos 12 tópicos apresentaram interatividade. Após a avaliação, a intervenção foi corrigida. A versão final da intervenção desenvolvida apresentou convergência com as diretrizes de tratamento. Estudos devem ser conduzidos para avaliar a eficácia da intervenção. / Web-assisted tobacco interventions (WATI) in Portuguese do not cover the standard guidelines for smoking treament and lack content quality. Current web-assisted tobacco interventions are not open-source, which reduce the development speed in developing countries. The objective of this study was to describe a development methodology of a open-source WATI and evaluate its quality. The development comprised the following stages: (1) prototype development, (2) assessment of the prototype using focus groups, and (3) content coverage, accuracy and interactivity evaluation using as reference the guideline “Treating tobacco use and depedence - 2008 update”, and (4) final review. Based on the data from focus groups and content review, the initial prototype was redesigned. The content evaluation, performed independently by two specialists, showed that 9 of 12 components were well covered and 3 minimally covered. Eight of 12 components were classified as correct and 4 as mostly correct. Just two topics were considered interactive. Based on the evaluation, a final review was conducted in the intervention content. The developed intervention was compliant with tobacco treatment guidelines, providing an evidence based guide for smokers who seek help over the internet. Future studies should address the clinical efficacy of the developed intervention.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-01T13:11:29Z No. of bitstreams: 1 nathaliamunckmachado.pdf: 2472600 bytes, checksum: 5e57568c0b9bd251def1f74cfdf9b386 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-06-02T15:13:27Z (GMT) No. of bitstreams: 1 nathaliamunckmachado.pdf: 2472600 bytes, checksum: 5e57568c0b9bd251def1f74cfdf9b386 (MD5) / Made available in DSpace on 2017-06-02T15:13:27Z (GMT). No. of bitstreams: 1 nathaliamunckmachado.pdf: 2472600 bytes, checksum: 5e57568c0b9bd251def1f74cfdf9b386 (MD5) Previous issue date: 2017-02-20 / Os fatores relacionados aos problemas causados pelo tabagismo justificam diversos esforços voltados para a busca de intervenções. Estratégias de comunicação para transmitir mensagens que expressam tanto as perdas associadas ao hábito de fumar quanto os ganhos obtidos ao parar de fumar têm sido usadas para reduzir o consumo de tabaco. Entretanto, poucos estudos têm avaliado o efeito de tais mensagens elaboradas para a cessação tabágica e ainda não existem conclusões claras sobre qual tipo de mensagem é mais eficaz para motivar as pessoas a parar de fumar. Objetivo: O estudo avaliou qual tipo de mensagem relacionada ao tabagismo (positiva ou negativa) foi mais eficaz para o recrutamento online de fumantes através do Facebook Advertising. Métodos: Anúncios contendo aspectos negativos do tabagismo e aspectos positivos da cessação foram criados e divulgados pelo Facebook Ads. Ao clicar nos anúncios, os usuários eram automaticamente direcionados para a intervenção “Viva sem Tabaco” (www.vivasemtabaco.com.br). O valor gasto na divulgação foi de 647,64 reais. Os dados foram extraídos da plataforma de anúncios do Facebook e dos logs de acesso do servidor. Os dados de logs foram tratados e analisados usando a linguagem de programação R. Resultados: O anúncio positivo atingiu 174.029 pessoas e o negativo atingiu 180.527 pessoas, que foram convertidos em 2.688 e 3.662 cliques, respectivamente. O custo do clique foi de R$0,12 para o anúncio positivo e de R$0,09 para o anúncio negativo. Conclusões: O anúncio negativo alcançou maior número de usuários, gerou mais cliques para o site e teve maior conversão em número de contas e plano de parada criados. Anúncios contendo aspectos negativos do tabagismo parecem ser mais custo efetivo para o recrutamento e engajamento de fumantes à intervenção. Além disso, o Facebook mostrou ser uma boa ferramenta de divulgação e recrutamento e pode ser uma solução para a dificuldade de alcançar fumantes para intervenções de cessação. / Introduction: Gain and loss-framed messages about smoking have been used to promote cessation. However, there are still no clear conclusions about what kind of message is more effective to motivate smokers to quit. This study compared the effectiveness of loss and gainframed messages on smokers’ online recruitment through Facebook Advertising. Methods: Loss and gain-framed messages about smoking were created and released by Facebook Ads. The users who clicked on the ads were automatically redirected to the "Live Without Tobacco" intervention (www.vivasemtabaco.com.br). The amount spent on disclosure was 647.64 Brazilian reals. Data were collected from Facebook Ads platform and from a relational database. Analyses were performed on the 6.350 users who clicked on one of the ads and on 1.731 that were redirected to the intervention. Results: Gain-framed ads reached 174,029 people and loss-framed ads reached 180,527, which were converted into 2.688 and 3,662 clicks, respectively. The cost of the click was R$0.12 for gain-famed ads and R$0.09 for the loss-framed. Conclusion: Loss-framed ads reached more users, got more clicks on the website, and had a greater conversion to the number of accounts and quit plans created. Loss-framed messages about smoking appear to be more cost effective for both recruitment and engagement of smokers to the intervention. Facebook has proven to be a good outreach and recruitment tool and can be a solution to the difficulty of reaching smokers for cessation interventions.