The associations between maternal smoking and nicotine dependence and patterns of smoking and nicotine dependence in offspring were examined in a large community-based sample of adolescents. Data were derived from baseline and 4-year follow-up assessments of 938 respondents aged 14–17 years at the outset of the Early Developmental Stages of Psychopathology (EDSP) study, a prospective-longitudinal community study of adolescents and young adults and their parents respectively. Smoking and nicotine dependence in respondents were assessed using the Munich Composite International Diagnostic Interview (DSM-IV algorithms). Diagnostic information about smoking behavior in mothers was collected by independent direct diagnostic interviews with the mothers. In comparison to children of non- or occasionally smoking mothers, children of regularly smoking and nicotine-dependent mothers had higher probabilities of using tobacco as well as of developing nicotine dependence. For all ages under consideration, survival analyses revealed a higher cumulative lifetime risk of regular smoking and nicotine dependence among these children. Maternal smoking during pregnancy seems to represent an additional risk for these outcomes in children, specifically with regard to the risk of developing nicotine dependence. Associations were comparable for sons and daughters. Our findings show that maternal smoking predicts escalation of smoking, development of nicotine dependence, and stability of smoking behavior in children. Implications for specific intervention and prevention efforts are discussed.

The diploma thesis is focused on the smoking issue of adolescents of different secondary schools in Pilsen. The theoretical part covers the current situation of smoking habit in the Czech republic and its legislation, and it clarifies a few definitions of addictions. This part also describes different types of smoking, including risks, which are connected with them. There are also adolescent development descriptions, their personalities and social abilities. Another part of the thesis covers important life factors. The last chapter includes smoking prevention. The empirical part explores an attitude to smoking of students of particular types of secondary schools of Pilsen (secondary vocational schools and grammar schools) and it compares them. The research was done by questionnaire. The data analysis brought information about smoker and non-smoker number while the sex, type of school, family, friends and other aspects were taken into consideration. Key words smoking (habit), tobacco, cigarettes, marijuana, water pipe, e-cigarette, adolescence, smoking prevention

Realizou-se estudo exploratório de revisão bibliográfica sistemática e metassíntese visando descrever e analisar aspectos das práticas educativas em saúde, voltados ao desenvolvimento de habilidades para a cessação do tabagismo, traduzidas na interpretação de autores de pesquisas qualitativas publicadas em periódicos entre 2000 e 2007. Concebeu-se a questão do tabagismo como um problema de enfrentamento complexo, que demanda intervenções em vários âmbitos. Destacou-se a educação em saúde, como campo estratégico e instrumental da promoção da saúde, que sob a perspectiva do \"empowerment\" e \"empowerment education\", é passível de atuação do profissional de saúde. Utilizando-se do instrumental metodológico da metassíntese qualitativa, descrito por Sandelowski e Barroso (2003), identificou-se a produção científica de pesquisas qualitativas originais sobre experiências relativas às práticas educativas na cessação do tabagismo, indexadas nas bases de dados eletrônicas MEDLINE, CINAHL e LILACS. Para tanto utilizou-se os descritores pesquisa qualitativa, educação em saúde e tabagismo, além de descritores de texto livre e palavras com truncamento, visando a identificação ampliada de artigos que pudessem ser relevantes. Mapeou-se os artigos selecionados para a amostra bibliográfica segundo suas características gerais, aplicando-se os critérios de qualidade, dados pelo instrumento \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002). Os resultados desta produção foram integrados através da análise de conteúdo descrita por Minayo (2004), de modo a buscar temas relacionados à educação em saúde, aos quais foram combinados atributos (ou sub-temas). A busca bibliográfica resultou na identificação de 989 citações nessa temática, das quais 634 foram consideradas relevantes. Após seleção com base na leitura do título, a seguir dos abstracts (340) e por fim dos artigos na íntegra (88), foram classificadas 14 publicações como pertinentes para este estudo. Na metassíntese os aspectos recorrentes e as diferenças entre os artigos foram agrupados em duas modalidades temáticas: contexto dos sujeitos (descrevendo os fatores facilitadores e dificultadores do processo de cessação do tabagismo) e abordagem educativa (com processos facilitadores e dificultadores dos programas de cessação do tabagismo e da relação profissional-paciente apresentados em quadro temático, com comentários). As estratégias de abordagem do processo educativo foram classificadas com base nos elementos da promoção da saúde e nos modelos educacionais. Conclui-se que a metassíntese apresenta-se como metodologia relevante no âmbito da enfermagem (que tem vasta produção de pesquisa qualitativa), pois favorece análises e interpretações com potencial de proporcionar visibilidade e impacto no processo de cuidar e ser cuidado, fornecendo elementos para tomada de decisão. A compreensão sobre temas relacionados às abordagens educativas em saúde, nos processos de cessação do tabagismo, e o seu significado para os pacientes foi ampliada / An explorative systematic bibliographic review and meta-synthesis was realized looking to describe and analyze aspects of the educational practices in health, directed to the development of abilities for the smoking cessation, translated through the interpretation of the authors of the qualitative researches published in journals from 2000 to 2007. The smoking question was identified as a complex approach problem, which requires interventions from various aspects. Health education was emphasized, which under the perspective of the empowerment and empowerment education, is liable to the performance of the health professional. Using the qualitative meta-synthesis instrumental method described by Sandelowski and Barroso (2003), it was possible to identify a scientific production of primary qualitative researches about educational practices in the smoking cessation, indexed in MEDLINE, CINAHL and LILACS databasis. For this was used qualitative research controlled vocabulary, health education and smoking, besides the free texts and words with truncation, looking to increase the identification of the studies that may be relevant. The selected studies were identified according to its general characteristics, having been applied quality criterias supplied by the \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002) instrument. The results of this production were integrated through the analysis of content described by Minayo (2004), in order to look for themes related to health education, of which had attributes (sub-themes) combined to them. The bibliographic research resulted in the identification of 989 citations about this theme, where 634 were considered relevant. After the selection based on the title of the studie, following the abstracts (340) and finally of the reading of 88 complete studies, 14 publications were classified as being pertinent to this study. In the meta-synthesis the reoccurring aspects and the differences between the studies were separated in two types of themes: context of the subjects (describing the facilitating and difficulting facts of the smoking cessation process) and education approach (with facilitating and difficulting processes of the smoking cessation programs and of the patient-professional relationship presented in a theme board, with comments). The strategies used in the educational processes were classified based on the elements of the health promotion and on educational models. We conclude that the meta-synthesis presents itself as a relevant methodology in nursing environment (which provides vast qualitative research productions), because it helps in analysis and interpretations with the potential of facilitating visibility and impact in the process of taking care and being taken care of, supplying elements for decision making. The comprehension about themes related to health educational approaches, in the smoking cessation processes, and its meaning to patients, has been increased

Introdução: O tabagismo é um problema crônico e de enfrentamento complexo. A ampliação da legislação, a conscientização da sociedade e a menor aceitação social do tabagismo, aumentaram a procura por serviços de cessação do tabagismo. A avaliação de programas desse tipo é tarefa complexa, considerando os diferentes níveis de intervenção, a diversidade de cenários e atores envolvidos. A avaliação de programas de cessação do tabagismo necessita incorporar ferramentas participativas, capazes de apontar a eficiência do programa, além de fomentar ações de transformação das práticas. Esta pesquisa buscou configurar uma matriz avaliativa capaz de contribuir na organização e autoaprendizagem de serviços dirigidos aos sujeitos em suas tentativas de parar de fumar, captando os diferentes contextos presentes na intervenção, nos cenários e nos atores. As questões da pesquisa foram: Quais são os indicadores que podem apontar o quanto um serviço se aproxima ou se distancia das práticas baseadas em evidências e dos modelos e diretrizes da promoção da saúde? Quais são os elementos que indicam ou não a qualidade de um serviço de tratamento do tabagismo? Objetivos: Desenvolver a matriz de indicadores de um serviço de tratamento do tabagismo. Para tanto buscou-se a) Identificar a percepção de experts, usuários e profissionais sobre serviços de tratamento do tabagismo; b) Caracterizar as práticas e bases de um serviço de cessação do tabagismo; c) Construir o modelo lógico avaliativo desse serviço; c) Formular as bases teóricas e práticas para a construção de matriz avaliativa de indicadores para um serviço de tratamento do tabagismo. Método: Situado no desenho orientado por modelo teórico (theory-driven evaluation) na perspectiva da Promoção da Saúde preconizada por Hartz, o percurso metodológico foi apoiado nas abordagens qualitativas e participativas e na estratégia da pesquisa-ação. O cenário de estudo foi o serviço de cessação do tabagismo de um hospital universitário, no município de São Paulo. Foram sujeitos dessa pesquisa profissionais de referência para o PNCT (experts), profissionais que atuam diretamente no serviço (implicados) e usuários do serviço. A análise e discussão dos achados apoiaram-se na triangulação de dados, correlacionada com a literatura. Resultados: O desfecho desta pesquisa foi o desenvolvimento da matriz avaliativa. Utilizou-se as percepções dos experts, implicados e usuários sobre as dimensões de estrutura, processo e resultado. A legislação, o financiamento, extensão e cobertura, a acessibilidade, as instalações, os recursos humanos, os equipamentos e insumos foram apontados como categorias para estrutura. Na dimensão processo as categorias foram: divulgação e captação, acolhimento e busca ativa, o perfil sócio psicológico dos usuários, a rede de referência e contra referência, o diagnóstico, acompanhamento e as estratégias educativas com base no autocuidado e na redução de danos. No âmbito de resultados os sujeitos pontuaram: a taxa de sucesso na cessação do tabagismo, a regularidade do serviço, a adesão, o respeito à autonomia, a melhora na qualidade de vida e a satisfação do usuário. Conclusão: Conclui-se que a matriz avaliativa construída possui potencial para avaliar a qualidade do serviço e promover o aprendizado institucional e o desenvolvimento pessoal/profissional. Contribui para o movimento de reflexão-ação-reorientação das práticas de cuidado. Ao ampliar a análise para além dos importantes indicadores solicitados pelo Programa Nacional do Controle do Tabagismo, a matriz elaborada dirige-se ao fortalecimento (empowerment) dos envolvidos (profissionais e usuários). Ajuda a estabelecer papéis e responsabilidades na reorientação de aspectos que possam influenciar o desempenho no acesso, acolhida, diagnóstico, tratamento e acompanhamento dos que desejam parar de fumar. / Introduction: Tobacco smoking is a chronic problem and very difficult to face. The improvements in the legislation, the awakening of the society and the smaller social acceptance to tobacco smoking have increased the number of people looking for smoking cessation services. The evaluation of such programs is a complex task, considering the different levels of intervention and the diversity of sceneries and actors involved. The evaluation of smoking cessation programs needs to incorporate participatory tools in order to indicate the program efficiency, and foster transformation actions of the practices. This study sought to configure an evaluation framework capable of contributing to the organization and self-learning of the services addressed to individuals in their attempts to quit smoking by capturing the different contexts present in the intervention sceneries and actors. The research questions were: Which are the indicators that may point out how much a service comes close or is distant from evidence-based practices, guidelines and models of health promotion? Which are the elements that indicate or not the quality of a smoking cessation treatment service? Objective: Developing the indicators framework of a smoking cessation service. For this it was sought to a) identify the experts, users and professionals perceptions about smoking cessation services, b) Characterize the practices and basis for a smoking cessation service c) Build the evaluative logical model of such service c) Formulate the theoretical and practical basis for the construction of an evaluative framework of indicators for a smoking cessation service. Method: Situated in the theoretical model oriented design (theory-driven evaluation) from the perspective of health promotion proposed by Hartz, the methodological trajectory was based on the qualitative and participative approaches as well as in the strategy of the action research. The study setting was the smoking cessation service at a university hospital in São Paulo. The subjects of this study were reference for the NTCP professionals (experts), the professionals who work directly in the service (stakeholders) and service users. The analysis and discussion of the findings were based upon the triangulation of data, correlated with the literature. Results: The outcome of this research was the development of the evaluation framework. It was used the perceptions of experts, and users concerned about the dimensions of structure, process and outcome. The legislation, funding, the extension and coverage, accessibility, facilities, human resources, equipment and supplies were identified for \"structure\". In the dimension \"process\" the categories were: dissemination and uptake, host and active search, the social psychological profile of the users, the network of reference and cross reference, diagnosis, monitoring and educational strategies based on self-care and harm reduction. Within the scope of \"outcomes\" the subjects pointed: the success rate of stop smoking, the regularity of service, treatment adherence, the autonomy, the improvement in quality of life and user satisfaction. Conclusions: We conclude that the evaluative framework constructed has the potential for assessing the service quality and to promote institutional learning and personal / professional development. It contributes to the movement of the reflection-action-reorientation of care practices. By broadening the analysis beyond the important indicators requested by the National Tobacco Control Program, the elaborate framework is targeted to the empowerment of those involved (professionals and patients). It helps to set roles and responsibilities in reorienting the aspects that may influence the access, reception, diagnosis, treatment and monitoring performance of those who want to quit smoking.

Realizou-se estudo exploratório de revisão bibliográfica sistemática e metassíntese visando descrever e analisar aspectos das práticas educativas em saúde, voltados ao desenvolvimento de habilidades para a cessação do tabagismo, traduzidas na interpretação de autores de pesquisas qualitativas publicadas em periódicos entre 2000 e 2007. Concebeu-se a questão do tabagismo como um problema de enfrentamento complexo, que demanda intervenções em vários âmbitos. Destacou-se a educação em saúde, como campo estratégico e instrumental da promoção da saúde, que sob a perspectiva do \"empowerment\" e \"empowerment education\", é passível de atuação do profissional de saúde. Utilizando-se do instrumental metodológico da metassíntese qualitativa, descrito por Sandelowski e Barroso (2003), identificou-se a produção científica de pesquisas qualitativas originais sobre experiências relativas às práticas educativas na cessação do tabagismo, indexadas nas bases de dados eletrônicas MEDLINE, CINAHL e LILACS. Para tanto utilizou-se os descritores pesquisa qualitativa, educação em saúde e tabagismo, além de descritores de texto livre e palavras com truncamento, visando a identificação ampliada de artigos que pudessem ser relevantes. Mapeou-se os artigos selecionados para a amostra bibliográfica segundo suas características gerais, aplicando-se os critérios de qualidade, dados pelo instrumento \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002). Os resultados desta produção foram integrados através da análise de conteúdo descrita por Minayo (2004), de modo a buscar temas relacionados à educação em saúde, aos quais foram combinados atributos (ou sub-temas). A busca bibliográfica resultou na identificação de 989 citações nessa temática, das quais 634 foram consideradas relevantes. Após seleção com base na leitura do título, a seguir dos abstracts (340) e por fim dos artigos na íntegra (88), foram classificadas 14 publicações como pertinentes para este estudo. Na metassíntese os aspectos recorrentes e as diferenças entre os artigos foram agrupados em duas modalidades temáticas: contexto dos sujeitos (descrevendo os fatores facilitadores e dificultadores do processo de cessação do tabagismo) e abordagem educativa (com processos facilitadores e dificultadores dos programas de cessação do tabagismo e da relação profissional-paciente apresentados em quadro temático, com comentários). As estratégias de abordagem do processo educativo foram classificadas com base nos elementos da promoção da saúde e nos modelos educacionais. Conclui-se que a metassíntese apresenta-se como metodologia relevante no âmbito da enfermagem (que tem vasta produção de pesquisa qualitativa), pois favorece análises e interpretações com potencial de proporcionar visibilidade e impacto no processo de cuidar e ser cuidado, fornecendo elementos para tomada de decisão. A compreensão sobre temas relacionados às abordagens educativas em saúde, nos processos de cessação do tabagismo, e o seu significado para os pacientes foi ampliada / An explorative systematic bibliographic review and meta-synthesis was realized looking to describe and analyze aspects of the educational practices in health, directed to the development of abilities for the smoking cessation, translated through the interpretation of the authors of the qualitative researches published in journals from 2000 to 2007. The smoking question was identified as a complex approach problem, which requires interventions from various aspects. Health education was emphasized, which under the perspective of the empowerment and empowerment education, is liable to the performance of the health professional. Using the qualitative meta-synthesis instrumental method described by Sandelowski and Barroso (2003), it was possible to identify a scientific production of primary qualitative researches about educational practices in the smoking cessation, indexed in MEDLINE, CINAHL and LILACS databasis. For this was used qualitative research controlled vocabulary, health education and smoking, besides the free texts and words with truncation, looking to increase the identification of the studies that may be relevant. The selected studies were identified according to its general characteristics, having been applied quality criterias supplied by the \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002) instrument. The results of this production were integrated through the analysis of content described by Minayo (2004), in order to look for themes related to health education, of which had attributes (sub-themes) combined to them. The bibliographic research resulted in the identification of 989 citations about this theme, where 634 were considered relevant. After the selection based on the title of the studie, following the abstracts (340) and finally of the reading of 88 complete studies, 14 publications were classified as being pertinent to this study. In the meta-synthesis the reoccurring aspects and the differences between the studies were separated in two types of themes: context of the subjects (describing the facilitating and difficulting facts of the smoking cessation process) and education approach (with facilitating and difficulting processes of the smoking cessation programs and of the patient-professional relationship presented in a theme board, with comments). The strategies used in the educational processes were classified based on the elements of the health promotion and on educational models. We conclude that the meta-synthesis presents itself as a relevant methodology in nursing environment (which provides vast qualitative research productions), because it helps in analysis and interpretations with the potential of facilitating visibility and impact in the process of taking care and being taken care of, supplying elements for decision making. The comprehension about themes related to health educational approaches, in the smoking cessation processes, and its meaning to patients, has been increased

Introdução: O tabagismo é um problema crônico e de enfrentamento complexo. A ampliação da legislação, a conscientização da sociedade e a menor aceitação social do tabagismo, aumentaram a procura por serviços de cessação do tabagismo. A avaliação de programas desse tipo é tarefa complexa, considerando os diferentes níveis de intervenção, a diversidade de cenários e atores envolvidos. A avaliação de programas de cessação do tabagismo necessita incorporar ferramentas participativas, capazes de apontar a eficiência do programa, além de fomentar ações de transformação das práticas. Esta pesquisa buscou configurar uma matriz avaliativa capaz de contribuir na organização e autoaprendizagem de serviços dirigidos aos sujeitos em suas tentativas de parar de fumar, captando os diferentes contextos presentes na intervenção, nos cenários e nos atores. As questões da pesquisa foram: Quais são os indicadores que podem apontar o quanto um serviço se aproxima ou se distancia das práticas baseadas em evidências e dos modelos e diretrizes da promoção da saúde? Quais são os elementos que indicam ou não a qualidade de um serviço de tratamento do tabagismo? Objetivos: Desenvolver a matriz de indicadores de um serviço de tratamento do tabagismo. Para tanto buscou-se a) Identificar a percepção de experts, usuários e profissionais sobre serviços de tratamento do tabagismo; b) Caracterizar as práticas e bases de um serviço de cessação do tabagismo; c) Construir o modelo lógico avaliativo desse serviço; c) Formular as bases teóricas e práticas para a construção de matriz avaliativa de indicadores para um serviço de tratamento do tabagismo. Método: Situado no desenho orientado por modelo teórico (theory-driven evaluation) na perspectiva da Promoção da Saúde preconizada por Hartz, o percurso metodológico foi apoiado nas abordagens qualitativas e participativas e na estratégia da pesquisa-ação. O cenário de estudo foi o serviço de cessação do tabagismo de um hospital universitário, no município de São Paulo. Foram sujeitos dessa pesquisa profissionais de referência para o PNCT (experts), profissionais que atuam diretamente no serviço (implicados) e usuários do serviço. A análise e discussão dos achados apoiaram-se na triangulação de dados, correlacionada com a literatura. Resultados: O desfecho desta pesquisa foi o desenvolvimento da matriz avaliativa. Utilizou-se as percepções dos experts, implicados e usuários sobre as dimensões de estrutura, processo e resultado. A legislação, o financiamento, extensão e cobertura, a acessibilidade, as instalações, os recursos humanos, os equipamentos e insumos foram apontados como categorias para estrutura. Na dimensão processo as categorias foram: divulgação e captação, acolhimento e busca ativa, o perfil sócio psicológico dos usuários, a rede de referência e contra referência, o diagnóstico, acompanhamento e as estratégias educativas com base no autocuidado e na redução de danos. No âmbito de resultados os sujeitos pontuaram: a taxa de sucesso na cessação do tabagismo, a regularidade do serviço, a adesão, o respeito à autonomia, a melhora na qualidade de vida e a satisfação do usuário. Conclusão: Conclui-se que a matriz avaliativa construída possui potencial para avaliar a qualidade do serviço e promover o aprendizado institucional e o desenvolvimento pessoal/profissional. Contribui para o movimento de reflexão-ação-reorientação das práticas de cuidado. Ao ampliar a análise para além dos importantes indicadores solicitados pelo Programa Nacional do Controle do Tabagismo, a matriz elaborada dirige-se ao fortalecimento (empowerment) dos envolvidos (profissionais e usuários). Ajuda a estabelecer papéis e responsabilidades na reorientação de aspectos que possam influenciar o desempenho no acesso, acolhida, diagnóstico, tratamento e acompanhamento dos que desejam parar de fumar. / Introduction: Tobacco smoking is a chronic problem and very difficult to face. The improvements in the legislation, the awakening of the society and the smaller social acceptance to tobacco smoking have increased the number of people looking for smoking cessation services. The evaluation of such programs is a complex task, considering the different levels of intervention and the diversity of sceneries and actors involved. The evaluation of smoking cessation programs needs to incorporate participatory tools in order to indicate the program efficiency, and foster transformation actions of the practices. This study sought to configure an evaluation framework capable of contributing to the organization and self-learning of the services addressed to individuals in their attempts to quit smoking by capturing the different contexts present in the intervention sceneries and actors. The research questions were: Which are the indicators that may point out how much a service comes close or is distant from evidence-based practices, guidelines and models of health promotion? Which are the elements that indicate or not the quality of a smoking cessation treatment service? Objective: Developing the indicators framework of a smoking cessation service. For this it was sought to a) identify the experts, users and professionals perceptions about smoking cessation services, b) Characterize the practices and basis for a smoking cessation service c) Build the evaluative logical model of such service c) Formulate the theoretical and practical basis for the construction of an evaluative framework of indicators for a smoking cessation service. Method: Situated in the theoretical model oriented design (theory-driven evaluation) from the perspective of health promotion proposed by Hartz, the methodological trajectory was based on the qualitative and participative approaches as well as in the strategy of the action research. The study setting was the smoking cessation service at a university hospital in São Paulo. The subjects of this study were reference for the NTCP professionals (experts), the professionals who work directly in the service (stakeholders) and service users. The analysis and discussion of the findings were based upon the triangulation of data, correlated with the literature. Results: The outcome of this research was the development of the evaluation framework. It was used the perceptions of experts, and users concerned about the dimensions of structure, process and outcome. The legislation, funding, the extension and coverage, accessibility, facilities, human resources, equipment and supplies were identified for \"structure\". In the dimension \"process\" the categories were: dissemination and uptake, host and active search, the social psychological profile of the users, the network of reference and cross reference, diagnosis, monitoring and educational strategies based on self-care and harm reduction. Within the scope of \"outcomes\" the subjects pointed: the success rate of stop smoking, the regularity of service, treatment adherence, the autonomy, the improvement in quality of life and user satisfaction. Conclusions: We conclude that the evaluative framework constructed has the potential for assessing the service quality and to promote institutional learning and personal / professional development. It contributes to the movement of the reflection-action-reorientation of care practices. By broadening the analysis beyond the important indicators requested by the National Tobacco Control Program, the elaborate framework is targeted to the empowerment of those involved (professionals and patients). It helps to set roles and responsibilities in reorienting the aspects that may influence the access, reception, diagnosis, treatment and monitoring performance of those who want to quit smoking.

In Deutschland fehlen bislang belastbare epidemiologische Daten über sowohl die Häufigkeit nikotinabhängiger Raucher im primärärztlichen Versorgungsbereich als auch das Ausmaß der von Hausärzten angebotenen Raucherentwöhnungsmaßnahmen. Die Ziele in der "Smoking and Nicotine Dependence Awareness and Screening (SNICAS)"-Studie waren/sind: (1) die Ermittlung repräsentativer Daten zur Prävalenz des Rauchens und der Nikotinabhängigkeit in Deutschland, (2) die Beschreibung des Rauchverhaltens und der Aufhörmotivation von Rauchern in der primärärztlichen Versorgung sowie (3) die Feststellung von Einstellungen, Fertigkeiten und Erfahrungen von Hausärzten im Zusammenhang mit der Raucherentwöhnung. SNICAS basierte auf einem zweistufigen epidemiologischen Studiendesign, woran sich eine derzeit noch laufende, klinische Interventionskomponente anschloss. In Stufe I (Vorstudien-Fragebogen) wurde eine repräsentative Auswahl von 889 Ärzten (Allgemeinärzte, praktische Ärzte, Internisten) hinsichtlich Erfahrungen und Einstellungen zu Raucherentwöhnungsmethoden charakterisiert. In Stufe II wurde an einem Stichtag (7. Mai 2002) in diesen Praxen n = 28 707 unausgelesene, konsekutive Patienten zunächst mittels eines Patientenfragebogens untersucht (konservative Ausschöpfungsrate: 52,8%). Daran schloss sich für jeden einzelnen Patienten eine unabhängige, standardisierte Arztbeurteilung (Erhebung des Rauchstatus, des Gesundheitszustands, vergangener und aktueller Interventionen u.ä.) an. Der Beitrag enthält eine Darstellung von Design und Methode der SNICAS-Studie und berichtet über die Gewinnung, Ausschöpfung und Repräsentativität der Arzt- und Patientenstichprobe. Auf der Grundlage ausgewählter Daten des Vorstudien- Fragebogens, aus denen eine geringe Anzahl (17,6%) an sich intensiv mit der Raucherentwöhnung befassenden Ärzten hervorgeht, werden ärztliche Interventionsstrategien, aber auch Einstellungs- und Strukturbarrieren vorgestellt. / Aims, Design and Methods of the "Smoking and Nicotine Dependence Awareness and Screening" (SNICAS) Study Germany lacks robust epidemiological data on the prevalence of smoking and nicotine dependence in primary care patients as it does on smoking cessation interventions provided by primary care physicians. Objectives of the "Smoking and Nicotine Dependence Awareness and Screening" (SNICAS) study are (1) to provide nationally representative data on the frequency of smoking and nicotine dependence among primary care patients in Germany, (2) to describe their smoking behaviour and motivation to quit as well as (3) attitudes, skills and experiences of physicians regarding smoking cessation. SNICAS is based on a 2-stage epidemiological design, supplemented by a subsequently conducted clinical intervention trial still ongoing. Stage I consists of a prestudy characterization of a nationwide sample of 889 primary care doctors (general practitioners, family doctors and internists with primary care functions). Stage II consists of a target day assessment (May 7th 2002) of n=28,707 unselected consecutive patients by means of a patient questionnaire (conservative response rate: 52.8%). For each patient a structured clinical appraisal form (screening of the patients' smoking status, physical and mental health, current and past interventions etc. ) was accomplished by the doctor. This article presents design and methods of the SNICAS study and describes its sampling strategy, its response rates and the representativity of primary care doctors and patients. By means of selected pre-study data, showing that only a small proportion of physician is extensively involved in smoking cessation (17.6%), intervention strategies of the doctors are presented as well as obstacles for smoking cessation (e.g. structures, attitudes).

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.

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