[Diversity and accessibility of smoking cessation aids in the internet]

AIM OF THE STUDY

Only a few smokers use smoking cessation aids. The Internet can act as a medium to improve the dissemination of traditional smoking cessation aids, but can also provide direct help by its own interactive capabilities. The purpose of this study is to give an overview of the different smoking cessation aids offered via the Internet and to categorise their contents.

METHODS

Two different search strategies were used to find smoking cessation aids on the Internet. The first was a search with the search engine Google. Six search terms were previously generated by interviews with one hundred smokers. Using these terms, the Google search resulted in a list of 106 websites. The second strategy was a direct search on 31 websites of different health-related institutions. To classify the smoking cessation aids on the websites, a system of different categories was developed.

RESULTS

The offers for smoking cessation on the Internet could be assigned to 11 categories. General information about smoking cessation was the most and interactive programs was the least represented category. The websites of the health-related institutions offered a larger variety of directly useable smoking cessation aids (39%) than the websites retrieved via Google (29%).

CONCLUSION

Interactive smoking cessation aids which provide individual support are still underrepresented on the Internet. Direct search strategies on the pages of health-related institutions were more promising than the use of a search engine. The proactive promotion of quality-controlled Internet offers seems to be important to capitalise on the potential of the Internet.

[Continuous individual support of smoking cessation in socially deprived young adults via mobile phones--results of a pilot study]

OBJECTIVE

The aim of this study was to test the feasibility and acceptability of an intervention using text messaging (SMS) for continuous, individual support of smoking cessation.

METHODS

Ninety-three socially deprived young adults were screened for smoking status and usage of text messaging in an institution for occupational rehabilitation. People who reported smoking daily and using text messaging at least weekly were invited to participate in a 12-week, SMS-based intervention. Individualised SMS-feedbacks were sent to the participants weekly, based on data from the baseline assessment and the weekly SMS assessment of the intention to quit smoking. Additionally, the participants could request SMS support whenever they suffered from withdrawal symptoms or craving. The intervention was based on the transtheoretical model of behaviour change (TTM). All of the 35 persons who met the inclusion criteria for the study registered for study participation; post-assessments were obtained from 33 participants.

RESULTS

The average participant answered 8 of the 12 weekly SMS questions. The SMS-based questions and -feedbacks were evaluated as self-explanatory by the participants. At post-assessment, five participants (15%) reported occasional instead of daily smoking. None of the participants reported abstinence after the intervention. Pre-post comparisons revealed a reduction in the number of cigarettes smoked per day as well as in the heaviness of smoking and an increase in risk perception. No significant differences were found for situational urge to smoke and intention to change.

CONCLUSION

The intervention proved to be feasible in a sample of socially deprived young adults, and was well accepted. The first results concerning its effectiveness are promising. The examination of this approach within a controlled study seems reasonable.

Extended recruitment efforts minimize attrition but not necessarily bias

OBJECTIVES

There has been a debate about the effect of extended recruitment efforts on attrition and bias. The aims of the present study are (1) to investigate the effectiveness of extensive multimode recruitment procedures; (2) to study their effect on attrition and bias; and (3) to determine the potential predictors of attrition.

STUDY DESIGN AND SETTING

We used data from the longitudinal population-based study of health in Pomerania.

RESULTS

Using multimode recruitment methods, we reached a follow-up response proportion of 83.6%. In-person contacts at home turned out to be an effective recruitment tool. Sociodemographic and health characteristics of late respondents and converted nonrespondents were most distinct from early respondents but not necessarily indicative of nonrespondents. Analyzing attrition bias, extended recruitment efforts produced an effect only for sociodemographic characteristics but not for health-related indicators. The strongest predictors for attrition from the regression model were late recruitment at baseline, unemployment, low educational level, female sex, and smoking habit.

CONCLUSION

Extended recruitment efforts appeared justified in terms of response maximization. However, enhanced response proportions may not necessarily minimize bias. In our analysis, aiming for a high-response proportion in terms of health-related indicators had no effect, because late respondents did not differ from early respondents.

Does response bias influence population studies of thyroid disorders?

BACKGROUND

Monitoring of iodine fortification programs is required for early recognition of oversupply or ineffective supply with iodine. We investigated the potential role of selection bias for studies performed to monitor the iodine supply and prevalence of thyroid disorders.

METHODS

We used the baseline population of 3949 subjects recruited for the Study of Health in Pomerania as a hypothesized source population and associated the information on response behavior from the 5-year follow-up examinations with baseline sociodemographic and thyroid-related characteristics. Due to nonresponse, 649 subjects were lost. The 3300 follow-up respondents were divided into early and late respondents according to their recruitment level.

RESULTS

We found no significant bias in the prevalence estimates of thyroid-related variables in the comparison between all respondents, and the source population after response maximization techniques had been applied. Prevalence estimates of thyroid-related characteristics (prior thyroid disorders, goiter, thyroid nodules, low serum thyrotropin, as well as increased and positive antithyroperoxidase [TPO] levels), however, were biased if we would have only investigated subjects who agreed to participate in our study after first invitation. When analyses were adjusted for sociodemographic variables, differences between early and late respondents were only statistically significant for positive anti-TPO levels.

CONCLUSIONS

We conclude that selection bias likely influences prevalence data for some studies of thyroid epidemiology. This could be diminished by making invitation procedures more rigorous.

Smoking during pregnancy and postpartum: smoking rates and intention to quit smoking or resume after pregnancy

BACKGROUND

A substantial number of women smoke while pregnant. The majority of those who quit return to smoking within 12 months. The aim of this study is to estimate smoking rates and to measure the urge to smoke and the motivation to change smoking behavior among women who recently delivered.

METHODS

Data presented stem from two studies. Study 1 is an epidemiological survey investigating the health of neonates. Study 2 presents screening data of an efficacy trial for a smoking cessation and relapse prevention intervention. Participants were recruited on maternity wards within 7 days after delivery.

RESULTS

Five hundred fifty-three (29.1%) women were never smokers, 145 (7.6%) were former smokers, 492 (25.9%) abstained during pregnancy, and 712 (37.4%) smoked throughout pregnancy. Of the smokers, 69% did not intend to quit smoking within the next 6 months. Of the women who quit during pregnancy, 80% did not want to resume smoking within the next 6 months or after weaning.

CONCLUSIONS

Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.

[Health behaviour and health-risk behaviour among job-seekers: a screening at an employment agency]

AIM

The purpose of this study was to investigate the distribution of health behaviours and health-risk behaviours among three groups of job-seeking persons at employment agencies: short-term unemployed, long-term unemployed, and non-unemployed (e.g., threatened by job loss) persons. A related aim was to identify the general willingness of persons recruited at employment agencies to participate in a study regarding health behaviours.

METHOD

At the employment agency Greifswald (Western Pomerania, Germany), over a period of two weeks, all job-seeking persons while waiting were personally asked to participate in a screening regarding health behaviours.

RESULTS

A total of 1672 persons (M=34 years, 54% women), that is 74.3% of all job-seekers, participated in the screening. Regarding physical activity, fruit and vegetable intake, smoking, at-risk drinking, drug use and overweight, all three groups showed a lack of health behaviour and increased risky behaviour compared to the general population or nation-wide guidelines. ANOVAs, chi (2) tests and logistic regressions showed significant differences among the three groups. Non-unemployed persons were more likely to report a healthier life style compared to both unemployed groups. Long-term unemployed persons had a higher risk of smoking (OR=1.56; CI 95%=1.14-2.12) and of using drugs (OR=2.79; CI 95%=1.30-5.98) compared to short-term unemployed persons.

CONCLUSIONS

The high participation rate, along with the high rates of risky behaviour and lack of health behaviour indicate the demand for intervention programs for job-seekers and the opportunity of using this setting for proactive interventions that could reach more than 70% of all job-seekers.

Computer-tailored smoking cessation intervention in a general population setting in Germany: outcome of a randomized controlled trial

This study reports the outcome of a randomized controlled trial testing a computer-tailored smoking cessation intervention based on the transtheoretical model in a general population setting in Germany. Participants of the smoking intervention study were recruited from an existing general population health examination survey in a university hospital. The sample consisted of 611 current and former smokers at baseline, and of 485 participants in the core group of baseline daily cigarette smokers. Follow-ups were conducted 6, 12, 18, and 24 months after baseline. The intervention was designed for both current and former smokers, involved up to three individualized feedback letters, and was created using expert-system technology. Based on 7-day point-prevalence abstinence and 6-month prolonged abstinence as the outcome measures, the study identified no significant differences between the intervention and control groups. Modeling the full longitudinal data in generalized estimation equation analyses, using different nonresponse procedures, and adjusting for covariates did not alter the results. We conclude that the computer-tailored transtheoretical model-based smoking cessation intervention, as delivered in this study and in this special setting, was ineffective.

Predicting utilization of formal and informal help among general hospital inpatients with alcohol use disorders

AIM

The aim of this prospective study was to identify predictors of utilizing formal and informal help among currently non-help-seeking individuals with alcohol use disorders.

METHODS

Data was based on 197 general hospital inpatients with alcohol dependence or abuse. Using multivariable logistic regression analyses, intention to utilize formal help was tested in addition to evidence based predictors of utilization of help.

RESULTS

Intention to seek help and prior help-seeking were identified as central predictors for formal and informal help-seeking.

CONCLUSIONS

The lack of utilization of formal help among persons with alcohol use disorders may be reduced by focusing professional interventions on enhancing help-seeking motivation.

Differences in help seeking rates after brief intervention for alcohol use disorders in general practice patients with and without comorbid anxiety or depressive disorders

AIMS

To examine, if the utilization of help for problematic drinking after brief intervention (BI) differs between general practice (GP) patients with and without comorbid depression or anxiety disorders.

METHODS

Longitudinal data of 374 GP patients, who met the diagnostic criteria of alcohol dependence or abuse according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and criteria of at-risk drinking or binge drinking, were drawn from a randomized controlled BI study. Participants were randomly allocated to either a control or one of two intervention groups, receiving a series of alcohol related BI. Of the sample, 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. At 12-months follow-up, differences in utilization of formal help for drinking problems were assessed between comorbid and non-comorbid individuals.

RESULTS

BI were significantly related to an increase in utilization of formal help in non-comorbid patients (chi(2 )= 4.54; df = 1; p < 0.05) but not in comorbid individuals (chi(2 )= 0.40; df = 1; p = 0.60). In a logistic regression analysis, comorbidity [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.14-2.88; p = 0.01) and previous help seeking (OR = 15.98; CI = 6.10-41.85; p < 0.001) were found to be positive predictors for utilization of formal help.

CONCLUSION

BIs do not seem to significantly support help-seeking in the comorbid. As comorbid anxiety and depression constitute a positive predictor for help-seeking, individuals with problematic drinking and comorbid anxiety or depressive disorders might benefit from more specialized support exceeding the low level of BI.

Postpartum Smoking Cessation and Relapse Prevention Intervention

The aim of the study was to test the effectiveness of a postpartum smoking cessation and relapse prevention intervention. Structural equation modeling techniques were applied to evaluate the impact of the intervention on smoking behavior and on non-behavioral variables derived from the Transtheoretical Model (TTM). Women were randomized to an intervention (I) and control group (C). Smoking status, TTM-variables, and control variables were assessed four weeks, six and 12 months postpartum. Membership in the intervention group significantly predicted non-smoking and higher self-efficacy six months, but not one year postpartum, after controlling for demographic, smoking, and postpartum risk variables.

Trauma and posttraumatic stress disorder in the elderly: findings from a German community study

OBJECTIVE

The present study assessed the risk of trauma exposure and subsequent posttraumatic stress disorder (PTSD) in an elderly community sample. Furthermore, gender differences and psychiatric comorbidity were analyzed.

METHOD

3170 adults living in a German community were assessed by the PTSD module of the Structured Clinical Interview for DSM-IV and the Composite International Diagnostic-Screener. They were assigned to 3 age groups: young (44 years and younger; N = 997), middle-aged (45-64 years; N = 1322), and elderly (65 years and older; N = 851). Data for the present study were collected between December 2002 and December 2006.

RESULTS

At least 1 trauma was reported by 54.6%, and the odds for trauma exposure were almost 4-fold in the elderly compared to the younger age groups (OR = 3.74; 95% CI = 3.13 to 4.47). Among those traumatized, the lifetime and 1-month prevalence rates of PTSD in the elderly were 3.1% and 1.5%, respectively, and did not differ from the rates of the young and middle-aged adults. Elderly men had a significantly increased risk for trauma exposure in general than elderly women (p = .012), but there were no gender differences in PTSD prevalence rates. Elderly PTSD-positive participants had significantly higher odds for any psychiatric syndrome than those without PTSD (OR = 9.10; 95% CI = 2.64 to 31.28) with depression and anxiety being the most frequent conditions.

CONCLUSION

Our findings suggest that PTSD is certainly not rare in the elderly and that a lifetime diagnosis of PTSD is associated with symptoms of depression and anxiety. Assessment of trauma and PTSD should be integrated into routine examinations of the elderly to improve management and treatment provisions.

Reasons for not using smoking cessation aids

Background

Few smokers use effective smoking cessation aids (SCA) when trying to stop smoking. Little is known why available SCA are used insufficiently. We therefore investigated the reasons for not using SCA and examined related demographic, smoking behaviour, and motivational variables.

Methods

Data were collected in two population-based studies testing smoking cessation interventions in north-eastern Germany. A total of 636 current smokers who had never used SCA and had attempted to quit or reduce smoking within the last 12 months were given a questionnaire to assess reasons for non-use. The questionnaire comprised two subscales: "Social and environmental barriers" and "SCA unnecessary."

Results

The most endorsed reasons for non-use of SCA were the belief to be able to quit on one's own (55.2%), the belief that help is not necessary (40.1%), and the belief that smoking does not constitute a big problem in one's life (36.5%). One quarter of all smokers reported that smoking cessation aids are not helpful in quitting and that the aids cost too much. Smokers intending to quit agreed stronger to both subscales and smokers with lower education agreed stronger to the subscale "Social and environmental barriers".

Conclusion

Main reasons for non-use of SCA are being overly self-confident and the perception that SCA are not helpful. Future interventions to increase the use of SCA should address these reasons in all smokers.

[Prevalence of smoking in women before and during pregnancy: population-based data]

BACKGROUND AND OBJECTIVE

Population-based data on smoking behavior in Germany of women before or during pregnancy have been lacking. Smoking rates of these women have now been recorded over a period of 3 years against the background of growing tobacco control activities in Germany.

METHODS

The study was conducted between 4/2003 and 3/2006 in the context of a prospective population-based survey about perinatal morbidity and mortality (Survey of Neonates in Pomerania - SNiP). This survey registers all newborns and their mothers in one defined region. Of the women eligible for the study 2 297 (68.1%) participated after delivery by giving data about their smoking behavior before and during pregnancy.

RESULTS

61.2% of the women had smoked at some time, 46.6% had smoked before, 24.2% into the 4. month and 20.5% into the last 4 weeks of pregnancy. Smoking rates remained unchanged over the 3 years that were studied. The rates of smokers who had quit by the time of delivery varied according to the length of school education: (<10 years: 30%; 10 y: 59%; >10 y: 84%) and age (<24 years: 45%; 25-30 y: 65%; >30 y: 77%).

CONCLUSION

This study for the first time provides population-based data about the prevalence of smoking before and during pregnancy among women in Germany. The data show extremely high numbers of smokers, especially younger women and women of only 10 years or less of school education. Despite growing tobacco control activities no changes in smoking rates were observed over three years. These findings underline the need to develop effective interventions to prevent smoking of women before and during pregnancy.

Harm avoidance in subjects with obsessive-compulsive disorder and their families

INTRODUCTION

This study investigates the role of harm avoidance (HA) as a possible risk factor in the familiality of obsessive-compulsive disorder (OCD). HA is considered to be a genetically influenced personality trait with an increasingly understood neuroanatomical basis.

METHOD

75 subjects with OCD from hospital sites and a community sample and their 152 first degree relatives and 75 age and sex matched controls with their 143 first degree relatives were evaluated with structured clinical interviews (DSM-IV). HA was assessed with Cloninger's Tridimensional Personality Questionnaire (TPQ).

RESULTS

Subjects with OCD had higher scores of HA than controls (p<or=0.001). First degree relatives of OCD cases also showed higher HA than relatives of control subjects (p=0.001).These results remained stable when comparing only OCD subjects versus controls (p<or=0.001) and relatives of OCD cases versus relatives of controls (p=0.005) without current comorbid disorders.

LIMITATIONS

The investigation of HA alone does not allow to disentangle the transmission of biological versus psychological factors related to an elevated level of anxiety in families of OCD cases.

CONCLUSION

This is the first study to extent previous findings of elevated HA in OCD cases to their first degree relatives. Thus, HA may partially mediate the familial risk for OCD.

Effectiveness of brief alcohol interventions for general practice patients with problematic drinking behavior and comorbid anxiety or depressive disorders

BACKGROUND

Brief interventions (BIs) are effective methods to reduce problematic drinking. It is not known, if the effectiveness of BI differs between patients with or without comorbid depression or anxiety disorders.

METHODS

In a randomized controlled BI study with two intervention groups and one control condition, data were collected from 408 general practice (GP) patients with alcohol use disorders, at-risk drinking or binge drinking. 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. The effectiveness of BI was assessed at a 12-month follow-up in relation to the presence and absence of comorbidity. Reduction of drinking in six ordered categories (g/alcohol) between baseline and follow-up served as the outcome variable.

RESULTS

BI were significantly related to reduction of drinking in the non-comorbid (-2.64 g/alcohol vs. -8.61 g/alcohol; p=.03) but not in the comorbid subsample (-22.06 g/alcohol vs. -22.09 g/alcohol; p=.76). Compared to non-comorbid participants, a significantly higher reduction of drinking was found for comorbid individuals (-6.55 g/alcohol vs. -22.08 g/alcohol; p=.01). An ordinal regression analysis revealed comorbidity to be a positive predictor for reduction of drinking (estimator=.594; CI=.175-1.013; p<.01). When entering the variables amount of drinking at baseline, intervention and classification of problematic drinking, these became significant predictors, whereas comorbidity showed only a tendency.

CONCLUSION

BI did not significantly effect a reduction of drinking in comorbid patients. As BI are known to be less effective for dependent drinkers, a larger proportion of dependents among the comorbid might have limited the effectiveness of BI. Future studies with larger sample sizes of comorbid problem drinkers are necessary to confirm the results.

A genome-wide association study identifies colorectal cancer susceptibility loci on chromosomes 10p14 and 8q23.3

To identify colorectal cancer (CRC) susceptibility alleles, we conducted a genome-wide association study. In phase 1, we genotyped 550,163 tagSNPs in 940 familial colorectal tumor cases (627 CRC, 313 high-risk adenoma) and 965 controls. In phase 2, we genotyped 42,708 selected SNPs in 2,873 CRC cases and 2,871 controls. In phase 3, we evaluated 11 SNPs showing association at P < 10(-4) in a joint analysis of phases 1 and 2 in 4,287 CRC cases and 3,743 controls. Two SNPs were taken forward to phase 4 genotyping (10,731 CRC cases and 10,961 controls from eight centers). In addition to the previously reported 8q24, 15q13 and 18q21 CRC risk loci, we identified two previously unreported associations: rs10795668, located at 10p14 (P = 2.5 x 10(-13) overall; P = 6.9 x 10(-12) replication), and rs16892766, at 8q23.3 (P = 3.3 x 10(-18) overall; P = 9.6 x 10(-17) replication), which tags a plausible causative gene, EIF3H. These data provide further evidence for the 'common-disease common-variant' model of CRC predisposition.

The relation of exposure to shift work with atherosclerosis and myocardial infarction in a general population

OBJECTIVES

We tested the hypothesis that working shifts is related to atherosclerosis and myocardial infarction.

BACKGROUND

The number of shift workers is continuously increasing. Shift work is discussed to be related with cardiovascular heart disease.

METHODS

A total of 2510 subjects recruited for the population-based Study of Health in Pomerania were tested, 698 of whom were former shift workers. A general population sample was examined to reach generalizibility and to produce results independent from the effects of the personal shift schedule and from the specific working conditions. Carotid ultrasound was performed to evaluate carotid intima-media thickness. We used multivariable analyses to estimate the coronary heart disease risk, adjusted for age, sex and atherosclerotic risk factors, stratified by exposure to shift work and its duration.

RESULTS

Atherosclerotic risk factors differed in part between shift workers and non-shift workers. Shift work was associated with atherosclerosis and myocardial infarction, depending on the duration of the exposure and the age of the participants. Multivariable Cox regression analysis identified shift work as a risk factor for myocardial infarction to be manifest at younger ages (adjusted hazard ratio 1.53, 95% CI 1.06-2.22).

CONCLUSIONS

Exposure to shift work is a risk factor for atherosclerosis and myocardial infarction. Special prevention programs for shift workers should be provided.