[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.

[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.

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.

[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.

Association between depression and subclinical carotid atherosclerosis in patients with Type 1 diabetes

AIMS

Recent studies have suggested an association between depression and subclinical atherosclerosis as measured by presence of carotid atherosclerotic plaque and increased intima-media thickening in non-clinical populations. Given the high prevalence of depression in patients with Type 1 diabetes and the diabetes-related risk factors for atherosclerosis, we hypothesized that this relation might also be of special relevance in Type 1 diabetic patients.

METHODS

Intima-media thickness (IMT) and the presence of plaques in the carotid arteries were quantitatively assessed by high-resolution ultrasound in 175 adults (89 men, 86 women) with an established diagnosis of Type 1 diabetes. Having been treated for depression or current Beck Depression Inventory scores > 10 were considered to indicate depression.

RESULTS

In men, the risk of plaque was higher in depressed subjects relative to non-depressed participants after adjustment for age, smoking status, systolic blood pressure, dyslipidaemia and body mass index [odds ratio (OR) 5.19; 95% confidence interval (CI) 1.29, 20.81]. Depressed women did not have an increased risk of plaque compared with non-depressed women (OR 0.97; 95% 95% CI 0.22, 4.34). We did not observe an association between depression and IMT, in men or in women.

CONCLUSIONS

In line with previous research, our findings suggest a link between depression and subclinical atherosclerosis in Type 1 diabetic men, but not in women.

Estimation of psycholeptic and psychoanaleptic medicine use in an adult general population sample using the Anatomical Therapeutic Chemical classification

Little is known about psycholeptic and psychoanaleptic medicine (PM) use in the general population. This study presents prevalence data about PM use. The sample included 4310 individuals aged 20-79 from a general population health examination in a northern German area (participation proportion: 68.8%; Study of Health in Pomerania, SHIP). Medicines taken during the past seven days were assessed from the medicine packages or self-reports and classified according to the Anatomical Therapeutic Chemical (ATC) classification developed by the World Health Organization. In total, 6.3% of the sample reported PM intake, 8.7% of the women and 4.7% of the men. During the past 12 months prior to the health examination, 49.2% of the individuals with PM use consulted a general practitioner but not a neurologist or a psychiatrist. Among the study participants with PM use, 88.8% had one or more mental disorders during lifetime according to a screening questionnaire. It is concluded that considerable proportions of individuals with current PM use exist although lower than may be expected on the basis of the number of individuals with mental disorder in the general population.

Associations of carotid intima-media thickness, tobacco smoking and overweight with hearing disorder in a general population sample

It has been argued that smoking or overweight might contribute to hearing disorder by atherogenic narrowing of the nutrient arteries to the cochlea. The carotid intima-media thickness (CIMT) is a surrogate marker for generalized atherosclerosis. We analyzed a subgroup (n=2619) from a general population sample in north-eastern Germany aged 45-81 years (Study of Health in Pomerania, SHIP). Assessments included self-statements about hearing disorder and medical examinations of CIMT. Using ordinal logistic regression for data analysis and after adjustment for cigarettes per day, waist circumference, diabetes, exposure to noise, age and sex, we found CIMT remained a predictor of hearing disorder (odds ratio 1.8, 95% confidence interval 1.0-3.2). Cigarettes per day and waist circumference were related to CIMT but not to hearing disorder. The findings suggest a positive association between CIMT and hearing disorder.

No influence of atopic diseases on antibody titres following tetanus, diphtheria and hepatitis B immunisation among adults

Several studies have reported associations between reduced humoral immune response to vaccine antigens and diseases with modified reactions of the immune system. We have investigated the influence of atopic diseases on specific IgG levels to tetanus, diphtheria and hepatitis B (HB), following immunisation, in a general adult population. From the Study of Health in Pomerania, a total number of 3,920 subjects aged 20 to 79 years were included in the analyses. Information on immunisation history, as well as behavioural and socio-demographic characteristics were collected. Anti-tetanus IgG, anti-diphtheria IgG and anti-HBs IgG were measured by indirect enzyme-linked immunosorbent assay (ELISA). Odds ratios and 95% confidence intervals were calculated using logistic regression. Atopic diseases were reported by 14% of participants. Proportions of 67%, 34% and 10% had been vaccinated against tetanus, diphtheria and hepatitis B within the past ten years, respectively. Multi-variable analyses revealed no associations between the presence of atopic diseases and all of the three vaccine-specific antibody titres. We conclude that there is no reduced immune response related to antibody production following immunisations against tetanus, diphtheria and hepatitis B in adults with atopic diseases.

[Referral behaviour of general practitioners to professionals in outpatient care and in addiction treatment sites in Mecklenburg-West Pommerania]

AIM

This study gives an overview about the collaboration of general practitioners (GP) with professionals in outpatient care and in addiction treatment sites. The goal of the study is to examine whether characteristics of the GP and distances to various specialised professionals have an effect on the referral of patients to GPs, primarily in the pilot study of nine "Medical practices for addiction".

METHOD

A random sample of 330 general practices was drawn from the records of the association of the Compulsory Health Insurance. The participation rate was 75.8%.

RESULTS

There was a high level of networking between general practitioners (GP) and professionals in outpatient care and in addiction treatment sites. The greater the distance to a "Medical practice for addiction", the lower was the chance of referral. There was no influence of distance concerning referral and other specialised outpatient professionals.

CONCLUSIONS

Only part of the general population benefits from the pilot study. Aspects such as accessibility and well proven habits of the GPs concerning referral, should be considered to a greater extent for future collaboration among addiction care systems.

[Kidney transplantation in childhood and adolescence. Management of functional disorders and follow-up care of the kidney transplant recipient]

The causes that lead to terminal renal failure in children and adolescents and subsequently require dialysis are different from those in adults. Moreover, children with a functioning kidney transplant evidence an approximately fourfold higher survival probability than children on dialysis. This contribution describes kidney transplantation in light of the specific features for this age group.