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Raspe M, Bals R, Bölükbas S, Faber G, Krabbe B, Landmesser U, Al Najem S, Przibille O, Raupach T, Rupp A, Rustler C, Tuffman A, Urlbauer M, Voigtländer T, Andreas S. [Smoking cessation in hospitalised patients - Initiate among inpatients, continue when outpatients - A Position Paper by the German Respiratory Society (DGP) Taskforce for Smoking Cessation]. Pneumologie 2023. [PMID: 37186277 DOI: 10.1055/a-2071-8900] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Tobacco smoking is the greatest preventable health risk. The effects are serious, both individually and societal. Nevertheless, the current prevalence of tobacco smokers in Germany is still high at around 35 %. A recent strong increase in actively smoking adolescents (14- to 17-year-olds, current prevalence approx. 16 %) and young adults (18- to 24-year-olds, current prevalence approx. 41 %) is also a cause for concern. About a third of all inpatients continue smoking while being treated. The hospitalization of active smokers in acute and rehabilitation hospitals serves as a "teachable moment" for initiation of cessation offers. An intervention that begins in hospital and continues for at least a month after discharge results in about 40 % additional smokefree patients. It is scientifically well-researched, effective and cost-efficient. After initiation in hospital these measures can be continued via ambulatory cessation programs, rehabilitation facilities, an Internet or telephone service. In Germany, there are structured and quality-assured cessation offers, both for the inpatient and for the outpatient area. The biggest obstacle to broad establishment of such offers is the lack of reimbursement. Two feasible ways to change this would be the remuneration of the existing OPS 9-501 "Multimodal inpatient treatment for smoking cessation" and the establishment of quality contracts according to § 110a SGB V. An expansion of tobacco cessation measures in healthcare facilities would reduce smoking prevalence, associated burden of disease and consecutive costs.
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Affiliation(s)
- Matthias Raspe
- Charité - Universitätsmedizin Berlin, Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, und des Berlin Institute of Health, Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin, Berlin
| | - Robert Bals
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Serve Bölükbas
- Klinik für Thoraxchirurgie, Universitätsmedizin Essen - Ruhrlandklinik, Essen
| | - Gerhard Faber
- CELENUS Teufelsbad Fachklinik Blankenburg, Blankenburg
| | - Bernd Krabbe
- Herz-Kreislaufmedizin/Angiologie, UKM Marienhospital Steinfurt, Steinfurt
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin
- DZHK (German Centre for Cardiovascular Research), partner site Berlin
| | | | | | - Tobias Raupach
- Universitätsklinikum Bonn (AÖR), Institut für Medizindidaktik, Bonn
| | | | - Christa Rustler
- Deutsches Netz Rauchfreier Krankenhäuser & Gesundheitseinrichtungen DNRfK e. V., Berlin
| | - Amanda Tuffman
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Standort Innenstadt, München, außerdem Deutsches Zentrum für Lungenforschung
| | - Matthias Urlbauer
- Medizinische Klinik 3 (Schwerpunkt Pneumologie) am Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - Thomas Voigtländer
- Deutsche Herzstiftung e. V., Frankfurt
- MVZ CCB Frankfurt und Main-Taunus, Frankfurt
| | - Stefan Andreas
- Lungenfachklinik Immenhausen, Immenhausen, außerdem Abteilung Kardiologie und Pneumologie der Universitätsmedizin Göttingen und Deutsches Zentrum für Lungenforschung
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Brinker TJ, Buslaff F, Suhre JL, Silchmüller MP, Divizieva E, Wilhelm J, Hillebrand G, Penka D, Gaim B, Swoboda S, Baumermann S, Walther JW, Brieske CM, Jakob L, Baumert HM, Anhuef O, Schmidt SM, Alfitian J, Batra A, Taha L, Mons U, Hofmann FJ, Haney AC, Haney CM, Schaible S, Tran TA, Beißwenger H, Stark T, Groneberg DA, Seeger W, Srivastava A, Gall H, Holzapfel J, Rigotti NA, Baudson TG, Enk AH, Fröhling S, von Kalle C, Bernardes-Souza B, Pereira RMDOS, Thomas R. Process Evaluation of a Medical Student-Delivered Smoking Prevention Program for Secondary Schools: Protocol for the Education Against Tobacco Cluster Randomized Trial. JMIR Res Protoc 2019; 8:e13508. [PMID: 30973348 PMCID: PMC6482400 DOI: 10.2196/13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/22/2019] [Accepted: 03/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background Most smokers start smoking during their early adolescence under the impression that smoking entails positive attributes. Given the addictive nature of cigarettes, however, many of them might end up as long-term smokers and suffering from tobacco-related diseases. To prevent tobacco use among adolescents, the large international medical students’ network Education Against Tobacco (EAT) educates more than 40,000 secondary school students per year in the classroom setting, using evidence-based self-developed apps and strategies. Objective This study aimed to evaluate the long-term effectiveness of the school-based EAT intervention in reducing smoking prevalence among seventh-grade students in Germany. Additionally, we aimed to improve the intervention by drawing conclusions from our process evaluation. Methods We conduct a cluster-randomized controlled trial with measurements at baseline and 9, 16, and 24 months postintervention via paper-and-pencil questionnaires administered by teachers. The study groups consist of randomized schools receiving the 2016 EAT curriculum and control schools with comparable baseline data (no intervention). The primary outcome is the difference of change in smoking prevalence between the intervention and control groups at the 24-month follow-up. Secondary outcomes are between-group differences of changes in smoking-related attitudes and the number of new smokers, quitters, and never-smokers. Results A total of 11,268 students of both sexes, with an average age of 12.32 years, in seventh grade of 144 secondary schools in Germany were included at baseline. The prevalence of cigarette smoking in our sample was 2.6%. The process evaluation surveys were filled out by 324 medical student volunteers, 63 medical student supervisors, 4896 students, and 141 teachers. Conclusions The EAT cluster randomized trial is the largest school-based tobacco-prevention study in Germany conducted to date. Its results will provide important insights with regards to the effectiveness of medical student–delivered smoking prevention programs at school. International Registered Report Identifier (IRRID) DERR1-10.2196/13508
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Affiliation(s)
- Titus Josef Brinker
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany.,Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Buslaff
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | | | | | | | - Jilada Wilhelm
- Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Gabriel Hillebrand
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Dominik Penka
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Benedikt Gaim
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Susanne Swoboda
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | | | - Jörg Werner Walther
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | | | - Lena Jakob
- Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Ole Anhuef
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen, Germany
| | - Selina Marisa Schmidt
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen, Germany
| | - Jonas Alfitian
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tübingen, Germany
| | - Lava Taha
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Ute Mons
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Ailís Ceara Haney
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Caelán Max Haney
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Samuel Schaible
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Thien-An Tran
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Hanna Beißwenger
- Faculty of Medicine, University of Göttingen, Göttingen, Germany
| | - Tobias Stark
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Werner Seeger
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Aayushi Srivastava
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Henning Gall
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Julia Holzapfel
- Faculty of Medicine, Justus-Liebig-University of Gießen, Gießen, Germany
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanja Gabriele Baudson
- Cognitive Science and Assessment Institute, University of Luxembourg, Luxembourg, Luxembourg
| | - Alexander H Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Fröhling
- National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - Christof von Kalle
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | | | | | - Roger Thomas
- Health Sciences Centre, University of Calgary, Calgary, AB, Canada
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Brinker TJ, Brieske CM, Esser S, Klode J, Mons U, Batra A, Rüther T, Seeger W, Enk AH, von Kalle C, Berking C, Heppt MV, Gatzka MV, Bernardes-Souza B, Schlenk RF, Schadendorf D. A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic. J Med Internet Res 2018; 20:e10976. [PMID: 30111525 PMCID: PMC6115598 DOI: 10.2196/10976] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/22/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. OBJECTIVE The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. METHODS We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. RESULTS During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%; women: 10, 67%); 41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%; women: 9, 60%); and 72 (91%) perceived the intervention as fun (men: 57, 90%; women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%; women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). CONCLUSIONS A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking.
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Affiliation(s)
- Titus Josef Brinker
- National Center for Tumor Diseases, Department of Translational Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Dermatology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
| | - Christian Martin Brieske
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
| | - Stefan Esser
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ute Mons
- Cancer Prevention Unit, German Cancer Research Center, Heidelberg, Germany
| | - Anil Batra
- Section for Addiction Medicine and Addiction Research, University Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Werner Seeger
- Universities of Giessen and Marburg Lung Center, Department of Internal Medicine, Justus-Liebig-University, Gießen, Germany
| | - Alexander H Enk
- Department of Dermatology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Christof von Kalle
- National Center for Tumor Diseases, Department of Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Carola Berking
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Markus V Heppt
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Martina V Gatzka
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | | | - Richard F Schlenk
- Trial Center, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
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A Face-Aging Smoking Prevention/Cessation Intervention for Nursery School Students in Germany: An Appearance-Focused Interventional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081656. [PMID: 30081549 PMCID: PMC6121507 DOI: 10.3390/ijerph15081656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/24/2018] [Accepted: 08/02/2018] [Indexed: 12/27/2022]
Abstract
The Education Against Tobacco (EAT) network delivers smoking prevention advice in secondary schools, typically using the mirroring approach (i.e., a “selfie” altered with a face-aging app and shared with a class). In November 2017, however, the German assembly of EAT opted to expand its remit to include nursing students. To assess the transferability of the existing approach, we implemented it with the self-developed face-aging app “Smokerface” (=mixed − methods approach) in six nursing schools. Anonymous questionnaires were used to assess the perceptions of 197 students (age 18–40 years; 83.8% female; 26.4% smokers; 23.3% daily smokers) collecting qualitative and quantitative data for our cross-sectional study. Most students perceived the intervention to be fun (73.3%), but a minority disagreed that their own animated selfie (25.9%) or the reaction of their peers (29.5%) had motivated them to stop smoking. The impact on motivation not to smoke was considerably lower than experienced with seventh graders (63.2% vs. 42.0%; notably, more smokers also disagreed (45.1%) than agreed (23.5%) with this statement. Agreement rates on the motivation not to smoke item were higher in females than in males and in year 2–3 than in year 1 students. Potential improvements included greater focus on pathology (29%) and discussing external factors (26%). Overall, the intervention seemed to be appealing for nursing students.
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Luck KE, Doucet S. What Are the Perceptions, Experiences, and Behaviors of Health Care Providers After Implementation of a Comprehensive Smoke-Free Hospital Policy? Glob Qual Nurs Res 2018; 5:2333393618756770. [PMID: 29568792 PMCID: PMC5858618 DOI: 10.1177/2333393618756770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to explore the perceptions, experiences, and behaviors of health care providers (HCPs) after the implementation of a comprehensive smoke-free policy. This qualitative descriptive study, using semi-structured interviews, was conducted with 28 HCPs working in a Canadian hospital. Four overarching themes emerged from the analysis including (a) greater support for tobacco reduction, (b) enhanced patient care and interactions, (c) improved staff morale, and (d) some barriers still exist. The main findings suggest a comprehensive smoke-free hospital environment can strengthen the tobacco-free workplace culture within a hospital setting among HCPs where support for tobacco reduction is amplified, patient care and interactions regarding tobacco dependence are improved, and staff morale is enhanced. While there are still some challenging barriers as well as opportunities for improvements, the implementation of a comprehensive smoke-free policy heightened the call-to-action among HCPs to take a more active role in tobacco reduction.
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Affiliation(s)
- Kerrie E Luck
- University of New Brunswick, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- University of New Brunswick, Saint John, New Brunswick, Canada.,Jarislowsky Chair in Interprofessional Patient-Centred Care, University of New Brunswick, Saint John, New Brunswick, Canada.,Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
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Faria BL, Brieske CM, Cosgarea I, Omlor AJ, Fries FN, de Faria COM, Lino HA, Oliveira ACC, Lisboa OC, Klode J, Schadendorf D, Bernardes-Souza B, Brinker TJ. A smoking prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised trial. BMJ Open 2017; 7:e018589. [PMID: 29229659 PMCID: PMC5778310 DOI: 10.1136/bmjopen-2017-018589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous; the dramatic health consequences are too far in the future to fathom. We recently designed and tested an intervention that takes advantage of the broad availability of mobile phones as well as adolescents' interest in their appearance. A free photoageing mobile app (Smokerface) was implemented by medical students in secondary schools via a novel method called mirroring. The pupils' altered three-dimensional selfies on tablets were 'mirrored' via a projector in front of their whole grade. This is the first randomised trial to measure the effectiveness of the mirroring approach on smoking behaviour in secondary schools. METHODS AND ANALYSIS The mirroring intervention, which lasts 45 min, is implemented by Brazilian medical students in at least 35 secondary school classes with 21 participants each (at least 35 classes with 21 participants for control) in February 2018 in the city of Itauna, Brazil. External block randomisation via computer is performed on the class level with a 1:1 allocation. In addition to sociodemographic data, smoking behaviour is measured via a paper-pencil questionnaire before, 3 and 6 months postintervention plus a random carbon monoxide breathing test at baseline and end line. The primary outcome is cigarette smoking in the past week at 6 months follow-up. Smoking behaviour (smoking onset, quitting) and effects on the different genders are studied as secondary outcomes. Analysis is by intention to treat. ETHICS AND DISSEMINATION Ethical approval is obtained from the ethics committee of the University of Itauna in Brazil. Results will be disseminated at conferences, in peer-reviewed journals, throughout the Education Against Tobacco network social media channels and on our websites. TRIAL REGISTRATION NUMBER NCT03178227.
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Affiliation(s)
| | - Christian M Brieske
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Ioana Cosgarea
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Albert J Omlor
- Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | - Fabian N Fries
- Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany
| | | | | | | | | | - Joachim Klode
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | | | - Titus J Brinker
- Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Dermatology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
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Brinker TJ, Owczarek AD, Seeger W, Groneberg DA, Brieske CM, Jansen P, Klode J, Stoffels I, Schadendorf D, Izar B, Fries FN, Hofmann FJ. A Medical Student-Delivered Smoking Prevention Program, Education Against Tobacco, for Secondary Schools in Germany: Randomized Controlled Trial. J Med Internet Res 2017; 19:e199. [PMID: 28588007 PMCID: PMC5478798 DOI: 10.2196/jmir.7906] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than 8.5 million Germans suffer from chronic diseases attributable to smoking. Education Against Tobacco (EAT) is a multinational network of medical students who volunteer for school-based prevention in the classroom setting, amongst other activities. EAT has been implemented in 28 medical schools in Germany and is present in 13 additional countries around the globe. A recent quasi-experimental study showed significant short-term smoking cessation effects on 11-to-15-year-old adolescents. OBJECTIVE The aim of this study was to provide the first randomized long-term evaluation of the optimized 2014 EAT curriculum involving a photoaging software for its effectiveness in reducing the smoking prevalence among 11-to-15-year-old pupils in German secondary schools. METHODS A randomized controlled trial was undertaken with 1504 adolescents from 9 German secondary schools, aged 11-15 years in grades 6-8, of which 718 (47.74%) were identifiable for the prospective sample at the 12-month follow-up. The experimental study design included measurements at baseline (t1), 6 months (t2), and 12 months postintervention (t3), via questionnaire. The study groups consisted of 40 randomized classes that received the standardized EAT intervention (two medical student-led interactive modules taking 120 minutes total) and 34 control classes within the same schools (no intervention). The primary endpoint was the difference in smoking prevalence from t1 to t3 in the control group versus the difference from t1 to t3 in the intervention group. The differences in smoking behavior (smoking onset, quitting) between the two groups, as well as gender-specific effects, were studied as secondary outcomes. RESULTS None of the effects were significant due to a high loss-to-follow-up effect (52.26%, 786/1504). From baseline to the two follow-up time points, the prevalence of smoking increased from 3.1% to 5.2% to 7.2% in the control group and from 3.0% to 5.4% to 5.8% in the intervention group (number needed to treat [NNT]=68). Notable differences were observed between the groups for the female gender (4.2% to 9.5% for control vs 4.0% to 5.2% for intervention; NNT=24 for females vs NNT=207 for males), low educational background (7.3% to 12% for control vs 6.1% to 8.7% for intervention; NNT=30), and migrational background (students who claimed that at least one parent was not born in Germany) at the 12-month follow-up. The intervention appears to prevent smoking onset (NNT=63) but does not appear to initiate quitting. CONCLUSIONS The intervention appears to prevent smoking, especially in females and students with a low educational background.
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Affiliation(s)
- Titus Josef Brinker
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt am Main, Germany
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Andreas Dawid Owczarek
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Werner Seeger
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - David Alexander Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt am Main, Germany
| | - Christian Martin Brieske
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Philipp Jansen
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Joachim Klode
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Ingo Stoffels
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Dirk Schadendorf
- Essen University Hospital, Department of Dermatology, Venerology and Allergology, University of Duisburg-Essen, Essen, Germany
- West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), University of Heidelberg, Heidelberg, Germany
| | - Benjamin Izar
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA, United States
| | - Fabian Norbert Fries
- Saarland University Medical Center and Saarland University Faculty of Medicine, Department of Ophthalmology, University of Homburg, Homburg, Germany
| | - Felix Johannes Hofmann
- Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
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8
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Price S, Hitsman B, Veluz-Wilkins A, Blazekovic S, Brubaker TR, Leone F, Hole A, Wileyto EP, Langer C, Kalhan R, Patel J, Schnoll R. The use of varenicline to treat nicotine dependence among patients with cancer. Psychooncology 2016; 26:1526-1534. [PMID: 27218657 DOI: 10.1002/pon.4166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/07/2016] [Accepted: 04/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Continuing to smoke after a cancer diagnosis can adversely influence the prognosis for patients with cancer. However, remarkably few studies have carefully examined the use of first-line FDA-approved medications for nicotine dependence in patients with cancer. This study evaluated the feasibility, safety, and effect on cessation of varenicline for smoking cessation in patients with cancer. METHODS Data from 132 treatment-seeking smokers who received 12 weeks of open-label varenicline and five brief behavioral counseling sessions were used to evaluate the feasibility, safety, and impact on cessation of varenicline. The effects of abstinence on cognitive function and affect were also explored. RESULTS Of 459 patients screened, 306 were eligible for the study (66.7%) and 132 entered treatment (43.1%). Retention was 84.1% over 12 weeks. The rate of biochemically verified abstinence at week 12 was 40.2%. Expected side effects were reported (e.g. sleep problems, nausea), but there were no reports of elevated depressed mood, suicidal thoughts, or cardiovascular events. Abstinence was associated with improved cognitive function and reduced negative affect over time (p < 0.05). CONCLUSIONS Although many patients with cancer who smoke did not enroll in treatment, the side effect profile of varenicline and its effect on short-term cessation converge with what is seen in the general population. Further, as with the general population, abstinence while taking varenicline may lead to improved cognitive function and reduced negative affect. The present data support the use of varenicline to help patients with cancer to quit smoking.
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Affiliation(s)
- Sarah Price
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna Veluz-Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sonja Blazekovic
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Tarah R Brubaker
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Frank Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, PA, USA
| | - Anita Hole
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Corey Langer
- Department of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA, USA
| | - Ravi Kalhan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jyoti Patel
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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