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Klosterhalfen S, Kotz D, Kastaun S. Smokers' perception of the comparative health risks of cigarettes, e-cigarettes and heated tobacco products: a survey among the German population. J Public Health (Oxf) 2024:fdae068. [PMID: 38741461 DOI: 10.1093/pubmed/fdae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/04/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Tobacco cigarettes, e-cigarettes and heated tobacco products can pose different health risks (harm continuum). As current tobacco smokers could benefit from switching to less harmful products, we aimed to assess current smokers' perceived comparative health risks of these three products and to explore associations between risk perceptions and specific user characteristics. METHODS We analysed data from 11 waves (2019-2021; N = 5657 current tobacco smokers) of a representative, cross-sectional household survey conducted in Germany. Associations were assessed with multivariable logistic regression models. RESULTS 55.2% of smokers (95%CI = 53.8-56.5%) ranked cigarettes as the most harmful product. 36.1% of smokers (95%CI = 34.8-37.3%) perceived e-cigarettes and 33.8% (95%CI = 32.5-35.0%) heated tobacco products as more harmful than cigarettes. Misperceptions that e-cigarettes or heated tobacco products are more harmful to health than cigarettes increased over the 3-year study period and were more common among those with lower educational attainment. CONCLUSIONS Only half of current tobacco smokers in Germany perceive the comparative health risks of cigarettes adequately and such misperceptions have increased recently. As current smokers could benefit most from switching to less harmful products, educational campaigns are needed to inform this group about the health risks of tobacco smoking and the comparative health risks of the various nicotine and tobacco products along the harm continuum.
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Affiliation(s)
- Stephanie Klosterhalfen
- Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
- Department of Behavioural Science and Health, University College London, WC1E 7HB London, UK
| | - Sabrina Kastaun
- Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
- Patient-Physician Communication Research Unit, Centre for Health and Society (chs), Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany
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Wolters I, Kastaun S, Kotz D. Associations between body mass index and smoking behaviour: A cross-sectional study of the German adult population. Physiol Behav 2024; 275:114436. [PMID: 38103627 DOI: 10.1016/j.physbeh.2023.114436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Both smoking and high body weight are risk factors for disease, hence, the association between smoking and body weight is an important health issue. Furthermore, concern about weight gain after quitting smoking is for many smokers a barrier to smoking cessation. The present study aims to explore the association between body mass index (BMI) and current tobacco smoking status in the population of Germany, and smoking and quitting behaviour amongst smokers (and recent ex-smokers =<12 months since quitting). METHODS Cross-sectional analysis of two waves of data collected from March through June 2021 through a representative face-to-face household survey in Germany (N = 3 997 respondents aged ≥18). The associations between smoking and quitting behaviours and BMI were analysed through four regression models adjusted for socio-demographic, socio-economic, and smoking characteristics of respondents. RESULTS Long-term ex-smokers (>= 12 months since quitting smoking) were more likely to have a higher BMI compared to never smokers (β = 0.64, 95% confidence interval (CI) = 0.10-1.19). There was no statistically significant association between current smoking status or recent ex-smoking status and BMI (β = -0.29,95 %CI = -0.75-0.17 and β = -0.53, 95 %CI = -2.45-1.40). Among current smokers, no statistically significant association was found between BMI and the motivation to stop smoking (OR = 1.01, 95 %CI = 0.99-1.03). Neither number of cigarettes smoked a day nor outcome of most recent quit attempt were related to BMI (β = 0.01, 95 %CI = -0.04-0.05 and OR = 0.41, 95 %CI = 0.05-3.05). CONCLUSION In the German population long-term ex-smoking but not current and recent ex-smoking was associated with increased BMI. Future research should further explore the association between smoking behaviour and abdominal obesity, preferably using a more accurate measure for abdominal obesity than BMI.
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Affiliation(s)
- Isabel Wolters
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Sabrina Kastaun
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany; Institute of General Practice (ifam), Centre for Health and Society (chs), Patient-Physician Communication Research Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany; Department of Behavioural Science and Health, University College London, London, United Kingdom.
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Kotz D, Kastaun S, Manthey J, Hoch E, Klosterhalfen S. Cannabis Use in Germany. Dtsch Arztebl Int 2024; 121:52-57. [PMID: 37967282 PMCID: PMC10979436 DOI: 10.3238/arztebl.m2023.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The federal government of Germany is planning to liberalize the recreational cannabis market for adults. We aimed to collect key baseline data on frequency of use, routes of administration, and co-use of cannabis and inhaled nicotine or tobacco products in the population. METHODS Based on data from a national survey of 9644 people aged >14 years, we analyzed self-reported use of cannabis in the past 12 months and preferred route of administration (single choice: smoked with tobacco; smoked without tobacco; inhaled without tobacco; consumed with food; consumed in another form). RESULTS The prevalence of past-year cannabis use was 4.6% (95% CI [4,2; 5,1%]), with higher rates among 14-24- (11.4%) and 25-39-year-olds (8.2%) as well as among co-users of inhaled nicotine or tobacco products, particularly waterpipe users (27.0%). Smoking cannabis with or without tobacco was the preferred route of administration, reported by 92.4% (95% CI [89,6; 94,6%]). It was most frequently reported by 14-24-year-olds and by co-users of inhaled nicotine or tobacco products. CONCLUSION Smoking remains the predominant form of using cannabis-especially among younger users, who are at greatest risk of cannabis-related consequences. The true prevalence of cannabis use may have been underestimated in our study, however, as not all participants answered the questions on cannabis. Nevertheless, preventive and harm reduction efforts are needed to reduce the harm from using cannabis. Continuous monitoring is required to evaluate the effects of the forthcoming law changes in Germany.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sabrina Kastaun
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
- Institute of General Practice (ifam), Patient-Physician Communication Research Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf (UKE)
- Department of Psychiatry, Medical Faculty, University of Leipzig
| | - Eva Hoch
- IFT Institut für Therapieforschung, Center for Mental Health and Addiction Research, Munich
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, Ludwig-Maximilans-Universität München, Munich
- Department of Psychiatry and Psychotherapy, Cannabinoid Research Group, University Hospital, LMU Munich, Munich
| | - Stephanie Klosterhalfen
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
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Kastaun S, Herrmann A, Müller BS, Klosterhalfen S, Hoffmann B, Wilm S, Kotz D. Are people interested in receiving advice from their general practitioner on how to protect their health during heatwaves? A survey of the German population. BMJ Open 2023; 13:e076236. [PMID: 37770266 PMCID: PMC10546099 DOI: 10.1136/bmjopen-2023-076236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE Climate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and provide advice on protective health behaviour against heat. Data is lacking on whether and what topic of GP advice people are interested in, and whether specific person characteristics are associated with such interests. DESIGN Cross-sectional, nationwide, face-to-face household survey, conducted during winter 2022/2023. SETTING Germany. PARTICIPANTS Population-based sample of 4212 respondents (aged 14-96 years), selected by using multistratified random sampling (50%) combined with multiquota sampling (50%). MAIN OUTCOME MEASURE Interest in receiving GP advice on health protection during heatwaves (yes/no), and the topic people find most important (advice on drinking behaviour, nutrition, cooling, cooling rooms, physical activity or medication management). Associations between predefined person characteristics and the likelihood of interest were estimated using adjusted logistic regressions. RESULTS A total of 4020 respondents had GP contact and provided data on the outcome measure. Of these, 23% (95% CI=22% to 25%) expressed interest in GP advice. The likelihood of expressing interest was positively associated with being female, older age (particularly those aged 75+ years: 38% were interested), having a lower level of educational attainment, having a migration background, living in a more urban area, and living in a single-person household. It was negatively associated with increasing income. Advice on medication management received highest interest (25%). CONCLUSIONS During winter season 2022/2023, around one quarter of the German population with GP contact-and around 40% of those aged 75+ years-was estimated to have a stated interest in receiving GP advice on protective health behaviour during heatwaves, especially on medication management. Climate change is creating new demands for healthcare provision in general practice. This study provides initial relevant information for research and practice aiming to address these demands.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Centre for Health and Society, Patient-Physician Communication Research Unit, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alina Herrmann
- Institute of General Practice, University of Cologne, Cologne, Germany
- Institute for Global Health (HIGH), Climate, Change, Nutrition and Health, Heidelberg University, Heidelberg, Germany
| | - Beate S Müller
- Institute of General Practice, University of Cologne, Cologne, Germany
| | - Stephanie Klosterhalfen
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice, Centre for Health and Society, Patient-Physician Communication Research Unit, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Behavioural Science and Health, University College London, London, UK
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Borchardt B, Kastaun S, Pashutina Y, Viechtbauer W, Kotz D. Motivation to stop smoking in the German population between 2016 - 2021 and associated factors: results from a repeated cross-sectional representative population survey (German Study on Tobacco Use, DEBRA study). BMJ Open 2023; 13:e068198. [PMID: 37253490 DOI: 10.1136/bmjopen-2022-068198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES We aimed to describe population trends in motivation to stop smoking between 2016 and 2021 in Germany. Furthermore, the aim was to estimate to what extent higher ratings on the validated German version of the Motivation To Stop Scale (MTSS) are associated with sociodemographics, nicotine dependence, past quit attempts, and use of e-cigarettes and tobacco product alternatives. METHODS We used data from the German Study on Tobacco Use: an ongoing repeated cross-sectional face-to-face household survey collecting representative data of the German population every other month since 2016. We analysed data from 18 969 adult current smokers with multivariable ordinal regression and described MTSS scores between 2016 and 2021 (scores 1-7=lowest to highest level of motivation). RESULTS The mean MTSS score was 2.04 (SD=1.37) and showed a slight downward trend over time. Younger age, higher level of education, fewer cigarettes per day, more time spent with urges to smoke, a recent quit attempt, no previous waterpipe use and current or past e-cigarette use were associated with higher MTSS scores. The largest effect estimates were observed for at least one quit attempt 0-6 months ago versus no attempt in the past year (OR=7.54; 95% CI 6.78 to 8.40), at least one quit attempt 7-12 months ago versus no attempt in the past year (OR=4.00; 95% CI 3.59 to 4.45) and for current versus never use of e-cigarettes (OR=1.71; 95% CI 1.48 to 1.99). CONCLUSIONS Recent quit attempts and current use of e-cigarettes were associated with higher motivation to stop smoking in the German population. Actions to boost the general motivation to stop smoking are required.
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Affiliation(s)
- Benjamin Borchardt
- Institute of General Practice, Center for Translational Neuro- and Behavioral Sciences, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Sabrina Kastaun
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Yekaterina Pashutina
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Daniel Kotz
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Behavioural Science and Health, University College London, London, UK
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Andreas S, Kotz D, Batra A, Hellmann A, Mühlig S, Nowak D, Schultz K, Worth H, Schüler S. [Smoking Cessation in Patients with COPD]. Pneumologie 2023; 77:206-219. [PMID: 36958341 DOI: 10.1055/a-2020-4284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Tobacco dependence is a common comorbidity in patients with COPD (Chronic Obstructive Pulmonary Disease) that negatively affects the course of the disease. However, clinically relevant improvement in COPD can only be achieved by complete and permanent abstinence. Therefore, abstinence from tobacco use is a central therapeutic concept in smoking patients with COPD and requires specific and targeted treatment.After detailed documentation of smoking behaviour and motivational counseling outlining the risks of smoking, all such patients shall be offered a structured therapy for tobacco cessation. There is high-quality evidence for the effectiveness of a combination therapy of behavioral therapy and medication (to treat the withdrawal syndrome). Due to insufficient data, there is currently no recommendation for the use of e-cigarettes as a primary option for a cessation attempt.Smoking is the most important cause of COPD. Smoking cessation is the most effective and cost-efficient single intervention to reduce the risk of developing and progressing COPD.
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Affiliation(s)
- Stefan Andreas
- Lungenfachklinik Immenhausen; Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung (DZL)
| | - Daniel Kotz
- Institut für Allgemeinmedizin (ifam), Schwerpunkt Suchtforschung und klinische Epidemiologie, Centre for Health and Society (chs), Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
| | - Anil Batra
- Klinik für Psychatrie und Psychotherapie, Sektion Suchtmedizin und Suchtforschung, Universitätsklinikum Tübingen
| | - Andreas Hellmann
- Praxis für Pneumologie, Onkologie und Schlafmedizin am Diako, die Stadtklinik, Augsburg
| | - Stephan Mühlig
- Institut für Psychologie, Klinische Psychologie und Psychotherapie, Technische Universität Chemnitz
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center (CPC) Munich, Deutsches Zentrum für Lungenforschung (DZL)
| | - Konrad Schultz
- Klinik Bad Reichenhall der Deutschen Rentenversicherung Bayern Süd
| | | | - Sabine Schüler
- Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin
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Kotz D, Acar Z, Kastaun S, Klosterhalfen S. Die Medienkampagne „Deine Chance“. SUCHT 2023. [DOI: 10.1024/0939-5911/a000803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Zusammenfassung: Zielsetzung: In 2021 wurde die bundesweite Medienkampagne „Deine Chance“ der damaligen Beauftragten der Bundesregierung für Sucht- und Drogenfragen und des Bundesministeriums für Gesundheit durchgeführt, um Raucherinnen und Raucher zu motivieren, mit dem Rauchen aufzuhören. Ziel unserer Studie war, die Wahrnehmung der Kampagne und ihre Effekte auf Rauchstoppmotivation und Rauchstoppversuche zu untersuchen. Methodik: Im Rahmen der repräsentativen Deutschen Befragung zum Rauchverhalten (DEBRA) wurden 1550 Raucher_innen im Zeitraum vor der Kampagne (18.02. bis 30.05.2021) und 2330 während der Kampagne (31.05. bis 14.11.2021) befragt. Spezifische Fragen bezogen sich auf die Wahrnehmung der Kampagne und davon ausgehende Impulse zur Änderung des Rauchverhaltens. Mögliche Effekte wurden anhand der Motivation zum Rauchstopp Skala sowie dem Anteil der Raucher_innen mit mindestens einem Rauchstoppversuch gemessen. Ergebnisse: 14.6 % (95%KI=13.2-16.1) der Raucher_innen nahm die Kampagne wahr. Hinsichtlich der Altersgruppen wurde die Kampagne am häufigsten von 14-24-Jährigen wahrgenommen (19.1 %, 95%KI=14.9-24.0). Raucher_innen mit niedriger Schulbildung nahmen die Kampagne seltener wahr als Raucher_innen mit hoher Schulbildung (OR=0.65, 95%KI=0.46-0.93). Unter den Raucher_innen, welche die Kampagne wahrgenommen hatten, informierten sich 6.4 % (95%KI=3.0-11.9) über die Kampagne, und 13.6 % (95%KI=9.1-19.0) wurden angeregt, über einen Rauchstopp nachzudenken. Im Vergleich zum Zeitraum vor der Kampagne gab es bei den Raucher_innen während der Kampagne keinen Unterschied in der Rauchstoppmotivation (OR=0.96, 95%KI=0.85-1.08) oder in durchgeführten Rauchstoppversuchen (OR=0.96, 95%KI=0.69-1.35). Schlussfolgerungen: Die Medienkampagne „Deine Chance“ hatte vermutlich keine nennenswerten Effekte auf die Rauchstoppmotivation und Rauchstoppversuche der Raucher_innen in Deutschland. Effektivere tabakkontrollpolitische Maßnahmen sind dringend notwendig, um das langfristige Ziel einer rauchfreien Gesellschaft zu erreichen.
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Affiliation(s)
- Daniel Kotz
- Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Institut für Allgemeinmedizin (ifam), Centre for Health and Society (chs), Düsseldorf, Deutschland
- Department of Behavioural Science and Health, University College London, UK
| | - Zeynep Acar
- Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Institut für Allgemeinmedizin (ifam), Centre for Health and Society (chs), Düsseldorf, Deutschland
| | - Sabrina Kastaun
- Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Institut für Allgemeinmedizin (ifam), Centre for Health and Society (chs), Düsseldorf, Deutschland
- Forschungsschwerpunkt Patient-Arzt-Kommunikation, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Institut für Allgemeinmedizin (ifam), Centre for Health and Society (chs), Düsseldorf, Deutschland
| | - Stephanie Klosterhalfen
- Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Institut für Allgemeinmedizin (ifam), Centre for Health and Society (chs), Düsseldorf, Deutschland
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Kotz D. In Reply. Dtsch Arztebl Int 2023; 120:58. [PMID: 36949642 DOI: 10.3238/arztebl.m2022.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Jackson SE, Kock L, Kotz D, Brown J. Real-world effectiveness of smoking cessation aids: A population survey in England with 12-month follow-up, 2015–2020. Addict Behav 2022; 135:107442. [PMID: 35908322 PMCID: PMC9587352 DOI: 10.1016/j.addbeh.2022.107442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/17/2022] [Accepted: 07/22/2022] [Indexed: 12/05/2022]
Abstract
Use of varenicline in a quit attempt was associated with increased odds of smoking cessation. Data were inconclusive regarding a benefit of e-cigarettes for smoking cessation. Use of e-cigarettes was unlikely associated with lower odds of smoking cessation. Associations between other aids and cessation were inconclusive.
Objective To examine the real-world effectiveness of popular smoking cessation aids, adjusting for potential confounders measured up to 12 months before the quit attempt. Methods 1,045 adult (≥18y) smokers in England provided data at baseline (April 2015-November 2020) and reported a serious past-year quit attempt at 12-month follow-up. Our outcome was smoking cessation, defined as self-reported abstinence at 12 months. Independent variables were use in the most recent quit attempt of: varenicline, prescription NRT, over-the-counter NRT, e-cigarettes, and traditional behavioural support. Potential confounders were age, sex, social grade, alcohol consumption, and level of dependence (measured at baseline), variables relating to the most recent quit attempt (measured at 12-month follow-up), and survey year. Results Participants who reported using varenicline in their most recent quit attempt had significantly higher odds of abstinence than those who did not, after adjustment for potential confounders and use of other aids (OR = 2.69, 95 %CI = 1.43–5.05). Data were inconclusive regarding whether using prescription NRT, over-the-counter NRT, e-cigarettes, or traditional behavioural support was associated with increased odds of abstinence (p > 0.05; Bayes factors = 0.41–1.71, expected effect size OR = 1.19), but provided moderate evidence that using e-cigarettes was more likely associated with no effect than reduced odds (Bayes factor = 0.31, expected effect size OR = 0.75). Conclusions Use of varenicline in a quit attempt was associated with increased odds of successful smoking cessation. Data were inconclusive regarding a benefit of e-cigarettes for cessation but showed use of e-cigarettes was unlikely to be associated with reduced odds of cessation. Associations between other cessation aids and cessation were inconclusive.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK; SPECTRUM Consortium, UK.
| | - Loren Kock
- Department of Behavioural Science and Health, University College London, London, UK; SPECTRUM Consortium, UK
| | - Daniel Kotz
- Department of Behavioural Science and Health, University College London, London, UK; Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK; SPECTRUM Consortium, UK
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Pashutina Y, Kotz D, Kastaun S. Attempts to quit smoking, use of smoking cessation methods, and associated characteristics among COPD patients. NPJ Prim Care Respir Med 2022; 32:50. [DOI: 10.1038/s41533-022-00316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
AbstractWe explored past-year quit attempts, cessation methods used, and associations with sociodemographic, smoking, and health-related characteristics among smoking patients with chronic obstructive pulmonary disease (COPD) in Germany. Cross-sectional survey data of 509 past-year smokers (current smokers and ≤12 months abstinent) with COPD (ICD-10 code J44.x and FEV1/FVC <0.70) from 19 pulmonary primary care practices were used. Associations were explored between age, sex, educational qualification, lung function, urges to smoke, psychological distress, and (a) ≥1 past-year quit attempt (yes/no), (b) use of ≥1 evidence-based smoking cessation method (yes/no). Of all patients, 48.5% (n = 247, 95% confidence interval (CI) 44.2–52.9) reported ≥1 past-year quit attempt. Such an attempt was positively associated with the male sex (Odds Ratio (OR) = 1.50, 95% CI 1.01–2.24) and negatively associated with time spent with urges to smoke (OR = 0.69, 95% CI 0.52–0.91). During the most recent past-year quit attempt, one-third of the patients used ≥1 evidence-based smoking cessation method (31.2%, 95% CI 25.4–37.0), which was positively associated with the strength of urges to smoke (OR = 1.62, 95% CI 1.09–2.41). Combined behavioural and pharmacological treatments were used by 4.0% (n = 10, 95% CI 1.6–6.5). Electronic cigarettes were used most frequently (21.5%, 95% CI 16.3–26.6). Although a high proportion of COPD patients in German pulmonary primary care attempt to quit smoking, only a few of them use evidence-based methods as assistance for quitting.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Gali K, Kastaun S, Pischke CR, Kotz D. Trends and consumption patterns in the use of e-cigarettes among adolescents and young adults in Germany (the DEBRA study). Addict Behav 2022; 133:107375. [PMID: 35671555 DOI: 10.1016/j.addbeh.2022.107375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/04/2022] [Accepted: 05/20/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Considering the growing popularity and rapid evolution of e-cigarettes, we examined e-cigarette use and tobacco smoking trends, and e-cigarette consumption patterns (i.e., device type, nicotine level) among adolescents and young adults in Germany. METHODS Data from 26 waves of the German Study on Tobacco Use (DEBRA), a repeated cross-sectional nationwide household survey, were used to explore trends in the prevalence of ever e-cigarette use and tobacco smoking in a sample of adolescents (aged 14-17 years, N = 1,396) and young adults (aged 18-24 years, N = 4,685) between June/July 2016 and Aug/Sept 2020. Among current e-cigarette users (N = 208), consumption patterns were examined. Associations with e-cigarette use were analysed using multivariable regression. RESULTS Adolescent e-cigarette use increased from 9.2% in 2016 to 16.5% in 2017, decreased in 2018 to 8.3% and then gradually increased to 13.4% by 2020. Adolescent tobacco smoking followed a similar trend. Young adult e-cigarette use rates remained relatively stable at 19.1% on average, while tobacco smoking slowly declined (2016: 44.7%, 2020: 38.5%). More than half of current e-cigarette users used refillable-style e-cigarettes (59.4% adolescents; 68.4% young adults) and also smoked tobacco (62.5% adolescents; 79.4% young adults). About 41.6% of adolescents and 56.0% of young adults vaped with nicotine. Among young adults, men (OR = 1.5; 95%CI: 1.3-1.8) and former (OR = 9.6; 95%CI: 1.1-13.1) and current (OR = 10.7; 95%CI: 8.7-13.2) tobacco smokers were more likely to have vaped. CONCLUSION E-cigarette use continues to rise in German adolescents and young adults requiring targeted health interventions and campaigns aimed at preventing and/or reducing use in this population.
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Affiliation(s)
- Kathleen Gali
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Hamburg Center for Health Economics, University of Hamburg, Germany
| | - Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Germany
| | - Claudia R Pischke
- Institute of Medical Sociology, Unit Public Health, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Duesseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Germany; Department of Behavioural Science and Health, University College London, London, United Kingdom.
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Kastaun S, Garnett C, Wilm S, Kotz D. Prevalence and characteristics of hazardous and harmful drinkers receiving general practitioners' brief advice on and support with alcohol consumption in Germany: results of a population survey. BMJ Open 2022; 12:e064268. [PMID: 36167398 PMCID: PMC9516087 DOI: 10.1136/bmjopen-2022-064268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The German treatment guideline on alcohol-related disorders recommends that general practitioners (GPs) offer brief advice on, and support with, reducing alcohol consumption to hazardous (at risk for health events) and harmful (exhibit health events) drinking patients. We aimed to estimate the implementation of this recommendation using general population data. DESIGN Cross-sectional analysis of data (2021/2022) of a nationwide, population-based household survey. SETTING Germany. PARTICIPANTS Population-based sample of 2247 adult respondents who reported hazardous or harmful drinking according to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; score women: 4-12 and men: 5-12). MAIN OUTCOME MEASURE Ever receipt of 'brief GP advice on, or support with, reducing alcohol consumption'. Differences in the likelihood of ever receiving advice and/or support (yes/no) relative to respondents' sociodemographic, smoking and alcohol consumption characteristics were estimated using logistic regressions. RESULTS Ever receipt of GP advice on/support with reducing drinking was reported among 6.3% (95% CI=5.3% to 7.4%), and the offer of support among 1.5% (95% CI=1.1% to 2.1%) of the hazardous and harmful drinking respondents. The likelihood of having ever received advice/support was positively associated with being older (OR=1.03 per year, 95% CI=1.01 to 1.04), a current or former (vs never) smoker (OR=2.36, 95% CI=1.46 to 3.80; OR=2.17, 95% CI=1.23 to 3.81) and with increasing alcohol consumption (OR=1.76 per score, 95% CI=1.59 to 1.95). One in two harmful drinking respondents (AUDIT-C score 10-12) reported appropriate advice/support. The likelihood was negatively associated with being woman (eg, OR=0.32, 95% CI=0.21 to 0.48), having a medium or high (vs low) education and with increasing household income. CONCLUSIONS A small proportion of hazardous and harmful drinking people in Germany report having ever received GP advice on, or support with, reducing alcohol consumption. The implementation of advice/support seems to be linked to specific socio-demographic characteristics, tobacco smoking and alcohol consumption level. Health policy measures should aim to increase alcohol screening, brief intervention rates and awareness for at-risk populations in primary care. TRIAL REGISTRATION NUMBER DRKS00011322, DRKS00017157.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Patient-Physician Communication Research Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Claire Garnett
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Stefan Wilm
- Institute of General Practice, Patient-Physician Communication Research Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Behavioural Science and Health, University College London, London, UK
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Li J, Parrott S, Keding A, Dogar O, Gabe R, Marshall AM, Huque R, Barua D, Fatima R, Khan A, Zahid R, Mansoor S, Kotz D, Boeckmann M, Elsey H, Kralikova E, Readshaw A, Sheikh A, Siddiqi K. Cost-utility of cytisine for smoking cessation over and above behavioural support in people with newly diagnosed pulmonary tuberculosis: an economic evaluation of a multicentre randomised controlled trial. BMJ Open 2022; 12:e049644. [PMID: 36028279 PMCID: PMC9422837 DOI: 10.1136/bmjopen-2021-049644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of cytisine over and above brief behavioural support (BS) for smoking cessation among patients who are newly diagnosed with pulmonary tuberculosis (TB) in low-income and middle-income countries. DESIGN An incremental cost-utility analysis was undertaken alongside a 12-month, double-blind, two-arm, individually randomised controlled trial from a public/voluntary healthcare sector perspective with the primary endpoint at 6 months post randomisation. SETTING Seventeen subdistrict hospitals in Bangladesh and 15 secondary care hospitals in Pakistan. PARTICIPANTS Adults (aged ≥18 years in Bangladesh and ≥15 years in Pakistan) with pulmonary TB diagnosed within the last 4 weeks who smoked tobacco daily (n=2472). INTERVENTIONS Two brief BS sessions with a trained TB health worker were offered to all participants. Participants in the intervention arm (n=1239) were given cytisine (25-day course) while those in the control arm (n=1233) were given placebo. No significant difference was found between arms in 6-month abstinence. PRIMARY AND SECONDARY OUTCOME MEASURES Costs of cytisine and BS sessions were estimated based on research team records. TB treatment costs were estimated based on TB registry records. Additional smoking cessation and healthcare costs and EQ-5D-5L data were collected at baseline, 6-month and 12-month follow-ups. Costs were presented in purchasing power parity (PPP) adjusted US dollars (US$). Quality-adjusted life years (QALYs) were derived from the EQ-5D-5L. Incremental total costs and incremental QALYs were estimated using regressions adjusting for respective baseline values and other baseline covariates. Uncertainty was assessed using bootstrapping. RESULTS Mean total costs were PPP US$57.74 (95% CI 49.40 to 83.36) higher in the cytisine arm than in the placebo arm while the mean QALYs were -0.001 (95% CI -0.004 to 0.002) lower over 6 months. The cytisine arm was dominated by the placebo arm. CONCLUSIONS Cytisine plus BS for smoking cessation among patients with TB was not cost-effective compared with placebo plus BS. TRIAL REGISTRATION NUMBER ISRCTN43811467.
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Affiliation(s)
- Jinshuo Li
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- ARK Foundation, Dhaka, Bangladesh
| | | | - Razia Fatima
- TB/HIV and Malaria Common Management Unit, Global Fund Grant, Islamabad, Pakistan
| | | | | | - Sonia Mansoor
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Daniel Kotz
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Melanie Boeckmann
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Helen Elsey
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Eva Kralikova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and the General University Hospital in Prague, Praha, Czech Republic
- 3rd Medical Department, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Hull York Medical School, University of York, York, North Yorkshire, UK
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Kotz D, O'Donnell A, McPherson S, Thomas KH. Using primary care databases for addiction research: An introduction and overview of strengths and weaknesses. Addict Behav Rep 2022; 15:100407. [PMID: 35111898 PMCID: PMC8789598 DOI: 10.1016/j.abrep.2022.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022] Open
Abstract
Primary care databases extract and combine routine data from the electronic patient records of various participating practices on a regular basis. These databases can be used for innovative and relevant addiction research, but such use requires a thorough understanding of how data were originally collected and how they need to be processed and statistically analysed to produce sound scientific evidence. The aims of this paper are therefore to (1) make a case for why primary care databases should be considered more frequently for addiction research; (2) provide an overview of how primary care databases are constructed; (3) highlight important methodological and statistical strengths and weaknesses of using primary care databases for research; and (4) give practical advice about how a researcher can get access to databases. Three major primary care databases from the UK serve as examples: Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), and QResearch.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich‐Heine‐University Düsseldorf, Germany
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sterling McPherson
- Program of Excellence in Addictions Research and the Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Elson S. Floyd College of Medicine, USA
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Kotz D, Jackson S, Brown J, Kastaun S. The Effectiveness of E-Cigarettes for Smoking Cessation. Dtsch Arztebl Int 2022; 119:297-301. [PMID: 35384835 PMCID: PMC9450504 DOI: 10.3238/arztebl.m2022.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/28/2021] [Accepted: 03/03/2022] [Indexed: 06/06/2023]
Abstract
BACKGROUND Our primary aim was to assess-in the German population-the effectiveness of e-cigarettes (ECs; with or without nicotine), nicotine replacement therapy (NRT), and no use of evidence-based aids in smoking cessation. METHODS Analysis of cross-sectional data from a representative survey of the population (age 14-96 years) conducted in 2016-2021. All current smokers and recent ex-smokers (< 12 months since quitting) who had made ≥ 1 attempt to quit in the past 12 months (n = 2740) were included. They were asked about use of cessation aids in their most recent quit attempt and their current smoking status. RESULTS Two hundred thirty-nine respondents had used ECs, 168 NRT, and 2333 no aid. After adjustment for potential confounders, the odds of abstinence were 1.78 times higher for smokers who had used ECs in their quit attempt than in the group that had used no aids (95% confidence interval [1.09; 2.92]; p = 0.02) and 1.46 times higher than in the NRT group ([0.68; 3.13]; p = 0.34, Bayes factor = 1.26). Compared with the unaided group, the odds of abstinence were 2.34 times higher ([1.21; 4.53]; p = 0.01) in the subgroup using ECs with nicotine and 1.48 times higher ([0.68; 3.26]; p = 0.33) in the subgroup using ECs without nicotine. The unadjusted abstinence rates in people who had started their quit attempt > 6 months earlier were 15.6% [9.4; 23.8] in the ECs group and 13.8% [7.3; 22.9] in the NRT group. CONCLUSION In Germany, use of ECs in an attempt to quit smoking is associated with a higher rate of abstinence than attempting to quit unaided.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty of the Heinrich-Heine-University Düsseldorf
| | - Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sabrina Kastaun
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty of the Heinrich-Heine-University Düsseldorf
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Garnett C, Kastaun S, Brown J, Kotz D. Alcohol consumption and associations with sociodemographic and health-related characteristics in Germany: A population survey. Addict Behav 2022; 125:107159. [PMID: 34735981 PMCID: PMC8642732 DOI: 10.1016/j.addbeh.2021.107159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND To assess the prevalence of ever-drinking and hazardous drinking among adults in Germany, and investigate the factors associated with level of alcohol consumption. METHODS Cross-sectional population survey of a representative sample of 11,331 adults in Germany (2018 to 2019). The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to define ever-drinking (AUDIT-C>=1), hazardous drinking (AUDIT-C>=5) and an overall AUDIT-C (alcohol consumption) score (from 0 to 12). Regression models were used to examine sociodemographic and health-related characteristics associated with AUDIT-C score. RESULTS The prevalence of ever-drinking and hazardous drinking was 84.7% (95% CI = 84.1-85.4) and 19.4% (95% CI = 18.6-20.1), respectively. The mean AUDIT-C score was 2.8 (SD = 2.16). AUDIT-C scores were independently positively associated with having medium (Badj = 0.12, 95% CI = 0.02-0.21) and high (Badj = 0.11, 95% CI = 0.01-0.21) educational qualifications (compared with low), monthly income (Badj = 0.31 per €1,000, 95% CI = 0.26-0.36), being a current smoker (Badj = 0.94, 95% CI = 0.86-1.02), anxiety (Badj = 0.26, 95% CI = 0.02-0.50), and living in North East (Badj = 0.43, 95% CI = 0.29-0.58), North West (Badj = 0.47, 95% CI = 0.39-0.55) and South East (Badj = 0.79, 95% CI = 0.64-0.93) Germany (compared with South West), and negatively associated with age (Badj = -0.17, 95% CI = -0.21- -0.13), being female (Badj = -1.21, 95% CI = -1.28- -1.14) and depression (Badj = -0.22, 95% CI = -0.43- -0.02). CONCLUSION In a large, representative sample of adults in Germany, the majority were ever-drinkers and one fifth were hazardous drinkers. Higher alcohol consumption scores were associated with being younger, male, current smoker, of high socioeconomic position, anxiety, and not living in South West Germany, and lower scores were associated with depression. These groups may benefit from targeted alcohol reduction policies and support.
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Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and Health, University College London, London, UK; SPECTRUM Consortium, London, UK.
| | - Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK; SPECTRUM Consortium, London, UK
| | - Daniel Kotz
- Department of Behavioural Science and Health, University College London, London, UK; Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
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Alayli AFG, Kotz D, Kastaun S. Recreational Cannabidiol: Awareness, Prevalence of use, and Associated Factors in a Representative Sample of the German Population. Subst Use Misuse 2022; 57:1417-1424. [PMID: 35686726 DOI: 10.1080/10826084.2022.2083175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recreational cannabidiol (CBD) is frequently promoted as a medicinal or therapeutic cannabis product worldwide. Nationwide population-based data on awareness and use of recreational CBD are currently lacking. OBJECTIVE This study estimates the prevalence of recreational CBD awareness and use among the population in Germany. It also explores potential associations with socio-demographic characteristics, tobacco smoking, and e-cigarette use. METHODS We used data from a cross-sectional household survey (German Study on Tobacco Use, DEBRA) fielded across two waves in October-November 2020 and February-March 2021. Data were collected using computer-assisted face-to-face interviews among participants aged ≥14 years (n = 4026). Outcome variables were CBD awareness (yes/no) and CBD ever use (yes/no). The sample was weighted to ensure representativeness of the prevalence estimates. Associations with socio-demographic variables, tobacco smoking, and e-cigarette use were assessed using multivariable logistic regression. RESULTS Approximately half of the population in Germany (48.3%, 95% CI: 46.8-49.9) was aware of recreational CBD products, and 4.3% (95% CI: 3.7-5.0) had ever used them (including 1.1% current users). Awareness was associated with younger age, higher education levels, female sex, living in urban regions, no migration background, tobacco smoking, and e-cigarette use. Ever use was associated with higher education levels, living in urban regions, tobacco smoking, and e-cigarette use. CONCLUSIONS Awareness of recreational CBD products is high but ever use is currently low in Germany. Given the uncertain legal framework regarding the marketing of recreational CBD products, the changing retail landscape, and potential harms of CBD use, structured monitoring is warranted for public health purposes.
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Affiliation(s)
- A F G Alayli
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - D Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Germany.,Department of Behavioural Science and Health, University College London, London, UK
| | - S Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Germany
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Batra A, Kiefer F, Andreas S, Gohlke H, Klein M, Kotz D, Mons U, Mühlig S, Pötschke-Langer M, Preuss UW, Rüther T, Rustler C, Thomasius R, Ulbricht S, Petersen KU. S3 Guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" - Short Version. Eur Addict Res 2022; 28:382-400. [PMID: 35760048 DOI: 10.1159/000525265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. METHODS Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. RESULTS In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms.
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Affiliation(s)
- Anil Batra
- Sektion Suchtmedizin des Universitätsklinikums Tübingen, Tübingen, Germany
| | - Falk Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim/Lehrstuhl für Suchtforschung, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Stefan Andreas
- Fachklinik für Lungenerkrankungen Philippsstiftung e.V, Immenhausen, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung, Göttingen, Germany
| | - Helmut Gohlke
- Deutsche Gesellschaft für Kardiologie - Herz- und Kreislaufforschung e. V., Düsseldorf, Germany
| | - Marianne Klein
- Zentrum für Psychiatrie, Klinikum Schloss Winnenden, Winnenden, Germany
| | - Daniel Kotz
- Institut für Allgemeinmedizin (ifam), Schwerpunkt Suchtforschung und klinische Epidemiologie, Centre for Health and Society (chs), Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ute Mons
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Germany
| | - Stephan Mühlig
- Klinische Psychologie und Psychotherapie TU Chemnitz, Chemnitz, Germany
| | | | - Ulrich W Preuss
- Vitos Klinik für Psychiatrie und Psychotherapie Herborn, Herborn, Germany
| | - Tobias Rüther
- Spezialambulanz für Tabakabhängigkeit, LMU Klinikum München, Klinik für Psychiatrie und Psychotherapie, Munich, Germany
| | | | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sabina Ulbricht
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung Präventionsforschung und Sozialmedizin, Greifswald, Germany
| | - Kay Uwe Petersen
- Sektion Suchtmedizin des Universitätsklinikums Tübingen, Tübingen, Germany,
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Siddiqi K, Keding A, Marshall AM, Dogar O, Li J, Huque R, Fatima R, Khan A, Elsey H, Gabe R, Kotz D, Sheikh A. Effect of quitting smoking on health outcomes during treatment for tuberculosis: secondary analysis of the TB & Tobacco Trial. Thorax 2022; 77:74-78. [PMID: 34272336 DOI: 10.1136/thoraxjnl-2020-215926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite treatment, patients with tuberculosis (TB) who smoke have poorer outcomes compared with non-smokers. It is unknown, however, if quitting smoking during the 6 months of TB treatment improves TB outcomes. METHODS The TB & Tobacco Trial was a double-blind, placebo-controlled randomised trial of cytisine for smoking cessation in 2472 patients with pulmonary TB in Bangladesh and Pakistan. In a secondary analysis, we investigated the hypothesis that smoking cessation improves health outcomes in patients during the TB treatment course. The outcomes included an eight-point TB clinical score, sputum conversion rates, chest X-ray grades, quality of life (EQ-5D-5L), TB cure plus treatment completion rates and relapse rates. These were compared between those who stopped smoking and those who did not, using regression analysis. RESULTS We analysed the data of 2273 (92%) trial participants. Overall, 25% (577/2273) of participants stopped smoking. Compared with non-quitters, those who quit had better TB cure plus treatment completion rates (91% vs 80%, p<0.001) and lower TB relapse rates (6% vs 14%, p<0.001). Among quitters, a higher sputum conversion rate at week 9 (91% vs 87%, p=0.036), lower mean TB clinical scores (-0.20 points, 95% CI -0.31 to -0.08, p=0.001) and slightly better quality of life (mean EQ-5D-5L 0.86 vs 0.85, p=0.015) at 6 months were also observed. These differences, except quality of life, remained statistically significant after adjusting for baseline values, trial arm and TB treatment adherence rates. CONCLUSION Patients with TB who stop smoking may have better outcomes than those who don't. Health professionals should support patients in stopping smoking.
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Affiliation(s)
- Kamran Siddiqi
- Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Ada Keding
- Health Sciences, University of York, York, UK
| | | | - Omara Dogar
- Health Sciences, University of York, York, UK
| | - Jinshuo Li
- Health Sciences, University of York, York, UK
| | - Rumana Huque
- Economics, Dhaka University, Dhaka, Bangladesh
- Research and Development, ARK Foundation, Dhaka, Bangladesh
| | - Razia Fatima
- Common Unit (HIV,TB,Malaria), Pakistan Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Amina Khan
- Research, The Initiative, Islamabad, Pakistan
| | - Helen Elsey
- Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Daniel Kotz
- Institute of General Practice, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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21
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Kastaun S, Brose LS, Scholz E, Viechtbauer W, Kotz D. Mental Health Symptoms and Associations with Tobacco Smoking, Dependence, Motivation, and Attempts to Quit: Findings from a Population Survey in Germany (DEBRA Study). Eur Addict Res 2022; 28:287-296. [PMID: 35358964 DOI: 10.1159/000523973] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to estimate prevalence rates of mental health symptoms (anxiety, depression, and overall psychological distress) by tobacco smoking status, and associations between such symptoms and the level of dependence, motivation, and attempts to quit smoking in the German population. METHODS Cross-sectional analysis of data from six waves of a nationally representative household survey collected in 2018/19 (N = 11,937 respondents aged ≥18). Mental health symptoms were assessed with the Patient Health Questionnaire-4. Associations with smoking status, dependence, motivation to quit, and ≥1 past-year quit attempt (yes/no) were analysed with adjusted regression models among the total group, and among subgroups of current (n = 3,248) and past-year smokers (quit ≤12 months ago, n = 3,357). RESULTS Weighted prevalence rates of mental health symptoms among current, former, and never smokers were: 4.1%, 2.4%, 2.5% (anxiety), 5.4%, 4.7%, 4.0% (depression), and 3.1%, 2.5%, 2.4% (psychological distress). Current versus never smokers were more likely to report symptoms of anxiety and depression. Smokers with higher versus lower levels of dependence were more likely to report higher levels of all three mental health symptoms. Higher versus lower levels of overall psychological distress were associated with a higher motivation to quit smoking and, among past-year smokers, with higher odds of reporting a past-year quit attempt. CONCLUSIONS We found various relevant associations between mental health symptoms and smoking behaviour. Healthcare professionals need to be informed about these associations and trained to effectively support this vulnerable group in translating their motivation into abstinence.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Leonie S Brose
- Institute of Psychiatry, Psychology and Neuroscience, Addictions, King's College London, and SPECTRUM consortium, London, United Kingdom
| | - Esther Scholz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Behavioural Science and Health, University College London, London, United Kingdom
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22
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Kalitzkus V, Wilm S, Kotz D, Kastaun S. Population Preferences for the Care of Family Members in the Same Primary Care Practice-Results of a Representative Population Survey. Dtsch Arztebl Int 2021; 118:844-845. [PMID: 35264285 DOI: 10.3238/arztebl.m2021.0367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/03/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022]
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23
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Kotz D, van Rossem C, Viechtbauer W, Spigt M, van Schayck OCP. Validity of urges to smoke measures in predicting smoking relapse during treatment in primary care. NPJ Prim Care Respir Med 2021; 31:48. [PMID: 34887425 PMCID: PMC8660873 DOI: 10.1038/s41533-021-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
In the context of smoking cessation treatment in primary care, identifying patients at the highest risk of relapse is relevant. We explored data from a primary care trial to assess the validity of two simple urges to smoke questions in predicting long-term relapse and their diagnostic value. Of 295 patients who received behavioural support and varenicline, 180 were abstinent at week 9. In this subgroup, we measured time spent with urges to smoke (TSU) and strength of urges to smoke (SUT; both scales 1 to 6 = highest). We used separate regression models with TSU or SUT as predictor and relapse from week 9–26 or week 9–52 as an outcome. We also calculated the sensitivity (SP), specificity and positive predictive values (PPV) of TSU and SUT in correctly identifying patients who relapsed at follow-up. The adjusted odds ratios (aOR) for predicting relapse from week 9–26 were 1.74 per point increase (95% CI = 1.05–2.89) for TSU and 1.59 (95% CI = 1.11–2.28) for SUT. The aORs for predicting relapse from week 9–52 were 2.41 (95% CI = 1.33–4.37) and 1.71 (95% CI = 1.14–2.56), respectively. Applying a cut-point of ≥3 on TSU resulted in SP = 97.1 and PPV = 70.0 in week 9–26, and SP = 98.8 and PPV = 90.0 in week 9–52. Applying a cut-point of ≥4 on SUT resulted in SP = 99.0 and PPV = 85.7 in week 9–26, and SP = 98.8 and PPV = 85.7 in week 9–52. Both TSU and SUT were valid predictors of long-term relapse in patients under smoking cessation treatment in primary care. These simple questions may be useful to implement in primary care. Trial registration: Dutch Trial Register (NTR3067).
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany. .,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. .,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Carolien van Rossem
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
| | - Mark Spigt
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
| | - Onno C P van Schayck
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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24
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Kotz D, West R. Key concepts in clinical epidemiology: addressing and reporting sources of bias in randomized controlled trials. J Clin Epidemiol 2021; 143:197-201. [PMID: 34571193 DOI: 10.1016/j.jclinepi.2021.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
Randomized controlled trials are widely considered the most robust design for evaluating the effects of clinical interventions. While generalisability is often limited, randomization aims to ensure that effects observed are genuine. However, there are common sources of bias, even in well-conducted trials, that pose a threat to this interpretation. The revised Cochrane risk-of-bias tool for trials (RoB 2) distinguishes five domains of bias that can affect the results of trials stemming from (1) the randomization process, (2) deviations from intended interventions, (3) missing outcome data, (4) outcome measurement, and (5) reporting of findings. We use RoB 2 as a framework for recommendations to help researchers mitigate these sources of bias and ensure transparency in reporting so that users of research are aware of them.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; Department of Behavioural Science and Health, University College London, London, UK.
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
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25
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Pashutina Y, Kastaun S, Ratschen E, Shahab L, Kotz D. Externe Validierung einer Single-Item Skala zur Erfassung der Motivation zum Rauchstopp. SUCHT 2021. [DOI: 10.1024/0939-5911/a000719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Zielsetzung: Die Motivation to Stop Scale (MTSS) ist eine englischsprachige Single-Item Skala zur Vorhersage von Rauchstoppversuchen. Ziel dieser Arbeit war die externe Validierung der deutschsprachigen Version der MTSS (Motivation zum Rauchstopp Skala, MRS) an einer Stichprobe von aktuell Tabakrauchenden in Deutschland. Methodik: Datenbasis war die Deutsche Befragung zum Rauchverhalten (DEBRA), eine deutschlandweite, persönlich-mündliche Haushaltsbefragung von Personen ab 14 Jahren mit telefonischer Nachbefragung nach 6 Monaten. Analysiert wurden Daten aus den ersten 18 Wellen (Juni 2016–Mai 2019) von 767 aktuell Tabakrauchenden. Die MRS (Stufe 1–7 = keine bis höchste Motivation) wurde bei der Erstbefragung eingesetzt. Bei der Nachbefragung wurde die Anzahl der Rauchstoppversuche seit Erstbefragung erfasst. Logistische Regression wurde durchgeführt und die diskriminative Genauigkeit der MRS mittels Area Under the Receiver Operating Characteristic Curve (ROC-AUC) berechnet. Ergebnisse: Bei Erstbefragung waren 61,1 % ( n = 469; 95 % Konfidenzintervall (KI) = 57.7–64.6) der 767 Rauchenden nicht zum Rauchstopp motiviert (MRS-Stufe 1–2). Insgesamt unternahmen 185 der 767 Rauchenden (24,1 %; 95 % KI = 21.1–27.1) zwischen der Erst- und Nachbefragung mindestens einen Rauchstoppversuch. Mit steigender Motivationsstufe auf der MRS nahm die Wahrscheinlichkeit für einen Rauchstoppversuch zu: Odds Ratio = 1.37, 95 % KI = 1.25–1.51, bei einer diskriminativen Genauigkeit von ROC-AUC = 0.64. Schlussfolgerung: Die MRS ist ein kurzes und valides Messinstrument zur Erfassung der Rauchstoppmotivation im deutschen Sprachraum.
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Affiliation(s)
- Yekaterina Pashutina
- Institut für Allgemeinmedizin (ifam), Schwerpunkt Suchtforschung und klinische Epidemiologie, Centre for Health and Society (chs), Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
| | - Sabrina Kastaun
- Institut für Allgemeinmedizin (ifam), Schwerpunkt Suchtforschung und klinische Epidemiologie, Centre for Health and Society (chs), Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
| | | | - Lion Shahab
- Department of Behavioural Science and Health, University College London, UK
| | - Daniel Kotz
- Institut für Allgemeinmedizin (ifam), Schwerpunkt Suchtforschung und klinische Epidemiologie, Centre for Health and Society (chs), Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
- Department of Behavioural Science and Health, University College London, UK
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26
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Kastaun S, Leve V, Hildebrandt J, Funke C, Klosterhalfen S, Lubisch D, Reddemann O, McRobbie H, Raupach T, West R, Wilm S, Viechtbauer W, Kotz D. Training general practitioners in the ABC versus 5As method of delivering stop-smoking advice: a pragmatic, two-arm cluster randomised controlled trial. ERJ Open Res 2021; 7:00621-2020. [PMID: 34322552 PMCID: PMC8311138 DOI: 10.1183/23120541.00621-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/10/2020] [Indexed: 11/05/2022] Open
Abstract
This study assessed the effectiveness of a 3.5-h training session for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice - ABC versus 5As - on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations. A pragmatic, two-arm cluster randomised controlled trial was carried out including a pre-/post-design for the analyses of the primary outcome in 52 GP practices in Germany. Practices were randomised (1:1) to receive a 3.5-h training session (ABC or 5As). In total, 1937 tobacco-smoking patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training, were included. The primary outcome was patient-reported rates of GP-delivered stop-smoking advice prior to and following the training, irrespective of the training method. Secondary outcomes were patient-reported receipt of recommendation/prescription of behavioural therapy, pharmacotherapy or combination therapy for smoking cessation, and the effectiveness of ABC versus 5As regarding all outcomes. GP-delivered stop-smoking advice increased from 13.1% (n=136 out of 1039) to 33.1% (n=297 out of 898) following the training (adjusted odds ratio (aOR) 3.25, 95% CI 2.34-4.51). Recommendation/prescription rates of evidence-based treatments were low (<2%) pre-training, but had all increased after training (e.g. behavioural support: aOR 7.15, 95% CI 4.02-12.74). Delivery of stop-smoking advice increased non-significantly (p=0.08) stronger in the ABC versus 5As group (aOR 1.71, 95% CI 0.94-3.12). A single training session in stop-smoking advice was associated with a three-fold increase in rates of advice giving and a seven-fold increase in offer of support. The ABC method may lead to higher rates of GP-delivered advice during routine consultations.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Verena Leve
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephanie Klosterhalfen
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Olaf Reddemann
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hayden McRobbie
- University of New South Wales, National Drug and Alcohol Research Centre, Randwick, Australia.,Lakes District Health Board, Rotorua, New Zealand
| | - Tobias Raupach
- Dept of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert West
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Stefan Wilm
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Dept of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Daniel Kotz
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.,Dept of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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27
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Kastaun S, Viechtbauer W, Leve V, Hildebrandt J, Funke C, Klosterhalfen S, Lubisch D, Reddemann O, Raupach T, Wilm S, Kotz D. Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice - ABC versus 5As. ERJ Open Res 2021; 7:00224-2021. [PMID: 34322551 PMCID: PMC8311137 DOI: 10.1183/23120541.00224-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/23/2021] [Indexed: 11/14/2022] Open
Abstract
We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC versus 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12 and 26 following GP consultation. Follow-up data were collected in 1937 smoking patients - independently of the receipt of GP advice - recruited before or after the training of 69 GPs. At week 26, ∼70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed. Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26. We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients' loss to follow-up or to contextual factors, e.g. access to free evidence-based cessation treatment, which can hamper the transfer of GPs' advice into patients' behaviour change.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Dept of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Verena Leve
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephanie Klosterhalfen
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Olaf Reddemann
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tobias Raupach
- Institute for Medical Education, University Hospital Bonn, Bonn, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Stefan Wilm
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Dept of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Kotz D, Kastaun S. Do people know that cigarette filters are mainly composed of synthetic material? A representative survey of the German population (the DEBRA study). Tob Control 2021; 30:345-347. [PMID: 32300028 DOI: 10.1136/tobaccocontrol-2019-055558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Most cigarettes are smoked with filters made of synthetic plastic, which are not fully biodegradable. Littering used cigarette filters (butts) represents a substantial environmental hazard. It is unclear if people, in particular smokers, know that filters consist of synthetic plastic. METHODS We used data collected in August/September 2019 from a representative household survey of the German population aged 14 years and over (wave 20 of the German Study on Tobacco Use; DEBRA). Respondents were asked: 'The majority of smokers use cigarettes with a filter. What do you think these filters are composed of? (1) Mainly of natural material; (2) Mainly of synthetic material; (3) I don't know what cigarette filters are composed of.' Response option 2 indicated correct knowledge. RESULTS A total of 2066 people were interviewed, including 625 current smokers. The weighted response rate to option 2 ('mainly of synthetic material') was 34.8% (95%CI 32.7 to 36.9) in the total sample and 42.7% (95%CI=38.7 to 46.8) in the subgroup of current smokers. In the latter subgroup, smokers with low compared with those with high educational level were less likely to know that filters are mainly composed of synthetic material (OR=0.62, 95%CI=0.39 to 0.99). CONCLUSIONS The majority of smokers in Germany does not know that cigarette filters are mainly composed of synthetic material. Our findings suggest a need for promoting awareness as well as knowledge of environmental health hazards of cigarette filters to the general population, and specifically to current smokers. TRIAL REGISTRATION NUMBER DRKS00011322 and DRKS00017157.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Sabrina Kastaun
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Boeckmann M, Dogar O, Saeed S, Majidulla A, Swami S, Khan A, Siddiqi K, Kotz D. Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: Contextual differences and opportunities. Tob Induc Dis 2021; 19:24. [PMID: 33841063 PMCID: PMC8029647 DOI: 10.18332/tid/133054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Tobacco smoking among tuberculosis (TB) patients leads to poorer treatment outcomes. Smoking cessation support should be integrated into routine TB care. We measured healthcare providers' fidelity to a smoking cessation intervention integrated into routine TB care, in Bangladesh and Pakistan. We aimed to understand the role of providers and settings in the implementation of behavior support (BS) messages for TB and smoking cessation. METHODS The integrated BS intervention was implemented in TB clinics (24 public and 1 private). Cross-sectional data were collected on the fidelity of delivery of the BS intervention using a predefined fidelity index based on an existing validated method of measuring intervention fidelity. Audio-recordings of patient-provider BS sessions were coded using the fidelity index. Intervention fidelity was presented as the proportion of sessions that implemented BS messages. RESULTS A total of 96 sessions were conducted, 37 in Bangladesh and 59 in Pakistan. In public settings, TB medication advice was offered in 91.9% (95% CI: 78.7- 97.2) of sessions in Bangladesh, and in 75.5% (95% CI: 62.4-85.1) of sessions in Pakistan; whilst it was offered in 83.3% (95% CI: 43.7-97.0) of sessions in the private setting in Pakistan. Patients' smoking status was assessed in 70.3% (95% CI: 54.2-82.5) of sessions in Bangladesh, and in 34.0% (95% CI: 22.7-47.4) of sessions in the public setting and in 66.7% (95% CI: 30.0-90.3) of sessions in the private setting in Pakistan. A quit date was set in 32.4% (95% CI: 19.6-48.5) of all sessions in Bangladesh, and in 33.3% (95% CI: 9.6-70.0) of all sessions in the public setting in Pakistan. CONCLUSIONS Fidelity to the intended delivery of the intervention was found to be high for TB-related messages but not for smoking cessation messages. Clinic contexts may play a mediating role in health workers' opportunities to deliver the intervention as planned. TRIAL REGISTRATION International Standard Randomized Clinical Trial Number (ISRCTN43811467). Registered 23 March 2016, https://doi.org/10.1186/ISRCTN43811467.
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Affiliation(s)
- Melanie Boeckmann
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of Health Sciences, University of York, York, United Kingdom
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Shilpi Swami
- Department of Health Sciences, University of York, York, United Kingdom
- Evidera, London, United Kingdom
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Batra A, Kiefer F, Andreas S, Gohlke H, Klein M, Kotz D, Mons U, Mühlig S, Pötschke-Langer M, Preuss UW, Rüther T, Rustler C, Thomasius R, Ulbricht S, Petersen KU. S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“. SUCHT 2021. [DOI: 10.1024/0939-5911/a000703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Einleitung: Neben der Prävention des Tabakkonsums bleibt die Herstellung und Sicherung eines hohen Niveaus der Behandlungsqualität bei schädlichem Gebrauch und Abhängigkeit von Tabakprodukten eine wichtige gesundheitsbezogene Aufgabe in Deutschland. Eine regelmäßige Aktualisierung der AWMF-S3-Leitlinie „Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung“ schafft eine nachhaltige und seriöse Quelle für den Wissensstand zur Tabakentwöhnung. Methoden: Unter Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und Suchttherapie e. V. (DG-Sucht) wurde die Tabakleitlinie 2019–2020 von insgesamt 63 am Entstehungsprozess des Textes beteiligten Personen in 11 Arbeitsgruppen überarbeitet. Der Einfluss von Interessenkonflikten (COI) konnte durch ein sorgfältiges COI-Management minimiert werden. Über die 80 Leitlinienempfehlungen diskutierten Delegierte aus 50 Fachgesellschaften und stimmten in einem moderierten Konsensprozess online ab. Ergebnisse: Neben Empfehlungen zum Screening und zur Diagnostik nimmt die Leitlinie positiv Stellung zur Nutzung niederschwelliger Beratungs- und Unterstützungsangebote. Falls aufgrund des Schweregrads der tabakbezogenen Störung Kurzberatung, Telefonberatung oder Internet- bzw. Smartphone-gestützte Verfahren nicht hinreichend wirksam sind, ist eine verhaltenstherapeutisch basierte Einzel- oder Gruppenbehandlung, ggf. in Verbindung mit Medikamenten, indiziert. Wenn eine Nikotinersatztherapie nicht wirksam sein sollte, soll Vareniclin oder Bupropion angeboten werden. Alternative Strategien mit niedrigerem Empfehlungsgrad sind Hypnotherapie, achtsamkeitsbasierte Verfahren, oder auch Cytisin. Bei Jugendlichen und Schwangeren ist das Angebot von Medikamenten auf genau spezifizierte Ausnahmen und Nikotinersatz zu beschränken. Die mittlere Zustimmung für die Empfehlungen der Leitlinie erreichte 98 %. Eine Gesamtübersicht über die Behandlungsempfehlungen der Tabakleitlinie geben drei klinische Algorithmen.
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Affiliation(s)
- Anil Batra
- Sektion Suchtmedizin des Universitätsklinikums Tübingen, Tübingen
| | - Falk Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim/ Lehrstuhl für Suchtforschung, Ruprecht-Karls-Universität Heidelberg
| | - Stefan Andreas
- Fachklinik für Lungenerkrankungen Philippsstiftung e.V, Immenhausen, Universitätsmedizin Göttingen, Deutsches Zentrum für Lungenforschung
| | - Helmut Gohlke
- Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V
| | - Marianne Klein
- Zentrum für Psychiatrie, Klinikum Schloss Winnenden, Winnenden
| | - Daniel Kotz
- Institut für Allgemeinmedizin (ifam), Schwerpunkt Suchtforschung und klinische Epidemiologie, Centre for Health and Society (chs), Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
| | - Ute Mons
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln
| | - Stephan Mühlig
- Klinische Psychologie und Psychotherapie TU Chemnitz, Chemnitz
| | | | | | - Tobias Rüther
- Spezialambulanz für Tabakabhängigkeit, LMU Klinikum München, Klinik für Psychiatrie und Psychotherapie
| | | | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf
| | - Sabina Ulbricht
- Universitätsmedizin Greifswald, Institut für Community Medicine, Abteilung Präventionsforschung und Sozialmedizin, Greifswald
| | - Kay Uwe Petersen
- Sektion Suchtmedizin des Universitätsklinikums Tübingen, Tübingen
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Schneider S, Lunau T, Eikemo TA, Kotz D, Bambra C, Kuntz B, Dragano N. Better air but not for all? Changes in second-hand smoke exposure at workplaces in 29 European countries over 10 years. Eur J Public Health 2021; 31:708-714. [PMID: 33760033 DOI: 10.1093/eurpub/ckab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As the largest study of its kind to date, this article aims to describe the scope, trends over time, socio-demographic risk groups and the association with different progressive regulations relating to workplace second-hand smoke (SHS) exposure in 29 European countries during a period of high regulatory action. METHODS Three waves of the European Working Conditions Surveys (2005, 2010 and 2015) were evaluated, including a total of 95 718 workers. The samples are representative for all employed residents of the 29 countries included. All interviews were conducted face-to-face at respondents' homes (computer-assisted personal interviews). SHS exposure among the overall working population of 29 countries-including smokers-was examined. Workplace regimes were grouped corresponding to the sub-scale 'workplace' as used in the Tobacco Control Scale. RESULTS Between 2005 and 2015, SHS exposure in the European countries declined from around 19.0% (95% CI 16.1-22.0) to 9.9% (8.3-11.5). High SHS-exposure was reported by workers with the lowest level of education [11.5% (9.7-13.2)], among high-skilled manual labourers [14.3% (12.1-16.4)] and among those without a standard employment contract [11.2% (9.3-13.1)]. The highest exposure was reported by workers in the food service industry [19.7% (16.8-22.6)]. Countries with less workplace-related smoking prevention regulations were found to have the highest overall levels of exposure. CONCLUSION This multinational series of cross-sectional surveys on the trends in passive smoking in the workplace have shown that countries with more comprehensive workplace smoking bans overall report lower levels of SHS exposure among their work force as compared with slow progressing countries.
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Affiliation(s)
- Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thorsten Lunau
- Institute of Medical Sociology, Medical Faculty, Centre for Health and Society, University of Düsseldorf, Düsseldorf, Germany
| | - Terje A Eikemo
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Clare Bambra
- Institute of Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Benjamin Kuntz
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Medical Faculty, Centre for Health and Society, University of Düsseldorf, Düsseldorf, Germany
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Kastaun S, Brown J, Kotz D. Association between income and education with quit attempts, use of cessation aids, and short-term success in tobacco smokers: A social gradient analysis from a population-based cross-sectional household survey in Germany (DEBRA study). Addict Behav 2020; 111:106553. [PMID: 32717499 DOI: 10.1016/j.addbeh.2020.106553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Smoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success. METHODS We analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) - a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders. RESULTS Of all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77-0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73-0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08-1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success. CONCLUSIONS In the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany.
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany; Department of Behavioural Science and Health, University College London, London, UK.
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Dogar O, Keding A, Gabe R, Marshall AM, Huque R, Barua D, Fatima R, Khan A, Zahid R, Mansoor S, Kotz D, Boeckmann M, Elsey H, Kralikova E, Parrott S, Li J, Readshaw A, Sheikh A, Siddiqi K. Cytisine for smoking cessation in patients with tuberculosis: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. The Lancet Global Health 2020; 8:e1408-e1417. [DOI: 10.1016/s2214-109x(20)30312-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
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Klosterhalfen S, Kotz D, Boeckmann M, Kastaun S. Waterpipe use and associated consumer characteristics in the German population: Data from a national representative survey (DEBRA study). Addict Behav 2020; 110:106542. [PMID: 32688228 DOI: 10.1016/j.addbeh.2020.106542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Waterpipes (WP) have a long tradition in certain regions of the world, and their use has been increasing worldwide. Current data on the use of WP in different subgroups of the German population are missing. OBJECTIVE To estimate the current prevalence of WP use and associated socio-demographic characteristics, tobacco smoking status and e-cigarette usage behaviour in the German population aged ≥14 years; to describe the frequency of use and starting age in current WP users. METHODS We analysed data from waves 13-18 (June/July 2018-April/May 2019; N = 12,220) of the German Study on Tobacco Use (DEBRA) - a representative, computer-assisted national household survey. Associations of socio-demographic characteristics, tobacco smoking status and e-cigarette usage behaviour were assessed with multivariable logistic regression models. RESULTS A total of 1.8% (n = 217) (95% confidence interval (CI) = 1.5%-2.0%) of the population were current WP users, 13% (n = 1618) (95% CI = 12.3%-13.5%) were ever users. Adjusted multivariable logistic models showed that people with migration background, male sex, younger age, and those who were smokers or used e-cigarettes, were more likely to use a WP. Among current WP users, 15.2% (n = 33) (95% CI = 10.7%-20.7%) had started to use WP at the age of 26 or older, and 23.0% (n = 50) (95%CI = 17.6%-29.2%) had used WP at least once a week or almost daily in the last month. CONCLUSIONS In Germany, the use of WP is popular and most strongly associated with migration background and use of tobacco and e-cigarettes. These aspects should be considered when designing future target group-specific prevention strategies.
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Klosterhalfen S, Kotz D, Kuntz B, Zeiher J, Starker A. Waterpipe Use among Adolescents in Germany: Prevalence, Associated Consumer Characteristics, and Trends (German Health Interview and Examination Survey for Children and Adolescents, KiGGS). Int J Environ Res Public Health 2020; 17:E7740. [PMID: 33105905 PMCID: PMC7660200 DOI: 10.3390/ijerph17217740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Waterpipe (WP) use is popular among youth worldwide, but epidemiological data from Germany are scarce. We aimed to describe prevalence rates of WP use (current, last 12 months, ever) and analysed correlates and trends among 11- to 17-year-olds in Germany. Analyses were based on data from the "German Health Interview and Examination Survey for Children and Adolescents" study during 2014-2017 (n = 6599). Changes in WP use prevalence compared with 2009-2012 were used to describe trends. Associations with sociodemographic characteristics and cigarette smoking were assessed with multivariable logistic regression models. Prevalence of current WP use among adolescents was 8.5% (95% confidence interval (CI) = 7.5-9.6), use in the last 12 months was 19.7% (95% CI = 18.3-21.2), and ever use was 25.8% (95% CI = 24.2-27.5). High prevalence rates were particularly found among 16-17-year-olds. During 2009-2012, these prevalence rates were 9.0%, 18.5%, and 26.1%, respectively. WP use was associated with older age, male sex, migration background, lower educational level, and current smoking status. Among current WP users, 66.2% (95% CI = 60.0-71.9) identified themselves as non-smokers, and 38.1% (95% CI = 32.5-44.0) had used WP ≥ three times in the last month. WP consumption is popular among German youth, and prevalence rates have not changed over time. Specific prevention strategies to reduce harmful WP consumption among youth should be implemented.
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Affiliation(s)
- Stephanie Klosterhalfen
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany; (S.K.); (D.K.)
| | - Daniel Kotz
- Institute of General Practice, Centre for Health and Society, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, 40225 Duesseldorf, Germany; (S.K.); (D.K.)
| | - Benjamin Kuntz
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany; (B.K.); (J.Z.)
| | - Johannes Zeiher
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany; (B.K.); (J.Z.)
| | - Anne Starker
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62-66, 12101 Berlin, Germany; (B.K.); (J.Z.)
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Kotz D, Batra A, Kastaun S. In Reply. Dtsch Arztebl Int 2020; 117:299. [PMID: 32530416 PMCID: PMC7297067 DOI: 10.3238/arztebl.2020.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Daniel Kotz
- *Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anil Batra
- **Sektion für Suchtmedizin und Suchtforschung, Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen
| | - Sabrina Kastaun
- ***Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
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Kotz D, Batra A, Kastaun S. Smoking Cessation Attempts and Common Strategies Employed. Dtsch Arztebl Int 2020; 117:7-13. [PMID: 32008606 DOI: 10.3238/arztebl.2020.0007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/11/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical guidelines on smoking cessation contain recommendations for various evidence-based methods. The goal of this study was to provide a represen- tative analysis for Germany of the percentage of smokers who try to quit smoking at least once per year, the use of evidence-based methods and other methods of smoking cessation, and potential associations of the use of such methods with the degree of tobacco dependence and with socioeconomic features. METHODS Data from 19 waves of the German Smoking Behavior Questionnaire (Deutsche Befragung zum Rauchverhalten, DEBRA), from the time period June/July 2016 to June/July 2019, were analyzed. Current smokers and recent ex-smokers (<12 months without smoking) were asked about their smoking cessation attempts in the past year and the methods they used during the last attempt (naming more than one method was permitted). The degree of tobacco dependence in current smokers was assessed with the Heaviness of Smoking Index. RESULTS Out of 11 109 current smokers and 407 recent ex-smokers, 19.9% (95% confidence interval: [19.1; 20.6]) had tried to quit smoking at least once in the preceding year. 13.0% of them [11.6; 14.5] had used at least one evidence-based method during their last attempt. The stronger the tobacco dependence, the more likely the use of an evidence-based method (odds ratio [OR] = 1.27 [1.16; 1.40]). Pharmacotherapy (nicotine replacement therapy, medication) was used more com- monly by persons with higher incomes (OR = 1.44 per 1000 euro/month [1.28; 1.62]). Electronic cigarettes were the most commonly used single type of smoking cessation support (10.2 % [9.0; 11.6]). CONCLUSION In Germany, only one in five smokers tries to quit smoking at least once per year. Such attempts are only rarely supported by evidence-based methods and are thus likely to fail. The high cost of treatment must be borne by the individual and thus fall disproportionately on poorer smokers. It follows that there is an urgent need for vered by health insurance pro- viders, in order to give all smokers fair and equal access to the medical care they need.
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Affiliation(s)
- Daniel Kotz
- Institute of General Medicine, Addiction Research and Clinical Epidemiology Unit, Medical Faculty ofthe Heinrich-Heine University Düsseldorf; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care,University College London, London, UK; Section for Addiction Medicine and Addiction Research, Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen
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Kastaun S, Hildebrandt J, Kotz D. Electronic Cigarettes to Vaporize Cannabis: Prevalence of Use and Associated Factors among Current Electronic Cigarette Users in Germany (DEBRA Study). Subst Use Misuse 2020; 55:1106-1112. [PMID: 32091941 DOI: 10.1080/10826084.2020.1729197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: In Germany, cannabis is the most widely used illicit drug, and inhalation together with tobacco is most popular. However, it has been described that electronic cigarettes (ECs) are being used to vaporize cannabis (extract). No current data on EC cannabis use in the German population are yet available. Objectives: This study examines the prevalence of EC cannabis consumption for mood changing effects among current EC users, and associated consumer characteristics in Germany. Methods: We used data from the German Study on Tobacco Use (period: 8/2016-01/2019, DEBRA, www.debra-study.info), a nationally representative household survey. EC cannabis use for mood-changing effects was assessed in 504 current EC users (aged ≥ 18 years) of the total sample (N = 32,678). Ever use was defined by: (1) occasional or regular use, or (2) experimental consumption. Associations with socio-demographic consumer characteristics and tobacco smoking were analyzed using multivariable regression analyses. Results: Amongst current EC users, 7.2% had ever vaporized cannabis: 2.3% (95%CI = 1.2-3.9) reported occasional or regular use (1) and 4.8% (95%CI = 3.2-7.1) reported experimental use (2). Age was associated with ever EC cannabis use: highest prevalence rates were found among 18-24-year-olds: 6.5% (95%CI = 2.3-13.1) (1) and 8.0% (95%CI = 3.7-15.8) (2), respectively. The majority (90.2%) of ever EC cannabis users were current tobacco smokers. Conclusions: One in 14 current EC users in Germany has ever vaporized cannabis for mood-changing reasons, and almost all EC cannabis consumers also smoke tobacco. Highest usage rates can be observed among young adults. Hence, trends of EC drug misuse need to be monitored consequently, particularly in young people.
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Affiliation(s)
- Sabrina Kastaun
- Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Düsseldorf, Germany
| | - Daniel Kotz
- Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Düsseldorf, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Kastaun S, Kotz D. [Should advertising for electronic cigarettes and heated tobacco products be banned in Germany? Results of a representative survey (DEBRA study)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1391-1396. [PMID: 31523755 DOI: 10.1007/s00103-019-03017-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The German federal parliament is discussing the implementation of a comprehensive tobacco advertising ban and whether that ban should include alternative nicotine delivery systems (ANDSs), such as e‑cigarettes and tobacco heaters. It would be important to know which outcome the general population, and in particular the users of tobacco/ANDSs, would prefer. OBJECTIVE Assessing public support for a comprehensive advertising ban on ANDSs in the German population, and particularly in tobacco and ANDSs users. MATERIAL AND METHODS The German Study on Tobacco Use ("Deutsche Befragung zum Rauchverhalten", DEBRA) is an ongoing, representative household survey of persons aged 14 years and older. Data from the June/July 2019 survey wave (n = 2019) were analysed. Participants were interviewed regarding their tobacco smoking status and ANDS use, sociodemographic factors, and their support of an advertising ban on ANDSs. Prevalence rates and associations (odds ratio, OR) between support and sociodemographic factors or use of tobacco/ANDSs are reported. RESULTS Of the population, 57.0% (95% confidence interval (95%CI) = 54.7-59.1%) support a ban on ANDS advertising; 11.1% (95%CI = 9.8-12.6%) reject it. There is support for the ban from 46.0% (95%CI = 42.2-49.9%) of current tobacco smokers and 42.7% (95%CI = 35.9-49.6%) of ANDS users. Ex-smokers show the highest rates of support (64.8%, 95%CI = 58.9-70.3%). Acceptance among never- and ex-smokers is higher than among current smokers (adjusted OR 2.06, 95%CI = 1.64-2.59 and OR 1.65, 95%CI = 1.23-2.21). CONCLUSIONS The majority of the German population supports a comprehensive advertising ban on ANDSs. Tobacco smokers and ANDS users are also more in favour of than against such a ban. Thus, only little resistance will be expected within the population if a comprehensive tobacco advertising ban, as currently discussed in parliament, includes e‑cigarettes and heated tobacco products.
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Affiliation(s)
- Sabrina Kastaun
- Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Postfach 101007, 40001, Düsseldorf, Deutschland.
| | - Daniel Kotz
- Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Postfach 101007, 40001, Düsseldorf, Deutschland
- Department of Behavioural Science and Health, University College London, London, Großbritannien
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Jackson SE, Kotz D, West R, Brown J. Reply to 'Smoke free, but dependent on nicotine' (Karam-Hage 2019). Addiction 2019; 114:1887-1888. [PMID: 31321828 DOI: 10.1111/add.14715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Daniel Kotz
- Department of Behavioural Science and Health, University College London, London, UK
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Kotz D, Viechtbauer W, Spigt M, Crutzen R. Submitting the original participant information letter as supplementary material of a trial report is useful and can be easily implemented. J Clin Epidemiol 2019; 117:151-153. [PMID: 31542506 DOI: 10.1016/j.jclinepi.2019.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany; Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands.
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University
| | - Mark Spigt
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
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Boeckmann M, Warsi S, Noor M, Dogar O, Mustagfira EH, Firoze F, Zahid R, Readshaw A, Siddiqi K, Kotz D. Health worker and patient views on implementation of smoking cessation in routine tuberculosis care. NPJ Prim Care Respir Med 2019; 29:34. [PMID: 31481678 PMCID: PMC6722140 DOI: 10.1038/s41533-019-0146-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
Smoking worsens tuberculosis (TB) outcomes. Persons with TB who smoke can benefit from smoking cessation. We report findings of a multi-country qualitative process evaluation assessing barriers and facilitators to implementation of smoking cessation behaviour support in TB clinics in Bangladesh and Pakistan. We conducted semi-structured qualitative interviews at five case study clinics with 35 patients and 8 health workers over a period of 11 months (2017-2018) at different time points during the intervention implementation phase. Interviews were conducted by trained researchers in the native languages, audio-recorded, transcribed into English and analysed using a combined deductive-inductive approach guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. All patients report willingness to quit smoking and recent quit attempts. Individuals' main motivations to quit are their health and the need to financially provide for a family. Behavioural regulation such as avoiding exposure to cigarettes and social influences from friends, family and colleagues are main themes of the interviews. Most male patients do not feel shy admitting to smoking, for the sole female patient interviewee stigma was an issue. Health workers report structural characteristics such as high workload and limited time per patient as primary barriers to offering behavioural support. Self-efficacy to discuss tobacco use with women varies by health worker. Systemic barriers to implementation such as staff workload and socio-cultural barriers to cessation like gender relations, stigma or social influences should be dealt with creatively to optimize the behaviour support for sustainability and scale-up.
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Affiliation(s)
- Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Werdener Str. 4, 40227, Duesseldorf, Germany. .,Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. .,Department of Environment and Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | | | - Maryam Noor
- The Initiative, Orange Grove Farm, Main Korung Road, Banigala, Islamabad, 44000, Pakistan
| | - Omara Dogar
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | | | - Fariza Firoze
- ARK Foundation, Suite C-3 & C-4, House #06, Road #109, Gulshan-2, Dhaka, 1212, Bangladesh
| | - Raana Zahid
- The Initiative, Orange Grove Farm, Main Korung Road, Banigala, Islamabad, 44000, Pakistan
| | - Anne Readshaw
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Werdener Str. 4, 40227, Duesseldorf, Germany.,Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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Jackson SE, Kotz D, West R, Brown J. Moderators of real-world effectiveness of smoking cessation aids: a population study. Addiction 2019; 114:1627-1638. [PMID: 31117151 PMCID: PMC6684357 DOI: 10.1111/add.14656] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Accepted: 05/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Understanding whether and how far smokers' characteristics influence the effectiveness of treatment may be important for tailoring recommendations on cessation aids to those most likely to help the user achieve abstinence. This study aimed to estimate the effectiveness of commonly used smoking cessation aids and test whether their effectiveness differs according to cigarette addiction, socio-economic status, age or sex. DESIGN Correlational design using cross-sectional survey data collected monthly between 2006 and 2018. SETTING England. PARTICIPANTS A total of 18 929 adults (aged ≥ 16 years, 52.0% female) who had smoked within the previous 12 months and had made at least one quit attempt during that period. MEASUREMENTS The outcome was self-reported abstinence from quit date to survey. Independent variables were self-reported use during the most recent quit attempt of: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, e-cigarettes, face-to-face behavioural support, telephone support, written self-help materials, websites and hypnotherapy. Moderators were cigarette addiction, social grade, age and sex. FINDINGS After adjustment for covariates and use of other cessation aids, users of e-cigarettes [odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.69-2.24] and varenicline (OR = 1.82, 95% CI = 1.51-2.21) had significantly higher odds of reporting abstinence than those who did not report use of these cessation aids. Use of prescription NRT was associated with increased abstinence in older (≥ 45 years) (OR = 1.58, 95% CI = 1.25-2.00) but not younger (< 45 years) smokers (OR = 1.09, 95% CI = 0.85-1.42). Use of websites was associated with increased abstinence in smokers from lower (OR = 2.20, 95% CI = 1.22-3.98) but not higher social grades (OR = 0.74, 95% CI = 0.40-1.38). There was little evidence of benefits of using other cessation aids. CONCLUSIONS Use of e-cigarettes and varenicline are associated with higher abstinence rates following a quit attempt in England. Use of prescription of nicotine replacement therapy is also associated with higher abstinence rates, but only in older smokers, and use of websites only in smokers from lower socio-economic status.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Daniel Kotz
- Department of Behavioural Science and Health, University College London, London, UK
- Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Düsseldorf, Germany
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Kastaun S, Kotz D, Brown J, Shahab L, Boeckmann M. Public attitudes towards healthcare policies promoting tobacco cessation in Germany: results from the representative German study on tobacco use (DEBRA study). BMJ Open 2019; 9:e026245. [PMID: 31462463 PMCID: PMC6720139 DOI: 10.1136/bmjopen-2018-026245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/23/2019] [Accepted: 08/01/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess public acceptance of four possible healthcare policies supporting tobacco dependence treatment in line with the Framework Convention for Tobacco Control, Article 14 recommendations in Germany. DESIGN Cross-sectional household survey. SETTING Data were drawn from the German population and collected through computer-assisted, face-to-face interviews. PARTICIPANTS Representative random sample of 2087 people (>14 years) from the German population. OUTCOME MEASURES Public acceptance was measured regarding (1) treatment cost reimbursement, (2) standard training for health professionals on offering cessation treatment, and making cessation treatment a standard part of care for smokers with (3) physical or (4) mental disorders. Association characteristics with smoking status and socio-economic status (SES) were assessed. RESULTS Support for all policies was high (50%-68%), even among smokers (48%-66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95% CI 1.07 to 1.92; OR 1.43; 95% CI 1.14 to 1.79, respectively). Ex-smokers were also more likely than current smokers to support cessation treatment for smokers with mental disorders (OR 1.39, 95% CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95% CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95% CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues. CONCLUSIONS The majority of the German population supports healthcare policies to improve the availability and affordability of tobacco dependence treatment. Non-smokers were more supportive than current smokers of two of the four policies, but odds of support were only about 40% higher. SES characteristics were not consistently associated with public acceptance. TRIAL REGISTRATION NUMBER DRKS00011322.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
- Department of Environment and Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Kastaun S, Leve V, Hildebrandt J, Funke C, Becker S, Lubisch D, Viechtbauer W, Reddemann O, Hempel L, McRobbie H, Raupach T, West R, Kotz D. Effectiveness of training general practitioners to improve the implementation of brief stop-smoking advice in German primary care: study protocol of a pragmatic, 2-arm cluster randomised controlled trial (the ABCII trial). BMC Fam Pract 2019; 20:107. [PMID: 31351460 PMCID: PMC6660716 DOI: 10.1186/s12875-019-0986-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022]
Abstract
Background The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. Methods A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. Discussion If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be proposed. Trial registration German Clinical Trials Register (DRKS00012786); registered on 22th August 2017, prior to the first patient in. Electronic supplementary material The online version of this article (10.1186/s12875-019-0986-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany.
| | - Verena Leve
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Stephanie Becker
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Olaf Reddemann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Linn Hempel
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,The Dragon Institute for Innovation, Auckland, New Zealand
| | - Tobias Raupach
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert West
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Willemsen MC, Walters BH, Kotz D, Bauld L. Recommendations on how to achieve tobacco-free nations in Europe. Tob Prev Cessat 2019; 5:24. [PMID: 32411887 PMCID: PMC7205141 DOI: 10.18332/tpc/110587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 11/24/2022]
Abstract
European countries vary widely in the development and implementation of effective tobacco-control programs and policies. Why some countries lag behind others is inherently a political matter. National-level policymakers struggle between the need to protect public health and the need to recognize economic and ideological considerations. Within this context, use of scientific evidence plays an important role in the policy making process. Articles 20 and 22 of the World Health Organisation's Framework Convention of Tobacco Control (FCTC) oblige countries to develop and coordinate research on aspects of tobacco control and require of them to facilitate knowledge transfer and capacity building between countries. This paper considers various ways how EU and national policy makers may accomplish this. We conclude that progress in three areas is needed: 1) generation of more scientific evidence relevant for each country; 2) facilitation of policy learning between countries; and 3) building capacity and collaborations between researchers and tobacco-control advocates to bridge the gap from research to policy, especially in countries with weak tobacco-control infrastructures.
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Affiliation(s)
- Marc C Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands.,Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, Netherlands
| | - Bethany Hipple Walters
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, Netherlands
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Linda Bauld
- College of Medicine and Veterinary Medicine, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Kotz D, Viechtbauer W, Spigt M, Crutzen R. Details about informed consent procedures of randomized controlled trials should be reported transparently. J Clin Epidemiol 2019; 109:133-135. [DOI: 10.1016/j.jclinepi.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/21/2019] [Indexed: 11/30/2022]
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Abstract
Zusammenfassung. Zielsetzung: Klinische Leitlinien empfehlen ärztliche Kurzberatung zur Tabakentwöhnung routinemäßig anzubieten. Repräsentative Daten zur Umsetzung in Deutschland und zu Assoziationen mit Soziodemographie und Rauchverhalten von Raucher/innen sollen erhoben werden. Methoden: Die Deutsche Befragung zum Rauchverhalten (DEBRA) erhebt zweimonatlich Daten in repräsentativen Bevölkerungsstichproben (je ~2.000 Personen, ≥14 Jahre) zu Tabak- und E-Zigarettenkonsum. In den ersten fünf Wellen seit Juni 2016 (10.225 Befragte) wurden Raucher/innen zu dem Erhalt von Rauchstoppberatung während des letzten Besuchs bei einer Hausärztin/einem Hausarzt (A) oder einer Ärztin/einem Arzt anderer Fachrichtung (B) befragt. Assoziationen mit Soziodemographie und Rauchverhalten wurden analysiert. Ergebnisse: Nach eigener Aussage von 2.910 Raucher/innen, hatten 72,8 % (95 %KI=71–74 %) eine Ärztin/einen Arzt des Fachgebiets A und/oder B konsultiert. Davon hatten 80,7 % (95 %KI=79–82 %) keine Rauchstoppempfehlung erhalten. 3,6 % (95 %KI=3–5 %) hatten ein evidenzbasiertes Therapieangebot bekommen. Starker Zigarettenkonsum und steigendes Alter waren mit dem Erhalt der Kurzberatung assoziiert (P<0,001), aber Bildung und Einkommen nicht. Es gab kaum Unterschiede zwischen Fachrichtung A und B. Schlussfolgerung: Der Erhalt leitliniengerechter ärztlicher Kurzberatung zur Tabakentwöhnung wird von Raucher/innen in Deutschland selten berichtet. Dringender Handlungsbedarf zur verbesserten Umsetzung der Leitlinienempfehlung besteht.
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Affiliation(s)
- Sabrina Kastaun
- Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
| | - Daniel Kotz
- Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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Kastaun S, Kotz D. It’s not the electronic cigarette, it’s the nicotine causing hemodynamic problems: A commentary on the article by Franzen et al. Vasc Med 2018. [DOI: 10.1177/1358863x18808374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
- Department of Behavioural Science and Health, University College London, London, UK
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Hummel K, Candel MJJM, Nagelhout GE, Brown J, van den Putte B, Kotz D, Willemsen MC, Fong GT, West R, de Vries H. Construct and Predictive Validity of Three Measures of Intention to Quit Smoking: Findings From the International Tobacco Control (ITC) Netherlands Survey. Nicotine Tob Res 2018; 20:1101-1108. [PMID: 28472427 PMCID: PMC6093485 DOI: 10.1093/ntr/ntx092] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/29/2017] [Indexed: 11/13/2022]
Abstract
Introduction The aim of the study was to compare the construct validity and the predictive validity of three instruments to measure intention to quit smoking: a Stages of Change measure, the Motivation To Stop Scale (MTSS), and a Likert scale. We used the Theory of Planned Behavior as theoretical framework. Methods We used data from the International Tobacco Control Netherlands Survey. We included smokers who participated in three consecutive survey waves (n = 980). We measured attitude, subjective norm, and perceived behavioral control in 2012, intention to quit with three instruments in 2013, and having made a quit attempt in the last year in 2014. We conducted Structural Equation Modeling with three models for the instruments of intention separately and with one model that included the three instruments simultaneously. Results All three instruments of intention were significantly and positively related to attitude and perceived behavioral control but none was related to subjective norm. All three instruments were significantly and positively related to making a quit attempt. The relation of the Likert scale with making a quit attempt (β = 0.38) was somewhat stronger than that of the Stages of Change measure (β = 0.35) and the MTSS (β = 0.22). When entering the three instruments together into one model, only the Likert scale was significantly related to making a quit attempt. Conclusions All three instruments showed reasonable construct validity and comparable predictive validity. Under the studied conditions, the Likert scale performed slightly better than the Stages of Change measure and the MTSS. Implications An assessment of the Stages of Change, the Motivation To Stop Scale, and a Likert scale showed comparable predictive and construct validity as measures for intention to quit smoking. All three instruments can be used in future research; however, under the studied theoretical framework, that is, the Theory of Planned Behavior, the Likert scale performed slightly better than the other two instruments.
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Affiliation(s)
- Karin Hummel
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Gera E Nagelhout
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Bas van den Putte
- Department of Communication, University of Amsterdam (ASCoR), Amsterdam, The Netherlands
- Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands
| | - Daniel Kotz
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute of General Practice, Addiction Research and Clinical Epidemiology unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom
| | - Marc C Willemsen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Dutch Alliance for a Smokefree Society, The Hague, The Netherlands
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom
| | - Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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