Broszkiewicz Marzenna, Drygas Wojciech
Uniwersytet Medyczny w Łodzi / Medical University of Lodz, Łódź, Poland (Katedra Medycyny Społecznej i Zapobiegawczej / Department of Social and Preventive Medicine).
Med Pr. 2016;67(1):97-108. doi: 10.13075/mp.5893.00327.
High rates of tobacco use is still observed in working-age population in Poland. The present level of the state tobacco control has been achieved through adopting legal regulations and population-based interventions. In Poland a sufficient contribution of health professionals to the diagnosis of the tobacco-addition syndrome (TAS) and the application of the 5A's (ask, advice, assess, assist, arrange follow-up) brief intervention, has not been confirmed by explicit research results. Systemic solutions of the health care system of the professional control, specialist health care, health professional trainings and reference centres have not as yet been elaborated. The tools for diagnosing tobacco dependence and motivation to quit smoking, developed over 30 years ago and recommended by experts to be used in clinical and research practice, have not met the current addiction criteria. In this paper other tools than those previously recommended - tests developed in the first decade of the 21st century (including Cigarette Dependence Scale and Nicotine Dependence Syndrome Scale), reflecting modern concepts of nicotine dependence are presented. In the literature on the readiness/motivation to change health behaviors, a new approach dominates. The motivational interviewing (MI) by Miller and Rollnick concentrates on a smoking person and his or her internal motivation. Motivational interviewing is recommended by the World Health Organization as a 5R's (relevance, risks, rewards, roadblocks, repetition) brief motivational advice, addressed to tobacco users who are unwilling to make a quit attempt. In Poland new research studies on the implementation of new diagnostic tools and updating of binding guidelines should be undertaken, to strengthen primary health care in treating tobacco dependence, and to incorporate MI and 5R's into trainings in TAS diagnosing and treating addressed to health professionals.
波兰劳动年龄人口的烟草使用率仍然很高。目前的国家烟草控制水平是通过制定法律法规和基于人群的干预措施实现的。在波兰，卫生专业人员对烟草成瘾综合征（TAS）的诊断以及应用5A法（询问、建议、评估、协助、安排随访）简短干预的充分贡献，尚未得到明确的研究结果证实。医疗保健系统在专业控制、专科医疗保健、卫生专业人员培训和参考中心方面的系统性解决方案尚未制定出来。30多年前开发并被专家推荐用于临床和研究实践的烟草依赖诊断工具和戒烟动机工具，不符合当前的成瘾标准。本文介绍了21世纪第一个十年开发的其他工具（包括香烟依赖量表和尼古丁依赖综合征量表），这些工具反映了尼古丁依赖的现代概念，而非先前推荐的工具。在关于改变健康行为的准备度/动机的文献中，一种新方法占主导地位。米勒和罗尔尼克提出的动机性访谈（MI）专注于吸烟者及其内在动机。世界卫生组织推荐将动机性访谈作为一种5R法（相关性、风险、回报、障碍、重复）简短动机建议，针对不愿尝试戒烟的烟草使用者。在波兰，应该开展关于新诊断工具实施和具有约束力指南更新的新研究，以加强初级卫生保健对烟草依赖的治疗，并将动机性访谈和5R法纳入针对卫生专业人员的TAS诊断和治疗培训中。
