Worni-Schudel Inge, Tzalis Vasilis, Jakob Julian, Tal Kali, Gilgien-Dénéréaz Lauriane, Gencer Baris, Matter Christian M, Lüscher Thomas Felix, Windecker Stephan, Mach François, Humair Jean-Paul, Rodondi Nicolas, Nanchen David, Auer Reto
Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
Department of Paediatrics, University Hospital Bern (Inselspital Bern), Switzerland.
Prev Med Rep. 2021 Oct 7;24:101583. doi: 10.1016/j.pmedr.2021.101583. eCollection 2021 Dec.
Guidelines recommend brief smoking cessation interventions for hospitalized smokers reporting low motivation-to-quit. However, an intensive smoking cessation intervention may improve smoking cessation for these smokers. We conducted a secondary analysis of a pre-post interventional study that tested the efficacy of a approach systematically offering intensive smoking cessation intervention to all hospitalized smokers with acute coronary syndrome (ACS) compared to a approach offering it only to smokers willing to quit. We analyzed data from one study site in Switzerland, which recorded motivation-to-quit smoking at study inclusion between 08.2009 and 02.2012. The primary outcome was smoking cessation at 1- and 5-year. We tested for interaction by participant's motivation-to-quit score (low vs. high motivation), and calculated multivariable adjusted risk ratios (RR), stratified by motivation score. We obtained motivation scores for 230 smokers. Follow-up was 94% (217/230) at 1-year and 68% (156/230) at 5-year. Among participants with low motivation to quit, 19% of smokers in the reactive phase had quit at 1 year compared to 50% of smokers in the proactive phase (multivariable adjusted RR = 2.85, 95%CI:0.91-8.91). Among highly motivated smokers, rates did not differ between phases: 48% vs. 49% (multivariable adjusted RR = 1.02, 95%CI:0.75-1.39, p-value for interaction between motivation-to-quit categories = 0.10). At 5-year follow-up, the point estimates were similar. While our study has limitations inherent to the study design and sample size, we found that a proactive approach to offer systematic smoking cessation counseling for smokers with ACS reporting low motivation to quit was associated with higher smoking cessation rates at 1 year.
指南建议，对于报告戒烟意愿较低的住院吸烟者，应采取简短的戒烟干预措施。然而，强化戒烟干预可能会提高这些吸烟者的戒烟成功率。我们对一项干预前后的研究进行了二次分析，该研究测试了一种方法的有效性，即与仅向愿意戒烟的吸烟者提供强化戒烟干预的方法相比，系统地向所有急性冠状动脉综合征（ACS）住院吸烟者提供强化戒烟干预。我们分析了瑞士一个研究地点的数据，该地点记录了2009年8月至2012年2月纳入研究时的戒烟意愿。主要结局是1年和5年时的戒烟情况。我们根据参与者的戒烟意愿得分（低意愿与高意愿）进行交互作用检验，并计算按意愿得分分层的多变量调整风险比（RR）。我们获得了230名吸烟者的意愿得分。1年随访率为94%（217/230），5年随访率为68%（156/230）。在戒烟意愿较低的参与者中，反应性阶段19%的吸烟者在1年时戒烟，而主动阶段为50%（多变量调整RR = 2.85，95%CI：0.91 - 8.91）。在积极性高的吸烟者中，各阶段的戒烟率没有差异：分别为48%和49%（多变量调整RR = 1.02，95%CI：0.75 - 1.39，戒烟意愿类别之间的交互作用p值 = 0.10）。在5年随访时，点估计值相似。虽然我们的研究存在研究设计和样本量固有的局限性，但我们发现，对于报告戒烟意愿较低的ACS吸烟者，采取主动为其提供系统戒烟咨询的方法与1年时较高的戒烟率相关。
