Tabakentwöhnung bei Patienten in einer Rettungsstelle – wiederholte Messungen des Raucherstatus’ bis zu 10 Jahre nach Studienbeginn

Eine spezifische Form der individuellen Tabakkontrolle ist die rettungsstellenbasierte Tabakentwöhnung (RTE). Diese in Deutschland wenig etablierte Form einer qualifizierten Tabakentwöhnung wird in Form eines motivierenden Interviews vor Ort in Kombination mit nachstationären, proaktiven, motivierenden Telefongesprächen angeboten. Vor 10 Jahren untersuchte die randomisierte, kontrollierte ‚Tobacco Control in an Urban Emergency Department’ (TED)-Studie den Effekt einer RTE auf die 12-Monats-Abstinenz. Ziel der hier vorliegenden Arbeit war es die Studienteilnehmer erneut hinsichtlich ihres aktuellen Tabakkonsums zu befragen und den Langzeiteffekt der RTE auf die 7-Tages-Abstinenz nach 10 Jahren sowie auf die wiederholte punktuelle 7-Tages-Abstinenz seit Studienbeginn zu untersuchen. Außerdem wurden Prädiktoren für die 7-Tages-Abstinenz nach 10 Jahren sowie für die wiederholte punktuelle 7-Tages-Abstinenz evaluiert. Ebenso wurde das Tabakkonsummuster der aktuellen Raucher analysiert. Nach Einwilligung der Ethikkommission der Charité und schriftlicher Einwilligung der Studienteilnehmer beantworteten diese einen per Post zugeschickten Fragebogen. Der Langzeiteffekt der RTE auf die 7-Tages-Abstinenz nach 10 Jahren wurde in ‚observed-only’- und ‚all-cases’-Analysen mittels Chi-Quadrat-Test und die Prädiktoren für eine 7-Tages-Abstinenz nach 10 Jahren mittels einer binären logistischen Regressionsanalyse berechnet. Der Langzeiteffekt der RTE auf die wiederholte punktuelle 7-Tages-Abstinenz wurde, ebenso wie die Prädiktoren für die wiederholte punktuelle 7-Tages-Abstinenz, mittels eines Multi-Level-Modells ermittelt. Beide multivariablen Berechnungen wurden für relevante Confounder adjustiert. Das Tabakkonsummuster bei aktuellen Rauchern wurde mittels deskriptiver Statistik analysiert. Von 1012 TED-Studienteilnehmern waren 986 (97,4%) ‚eligible’ für das Langzeit-Follow-up. Von diesen beantworteten 229 (23,2%) den postalischen Fragebogen. Insgesamt 112 Studienteilnehmer (48,9%) waren aktuelle Nichtraucher, 61 in der RTE-Gruppe und 51 in der Kontrollgruppe, p=0,46. Auch in der ‚all-cases’-Analyse war dieser Unterschied nicht statistisch signifikant (p=0,31). Bezogen auf die wiederholte punktuelle 7-Tages-Abstinenz und adjustiert für relevante Confounder, zeigte sich ein signifikanter Effekt der RTE mit einer Odds Ratio von OR=1,30 (95%-KI (1,001-1,686), (p=0,0495). Nur für die wiederholte punktuelle 7-Tages-Abstinenz ergaben sich signifikante Prädiktoren für einen erfolgreichen Rauchstopp: eine hohe Motivation das Rauchverhalten zu ändern (p<0,001) und ein niedriger Grad der Nikotinabhängigkeit (p<0,001). Beim Tabakkonsummuster der aktuellen Raucher zeigte sich, dass unabhängig vom Randomisierungsstatus alle aktuellen Raucher signifikant weniger rauchten und weniger nikotinabhängig waren als zum Zeitpunkt der Basiserhebung der TED-Studie. Eine RTE scheint keinen Einfluss auf eine einmalige Punktabstinenz nach etwa 10 Jahren zu haben, zeigte aber eine schwache Assoziation mit einer wiederholten punktuellen Tabakabstinenz. Weitere Studien mit höheren Follow-up-Raten sind nötig, um diese Ergebnisse zu bestätigen. Die ermittelten Prädiktoren für wiederholte punktuelle Tabakabstinenz zeigen, dass vor allem tabakassoziierte Faktoren relevant für einen erfolgreichen Rauchstopp sind.A distinct form of individual tobacco control intervention is the Emergency Department-Initiated Tobacco Control (ETC). This form of smoking intervention, which is not broadly implemented in Germany, typically consists of an on-site motivational interview and proactive follow-up telephone calls. Ten years ago, the randomized control trial ‘Tobacco Control in an Urban Emergency Department (TED)’ evaluated the effect of ETC on 12-month-abstinence. The aim of this study was to examine the current tobacco consumption among the original participants, determining the long-term effect of ETC on 7-day-abstinence after 10 years, as well as the repeated-point-prevalence 7-day-abstinence since the beginning of the TED-study. In addition, predictors for 7-day-abstinence after 10 years and repeated-point-prevalence 7-day-abstinence were evaluated, along with the tobacco consumption pattern in current smokers. After approval by the Charité ethics committee and written consent from the study participants, data was collected via a mailed questionnaire. The long-term effect of the RTE on 7-day-abstinence after 10 years was calculated in observed-only and all-cases analyses using the Chi-square-test, and the predictors for 7-day-abstinence after 10 years was calculated using binary logistic regression analysis. The long-term effect of RTE on repeated-point-prevalence 7-day-abstinence and the predictors for repeated-point-prevalence 7-day-abstinence were determined using a multi-level model. Both multivariable calculations were adjusted for relevant confounders. The tobacco consumption pattern in current smokers was analyzed using descriptive statistics. Out of 1012 TED study participants, 986 (97.4%) were eligible for the long-term follow-up, and 229 (23.2%) answered the questionnaire. A total of 112 study participants (48.9%) were current non-smokers, 61 in the ETC group and 51 in the control group, p=0.46. No significant differences were observed in the all-cases analysis (p=0.31). However, the effect of ETC on the repeated-point-prevalence 7-day-abstinence was significant when adjusted for confounders, OR=1.30 (95%CI (1.001-1.686); p=0.0495). Only the repeated-point-prevalence 7-day-abstinence showed significant predictors for a successful smoking cessation: a high motivation to change smoking behavior (p<0,001) and a low degree of nicotine dependence (p<0,001). The tobacco consumption pattern of current smokers revealed that all smoked significantly less and were less nicotine-dependent compared to the baseline survey, regardless of randomization status. ETC does not have an influence on single point abstinence after 10 years, but showed a weak association with repeated-point-prevalence abstinence. Further studies with higher follow-up rates are needed to confirm these results. The predicators for repeated-point-prevalence abstinence show that tobacco-associated factors are particularly relevant for a successful smoking cessation

Secondary analysis of an RCT on Emergency Department-Initiated Tobacco Control: Repeatedly assessed point-prevalence abstinence up to 12 months and extension of results through a 10-year follow-up.

INTRODUCTION:Emergency departments (EDs) are opportune places for tobacco control interventions. The 'Tobacco Control in an Urban Emergency Department' (TED) study, ISRCTN41527831, originally evaluated the effect of motivational interviewing on-site plus up to four booster telephone calls on 12-month abstinence. This study's aim was to evaluate the effect of the intervention on 7-day point-prevalence abstinence at 10 years follow-up (primary outcome) as well as on repeated point-prevalence abstinence at 1, 3, 6, 12 months and at 10 years (continual smoking abstinence, secondary outcome). METHODS:At the 10 years follow-up and after informed consent, study participants responded to a mailed questionnaire. The primary outcome was analyzed in observed-only and in all-cases analyses. The secondary outcomes were analyzed using a multiple adjusted GLMM for binary outcomes. RESULTS:Out of 1012 TED-study participants, 986 (97.4%) were alive and 231 (23.4% of 986) responded to the follow-up at 10 years. For observed-only and all-cases analyses, the effect of the baseline intervention on 7-day point-prevalence abstinence at the 10 years follow-up was statistically non-significant. However, when taking into account all repeated measures, the intervention significantly influenced continual abstinence with odds ratio 1.32 (95% CI: 1.01-1.73; p=0.042). Baseline motivation, perceived self-efficacy to stop smoking, and nicotine dependency were independently associated with long-term continual smoking abstinence (all p&lt;0.05). CONCLUSIONS:A conventional analysis failed to confirm a significant effect of the ED-initiated tobacco control intervention on the point-prevalence abstinence at 10 years. Results from a more integrative analysis nonetheless indicated an enduring intervention effect on continual abstinence among smokers first encountered in the emergency department setting 10 years earlier

Secondary analysis of an RCT on Emergency Department-Initiated Tobacco Control: Repeatedly assessed point-prevalence abstinence up to 12 months and extension of results through a 10-year follow-up.

INTRODUCTION:Emergency departments (EDs) are opportune places for tobacco control interventions. The 'Tobacco Control in an Urban Emergency Department' (TED) study, ISRCTN41527831, originally evaluated the effect of motivational interviewing on-site plus up to four booster telephone calls on 12-month abstinence. This study's aim was to evaluate the effect of the intervention on 7-day point-prevalence abstinence at 10 years follow-up (primary outcome) as well as on repeated point-prevalence abstinence at 1, 3, 6, 12 months and at 10 years (continual smoking abstinence, secondary outcome). METHODS:At the 10 years follow-up and after informed consent, study participants responded to a mailed questionnaire. The primary outcome was analyzed in observed-only and in all-cases analyses. The secondary outcomes were analyzed using a multiple adjusted GLMM for binary outcomes. RESULTS:Out of 1012 TED-study participants, 986 (97.4%) were alive and 231 (23.4% of 986) responded to the follow-up at 10 years. For observed-only and all-cases analyses, the effect of the baseline intervention on 7-day point-prevalence abstinence at the 10 years follow-up was statistically non-significant. However, when taking into account all repeated measures, the intervention significantly influenced continual abstinence with odds ratio 1.32 (95% CI: 1.01-1.73; p=0.042). Baseline motivation, perceived self-efficacy to stop smoking, and nicotine dependency were independently associated with long-term continual smoking abstinence (all p&lt;0.05). CONCLUSIONS:A conventional analysis failed to confirm a significant effect of the ED-initiated tobacco control intervention on the point-prevalence abstinence at 10 years. Results from a more integrative analysis nonetheless indicated an enduring intervention effect on continual abstinence among smokers first encountered in the emergency department setting 10 years earlier