Did Smoking, Alcohol Consumption, and Physical Activity Change during the COVID-19 Restrictions in Germany in Spring 2020?

Zielsetzung: Im März 2020 wurden in Deutschland flächendeckende Beschränkungen eingeführt, um die Ausbreitung des schweren akuten respiratorischen Syndroms Coronavirus Typ 2 einzudämmen. Es ist unklar, wie sich diese Beschränkungen auf das Gesundheitsverhalten der Menschen auswirkten. Ziel dieser Arbeit war es, rückblickend von den Befragten wahrgenommene Veränderungen in Bezug auf ihr Tabakrauchen, ihren Alkoholkonsum und ihre körperliche Aktivität im Vergleich zu der Zeit vor den Beschränkungen zu untersuchen und Zusammenhänge zwischen möglichen Veränderungen und sozioökonomischen und soziodemografischen Merkmalen zu erforschen. Methodik: Datenbasis war die Deutsche Befragung zum Rauchverhalten (DEBRA), eine repräsentative Querschnittserhebung bei Personen ab 14 Jahren. Analysiert wurden Daten aus 2 Wellen (Juni-August 2020) von 4.078 Teilnehmenden. Zusammenhänge zwischen sozioökonomischen und soziodemografischen Merkmalen und Veränderungen in den einzelnen Gesundheitsverhaltensweisen wurden mithilfe multinomialer logistischer Regressionsanalysen analysiert. Ergebnisse: Veränderungen im Gesundheitsverhalten: Zunahme im Rauchverhalten=24,0 % (95 % Konfidenzintervall (KI)=21,5-26,7), Abnahme=12,2 % (95 %KI=10,4-14,4); Zunahme des Alkoholkonsums=12,9 % (95 %KI=11,7-14,1), Abnahme=19,9 % (95 %KI=18,4-21,3); Zunahme des Bewegungsverhaltens=18,5 % (95 %KI=17,3-19,7), Abnahme=29,4 % (95 %KI=28,0-31,0). Personen mit einem niedrigeren Bildungsniveau und jüngerem Alter berichteten häufiger über eine schädliche Veränderung desGesundheitsverhaltens. Schlussfolgerungen: Die meisten Menschen gaben keine Veränderung ihres Gesundheitsverhalten an. Von den Personen, die ihr Verhalten verändert haben, rauchten relativ mehr Tabak, und tranken weniger Alkohol bzw. bewegten sich weniger. Von diesen Veränderungen waren vor allem Personen mit einem niedrigeren Bildungsniveau und jüngeren Alters betroffen, was bei Präventivmaßnahmen berücksichtig werden sollte.Aims: Nationwide restrictions were implemented in Germany in March 2020 to reduce the spread of the severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2). It is not yet precisely known how these restrictions affected peoples’ health behaviours in Germany. Objectives were to 1) retrospectively examine changes in self-reported health behaviours (tobacco smoking, alcohol consumption, and physical activity) in response to these restrictions; and 2) to explore associations among health behaviour changes as well as links to socioeconomic and sociodemographic characteristics. Methodology: We used data from two waves (June-August 2020) of the German Study on Tobacco Use (DEBRA): a cross-sectional, representative survey with people aged ≥14 years (n=4078). Associations between socioeconomic and sociodemographic characteristics and health behaviour changes were analysed using multinomial logistic regression analyses. Results: Changes in health behaviours were as follows: smoking increase=24.0 % (95 % confidence interval (CI)=21.5-26.7), decrease=12.2 % (95 %CI=10.4-14.4); alcohol consumption increase=12.9 % (95 %CI=11.7-14.1), decrease=19.9 % (95 %CI=18.4-21.3); physical activity increase=18.5 % (95 %CI=17.3-19.7); decrease=29.4 % (95 %CI=28.0-31.0). Younger people with a lower level of education were more likely to report a harmful health behaviour change. Conclusions: The majority of people did not change their health behaviours. Among those who did, comparatively more increased their smoking and decreased their alcohol consumption and physical activity. Public health interventions in this context should particularly target younger people and those with a lower level of education

The Effectiveness of E-Cigarettes for Smoking Cessation: A Comparison With Nicotine Replacement Therapy and No Use of Evidence-Based Cessation Aids in the German Population

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 (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

Real-world effectiveness of smoking cessation aids: a population survey in England with 12-month follow-up, 2015-2020

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

Using primary care databases for addiction research:An introduction and overview of strengths and weaknesses

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

Der neo-liberale Elfenbeinturm und die Linke. Zu den Produktionsbedingungen der heterodoxen ÖkonomInnen

(no abstract available

Efficacy of confrontational counselling for smoking cessation in smokers with previously undiagnosed mild to moderate airflow limitation: study protocol of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The use of spirometry for early detection of chronic obstructive pulmonary disease (COPD) is still an issue of debate, particularly because of a lack of convincing evidence that spirometry has an added positive effect on smoking cessation. We hypothesise that early detection of COPD and confrontation with spirometry for smoking cessation may be effective when applying an approach we have termed "confrontational counselling"; a patient-centred approach which involves specific communication skills and elements of cognitive therapy. An important aspect is to confront the smoker with his/her airflow limitation during the counselling sessions. The primary objective of this study is to test the efficacy of confrontational counselling in comparison to regular health education and promotion for smoking cessation delivered by specialized respiratory nurses in current smokers with previously undiagnosed mild to moderate airflow limitation.</p> <p>Methods/Design</p> <p>The study design is a randomized controlled trial comparing confrontational counselling delivered by a respiratory nurse combined with nortriptyline for smoking cessation (experimental group), health education and promotion delivered by a respiratory nurse combined with nortriptyline for smoking cessation (control group 1), and "care as usual" delivered by the GP (control group 2). Early detection of smokers with mild to moderate airflow limitation is achieved by means of a telephone interview in combination with spirometry. Due to a comparable baseline risk of airflow limitation and motivation to quit smoking, and because of the standardization of number, duration, and scheduling of counselling sessions between the experimental group and control group 1, the study enables to assess the "net" effect of confrontational counselling. The study has been ethically approved and registered.</p> <p>Discussion</p> <p>Ethical as well as methodological considerations of the study are discussed in this protocol. A significant and relevant effect of confrontational counselling would provide an argument in favour of early detection of current smokers with airflow limitation. Successful treatment of tobacco dependence in respiratory patients requires repeated intensive interventions. The results of this study may also show that respiratory nurses are able to deliver this treatment and that intensive smoking cessation counselling is more feasible.</p> <p>Trial registration:</p> <p>Netherlands Trial Register (ISRCTN 64481813).</p

Prospective cohort study of the effectiveness of varenicline versus nicotine replacement therapy for smoking cessation in the “real world

Abstract and Introduction Abstract Background It is important to know the comparative effectiveness of varenicline and nicotine replacement therapy (NRT) for smoking cessation when prescribed under routine circumstances and in the general population. Previous estimates relied on cross-sectional data. The objective of the current study was to use longitudinal data to compare the abstinence rates of smokers trying to stop having used varenicline versus NRT on prescription (Rx) when provided with minimal professional support in the general population while adjusting for key potential confounders

Cardiovascular and neuropsychiatric risks of varenicline and bupropion in smokers with chronic obstructive pulmonary disease

BACKGROUND: Varenicline and bupropion are effective smoking cessation treatments, but there are concerns about their safety in smokers with COPD. OBJECTIVE: To investigate whether varenicline and bupropion are associated with serious adverse cardiovascular and neuropsychiatric events in smokers with COPD. METHODS: In a retrospective cohort study, we used data from 14 350 patients with COPD included in the QResearch database, which holds data from 753 National Health Service general practices across England. We identified patients with COPD who received a prescription of nicotine replacement therapy (NRT; N=10 426; reference group), bupropion (N=350) or varenicline (N=3574) in the period between January 2007 and June 2012. Patients were followed up for 6 months to compare incident cardiovascular (ie, ischaemic heart disease, stroke, heart failure, peripheral vascular disease and cardiac arrhythmias) and neuropsychiatric (ie, depression and self-harm) events using Cox proportional hazards models, adjusted for potential confounders. Propensity score analysis was used as an additional approach to account for potential confounding by indication. We also modelled the effects of possible unmeasured confounders. RESULTS: Neither bupropion nor varenicline showed an increased risk of adverse events compared with NRT. Varenicline was associated with a significantly reduced risk of heart failure (HR=0.56, 95% CI 0.34 to 0.92) and depression (HR=0.73, 95% CI 0.61 to 0.86). Similar results were obtained from the propensity score analysis. Modelling of unmeasured confounding provided additional evidence that an increased risk of these adverse events was very unlikely. CONCLUSION: In smokers with COPD, varenicline and bupropion do not appear to be associated with an increased risk of cardiovascular events, depression or self-harm in comparison with NRT