How prevalent is smoking and nicotine dependence in primary care in Germany?
How prevalent is smoking and nicotine dependence in primary care in Germany?
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DOI：
10.1111/j.1360-0443.2004.00887.x
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发表时间：
2004-12-01
期刊：
影响因子：
6
通讯作者：
Wittchen, HU
中科院分区：
文献类型：
--
作者：
Hoch, E;Muehlig, S;Wittchen, HU
目的识别、诊断和减少尼古丁的使用、依赖和相关发病率被认为是初级保健医生的主要责任。然而，人们对德国初级保健问题的严重程度和治疗程度知之甚少。本文报告了(1)未经选择的连续德国初级保健患者中吸烟和尼古丁依赖的终生和时点流行情况；(2)吸烟状况与社会人口学特征的关系；(3)医生的认知率和治疗模式。设计数据来自吸烟和尼古丁依赖意识和筛查研究(SNICAS)，一项具有全国代表性的两阶段流行病点流行研究(阶段I：对全国889名初级保健医生样本的预研究特征；结果(1)在所有初级保健就诊者中，71%的人报告曾经使用过烟草产品(一生中经常吸烟的人占51%，一生中偶尔吸烟的人占21.5%)。吸烟时点患病率(4周)明显较低(偶尔吸烟4.7%，经常吸烟24.9%)。在最年轻的年龄组中，DSM-IV尼古丁依赖率最高(13.9%)。(2)经常吸烟者和依赖吸烟者的比例随着年龄的增长而显著下降，这主要是由于男性戒烟者的数量稳步增加，而老年女性终生吸烟者的数量较少。年轻、失业、单身、离婚、丧偶或与伴侣分居与吸烟或尼古丁依赖率较高有关。(3)在约25%的患者中，初级保健医生未能认识到患者目前的吸烟和/或尼古丁依赖。尼古丁依赖的病例识别率最高(76%)。在已确认的病例中，56%的人曾接受过任何形式的戒烟建议或咨询，但只有12%的人曾参与过任何戒烟计划。结论除了证实初级保健吸烟者的高患病率之外，本文还证明了(1)DSM-IV尼古丁依赖的相当大的点患病率(14%)；(2)值得注意的是，这一比率并不高于社区样本；(3)不同年龄组的患病率差异很大，年轻人的患病率最高(22-31%)，但50岁及以上人群的患病率较低(最大的为16%-0.9%)。这种与年龄的实质性联系似乎主要是由于老年女性的吸烟率较低，以及成功吸烟人数的增加。尤其是男性，从40年后开始戒烟。初级保健从业者对初级保健患者吸烟状况的认知程度中等，过去和现在初级保健干预的频率很低。这些发现要求对阻碍在初级保健环境中实施戒烟干预的障碍进行系统调查。
Aims Identifying, diagnosing and reducing nicotine use, dependence and related morbidity are considered key responsibilities of primary care physicians. Little is known, however, about the magnitude of the problem in primary care and the extent of treatment in Germany. This paper reports on (1) life-time and point prevalences of smoking and nicotine dependence among unselected consecutive German primary care attendees; (2) associations of smoking status with socio-demographic features and (3) rates of doctors' recognition and treatment patterns.Design Data came from the Smoking and Nicotine Dependence Awareness and Screening Study (SNICAS), a nationally representative two-stage epidemiological point prevalence study (stage I: prestudy characterization of a nationwide sample of 889 primary care doctors; stage II: target day assessment of 28 707 unselected consecutive patients).Results (1) Of all primary care attendees, 71%, reported having ever used a tobacco product (life-time regular smokers 51%; life-time occasional smokers 21.5%.). Point prevalence (4 weeks) of smoking was considerably lower (occasional use 4.7%, regular use 24.9%). The rate of DSM-IV nicotine dependence (13.9%) was highest among the youngest age groups. (2) Rates of regular and dependent smokers decreased markedly with age, mainly as a result of the steadily increasing numbers of male ex-smokers and low numbers of older female life-time ever smokers. Young age, unemployment, being single, divorced, widowed or separated from the partner were associated with higher rates of smoking or nicotine dependence. (3) In about 25% of patients, primary care doctors failed to recognize the patient's current smoking and/or nicotine dependence. Case recognition was highest for nicotine dependence (76%). Among recognized cases, 56% had ever received any kind of advice or counselling about quitting; yet only 12% had ever participated in any smoking cessation programme.Conclusions Beyond the confirmation of the well-established finding of a high prevalence of smokers in primary care, this paper demonstrates (1) considerable point prevalence of DSM-IV nicotine dependence (14%); (2) that it is noteworthy, however, that the rates are not higher than those in community samples; and (3) a considerable variation by age group with highest rates among the young (22-31%), but considerably lower rates among subjects aged 50 and above (16% to 0.9% in the oldest). This substantial association with age seems to be due mainly to the low smoking rates in older women and the increasing numbers of successful. particularly male, quitters from 40 years onwards. Recognition of primary care patients' smoking status by primary-care practitioners was moderate, and the frequency of past and current primary care interventions was low. These findings call for systematic investigation into barriers that impede the implementation of smoking cessation interventions in primary care settings.