题名

國軍醫院免費戒菸門診成效之探討

并列篇名

The effectiveness of a free smoking cessation clinic for military personnel

DOI

10.6288/TJPH201635105064

作者

邱于容(Yu-Lung Chiu);陳劭淇(Shao-Chi Chen);江香慧(Shiang-Huei Jiang);黃姝嘉(Shu-Jia Huang);賴錦皇(Ching-Huang Lai);李善茹(Shan-Ru Li);曾雅梅(Ya-Mei Tzeng);林富宮(Fu-Gong Lin);高森永(Senyong Kao)

关键词

戒菸門診 ; 戒菸 ; 經濟誘因 ; 軍人 ; smoking cessation clinic ; smoking cessation ; financial incentives ; military personnel

期刊名称

台灣公共衛生雜誌

卷期/出版年月

35卷6期(2016 / 12 / 15)

页次

631 - 641

内容语文

繁體中文

中文摘要

目標:因國軍人員吸菸盛行率高於一般成年男性,國防部提供補助以增加戒菸門診的利用。本研究旨在比較軍人使用免費戒菸門診與自行戒菸者之戒菸成效,並找出影響戒菸成功的因素。方法:採觀察性研究,研究對象為吸菸軍人且有戒菸意願者,再依據研究對象的意願分為2組,免費戒菸門診組有222人,自行戒菸組405人。免費戒菸門診組會接受8週的醫師諮詢及藥物治療,而自行戒菸組不接受任何協助。研究工具為自擬結構式問卷,以電話方式追蹤一個月及三個月點戒菸率及連續戒菸率。結果:免費戒菸門診組點戒菸率顯著高於自行戒菸組(一個月23.9% vs. 11.6%, p < 0.001;三個月27.9% vs. 5.7%, p < 0.001)。免費戒菸門診組連續戒菸率顯著高於自行戒菸組(一個月20.3% vs. 5.9%, p < 0.001;三個月27.0% vs. 5.7%, p < 0.001)。三個月戒菸成效影響因素為組別(免費戒菸門診組 vs. 自行戒菸組)、教育程度(大學以上 vs. 高中職)、性別(女 vs. 男)、每月收入(> 5萬vs. < 3萬)、工作性質(非領導職 vs. 領導職)及自覺戒菸成功的信心。結論:軍人使用免費戒菸門診者的戒菸成效高於自行戒菸者,教育程度、性別、每月收入、工作性質及自覺戒菸成功的信心為影響短期戒菸成效的因素,但本研究無法排除使用藥物之影響。

英文摘要

Objectives: The prevalence of smoking by military personnel is higher than that of the general adult male population. The Ministry of National Defense provides a fee to increase the utilization of smoking cessation clinics. The purpose of the study was to compare the effectiveness of a free smoking cessation clinic and a self-help approach in order to determine the factors which influenced successful quitting by military personnel. Methods: This was an observational study in which participants who intended to quit smoking were assigned to two groups (free smoking cessation clinics and self-help) according to their choice. There were 222 and 405 participants in the free smoking cessation clinics and self-help groups, respectively. The free smoking cessation clinics group received counseling from a physician and 8 weeks of pharmacotherapy for smoking cessation. No support for smoking cessation was provided to the self-help group. Abstinence over the previous 7 days and sustained abstinence were evaluated by telephone using a self-administrated questionnaire 1 and 3 months after the first visit. Results: The 7-day point prevalence cessation rates at 1 month (23.9% vs. 11.6%) and at 3 months (27.9% vs. 5.7%) were higher in the free smoking cessation clinics than in the self-help group. The sustained abstinence rate at 1 month (20.3% vs. 5.9%) and at 3 months (27.0% vs. 5.7%) was higher in the free smoking cessation clinics than in the self-help group. Smokers who attended the free smoking cessation clinics and were more successful in sustained abstinence at 3 months, were characterized by higher education level, female gender, higher monthly income, supervisory position, and more confidence in quitting. Conclusions: Smokers who attended a free smoking cessation clinic had higher abstinence rates than those in a self-help group. Education level, gender, monthly income, job category and confidence in quitting smoking were important factors in successfully quitting; however, the influence of pharmacotherapy could not be ruled out.

主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
参考文献
  1. Wang, KY,Yang, CC,Chu, NF,Wu, DM.(2009).Predictors of cigarette smoking behavior among military university students in Taiwan.J Nurs Res,17,161-9.
    連結:
  2. 張文道、王雅瑜、周崇頌(2007)。台灣中部某醫學中心門診戒菸治療病患一年追蹤。台灣家醫誌,17,38-52。
    連結:
  3. 陳宙珍、李蘭、趙坤郁(2008)。門診戒菸治療之成效及其相關因素探討。台灣衛誌,27,44-56。
    連結:
  4. 蔡韻竹、蔡憶文(2015)。我國菸害防制政策制定的政治分析。台灣衛誌,34,447-62。
    連結:
  5. 薛光傑、杜明勳、葛魯蘋、周明岳、陳麗玲(2006)。某醫學中心門診戒菸成效。台灣家醫誌,16,1-12。
    連結:
  6. 簡武雄、丘亮、董道興(2010)。台灣北部某區域教學醫院戒菸門診介入之成效評估。台灣家醫誌,20,181-91。
    連結:
  7. Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Adult Smoking Behavior Survey (ASBS). Available at: http://www.hpa.gov.tw/English/ClassShow.aspx?No=201502020004. Accessed July 10, 2016.
  8. 衛生福利部國民健康署:國人吸菸行為調查。https://olap.hpa.gov.tw/。引用2016/07/10。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Adult smoking behavior survey. Available at: https://olap.hpa.gov.tw/. Accessed July 10, 2016. [In Chinese]
  9. 衛生福利部:實施二代戒菸治療試辦計畫。http://tobacco.hpa.gov.tw/Show.aspx?MenuId=637。引用2016/09/30。Ministry of Health and Welfare, R.O.C. (Taiwan). Implementation of second-generation tobaccocessation program pilot project. Available at: http://tobacco.hpa.gov.tw/Show.aspx?MenuId=637. Accessed September 30, 2016. [In Chinese]
  10. WHO. WHO Framework Convention on Tobacco Control (WHO FCTC). Available at: http://www.who.int/fctc/en/. Accessed November 3, 2016.
  11. Brandon, TH,Herzog, TA,Juliano, LM,Irvin, JE,Lazev, AB,Simmons, VN.(2003).Pretreatment task persistence predicts smoking cessation outcome.J Abnorm Psychol,112,448-56.
  12. Brandon, TH,Zelman, DC,Baker, TB.(1987).Effects of maintenance sessions on smoking relapse: delaying the inevitable?.J Consult Clin Psychol,55,780-2.
  13. Businelle, MS,Kendzor, DE,Kesh, A(2014).Small financial incentives increase smoking cessation in homeless smokers: a pilot study.Addict Behav,39,717-20.
  14. Carpenter, CR.(1998).Promoting tobacco cessation in the military: an example for primary care providers..Mil Med,163,515-8.
  15. Chang, FC,Sung, HY,Zhu, SH,Chiou, ST.(2014).Impact of the 2009 Taiwan Tobacco Hazards Prevention Act on smoking cessation.Addiction,109,140-6.
  16. Chiang, K,Borrelli, B.(2014).Income predictors of smoking cessation among Hispanics.J Health Psychol,19,869-76.
  17. Drobes, DJ,Meier, EA,Tiffany, ST.(1994).Assessment of the effects of urges and negative affect on smokers' coping skills.Behav Res Ther,32,165-74.
  18. Feinberg, JH,Ryan, MA,Johns, M,Marvin, BA,Reading, JE,White, MR.(2015).Smoking cessation and improvement in physical performance among young men.Mil Med,180,343-9.
  19. Fendrich, M,Mackesy-Amiti, ME,Johnson, TP,Hubbell, A,Wislar, JS.(2005).Tobacco-reporting validity in an epidemiological drug-use survey.Addict Behav,30,175-81.
  20. Giles, EL,Robalino, S,McColl, E,Sniehotta, FF,Adams, J.(2014).The effectiveness of financial incentives for health behaviour change: systematic review and metaanalysis.PLoS One,9,e90347.
  21. Halpern, SD,French, B,Small, DS(2015).Randomized trial of four financial-incentive programs for smoking cessation.N Engl J Med,372,2108-17.
  22. Heatherton, TF,Kozlowski, LT,Frecker, RC,Fagerström, KO(1991).The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom tolerance questionnaire.Br J Addict,86,1119-27.
  23. Hecht, SS.(2006).Cigarette smoking: cancer risks, carcinogens, and mechanisms.Langenbecks Arch Surg,391,603-13.
  24. Hsueh, KC,Chen, CY,Yang, YH,Huang, CL.(2010).Smoking cessation program in outpatient clinics of Family Medicine Department in Taiwan: a longitudinal evaluation.Eval Health Prof,33,12-25.
  25. Hsueh, KC,Hsueh, SC,Chou, MY(2014).Varenicline versus transdermal nicotine patch: a 3-year followup in a smoking cessation clinic in Taiwan.Psychopharmacology,231,2819-23.
  26. Huang, CL,Lin, HH,Wang, HH.(2006).The psychometric properties of the Chinese version of the Fagerstrom Test for Nicotine Dependence.Addict Behav,31,2324-7.
  27. Huntzinger, PE.(2002).SMOKED: a pharmacist-monitored tobacco cessation program.Mil Med,167,1001-5.
  28. Klesges, RC,Haddock, CK,Lando, H,Talcott, GW.(1999).Efficacy of forced smoking cessation and an adjunctive behavioral treatment on long-term smoking rates.J Consult Clin Psychol,67,952-8.
  29. Lemmens, V,Oenema, A,Knut, IK,Brug, J.(2008).Effectiveness of smoking cessation interventions among adults: a systematic review of reviews.Eur J Cancer Prev,17,535-44.
  30. Leung, DY,Au, DW,Lam, TH,Chan, SS.(2013).Predictors of long-term abstinence among Chinese smokers following treatment: the role of personality traits.Asian Pac J Cancer Prev,14,5351-4.
  31. Lin, YS,Wu, DM,Chu, NF,Lai, HR,Shi, ZP,Chen, HI.(2008).Factors associated with cigarette smoking among young military conscripts in Taiwan.J Chin Med Assoc,71,559-65.
  32. Morgan, BJ.(2001).Evaluation of an educational intervention for military tobacco users.Mil Med,166,1094-8.
  33. Nagelhout, GE,Hummel, K,Willemsen, MC(2014).Are there income differences in the impact of a national reimbursement policy for smoking cessation treatment and accompanying media attention? Findings from the International Tobacco Control (ITC) Netherlands Survey.Drug Alcohol Depend,140,183-90.
  34. Nelson, JP,Pederson, LL.(2008).Military tobacco use: a synthesis of the literature on prevalence, factors related to use, and cessation interventions.Nicotine Tob Res,10,775-90.
  35. Ockene, JK,Emmons, KM,Mermelstein, RJ(2000).Relapse and maintenance issues for smoking cessation.Health Psychol,19,17-31.
  36. Reda, AA,Kotz, D,Evers, SM,van, Schayck, CP.(2012).Healthcare financing systems for increasing the use of tobacco dependence treatment.Cochrane Database Syst Rev,6,CD004305.
  37. Rentería, E,Jha, P,Forman, D,Soerjomataram, I.(2016).The impact of cigarette smoking on life expectancy between 1980 and 2010: a global perspective.Tob Control,25,551-7.
  38. Sakata, R,McGale, P,Grant, EJ,Ozasa, K,Peto, R,Darby, SC.(2012).Impact of smoking on mortality and life expectancy in Japanese smokers: a prospective cohort study.BMJ,345,e7093.
  39. Scherphof, CS,van den, Eijnden, RJ,Harakeh, Z(2013).Effects of nicotine dependence and depressive symptoms on smoking cessation: a longitudinal study among adolescents.Nicotine Tob Res,15,1222-9.
  40. Shipley, R,Tresch, K,Tracey, S,Wilcox, A.(2002).The Buckley tobacco cessation program: helping smokers quit.Fed Pract,13-22.
  41. Smit, ES,Hoving, C,Schelleman-Offermans, K,West, R,de Vries, H.(2014).Predictors of successful and unsuccessful quit attempts among smokers motivated to quit.Addict Behav,39,1318-24.
  42. Stead, LF,Bergson, G,Lancaster, T.(2008).Physician advice for smoking cessation.Cochrane Database Syst Rev,2,CD000165.
  43. Steinberg, MB,Foulds, J,Richardson, DL,Burke, MV,Shah, P.(2006).Pharmacotherapy and smoking cessation at a tobacco dependence clinic.Prev Med,42,114-9.
  44. Tai, Z,Tao, SP,Hung, YJ.(2012).Cigarette use, smoking cessation, and quit intentions among activeduty military personnel in Taiwan.Mil Psychol,24,236-50.
  45. Tappin, D,Bauld, L,Purves, D(2015).Financial incentives for smoking cessation in pregnancy: randomised controlled trial.BMJ,350,h134.
  46. West, R.(2004).Assessment of dependence and motivation to stop smoking.BMJ,328,338-9.
  47. Woodruff, SI,Conway, TL,Edwards, CC.(2000).Effect of an eight week smoking ban on women at US Navy recruit training command.Tob Contro,9,40-6.
  48. Wu, PC,Hsueh, KC,Mar, GY(2016).Gender differences in outcome of an attempt to stop smoking among smokers attending a smoking cessation clinic in Taiwan: 3-year follow-up study.Eval Health Prof,39,317-25.
  49. Yang, JJ,Song, M,Yoon, HS,Lee, HW(2015).What are the major determinants in the success of smoking cessation: results from the health examinees study.PLoS One,10,e0143303.
  50. Yilmazel, Ucar, E,Araz, O,Yilmaz, N(2014).Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic.Multidiscip Respir Med,9,9.
  51. Zhu, WH,Yang, L,Jiang, CQ(2010).Characteristics of smokers and predictors of quitting in a smoking cessation clinic in Guangzhou, China.J Public Health,32,267-76.
  52. 王建楠、李璧伊、洪雅珊(2014)。南部某醫院門診戒菸治療成效及相關因子分析。中華職醫誌,21,101-9。
  53. 國防部軍醫局(2015)。,台北=Taipei:國防部軍醫局=Medical Affairs Bureau, Ministry of National Defense, R.O.C. (Taiwan)。
  54. 薛光傑(2014)。高雄=Kaohsiung,高雄醫學大學醫務管理學研究所=Department of Healthcare Administration, Kaohsiung Medical University。