中重度烟草依赖患者文化程度对戒烟干预策略选择的影响

Effects of educational level on the choice of intervention strategies for smoking cessation in patients with moderate to severe tobacco dependence

目的观察文化程度对中重度烟草依赖患者戒烟效果的影响,探讨个体化有效戒烟方法,提高戒烟率。方法选取2020年1-12月在胜利油田中心医院呼吸与危重症医学科及戒烟门诊就诊有戒烟意愿的患者480例,按文化程度分为四组,每组120例,A组为小学及以下,B组为初中及高中,C组中专或大专,D组为大学及以上。每组随机给予“5A”干预和“5A”联合伐尼克兰戒烟干预(联合干预)措施。观察四组患者对吸烟危害认知度及不同干预措施在各时间点戒烟率的差异。结果D组、C组、B组、A组吸烟危害认知度评分分别为(806.5±35.7)分、(710.8±26.2)分、(643.6±43.4)分、(512.4±30.1)分,文化程度高的患者有较高的烟草危害认识度,组间差异有统计学意义(F=1543.26,P<0.001)。四组1个月、3个月、6个月戒烟率比较,联合干预均高于“5A”干预(A组:χ^(2)=3.85、4.23、4.10,B组:χ^(2)=4.30、4.09、4.60,C组:χ^(2)=6.81、4.30、4.03,D组:χ^(2)=6.71、6.51、4.73,均P<0.05);D组“5A”干预、联合干预6个月戒烟率分别为60.0%、78.3%,均高于C组(41.7%、60.0%)、B组(23.3%、41.7%)、A组(20.0%、36.7%)(χ^(2)=26.59、26.12,均P<0.001),且D组不同时间点“5A”干预戒烟率高于A组和B组联合干预(χ^(2)=9.25、25.04、7.29,均P<0.05)。结论烟草危害认知与患者文化程度相关,影响戒烟效果,根据文化程度给予个体化戒烟干预措施,可提高戒烟率。

Objective To investigate the effects of educational level on smoking cessation in patients with moderate to severe tobacco dependence,explore effective individualized smoking cessation methods,and increase smoking cessation rate.Methods A total of 480 patients with moderate to severe tobacco dependence who were willing to quit smoking and received treatment in the Department of Respiratory and Critical Care Medicine,Shengli Oilfield Central Hospital from January to December 2020 were included in this study.They were divided into four groups(n=120/group)according to their educational level:group A(elementary school and below),group B(junior high school and senior high school),group C(technical secondary school or college),and group D(university and above).All patients were randomly assigned to undergo"5A"intervention alone or"5A"intervention combined with varenicline intervention(combined intervention).Patients'awareness of the health risks of tobacco smoking was compared among the four groups.The smoking cessation rate measured at different time points was compared between different intervention strategies.Results The scores of health risk of tobacco smoking in groups D,C,B,and A were(806.5±35.7)points,(710.8±26.2)points,(643.6±43.4)points,and(512.4±30.1)points,respectively.Patients with high education levels had high awareness of the health risk of tobacco smoking(F=1543.26,P<0.001).At 1,3,and 6 months,the smoking cessation rate of combined intervention was higher than that of"5A"intervention alone in each group(group A:χ^(2)=3.85,4.23,4.10,group B:χ^(2)=4.30,4.09,4.60,group C:χ^(2)=6.81,4.30,4.03,group D:χ^(2)=6.71,6.51,4.73,all P<0.05).The smoking cessation rate after 6 months of"5A"intervention alone or combined intervention in group D was 60.0%and 78.3%respectively,which were significantly higher than 41.7%and 60.0%in group C,23.3%and 41.7%in group B,and 20.0%and 36.7%in group A(χ^(2)=26.59,26.12,both P<0.001).At different time points,the smoking cessation rates of the"5A"intervention alone in group D were significantly higher than those of combined intervention in groups A and B(χ^(2)=9.25,25.04,7.29,all P<0.05).Conclusion Awareness of the health risks of tobacco smoking is related to a patient's educational level,and affects smoking cessation.Individualized smoking cessation interventions based on a patient's educational level can increase the rate of smoking cessation.