BackgroundCardiovascular disease (CVD) prevention guidelines stress the importance of smoking cessation and recommend intensive follow-up. To guide the development of such cessation support strategies, we analysed the characteristics that are associated with successful smoking cessation after an acute coronary syndrome (ACS).MethodsWe used data from the Randomised Evaluation of Secondary Prevention for ACS patients coordinated by Outpatient Nurse SpEcialists (RESPONSE) trial (n = 754). This was designed to quantify the impact of a nurse-coordinated prevention program, focusing on healthy lifestyles, traditional CVD risk factors and medication adherence. For the current analysis we included all smokers (324/754, 43 %). Successful quitters were defined as those who reported abstinence at 1 year of follow-up.ResultsThe majority of successful quitters quit immediately after the ACS event and remained abstinent through 1 year of follow-up, without extra support (128/156, 82 %). Higher education level (33 vs. 15 %, p < 0.01), no history of CVD (87 vs. 74 %, p < 0.01) and being on target for LDL-cholesterol level at 1 year (78 vs. 63 %, p < 0.01) were associated with successful quitting.ConclusionThe majority of successful quitters at 1 year stopped immediately after their ACS. Patients in this group showed that it was within their own ability to quit, and they did not relapse through 1 year of follow-up. Our study indicates that in a large group of patients who quit immediately after a life-threatening event, no relapse prevention program is needed.
Smoking-behavior during pregnancy and the reliability of an interview were prospectively investigated. The tobacco-exposure was assessed a) by an intake interview b) by a smoking diary and c) by maternal thiocyanate and carboxy-hemoglobin concentrations. Of the 115 nulliparous women, 66 smoked (57.4%). Seventeen women (25.8%) quit and 39 women (59.1%) reduced smoking. Directly after intake, in the first week of the diary, significantly more cigarettes were smoked than stated during the intake interview. According to the diaries, the number of cigarettes increased during the first half of pregnancy. In the 24th week significantly more cigarettes were smoked than in the first week after intake. Also a significant increase of thiocyanate between the measurements at intake and in the 24th of amenorrhea was found. The maternal carboxy-hemoglobin levels did not significantly change during pregnancy. Investigators should be aware of changes in smoking behavior during pregnancy and the potential bias of self reported smoking behavior at the beginning of pregnancy. The tobacco-exposure should be assessed (anamnestic or biochemical) several times during pregnancy, anyway it should include the second half of pregnancy.
Dit artikel beschrijft hoe woonkwaliteit 'gegroeid' is van woonkwaliteit naar woonomgevingskwaliteit naar kwaliteit van relaties met buren. Die laatste dimensie van woonkwaliteit betekent een nieuwe agenda voor opbouwwerk en woningcorporaties, en vraagt om nieuwe instrumenten. Daarvan worden er een aantal beschreven, zoals de woonladder en straatetiquettes.
