Leal BBM, Ocampo O MA, Cicero SR

Language: Spanish
References: 55
Page: 489-497
PDF size: 110.34 Kb.

ABSTRACT

Introduction
Tobacco consumption is a serious public health problem and the principal cause of death worldwide. It is linked to chronic obstructive pulmonary disease (COPD), coronary disease, and various cancers such as lung cancer, which is the most frequent, and cancer of the larynx and other organs. Smoking affects the quality of life of millions of people. Those who live with smokers also become involuntary or passive smokers. It is important to determine the factors that influence initiation and continuation of smoking and the reasons that facilitate or favor smoking cessation. The dependence of cigarette smoking acts as a modulator of the relationship that smokers have with their social environment and on the expression of their feelings. We considered important to study the assertiveness of smokers, which is considered to be the social skill that individuals have to express what they think, feel and opine about respecting their rights and the rights of others as a factor that may influence smoking cessation or continuation of smoking.
Objective
We undertook this study to determine the levels of assertiveness and the sociodemographic profile of a population of 130 patients who were smokers and who came to the «Clinic against Smoking» located at a tertiary level teaching and research hospital in Mexico City. This was the first attempt for these patients to undergo cognitive behavioral treatment to stop smoking. We sought to determine if there are any significant differences between those patients who smoke and who continue treatment and those patients who abandon treatment.
Material and methods
Only patients who were active smokers were studied. Of a total of 130 subjects, 65 completed the treatment and 65 abandoned treatment. For each patient, the socioeconomic profile was investigated with regard to gender, age, marital status, education, occupation, and contribution to the family income. The Gambrill and Richey Assertiveness Inventory for the Mexico City population was used. The Fagerström questionnaire was applied for evaluation of nicotine dependence, with a value › 6 considered to be positive to qualify as dependence and the Russell reasons for smoking, which include stress reduction, the need to smoke, relaxation, the stimuli to perform activities and manipulation. Results were analyzed by descriptive analysis evaluating the assertiveness profile by probability of assertive response and the degree of discomfort classified as high, medium and low. The level of assertiveness was diagnosed according to the probability of response and the degree of discomfort as indifferent, assertive, nonassertive, average level of assertiveness and anxiety; a group was not classified between the groups mentioned. We used χ² for comparison of the levels of assertiveness between those who completed the treatment and those who did not.
Results
Of the 130 subjects studied, 65 completed the study satisfactorily and 65 abandoned treatment. Average age of the group of patients was 39.8 years (range: 19-60 years). There were 56.9% (74/130) females and 43.07% (56/130) males. It was determined that 60% of the population lived with a partner (78/130). Of the study population, those reporting a higher educational level (51.5%) (67/130) had a slight predominance over those subjects with either primary or secondary level of education. Of the 130 patients studied with the Fagerström questionnaire, 56.4% were nicotine dependent (73/130) and 47.4% (57/130) were not dependent. According to the Russell questionnaire for reasons for smoking, the most important reasons for smoking were stress reduction in 30.4% (42/130), the need to smoke in 33.1% (43/130) and for relaxation, with no difference between those who completed treatment and those who abandoned treatment. Stimulation, habit and manipulation were less frequently observed reasons.
In general, the population studied presented a low level of assertiveness and a deficit in social behavior without significant differences between those who leave or continue the treatment. Only 20% of all smokers were assertive, 19% were not assertive, 30% were indifferent, 15% had an average level of assertiveness, 5% demonstrated anxiety and 36% of those who had other levels remained in the «unclassified» group. The analysis of reactives demonstrated that the smokers presented a low probability of response in the areas that manifested in the expression of annoyance, anger or disagreement with others, recognizing personal limitations and acting in defense of rights in commercial situations and interactions with neighbors. They demonstrated a greater degree of discomfort in the areas of confrontation, defense of views and resisting pressure from others.
Discussion
Knowledge of the socioeconomic environment of smokers who desire to stop smoking using cognitive behavioral therapy is important because the environment in which the smoker lives exerts an influence on the success or failure of the attempt to stop smoking.
Gender, age, living with a partner, economic status and educational level are factors that may influence adherence to treatment and also influence the tendency to abandon treatment. Nicotine dependence was a determinant factor regarding completion or abandonment of treatment. Stress reduction and searching for and needing relaxation were the most frequently mentioned reasons for smoking. The level of assertiveness does not appear to play a definitive role for treatment success or for abandoning the smoking habit. Only 20% of the smokers were assertive and, of those, only half completed the treatment, with no difference between those who did not complete the treatment. The probability of an assertive response and the degree of discomfort did not show differences in the two groups mentioned, which suggests that assertiveness does not have a great influence on the final results. In general, the population studied had a deficit in social abilities. In the reactive analysis it was found that there is an opposition in the areas of defense of opinions and for resisting pressure from others, for manifesting annoyance, anger or disagreement and in regard to the defense of rights in commercial situations and interaction with others. There were no significant differences observed in between-group comparisons (χ 2 0.406). There were also no significant differences between those who are assertive and those who have a low level of assertiveness. These individuals prefer to reduce stress, satisfy their needs and seek relaxation or the stimulation produced by nicotine vs. the effort required to follow smoking cessation treatment, particularly within a social environment where smoking may be an element that eases relationships with others.
The observations obtained in this study suggest that assertiveness training specific to the type of smoker who tends to abandon treatment may be appropriate to obtain positive results and contribute not only to avoid abandoning treatment but also to maintaining positive results and to avoid relapses. This training may influence those susceptible subjects to avoid initiating a smoking habit.
Conclusion
The level of assertiveness is not an important factor to explain the success or failure of a smoking cessation program. Training in assertiveness may be useful to enhance success of treatment to quit smoking

REFERENCES

1. Ramirez-Venegas A. Daños a la salud que ocurren con el consumo de tabaco. Ciencia 2004;55:54-59.

2. Valdes-Salgado R. Las cifras de la epidemia. Daños a la salud y mortalidad atribuibles al consumo de tabaco. En: Primer informe sobre el combate al tabaquismo. Valdes-SR, Lazcano-PE, Hernández-A (eds.). M.INSP. México: Sría de Salud; 2005; pp.29-41.

3. Valdés-Salgado R, Hernández M, Sepúlveda J. El consumo de tabaco en la Región Americana. Elementos para un programa de acción. Salud Pub Méx 2002;44:(Supl 1):S125-S135.

4. Lotrean NM, Sánchez-Zamorano LM, Valdés-Salgado R et al. Consumption of higher numbers of cigarettes in Mexican youth: the importance of permissiveness of smoking. Adict Behav 2005;30:1035-1041.

5. Kuri-MP, González-RJ, Hoy M, Cortés-R M. Epidemiología del tabaquismo en México. Salud Púb Méx 2007;49(Supl):S91-S98.

6. Ling P, Neilands TM Glantz S. Young adult smoking behavior. A National Survey. Am J Prev Med 2009;36:389-394.

7. Instituto Nacional de Salud Pública. Encuesta Nacional de Adicciones 2008. CONADIC, INSP, INSMRF. Sría. de Salud (eds.). México: 2008. (Puede consultarse en la página de Google del Instituto Nacional de Salud Pública. Veáse también en esta página: DiarioSalud.net.Portal y agencia de noticias medicina.Salud.médicamentos y farmacia en español.

8. Baska T, Sovinová H, Mémeth A et al. Findings from the global youth tobacco durvey in Czech Rep, Hungary, Poland and Slovakia. Sozial Preventive Medicine 2006;51:110-116.

9. Franco-Marina F, Villalba-Caloca J, Corcho-Berdugo A. Grupo interinstitucional de cáncer pulmonar. Salud Pub México 2006;48(Supl 1):S71-S82.

10. Franco-Marina F. Adult smoking trends in Mexico: An analysis of the Mexican national addiction surveys. Salud Pub Méx 2007;49(Supl):S137-146.

11. Instituto Nacional de Salud Pública. Encuesta Nacional de Adicciones. México: Ed. CONADIC, Sría. de Salud; 2008. [ver también: Informe Pfizer. Libre de cigarro. Datos estadísticos en México y en el mundo. 2007. Disponible en: http://pfizer.com.mx.tabaquismo/index.asp?actionhome. interior&Sectid=682&Catld=951. Consultado, enero 30, 2008].

12. Sweetman SC (editor). Martindale. The complete drug reference. 35th ed. London: The Pharmaceutical Press; 2007; pp.2133-2135.

13. Leutweiler-Ozelli K. Obesity and addiction. This is your brain on food. Scientif Am 2007;297:56-57.

14. Rondina RG, Gorayeb R, Botelho C. Psychological characteristics associated with tobacco smoking behavior. J Brasil Pneumol 2007;33:592-601.

15. Carmody TP, Loew DE, Hall RG, Brekenridge JS et al. Nicotine polacrilex: Clinic-based strategies with chronically ill smokers. J Psych Drugs 1988;20:269-274.

16. Wolpe J. Psicotherapy by reciprocal inhibition San Francisco: Standford University Press; 1958.

17. Wolpe J. La práctica de la terapia de la conducta. Mexico: Ed. Trillas: 1997; pp.183-184.

18. Lazarus A. On assertive behaviour: A brief note. Behav Ther 1973;4:597- 699.

19. Gambrill E, Richey C. An assertion inventory for use in assessment and research. Behav Ther 1975;6:550-561.

20. Carrasco C. Análisis del inventario de asertividad de Gambrill y Richey. Estudios Psicología 1989;37:63-74.

21. Caballo VE. El entrenamiento en habilidades sociales valuación de las habilidades sociales. En: Caballo VE (Comp). Manual de técnicas de terapia y modificación de conducta. Quinta ed. Madrid: Siglo XX; 1991; pp.403-443.

22. Florez Galaz M. Asertividad agresividad y solución de situaciones problemáticas en una muestra mexicana. Tesis de maestría. Facultad de Psicología, UNAM. México: 1989 (Disponible REDUNAM.USUARIOS. Biblioteca Central).

23. Gaeta-Gonzalez L, Galvanovskis-Kasparane A. Asertividad: un análisis teórico empírico. Enseñanza Invest Psicol 2009;14:403-425.

24. Becoña E, Palomares A, García M: Tabaco y salud, guía de prevención y tratamiento del tabaquismo. México: Ediciones Pirámide; 1998.

25. Guerra-Ramos MT. Estandarización del inventario de asertividad Gambrill y Richey para la población de la Ciudad de México. Tesis de licenciatura. México: Facultad de Psicología, UNAM; 1996 (Disponible REDUNAM -USUARIOS. Biblioteca Central).

26. Castaños-Cervantes S. Estandarización del inventario de asertividad Gambrill y Richey II. Tesis de licenciatura. Facultad de Psicología, UNAM. México: 2008 (Disponible REDUNAM-USUARIOS. Biblioteca Central).

27. Jakuboski P, Lange AJ. Responsible assertive behavior: cognitive/behavioral procedures for trainers. Champaign Ill: Research Press Co; 1976.

28. Jakuboski P, Lange AJ. The assertive option, your rights & responsibilities. Champaign Ill: Research Press Co.; 1978.

29. Corbin S, Jones R, Schulman R : Drug refusal behavior: The relative efficacy of skills-based and information-based treatment. J Pediatr Psychol 1993;18:769-784.

30. Donohue B, van Nasselt VB, Hersen M, Perrin S: Substance refusal skills in a population of adolescents diagnosed with conduct disorder and substance abuse. Addic Behav 1999;24:37-46.

31. Botvin GJ, Griffin K, Diaz T, Miller N, Ifill-Williams M: Smoking initiation and scalation in early adolescent girls: one year follow-up of a school based prevention intervention for minority youth. J Am Med Wom Ass 1999;54:139-142.

32. Lopez-Torrecillas F, Martín J, De la Fuente J, Godoy JF. Estilo atribucional, autocontrol y asertividad como predictores del consumo de drogas. Psicotherma 2000;12:331-334.

33. Ping-Han C, Raskin H, Pandina R. Predictor of smoking cessation from adolescence to young adulthood. Addictive Behav 2001;25:517-529.

34. Marlat G, Curry S, Gordon J: A longitudinal analysis of unaided smoking cessation. J Cons Clin Psych 1988;56:715-720.

35. Evans DS, Byrne C, Mulcathy M. Smoking in the home: attitudes and the impact of the 2004 Irish smoking ban. Health Promotion Services and the Department of Health Executive West. Public. Ireland: Health Service Executive West; 2006; pp.28-38.

36. Germain D, Wakefield M, Durkin S. Non-smoker· responses when smokers Light up: A population based study. Prevent Med 2007;45:21-25.

37. Eleftherios A, Lambros L, Angelos R, Richard EJ. Can you please put it out? Predicting non-smokers’ assertiveness intentions at work. Tobacco Control 2010;19:148-152.

38. Siddiqi O, Flay B, Hu F: Factors affecting addiction in a longitudinal smoking prevention study. Prev Med 1996;25:554-560.

39. Ocampo-OA, Magallan-VAS, Elpihue-V-HT, Cuevas-AE. Programa de cesación del tabaquismo en un hospital de tercer nivel. Terapia breve cognitivo-conductual. México: CONADIC, Sría de Salud; 2007.

40. Fargestrom KO, Schneider N. Measuring nicotine dependence: a review of Fargerström tolerance questionarie. J Behav Med 1998;12:159-182.

41. Russell MAH, Wilson C, Taylor C, Baker DSC. Effects of general practitioners advice against smoking. Brit Med J 1979;2:231-235.

42. Precioso J. Factores de risco relacionados com as varias faces de «carreira » de fumador: implicaçoes para prevençao. Analise Psicologica 2008;26:177-192.

43. Daly JE, Pesowski S. Predictor of drop-out among men who batter: a review of studies with implications for research and practice. Violence Victims Summer 2000;15:137-160.

44. Gilbert M, Gines S, Haley G. Factors associated with drop-out from group psychotherapy with depressant adolescents. Canad J Psychiatry 1994;39:358-359.

45. Flores M, Díaz-Loving R, Rivera S. MERA. Una medida de rasgos asertivos para la cultura mexicana. Rev Mex Psicol 1998;4:29-36.

46. Comeau N, Stewart S, Loba P. The relation of trait anxiety. Anxiety, sensitivity and cessation seeking to adolescents motivations for alcohol, cigarette and marijuana use. Addictive Behav 2000;26:803-825.

47. Palmatier MI, Liu X, Donny E, Caggiula R et al. Metabotropic glutamate 5 receptor (mGluR5) antagonist decrease nicotine seeking, but do nor affect the reinforcement enhancing effects of nicotine. Neuropsychopharmacol 2006;33:2139-2147.

48. Fleming C, Kim H, Karachi T, Catalana R. Processes for children in early elementary school as predictor of smoking initiation. J Adolescent Health 2002;30:184-189.

49. Vendetti J, McRee B, Millar M, Christiansen K, Herrel J. Correlates of pre-treatment drop-out among persons with marijuana dependence. Addiction 2002;97(Supl 1):125-134.

50. Nichols TR, Graber JA, Brooks-Gum J, Botvin. Ways to say no: refusal skill strategies among urban adolescents. Am J Health Behav 2006;30:227-236.

51. Delavar A, Rashi KH. The role of assertive training and problem-solving in prevention and reduction of cigarette usage among students in the city of Theheran. Psychological studies. Winter 2005;1(abstract):19-34.

52. Zerning G, Wallner R, Grohs U et al. A randomized trial of short psychotherapy versus sustained-release bupropion for smoking cessation. Addiction 2008;103:2024-2031.

53. Wu Ping, Wilson K, Dimoulas P, Mills EJ. Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Public Health 2006;6:2-16.

54. Cofta-Woerpel L, Wright KL, David W, Wetter DW. Smoking cessation 3: Multicomponent interventions. Behav Med 2007;32:135–149.

55. Epstein JA. Which psychosocials factors moderate or directly affect substance use among inner-city adolescents? Addict Behav 2007;32:700-713.