Profile of smokers who seek treatment at a smoking cessation clinic

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Resultados a medio plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J de Miguel Díez, P de Lucas Ramos, JJ Pérez Parra, MJ Buendía García, JM Cubillo Marcos, JMR González-Moro" "autores" => array:6 [ 0 => array:2 [ "Iniciales" => "J" "apellidos" => "de Miguel Díez" ] 1 => array:2 [ "Iniciales" => "P" "apellidos" => "de Lucas Ramos" ] 2 => array:2 [ "Iniciales" => "JJ" "apellidos" => "Pérez Parra" ] 3 => array:2 [ "Iniciales" => "MJ" "apellidos" => "Buendía García" ] 4 => array:2 [ "Iniciales" => "JM" "apellidos" => "Cubillo Marcos" ] 5 => array:2 [ "nombre" => "JMR" "apellidos" => "González-Moro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13046503?idApp=UINPBA00003Z" "url" => "/15792129/0000003900000007/v0_201307090915/13046503/v0_201307090915/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Profile of smokers who seek treatment at a smoking cessation clinic" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "298" "paginaFinal" => "302" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "I Nerín, A Crucelaegui, A Mas, D Guillén" "autores" => array:4 [ 0 => array:3 [ "Iniciales" => "I" "apellidos" => "Nerín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "A" "apellidos" => "Crucelaegui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "A" "apellidos" => "Mas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 3 => array:3 [ "Iniciales" => "D" "apellidos" => "Guillén" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Medicina y Psiquiatría. Unidad de Tabaquismo FMZ. Facultad de Medicina. Universidad de Zaragoza. Spain." "etiqueta" => "a" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Especialistas en Medicina de Familia y Comunitaria. Unidad de Tabaquismo FMZ. Facultad de Medicina. Universidad de Zaragoza. Spain." "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfil de los fumadores que solicitan tratamiento en una unidad de tabaquismo" ] ] "textoCompleto" => "IntroductionThe variety of smoking cessation therapies that have proven effective ranges from simple counseling to intensive interventions using medications -- either nicotine replacement therapy or bupropion -- in combination with cognitive-behavioral therapy1-5.At present smoking is considered a chronic disease, given that it is a process that persists over time with periods of improvement (abstinence) and with a strong tendency to relapse1. As with other chronic diseases the treatment strategy should include both primary and specialized care. Various primary care protocols6 exist which identify the characteristics of smokers who can benefit from smoking cessation programs.As is the case with other chronic health conditions, it is also necessary to define the level of the specialized care provided by smoking cessation clinics. To date, Spain has had relatively limited experience with these clinics. Though recommendations have been made as to how they should be organized and operated in this country7, they are presently covered by the public health system only in certain autonomous regions where they have been set up. Smoking is the primary cause of preventable morbidity and mortality in developed countries8. According to the latest National Health Survey carried out in 2001 by the Ministry of Health, 34% of the population in Spain over the age of 16 smokes9. This high prevalence, together with the enormous cost of treatment of smoking-related diseases, underlines the need for therapeutic interventions aimed at reducing the numbers of smokers. As some authors have affirmed2,10, smoking cessation treatment is a priority intervention among the policies aimed at controlling smoking, given that treatment directly affects smoking-related morbidity and mortality in a population and therefore is the most cost-effective intervention in the short term, justifying the development of therapeutic services available at all levels of the system.The objective of our study was to describe the profile of smokers who seek treatment at a smoking cessation clinic and thus contribute to establishing treatment criteria at a level of specialized care.Material and methodsA descriptive observational study was carried out. The target population comprised smokers who voluntarily sought treatment at the Smoking Cessation Clinic of the University of Zaragoza School of Medicine (FMZ). The clinic is located in the School of Medicine and offers free treatment to smokers wishing to quit, under an agreement between the University of Zaragoza, the regional autonomous government of Aragon and an insurance company (Mutua de Accidentes de Zaragoza). The patients were representative of the general urban population and were either self-referred or referred to the clinic by their doctor at the workplace or a family physician. In all cases the smokers personally sought access to the program through an initial telephone call to the clinic.The following variables were studied: sex; age; referral source; marital status; educational level; age at which smoking began, age at which it became a regular habit and the time elapsed between the two moments; level of nicotine dependence (measured by the Modified Fagerström Questionnaire for Nicotine)11; number of cigarettes smoked per day; number of years smoking; use of other potentially-addictive substances (alcohol, caffeine, psychotropic medications and other drugs); presence of concomitant disease; previous attempts to quit smoking; current reasons for smoking cessation; and expired air carbon monoxide (CO).All of the patients seeking treatment at the smoking cessation clinic were placed on a waiting list; following that, an appointment was arranged for each, at which time the smoker's medical history was taken in order to gather data on the study variables and measure weight, blood pressure and CO in expired air. These individuals were then enrolled in a multicomponent treatment program (utilizing medication and psychotherapy). In all cases, the choice of pharmacologic therapy was discussed and agreed upon with the smoker in advance and determined according to the degree of nicotine-dependence previously diagnosed in the first interview. Either combined nicotine replacement therapy (fast-acting nicotine substitutes and/or the transdermal patch system) or bupropion was prescribed, depending upon the individual characteristics of each smoker and possible contraindications. Severe psychiatric disorders or concurrent dependence on another addictive substance were considered exclusion criteria for patients seeking multi-component group smoking cessation treatment. Expired air CO was measured with a CO-oximeter (Mini Smokerlyzer, Bedfont Scientific Ltd.), and findings above 10 ppm12 identified an individual as a smoker. Nicotine dependence, as measured by the Fagerström Test, was considered low for individuals scoring 0 to 3; average for those scoring between 4 and 6; and high for those with scores above 713. SPSS software in a Windows® operating system was used for the database, statistical analysis and data handling. The results are presented in percentages and means with standard deviations (SD) and 95% confidence intervals (CI).ResultsThe population sample comprised 385 smokers -- 239 (62%) men and 146 (38%) women -- with an average age of 43.05 years (SD: 9.07; 95% CI, 42.14-43.96 years). Figure 1 shows the sample distribution according to age.<img src="260v39n07-13046504tab01.gif"></img>Fig. 1. Distribution of subjects by age (numbers are percentages).In 67.3% of the cases, subjects were referred to the clinic by their workplace physician, 17.4% were referred by their primary care physician and the remaining 15.3% were self-referred. The majority of the participants (72.5%) were married and 83% had children. Thirty-three percent of the study sample had received a basic education (elementary or early secondary schooling), 39% had received higher secondary education or vocational training and the remaining 28% had attended university. Ninety-two of the participants began smoking between the ages of 8 and 20, the average age being 14.83 years (SD: 4.27; 95% CI, 14.40-15.27 years). The average age at which smoking became a regular habit was 17.7 years (SD: 4.59; 95% CI, 17.32-18.25 years). The mean interval of time between the age at which smoking began and the age at which it became a regular habit was 3 years (SD: 3.01; 95% CI, 2.69-3.30 years).The mean Fagerström test score was 6.05 points (SD: 2.19; 95% CI, 5.83-6.27); 14% of the study sample scored as having low dependence (0-3); 42% medium dependence (4-6), and 44% high dependence (scores of 7 and above) (Fig. 2). Responses to the Fagerström questionnaire showed that 32.1% of the subjects smoked their first cigarette of the day within 5 minutes of waking and 35.5% smoked more than 30 cigarettes per day.<img src="260v39n07-13046504tab02.gif"></img>Fig. 2. Degree of nicotine-dependence. A: low dependence (0-3). B: moderate dependence (4-6). C: high dependence (>7).The average number of cigarettes smoked per day was 25.9 (SD: 12.11; with 95% CI, 24.74-27.18 cigarettes per day), and the average number of years smoking was 25.3 (SD: 9.04); the mean concentration of CO in expired air measured at the initial interview (before smoking cessation) was 39.30 ppm (SD: 25.18; 95% CI, 36.75-41.84 ppm).A study of the concomitant use of other potentially-addictive substances showed the following results: 26% of the subjects consumed alcohol on a daily basis, 92% consumed caffeine daily and 18% were taking psychotropic medications at the time the medical history was taken. Seven percent of the sample group had experimented with other drugs such as marijuana and cocaine though none of the subjects was using those substances at the time of the study. Associated disease was present as chronic bronchitis for 27.5% of the sample studied while 9% had history of peptic ulcers, though none active at the time of the initial interview, and cardiovascular risk factors were present for 15%. Seventy-two percent of the smokers in the study had tried to quit smoking on previous occasions; of these, 122 (46%) had made only one attempt at smoking cessation, and theirs was the most frequently encountered situation in our study population. The main reasons for giving up smoking were the prevention of disease (38%), awareness of dependence (20%) and parental desire to serve as a positive role model for children (10%) (Fig. 3).<img src="260v39n07-13046504tab03.gif"></img>Fig. 3. Reasons for cessation. A: prevention of disease. B: awareness of dependence. C: parental model for children.DiscussionThe individuals seeking treatment at this smoking cessation clinic were referred by their doctor at the workplace, their primary care physician or were self-referrals, indicating to us that it is a heterogeneous, representative sampling of smokers wishing to quit. The reason the majority of participants in this study were from work-related referrals is due to the fact that when the FMZ Smoking Cessation Clinic first went into operation its primary links were with clinics in the workplace. Nonetheless, regardless of the referral source, each participant voluntarily came to the clinic for smoking cessation treatment, which was offered at no cost other than for the purchase of medications that are not presently covered by the Public Health Service in Spain.The fact that potential participants personally contacted the clinic by telephone to seek treatment and then were placed on a waiting list, served as a way to screen out smokers who, in accordance with the stages of change proposed by Prochazka and DiClemente14, were neither ready nor sufficiently motivated to quit smoking. When the medical histories were taken each subject chose his or her own quitting date, another criterion that indicates the individual is ready for smoking cessation13.The average age of the subjects in the study was 43 years and most of the smokers showed no smoking-related disease. Approximately a quarter of the study sample (27.5%) presented with chronic bronchitis. That prevalence is lower than that described for smokers15, probably directly owing to the average age of the subjects studied. Thus, we can generally define the group as young adult smokers with no smoking-related diseases. One study on smoking cessation carried out in Spain16 describes very different characteristics for smokers who quit. The differences are probably due to the methodology used, given that the variables in that study were drawn indirectly from an analysis of a National Health Survey and referred to exsmokers. Thus, the target group was not the same as that in our study and therefore could not serve as a valid point of comparison.The prevalence of psychotropic medication use in the population at large has been determined to be slightly lower (14%)17,18 than that found in our study (18%), possibly owing to specific emotional and personality traits of smokers as yet not fully understood19.The higher percentage of men to women in the sample studied reflects the current tendency of men to quit smoking in greater numbers than women. This observation is consistent with Stage 3 of the epidemiological model described by López et al20, which includes Spain, and with statistics gathered from a recent population survey in Catalonia (Spain)21,22.We observed that the average age at which subjects began to smoke was 14.8 years (between 8 and 20 years of age), with a mean interval of 3 years between the age at which smoking began and the age at which it became a regular habit. These figures match those in the literature23,24.The Fagerström test for nicotine dependence shows overall results of moderate dependence (mean value of 6)12, though individual analysis of questionnaire results for this group of smokers indicates that a minority (14%) of the subjects had low dependence and the majority had medium or high dependence, consistent with the mean concentration of expired CO (39.3) found. Along these same lines it has been postulated that smokers with low nicotine-dependence are able to quit smoking on their own while more severely nicotine-dependent smokers are those who seek smoking cessation treatment25.An analysis of the two most weighted items in the Fagerström test26 (time elapsed before the first cigarette and number of cigarettes smoked per day) showed that one-third of the subjects smoked their first cigarette within 5 minutes of waking and smoked more than 30 cigarettes per day (32% and 35.5%, respectively); this finding is of interest because it sheds further light on degree-of-dependence and indicates that one-third of the subjects seeking smoking cessation treatment fit a severely nicotine-dependent profile as described by some authors27. Degree of dependence could be related to the average age of the subjects in the sample population (43 years) and is in keeping with a recent study of smokers in Europe which reports that the most severely nicotine-dependent smokers fall with the range of 35 to 65 years of age28.The majority of the subjects (72%) had made a past attempt to quit smoking, which can be interpreted as indicating a high degree of dissonance and is consistent with the profile of this group as being, generally speaking, at the stage of preparing to quit29. We observed that the most frequently cited reason for wanting to quit smoking was prevention of disease -- in keeping with reports from other studies30 -- though other significant factors included awareness of dependence and parental desire to serve as a positive role model for children. Understanding the reasons behind smokers' desire to quit can be helpful in designing specifically-targeted smoking cessation interventions linked with both public and preventive health care policies.The subjects enrolled in this smoking cessation clinic were not pre-selected to fit the described profile of the subgroup of smokers needing specialized treatment7; nonetheless, the results show this population sample to be severely nicotine-dependent young adults with a strong desire to quit smoking but showing no concomitant disease.In the near future, with the development of a stepped-care model of smoking-cessation intervention in which treatment of smokers would come under the umbrella of primary and specialized care -- as is the case with any other chronic health problem31 -- we will see a larger sample group of people seeking specialized treatment. This will include a greater number of smokers with diseases (chronic obstructive pulmonary disease, heart disease, psychiatric disorders) as well as other specific groups of smokers such as pregnant women, older-aged smokers, etc. who do not currently represent a significant percentage of people seeking treatment at smoking cessation clinics. The few Spanish publications reporting on smoking cessation clinics and intensive interventions have demonstrated the efficacy of such programs32-35. Such reports will require us to direct resources to specialized smoking cessation services in Spain, a recommendation which has in fact been made in a recent report by the Ministry of Health and Consumer Affairs36.<hr></hr>Correspondence: Dr. I. Nerín. Departamento de Medicina y Psiquiatría. Facultad de Medicina, edificio B. Domingo Miral, s/n. 50009 Zaragoza. Spain E-mail: <a href="mailto:isabelne@posta.unizar.es" class="elsevierStyleCrossRefs"> isabelne@posta.unizar.es</a>Manuscript received 1 August 2002. Accepted for publication 12 October 2002." "pdfFichero" => "260v39n07a13046504pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec191505" "palabras" => array:3 [ 0 => "Smoking" 1 => "Smoking cessation" 2 => "Smoking cessation clinic" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec191506" "palabras" => array:3 [ 0 => "Tabaquismo" 1 => "Deshabituación tabáquica" 2 => "Unidad de tabaquismo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "Objectives: The variety of smoking cessation therapies that have proven effective ranges from simple counseling to intensive interventions. The objective of our study was to identify the characteristics of smokers who currently seek treatment at a smoking cessation clinic. Methods: Descriptive observational study. The target population consisted of smokers who sought treatment at a smoking cessation clinic. The following variables were studied: sex; age; referral source; marital status; educational level; age at which smoking began, age at which it became a regular habit and the time elapsed between the two moments; level of nicotine dependence (Fagerström Test for Nicotine Dependence); number of cigarettes per day; number of years smoking; use of other potentially-addictive substances (alcohol, caffeine, psychotropic medications and other drugs); presence of concomitant disease; previous attempts to quit smoking; current reasons for smoking cessation; and concentration of expired air carbon monoxide (CO). An initial medical history was taken from each smoker on the waiting list for treatment at the clinic in order to gather data on the study variables; these individuals were then enrolled in a 3-month group smoking cessation program that utilized both medication and cognitive-behavioral therapy. The results are presented in percentages and means with standard deviations (SD) and 95% confidence intervals (CI). Results: 385 smokers were studied--239 (62%) men and 146 (38%) women--the average age being 43.05 years (SD: 9.07). Mean nicotine-dependence (Fagerström Test score) was 6.05 (SD: 2.19); mean number of cigarettes per day: 25.9 (SD: 12.11); mean number of years as a smoker: 25.3 (SD: 9.04); and mean expired air CO: 39.30 (SD: 25.18). Associated disease was present as chronic bronchitis for 27.5% and cardiovascular risk factors for 15%. Previous attempts to quit smoking were reported by 72%; the reasons for the present attempt to quit smoking were the prevention of disease (38%), awareness of dependence (20%) and parental desire to serve as a positive role model for children (10%). Conclusions: At present, the smokers who attend a smoking cessation clinic are young, severely-dependent adults in the initial stage of preparing to quit. The prevalence of symptoms in this population is low. The profile of the population seeking specialized smoking cessation treatment is expected to change in the future as those with smoking-related diseases and other specific populations of smokers become included." ] "es" => array:1 [ "resumen" => "Objetivos: El tratamiento del tabaquismo incluye diversas intervenciones terapéuticas que han demostrado ser eficaces, desde el consejo mínimo hasta la atención intensiva. El objetivo de nuestro trabajo es conocer las características que presenta la población de fumadores que actualmente solicitan tratamiento de deshabituación tabáquica en una unidad de tabaquismo. Método: Estudio descriptivo observacional. La población objetivo fueron los fumadores que acuden a una unidad de tabaquismo para deshabituación tabáquica. Se estudiaron las siguientes variables: sexo, edad, procedencia, estado civil, nivel de formación, edad de primer consumo de tabaco y de consumo regular y tiempo transcurrido entre ambos, grado de dependencia a la nicotina (test de Fagerström), número de cigarrillos-día, número de años de fumador, consumo de otras sustancias con capacidad de originar adicción (alcohol, cafeína, psicofármacos, otras drogas), presencia de patología concomitante, intentos previos de cesación, motivos actuales de abandono y determinación de monóxido de carbono en aire espirado. A todos los fumadores incluidos en la lista de espera se les realizó una historia de primer día en la que se recogían las variables de estudio y se les incluía en un programa de deshabituación tabáquica en grupo, mediante tratamiento multicomponente (farmacológico y terapia cognitivo-conductual) a lo largo de 3 meses. Se presentan los resultados como proporciones y medias con sus desviaciones estándar (DE) y sus intervalos de confianza (IC) del 95%. Resultados: Se estudió a 385 fumadores 239 [62%] varones y 146 [38%] mujeres, con una edad media de 43,05 años (DE, 9,07). La dependencia media a la nicotina (test de Fagerström) fue de 6,05 (DE, 2,19); media de cigarrillos/día, 25,9 (DE, 12,11); media de número de años de fumador, 25,3 años (DE, 9,04), y media de monóxido de carbono, 39,30 (DE, 25,18). En cuanto a la presencia de patología asociada, el 27,5% de los pacientes presentaba bronquitis crónica, y el 15%, factores de riesgo cardiovascular asociados. El 72% había tenido intentos previos de cesación; los motivos actuales para dejar de fumar eran la prevención de enfermedades (38%), la conciencia de dependencia (20%) y el papel ejemplar para los hijos (10%). Conclusiones: Actualmente los fumadores que acuden a una unidad de tabaquismo son adultos jóvenes, en fase de preparación, con alto grado de dependencia y con escasa prevalencia de síntomas. En un futuro se prevé que la población que solicite tratamiento especializado se modifique, con la incorporación de fumadores con patología o características específicas." ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "tbl1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "260v39n07-13046504tab01.gif" "imagenAlto" => 302 "imagenAncho" => 381 "imagenTamanyo" => 5890 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of subjects by age (numbers are percentages)." ] ] 1 => array:8 [ "identificador" => "tbl2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "260v39n07-13046504tab02.gif" "imagenAlto" => 262 "imagenAncho" => 379 "imagenTamanyo" => 5851 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Degree of nicotine-dependence. A: low dependence (0-3). B: moderate dependence (4-6). C: high dependence (>7)." ] ] 2 => array:8 [ "identificador" => "tbl3" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "260v39n07-13046504tab03.gif" "imagenAlto" => 261 "imagenAncho" => 381 "imagenTamanyo" => 5289 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Reasons for cessation. A: prevention of disease. B: awareness of dependence. C: parental model for children." ] ] 3 => array:5 [ "identificador" => "tbl4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 4 => array:5 [ "identificador" => "tbl5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 5 => array:5 [ "identificador" => "tbl6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "A clinical practice guideline for treating tobacco use and dependence." 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Perfil de los fumadores que solicitan tratamiento en una unidad de tabaquismo

I. Nerína, A. Crucelaeguib, A. Masb, D. Guillénb

a Departamento de Medicina y Psiquiatría. Unidad de Tabaquismo FMZ. Facultad de Medicina. Universidad de Zaragoza. Spain.

b Especialistas en Medicina de Familia y Comunitaria. Unidad de Tabaquismo FMZ. Facultad de Medicina. Universidad de Zaragoza. Spain.

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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction</span></p><p class="elsevierStylePara">The variety of smoking cessation therapies that have proven effective ranges from simple counseling to intensive interventions using medications -- either nicotine replacement therapy or bupropion -- in combination with cognitive-behavioral therapy<span class="elsevierStyleSup">1-5</span>&#46;</p><p class="elsevierStylePara">At present smoking is considered a chronic disease&#44; given that it is a process that persists over time with periods of improvement &#40;abstinence&#41; and with a strong tendency to relapse<span class="elsevierStyleSup">1</span>&#46; As with other chronic diseases the treatment strategy should include both primary and specialized care&#46; Various primary care protocols<span class="elsevierStyleSup">6</span> exist which identify the characteristics of smokers who can benefit from smoking cessation programs&#46;</p><p class="elsevierStylePara">As is the case with other chronic health conditions&#44; it is also necessary to define the level of the specialized care provided by smoking cessation clinics&#46; To date&#44; Spain has had relatively limited experience with these clinics&#46; Though recommendations have been made as to how they should be organized and operated in this country<span class="elsevierStyleSup">7</span>&#44; they are presently covered by the public health system only in certain autonomous regions where they have been set up&#46;</p><p class="elsevierStylePara"> Smoking is the primary cause of preventable morbidity and mortality in developed countries<span class="elsevierStyleSup">8</span>&#46; According to the latest National Health Survey carried out in 2001 by the Ministry of Health&#44; 34&#37; of the population in Spain over the age of 16 smokes<span class="elsevierStyleSup">9</span>&#46; This high prevalence&#44; together with the enormous cost of treatment of smoking-related diseases&#44; underlines the need for therapeutic interventions aimed at reducing the numbers of smokers&#46; As some authors have affirmed<span class="elsevierStyleSup">2&#44;10</span>&#44; smoking cessation treatment is a priority intervention among the policies aimed at controlling smoking&#44; given that treatment directly affects smoking-related morbidity and mortality in a population and therefore is the most cost-effective intervention in the short term&#44; justifying the development of therapeutic services available at all levels of the system&#46;</p><p class="elsevierStylePara">The objective of our study was to describe the profile of smokers who seek treatment at a smoking cessation clinic and thus contribute to establishing treatment criteria at a level of specialized care&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Material and methods</span></p><p class="elsevierStylePara">A descriptive observational study was carried out&#46; The target population comprised smokers who voluntarily sought treatment at the Smoking Cessation Clinic of the University of Zaragoza School of Medicine &#40;FMZ&#41;&#46; The clinic is located in the School of Medicine and offers free treatment to smokers wishing to quit&#44; under an agreement between the University of Zaragoza&#44; the regional autonomous government of Aragon and an insurance company &#40;Mutua de Accidentes de Zaragoza&#41;&#46; The patients were representative of the general urban population and were either self-referred or referred to the clinic by their doctor at the workplace or a family physician&#46; In all cases the smokers personally sought access to the program through an initial telephone call to the clinic&#46;</p><p class="elsevierStylePara">The following variables were studied&#58; sex&#59; age&#59; referral source&#59; marital status&#59; educational level&#59; age at which smoking began&#44; age at which it became a regular habit and the time elapsed between the two moments&#59; level of nicotine dependence &#40;measured by the Modified Fagerstr&#246;m Questionnaire for Nicotine&#41;<span class="elsevierStyleSup">11</span>&#59; number of cigarettes smoked per day&#59; number of years smoking&#59; use of other potentially-addictive substances &#40;alcohol&#44; caffeine&#44; psychotropic medications and other drugs&#41;&#59; presence of concomitant disease&#59; previous attempts to quit smoking&#59; current reasons for smoking cessation&#59; and expired air carbon monoxide &#40;CO&#41;&#46;</p><p class="elsevierStylePara">All of the patients seeking treatment at the smoking cessation clinic were placed on a waiting list&#59; following that&#44; an appointment was arranged for each&#44; at which time the smoker&#39;s medical history was taken in order to gather data on the study variables and measure weight&#44; blood pressure and CO in expired air&#46; These individuals were then enrolled in a multicomponent treatment program &#40;utilizing medication and psychotherapy&#41;&#46; In all cases&#44; the choice of pharmacologic therapy was discussed and agreed upon with the smoker in advance and determined according to the degree of nicotine-dependence previously diagnosed in the first interview&#46; Either combined nicotine replacement therapy &#40;fast-acting nicotine substitutes and&#47;or the transdermal patch system&#41; or bupropion was prescribed&#44; depending upon the individual characteristics of each smoker and possible contraindications&#46;</p><p class="elsevierStylePara"> Severe psychiatric disorders or concurrent dependence on another addictive substance were considered exclusion criteria for patients seeking multi-component group smoking cessation treatment&#46;</p><p class="elsevierStylePara"> Expired air CO was measured with a CO-oximeter &#40;Mini Smokerlyzer&#44; Bedfont Scientific Ltd&#46;&#41;&#44; and findings above 10 ppm<span class="elsevierStyleSup">12</span> identified an individual as a smoker&#46;</p><p class="elsevierStylePara"> Nicotine dependence&#44; as measured by the Fagerstr&#246;m Test&#44; was considered low for individuals scoring 0 to 3&#59; average for those scoring between 4 and 6&#59; and high for those with scores above 7<span class="elsevierStyleSup">13</span>&#46;</p><p class="elsevierStylePara"> SPSS software in a Windows<span class="elsevierStyleSup">&#174;</span> operating system was used for the database&#44; statistical analysis and data handling&#46; The results are presented in percentages and means with standard deviations &#40;SD&#41; and 95&#37; confidence intervals &#40;CI&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results</span></p><p class="elsevierStylePara">The population sample comprised 385 smokers -- 239 &#40;62&#37;&#41; men and 146 &#40;38&#37;&#41; women -- with an average age of 43&#46;05 years &#40;SD&#58; 9&#46;07&#59; 95&#37; CI&#44; 42&#46;14-43&#46;96 years&#41;&#46; Figure 1 shows the sample distribution according to age&#46;</p><p class="elsevierStylePara"><img src="260v39n07-13046504tab01.gif"></img></p><p class="elsevierStylePara">Fig&#46; 1&#46; Distribution of subjects by age &#40;numbers are percentages&#41;&#46;</p><p class="elsevierStylePara">In 67&#46;3&#37; of the cases&#44; subjects were referred to the clinic by their workplace physician&#44; 17&#46;4&#37; were referred by their primary care physician and the remaining 15&#46;3&#37; were self-referred&#46; The majority of the participants &#40;72&#46;5&#37;&#41; were married and 83&#37; had children&#46; Thirty-three percent of the study sample had received a basic education &#40;elementary or early secondary schooling&#41;&#44; 39&#37; had received higher secondary education or vocational training and the remaining 28&#37; had attended university&#46;</p><p class="elsevierStylePara"> Ninety-two of the participants began smoking between the ages of 8 and 20&#44; the average age being 14&#46;83 years &#40;SD&#58; 4&#46;27&#59; 95&#37; CI&#44; 14&#46;40-15&#46;27 years&#41;&#46; The average age at which smoking became a regular habit was 17&#46;7 years &#40;SD&#58; 4&#46;59&#59; 95&#37; CI&#44; 17&#46;32-18&#46;25 years&#41;&#46; The mean interval of time between the age at which smoking began and the age at which it became a regular habit was 3 years &#40;SD&#58; 3&#46;01&#59; 95&#37; CI&#44; 2&#46;69-3&#46;30 years&#41;&#46;</p><p class="elsevierStylePara">The mean Fagerstr&#246;m test score was 6&#46;05 points &#40;SD&#58; 2&#46;19&#59; 95&#37; CI&#44; 5&#46;83-6&#46;27&#41;&#59; 14&#37; of the study sample scored as having low dependence &#40;0-3&#41;&#59; 42&#37; medium dependence &#40;4-6&#41;&#44; and 44&#37; high dependence &#40;scores of 7 and above&#41; &#40;Fig&#46; 2&#41;&#46; Responses to the Fagerstr&#246;m questionnaire showed that 32&#46;1&#37; of the subjects smoked their first cigarette of the day within 5 minutes of waking and 35&#46;5&#37; smoked more than 30 cigarettes per day&#46;</p><p class="elsevierStylePara"><img src="260v39n07-13046504tab02.gif"></img></p><p class="elsevierStylePara">Fig&#46; 2&#46; Degree of nicotine-dependence&#46; A&#58; low dependence &#40;0-3&#41;&#46; B&#58; moderate dependence &#40;4-6&#41;&#46; C&#58; high dependence &#40;&#62;7&#41;&#46;</p><p class="elsevierStylePara">The average number of cigarettes smoked per day was 25&#46;9 &#40;SD&#58; 12&#46;11&#59; with 95&#37; CI&#44; 24&#46;74-27&#46;18 cigarettes per day&#41;&#44; and the average number of years smoking was 25&#46;3 &#40;SD&#58; 9&#46;04&#41;&#59; the mean concentration of CO in expired air measured at the initial interview &#40;before smoking cessation&#41; was 39&#46;30 ppm &#40;SD&#58; 25&#46;18&#59; 95&#37; CI&#44; 36&#46;75-41&#46;84 ppm&#41;&#46;</p><p class="elsevierStylePara">A study of the concomitant use of other potentially-addictive substances showed the following results&#58; 26&#37; of the subjects consumed alcohol on a daily basis&#44; 92&#37; consumed caffeine daily and 18&#37; were taking psychotropic medications at the time the medical history was taken&#46; Seven percent of the sample group had experimented with other drugs such as marijuana and cocaine though none of the subjects was using those substances at the time of the study&#46;</p><p class="elsevierStylePara"> Associated disease was present as chronic bronchitis for 27&#46;5&#37; of the sample studied while 9&#37; had history of peptic ulcers&#44; though none active at the time of the initial interview&#44; and cardiovascular risk factors were present for 15&#37;&#46;</p><p class="elsevierStylePara"> Seventy-two percent of the smokers in the study had tried to quit smoking on previous occasions&#59; of these&#44; 122 &#40;46&#37;&#41; had made only one attempt at smoking cessation&#44; and theirs was the most frequently encountered situation in our study population&#46; The main reasons for giving up smoking were the prevention of disease &#40;38&#37;&#41;&#44; awareness of dependence &#40;20&#37;&#41; and parental desire to serve as a positive role model for children &#40;10&#37;&#41; &#40;Fig&#46; 3&#41;&#46;</p><p class="elsevierStylePara"><img src="260v39n07-13046504tab03.gif"></img></p><p class="elsevierStylePara">Fig&#46; 3&#46; Reasons for cessation&#46; A&#58; prevention of disease&#46; B&#58; awareness of dependence&#46; C&#58; parental model for children&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara">The individuals seeking treatment at this smoking cessation clinic were referred by their doctor at the workplace&#44; their primary care physician or were self-referrals&#44; indicating to us that it is a heterogeneous&#44; representative sampling of smokers wishing to quit&#46; The reason the majority of participants in this study were from work-related referrals is due to the fact that when the FMZ Smoking Cessation Clinic first went into operation its primary links were with clinics in the workplace&#46; Nonetheless&#44; regardless of the referral source&#44; each participant voluntarily came to the clinic for smoking cessation treatment&#44; which was offered at no cost other than for the purchase of medications that are not presently covered by the Public Health Service in Spain&#46;</p><p class="elsevierStylePara">The fact that potential participants personally contacted the clinic by telephone to seek treatment and then were placed on a waiting list&#44; served as a way to screen out smokers who&#44; in accordance with the stages of change proposed by Prochazka and DiClemente<span class="elsevierStyleSup">14</span>&#44; were neither ready nor sufficiently motivated to quit smoking&#46; When the medical histories were taken each subject chose his or her own quitting date&#44; another criterion that indicates the individual is ready for smoking cessation<span class="elsevierStyleSup">13</span>&#46;</p><p class="elsevierStylePara">The average age of the subjects in the study was 43 years and most of the smokers showed no smoking-related disease&#46; Approximately a quarter of the study sample &#40;27&#46;5&#37;&#41; presented with chronic bronchitis&#46; That prevalence is lower than that described for smokers<span class="elsevierStyleSup">15</span>&#44; probably directly owing to the average age of the subjects studied&#46; Thus&#44; we can generally define the group as young adult smokers with no smoking-related diseases&#46; One study on smoking cessation carried out in Spain<span class="elsevierStyleSup">16</span> describes very different characteristics for smokers who quit&#46; The differences are probably due to the methodology used&#44; given that the variables in that study were drawn indirectly from an analysis of a National Health Survey and referred to ex&#173;smokers&#46; Thus&#44; the target group was not the same as that in our study and therefore could not serve as a valid point of comparison&#46;</p><p class="elsevierStylePara">The prevalence of psychotropic medication use in the population at large has been determined to be slightly lower &#40;14&#37;&#41;<span class="elsevierStyleSup">17&#44;18</span> than that found in our study &#40;18&#37;&#41;&#44; possibly owing to specific emotional and personality traits of smokers as yet not fully understood<span class="elsevierStyleSup">19</span>&#46;</p><p class="elsevierStylePara">The higher percentage of men to women in the sample studied reflects the current tendency of men to quit smoking in greater numbers than women&#46; This observation is consistent with Stage 3 of the epidemiological model described by L&#243;pez et al<span class="elsevierStyleSup">20</span>&#44; which includes Spain&#44; and with statistics gathered from a recent population survey in Catalonia &#40;Spain&#41;<span class="elsevierStyleSup">21&#44;22</span>&#46;</p><p class="elsevierStylePara">We observed that the average age at which subjects began to smoke was 14&#46;8 years &#40;between 8 and 20 years of age&#41;&#44; with a mean interval of 3 years between the age at which smoking began and the age at which it became a regular habit&#46; These figures match those in the literature<span class="elsevierStyleSup">23&#44;24</span>&#46;</p><p class="elsevierStylePara">The Fagerstr&#246;m test for nicotine dependence shows overall results of moderate dependence &#40;mean value of 6&#41;<span class="elsevierStyleSup">12</span>&#44; though individual analysis of questionnaire results for this group of smokers indicates that a minority &#40;14&#37;&#41; of the subjects had low dependence and the majority had medium or high dependence&#44; consistent with the mean concentration of expired CO &#40;39&#46;3&#41; found&#46; Along these same lines it has been postulated that smokers with low nicotine-dependence are able to quit smoking on their own while more severely nicotine-dependent smokers are those who seek smoking cessation treatment<span class="elsevierStyleSup">25</span>&#46;</p><p class="elsevierStylePara">An analysis of the two most weighted items in the Fagerstr&#246;m test<span class="elsevierStyleSup">26</span> &#40;time elapsed before the first cigarette and number of cigarettes smoked per day&#41; showed that one-third of the subjects smoked their first cigarette within 5 minutes of waking and smoked more than 30 cigarettes per day &#40;32&#37; and 35&#46;5&#37;&#44; respectively&#41;&#59; this finding is of interest because it sheds further light on degree-of-dependence and indicates that one-third of the subjects seeking smoking cessation treatment fit a severely nicotine-dependent profile as described by some authors<span class="elsevierStyleSup">27</span>&#46; Degree of dependence could be related to the average age of the subjects in the sample population &#40;43 years&#41; and is in keeping with a recent study of smokers in Europe which reports that the most severely nicotine-dependent smokers fall with the range of 35 to 65 years of age<span class="elsevierStyleSup">28</span>&#46;</p><p class="elsevierStylePara">The majority of the subjects &#40;72&#37;&#41; had made a past attempt to quit smoking&#44; which can be interpreted as indicating a high degree of dissonance and is consistent with the profile of this group as being&#44; generally speaking&#44; at the stage of preparing to quit<span class="elsevierStyleSup">29</span>&#46; We observed that the most frequently cited reason for wanting to quit smoking was prevention of disease -- in keeping with reports from other studies<span class="elsevierStyleSup">30</span> -- though other significant factors included awareness of dependence and parental desire to serve as a positive role model for children&#46; Understanding the reasons behind smokers&#39; desire to quit can be helpful in designing specifically-targeted smoking cessation interventions linked with both public and preventive health care policies&#46;</p><p class="elsevierStylePara">The subjects enrolled in this smoking cessation clinic were not pre-selected to fit the described profile of the subgroup of smokers needing specialized treatment<span class="elsevierStyleSup">7</span>&#59; nonetheless&#44; the results show this population sample to be severely nicotine-dependent young adults with a strong desire to quit smoking but showing no concomitant disease&#46;</p><p class="elsevierStylePara">In the near future&#44; with the development of a stepped-care model of smoking-cessation intervention in which treatment of smokers would come under the umbrella of primary and specialized care -- as is the case with any other chronic health problem<span class="elsevierStyleSup">31</span> -- we will see a larger sample group of people seeking specialized treatment&#46; This will include a greater number of smokers with diseases &#40;chronic obstructive pulmonary disease&#44; heart disease&#44; psychiatric disorders&#41; as well as other specific groups of smokers such as pregnant women&#44; older-aged smokers&#44; etc&#46; who do not currently represent a significant percentage of people seeking treatment at smoking cessation clinics&#46; The few Spanish publications reporting on smoking cessation clinics and intensive interventions have demonstrated the efficacy of such programs<span class="elsevierStyleSup">32-35</span>&#46; Such reports will require us to direct resources to specialized smoking cessation services in Spain&#44; a recommendation which has in fact been made in a recent report by the Ministry of Health and Consumer Affairs<span class="elsevierStyleSup">36</span>&#46;</p><hr></hr><p class="elsevierStylePara">Correspondence&#58; Dr&#46; I&#46; Ner&#237;n&#46;<br></br> Departamento de Medicina y Psiquiatr&#237;a&#46; Facultad de Medicina&#44; edificio B&#46; Domingo Miral&#44; s&#47;n&#46; 50009 Zaragoza&#46; Spain<br></br> E-mail&#58; <a href="mailto&#58;isabelne&#64;posta&#46;unizar&#46;es" class="elsevierStyleCrossRefs"> isabelne&#64;posta&#46;unizar&#46;es</a></p><p class="elsevierStylePara">Manuscript received 1 August 2002&#46;<br></br> Accepted for publication 12 October 2002&#46;</p>"
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            0 => "Smoking"
            1 => "Smoking cessation"
            2 => "Smoking cessation clinic"
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            0 => "Tabaquismo"
            1 => "Deshabituaci&#243;n tab&#225;quica"
            2 => "Unidad de tabaquismo"
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        "resumen" => "Objectives&#58; The variety of smoking cessation therapies that have proven effective ranges from simple counseling to intensive interventions&#46; The objective of our study was to identify the characteristics of smokers who currently seek treatment at a smoking cessation clinic&#46; Methods&#58; Descriptive observational study&#46; The target population consisted of smokers who sought treatment at a smoking cessation clinic&#46; The following variables were studied&#58; sex&#59; age&#59; referral source&#59; marital status&#59; educational level&#59; age at which smoking began&#44; age at which it became a regular habit and the time elapsed between the two moments&#59; level of nicotine dependence &#40;Fagerstr&#246;m Test for Nicotine Dependence&#41;&#59; number of cigarettes per day&#59; number of years smoking&#59; use of other potentially-addictive substances &#40;alcohol&#44; caffeine&#44; psychotropic medications and other drugs&#41;&#59; presence of concomitant disease&#59; previous attempts to quit smoking&#59; current reasons for smoking cessation&#59; and concentration of expired air carbon monoxide &#40;CO&#41;&#46; An initial medical history was taken from each smoker on the waiting list for treatment at the clinic in order to gather data on the study variables&#59; these individuals were then enrolled in a 3-month group smoking cessation program that utilized both medication and cognitive-behavioral therapy&#46; The results are presented in percentages and means with standard deviations &#40;SD&#41; and 95&#37; confidence intervals &#40;CI&#41;&#46; Results&#58; 385 smokers were studied--239 &#40;62&#37;&#41; men and 146 &#40;38&#37;&#41; women--the average age being 43&#46;05 years &#40;SD&#58; 9&#46;07&#41;&#46; Mean nicotine-dependence &#40;Fagerstr&#246;m Test score&#41; was 6&#46;05 &#40;SD&#58; 2&#46;19&#41;&#59; mean number of cigarettes per day&#58; 25&#46;9 &#40;SD&#58; 12&#46;11&#41;&#59; mean number of years as a smoker&#58; 25&#46;3 &#40;SD&#58; 9&#46;04&#41;&#59; and mean expired air CO&#58; 39&#46;30 &#40;SD&#58; 25&#46;18&#41;&#46; Associated disease was present as chronic bronchitis for 27&#46;5&#37; and cardiovascular risk factors for 15&#37;&#46; Previous attempts to quit smoking were reported by 72&#37;&#59; the reasons for the present attempt to quit smoking were the prevention of disease &#40;38&#37;&#41;&#44; awareness of dependence &#40;20&#37;&#41; and parental desire to serve as a positive role model for children &#40;10&#37;&#41;&#46; Conclusions&#58; At present&#44; the smokers who attend a smoking cessation clinic are young&#44; severely-dependent adults in the initial stage of preparing to quit&#46; The prevalence of symptoms in this population is low&#46; The profile of the population seeking specialized smoking cessation treatment is expected to change in the future as those with smoking-related diseases and other specific populations of smokers become included&#46;"
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        "resumen" => "Objetivos&#58; El tratamiento del tabaquismo incluye diversas intervenciones terap&#233;uticas que han demostrado ser eficaces&#44; desde el consejo m&#237;nimo hasta la atenci&#243;n intensiva&#46; El objetivo de nuestro trabajo es conocer las caracter&#237;sticas que presenta la poblaci&#243;n de fumadores que actualmente solicitan tratamiento de deshabituaci&#243;n tab&#225;quica en una unidad de tabaquismo&#46; M&#233;todo&#58; Estudio descriptivo observacional&#46; La poblaci&#243;n objetivo fueron los fumadores que acuden a una unidad de tabaquismo para deshabituaci&#243;n tab&#225;quica&#46; Se estudiaron las siguientes variables&#58; sexo&#44; edad&#44; procedencia&#44; estado civil&#44; nivel de formaci&#243;n&#44; edad de primer consumo de tabaco y de consumo regular y tiempo transcurrido entre ambos&#44; grado de dependencia a la nicotina &#40;test de Fagerstr&#246;m&#41;&#44; n&#250;mero de cigarrillos-d&#237;a&#44; n&#250;mero de a&#241;os de fumador&#44; consumo de otras sustancias con capacidad de originar adicci&#243;n &#40;alcohol&#44; cafe&#237;na&#44; psicof&#225;rmacos&#44; otras drogas&#41;&#44; presencia de patolog&#237;a concomitante&#44; intentos previos de cesaci&#243;n&#44; motivos actuales de abandono y determinaci&#243;n de mon&#243;xido de carbono en aire espirado&#46; A todos los fumadores incluidos en la lista de espera se les realiz&#243; una historia de primer d&#237;a en la que se recog&#237;an las variables de estudio y se les inclu&#237;a en un programa de deshabituaci&#243;n tab&#225;quica en grupo&#44; mediante tratamiento multicomponente &#40;farmacol&#243;gico y terapia cognitivo-conductual&#41; a lo largo de 3 meses&#46; Se presentan los resultados como proporciones y medias con sus desviaciones est&#225;ndar &#40;DE&#41; y sus intervalos de confianza &#40;IC&#41; del 95&#37;&#46; Resultados&#58; Se estudi&#243; a 385 fumadores 239 &#91;62&#37;&#93; varones y 146 &#91;38&#37;&#93; mujeres&#44; con una edad media de 43&#44;05 a&#241;os &#40;DE&#44; 9&#44;07&#41;&#46; La dependencia media a la nicotina &#40;test de Fagerstr&#246;m&#41; fue de 6&#44;05 &#40;DE&#44; 2&#44;19&#41;&#59; media de cigarrillos&#47;d&#237;a&#44; 25&#44;9 &#40;DE&#44; 12&#44;11&#41;&#59; media de n&#250;mero de a&#241;os de fumador&#44; 25&#44;3 a&#241;os &#40;DE&#44; 9&#44;04&#41;&#44; y media de mon&#243;xido de carbono&#44; 39&#44;30 &#40;DE&#44; 25&#44;18&#41;&#46; En cuanto a la presencia de patolog&#237;a asociada&#44; el 27&#44;5&#37; de los pacientes presentaba bronquitis cr&#243;nica&#44; y el 15&#37;&#44; factores de riesgo cardiovascular asociados&#46; El 72&#37; hab&#237;a tenido intentos previos de cesaci&#243;n&#59; los motivos actuales para dejar de fumar eran la prevenci&#243;n de enfermedades &#40;38&#37;&#41;&#44; la conciencia de dependencia &#40;20&#37;&#41; y el papel ejemplar para los hijos &#40;10&#37;&#41;&#46; Conclusiones&#58; Actualmente los fumadores que acuden a una unidad de tabaquismo son adultos j&#243;venes&#44; en fase de preparaci&#243;n&#44; con alto grado de dependencia y con escasa prevalencia de s&#237;ntomas&#46; En un futuro se prev&#233; que la poblaci&#243;n que solicite tratamiento especializado se modifique&#44; con la incorporaci&#243;n de fumadores con patolog&#237;a o caracter&#237;sticas espec&#237;ficas&#46;"
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Article information

ISSN: 15792129
Original language: English

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Year/Month	Html	Pdf	Total

2024 November	2	3	5
2024 October	34	21	55
2024 September	43	19	62
2024 August	50	35	85
2024 July	34	21	55
2024 June	41	21	62
2024 May	44	28	72
2024 April	26	25	51
2024 March	32	26	58
2024 February	28	32	60
2023 March	5	2	7
2023 February	27	17	44
2023 January	23	34	57
2022 December	37	34	71
2022 November	41	22	63
2022 October	32	25	57
2022 September	39	25	64
2022 August	29	36	65
2022 July	32	22	54
2022 June	37	32	69
2022 May	34	28	62
2022 April	36	27	63
2022 March	33	41	74
2022 February	35	35	70
2022 January	26	24	50
2021 December	56	40	96
2021 November	44	33	77
2021 October	75	26	101
2021 September	64	39	103
2021 August	63	23	86
2021 July	41	28	69
2021 June	33	23	56
2021 May	44	30	74
2021 April	121	73	194
2021 March	62	16	78
2021 February	43	15	58
2021 January	34	14	48
2020 December	48	11	59
2020 November	51	8	59
2020 October	38	8	46
2020 September	38	3	41
2020 August	35	8	43
2020 July	58	18	76
2020 June	33	4	37
2020 May	47	13	60
2020 April	59	9	68
2020 March	37	13	50
2020 February	44	15	59
2020 January	30	20	50
2019 December	46	17	63
2019 November	55	13	68
2019 October	53	12	65
2019 September	46	14	60
2019 August	30	16	46
2019 July	45	14	59
2019 June	14	10	24
2019 May	25	22	47
2019 April	56	23	79
2019 March	38	15	53
2019 February	41	17	58
2019 January	30	9	39
2018 December	24	18	42
2018 November	21	19	40
2018 October	32	17	49
2018 September	19	10	29
2018 May	7	0	7
2018 April	18	6	24
2018 March	11	3	14
2018 February	23	3	26
2018 January	18	7	25
2017 December	20	4	24
2017 November	28	1	29
2017 October	23	6	29
2017 September	32	4	36
2017 August	63	10	73
2017 July	48	14	62
2017 June	81	5	86
2017 May	43	4	47
2017 April	55	7	62
2017 March	84	44	128
2017 February	32	4	36
2017 January	25	4	29
2016 December	58	6	64
2016 November	72	9	81
2016 October	103	19	122
2016 September	80	11	91
2016 August	74	5	79
2016 July	655	963	1618
2016 March	1	0	1
2016 February	1	0	1
2016 January	2	0	2
2015 December	2	0	2
2015 October	51	11	62
2015 September	64	6	70
2015 August	48	10	58
2015 July	38	10	48
2015 June	33	5	38
2015 May	41	8	49
2015 April	36	11	47
2015 March	13	6	19
2015 February	15	1	16
2015 January	18	5	23
2014 December	17	3	20
2014 November	15	7	22
2014 October	38	9	47
2014 September	22	9	31
2014 August	24	9	33
2014 July	22	3	25
2014 June	36	6	42
2014 May	39	8	47
2014 April	42	9	51
2014 March	43	8	51
2014 February	39	10	49
2014 January	30	9	39
2013 December	30	5	35
2013 November	28	8	36
2013 October	15	10	25
2013 September	32	13	45
2013 August	24	6	30
2013 July	31	10	41
2013 June	22	8	30
2013 May	24	4	28
2013 April	10	0	10
2013 March	6	2	8

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