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Jean-François Etter

Publications and source records attributed to Jean-François Etter.

At least 19 recordsLinked to original sources
PubMed2006

Acceptability and impact of a partial smoking ban in a psychiatric hospital.

OBJECTIVE: The acceptability and impact of partial smoking bans in psychiatric hospitals are not well documented. We assessed the impact of a partial smoking ban in a psychiatric hospital in Switzerland. METHODS: Before the intervention, smoking was not allowed in bedrooms and dining rooms, but this ban was not enforced. The intervention consisted of banning smoking everywhere, except in dedicated smoking rooms. Patients and staff were surveyed before (October 2003, 49 patients and 57 staff) and 2 months after the smoking ban (April 2004, 54 patients and 54 staff). Analyses included both patients and staff. RESULTS: Compared with baseline, after the intervention twice as many non-smokers reported that they were "never" exposed to environmental tobacco smoke (ETS) in bedrooms (before=25.0%, after=54.5%, p=0.046), dining rooms (35.5 vs. 65.5%, p=0.037), corridors (10.4 vs. 30.9%, p=0.001) and meeting rooms (36.8 vs. 75.0%, p=0.012). The smoking ban was loosely enforced; although the ban reduced ETS, substantial exposure to ETS remained after it was introduced. Most participants (87%) rejected the idea of a total smoking ban. CONCLUSION: The partial smoking ban was well accepted and was associated with less exposure to ETS. However, even a partial ban proved difficult to enforce in this hospital.

Adult↗
PubMed2006

Laws prohibiting the sale of tobacco to minors: impact and adverse consequences.

This paper discusses the consequences of laws that prohibit the sale of tobacco to minors. When enforced, such laws may decrease tobacco sales to minors, but local authorities are often reluctant to enforce these laws. However, the prohibition of tobacco sales to minors is often followed by an increase in the use of tobacco obtained from social sources, mainly family and friends. Importantly, these laws do not decrease smoking prevalence among minors. Several local laws prohibit youths from purchasing, using, and possessing tobacco. However, these laws shift responsibility from retailers to youth, criminalizing young smokers. Those who advocate this type of approach have not documented the adverse consequences of laws that prohibit minors from purchasing, using, or possessing tobacco. In conclusion, youth access laws are ineffective and are not based on sound science.

Adolescent↗
PubMed2006

The internet and the industrial revolution in smoking cessation counselling.

The internet can provide wide access to online smoking cessation programmes developed by highly qualified professionals. Compared with one-to-one counselling in smoking cessation clinics or on telephone quitlines, the mass-level dissemination of automatised, individualised counselling on the internet is comparable to the industrial revolution, when skilled craftsmen working in small shops were replaced by huge plants. Hundreds of websites provide information and advice on smoking cessation, but very few of them have been evaluated scientifically. Therefore, it is not yet known whether web-based smoking cessation interventions are effective in the long term, and which of their components are most effective for subgroups of smokers. Claims for efficacy found on some popular websites have not been evaluated. The internet is being used increasingly by tobacco companies to promote their products. The overall effect of internet smoking cessation programs on smoking prevalence is unknown. Greater efforts should be expended to improve the reach and efficacy of smoking cessation websites.

Advertising↗
PubMed2006

Impact of educational outreach visits on smoking cessation activities performed by specialist physicians: a randomized trial.

OBJECTIVES: To find out whether educational visits by a nurse to specialist physicians improved their self-reporting of smoking cessation activities; whether these visits increased the percentage of physicians who were aware of and recommended a computer-tailored smoking cessation program and who participated in a training workshop on tobacco dependency treatment. METHODS: Specialist private practice physicians (n = 523) working in Geneva, Switzerland were randomly assigned to either receiving (n = 261) or not receiving (n = 262) a single 40-minute visit by a trained nurse in 2003. The physicians answered a postal questionnaire 5 months after the visits indicating the percentage of their patients they counselled or treated for tobacco dependency and we recorded whether physicians took part in the workshop. FINDINGS: Only half (53%) of the physicians agreed to receive a visit. At follow-up more physicians in the intervention group than in the control group were aware of the computer-tailored program (73% vs. 39%, p < 0.001) and more physicians in the intervention group said they recommended the use of this program to more patients (20% vs. 10%, p = 0.009). Among non-smoking physicians only, the proportion of patients who were advised to quit smoking was higher in the intervention than in the control group (69% vs. 54%, p = 0.019, as reported by physicians). The intervention had no impact on physicians' participation in the workshop. CONCLUSIONS: Visits by a nurse increased the proportion of physicians who recommended to their patients the use of a computer-tailored smoking cessation program. Among non-smoking physicians only, the intervention increased the proportion of patients who received the advice to quit smoking, as reported by physicians.

Attitude of Health Personnel↗
PubMed2006

A comparison of the psychometric properties of three cigarette withdrawal scales.

AIMS: To compare the psychometric properties of three cigarette withdrawal scales. DESIGN: An internet cohort study. PARTICIPANTS: Each of 4,644 current (44%), former (49%) and never smokers (7%) completed the three scales via the internet. A subsample completed the scales again after 14 days (n=1309), and indicated their smoking status after 42 days (n=1431). MEASUREMENTS: The Cigarette Withdrawal Scale (CWS), the Wisconsin Withdrawal Scale (WWS) and the Minnesota Withdrawal Form (MWF). FINDINGS: All three scales covered the main elements in the Diagnostic and Statistical Manual version IV (DSM-IV) and the International Classification of Diseases version 10 (ICD-10) definitions of tobacco withdrawal, but WWS did not cover weight gain. Factor analyses indicated that only six factors were present in WWS, instead of the expected seven factors. Cronbach's alpha coefficients (0.76-0.93) were high for all scales. Test-retest coefficients were in the range of 0.66-0.86 for CWS and WWS, but were somewhat lower for some MWF items (range 0.52-0.80). In 324 ex-smokers who had quit smoking 31 days or less before baseline, craving predicted relapse at 14-day follow-up (CWS: odds ratio=1.53 per point, P=0.003; WWS: odds ratio=1.40, P=0.04; MWF: odds ratio=1.49, P=0.002). In 34 baseline smokers who had quit smoking by 14-day retest, an increase in craving (WWS and MWF), depressed mood (MWF) and difficulty concentrating (WWS) between baseline and retest predicted relapse at 42-day follow-up. In terms of construct validity, scales performed similarly, but performance on some key tests (e.g. withdrawal will increase post-cessation) were inadequate, due perhaps to methodological limitations. CONCLUSIONS: No scale showed a decisive advantage over the others. MWF has the advantage of brevity.

Adult↗
PubMed2006

Some doubts about one of the largest smoking prevention programmes in Europe, the smokefree class competition.

With over 600,000 participants in 16 countries, the smokefree class competition is one of the largest smoking prevention programmes in Europe. Participating classes that maintain a smoking prevalence usually below 10% are eligible for a contest and the winner is rewarded with money. There is however no convincing evidence that this competition has any effect on smoking prevalence beyond the short term, and this approach raises serious ethical issues. In particular, the central principle of this competition is to apply negative peer pressure upon teenage smokers. However, promoters of this competition have neglected to report the possible adverse consequences of using negative peer pressure upon smokers. This is a concern, because teenage smokers are more vulnerable than non-smokers, and they are at higher risk of suffering from psychological problems and school failure.

Adolescent↗
PubMed2006

Nicotine replacement therapy for long-term smoking cessation: a meta-analysis.

OBJECTIVE: To assess if the effect of a single treatment episode with nicotine replacement therapy (NRT) enhances smoking cessation over many years. DATA SOURCES: Meta-analysis of all randomised controlled trials of NRT with final follow-up more than one year after the start of treatment. Twelve eligible trials were identified, all placebo-controlled, having final follow-ups ranging from 2-8 years. All had earlier follow-ups at 12 months. They comprised 2408 active and 2384 placebo treatment participants. DATA SYNTHESIS: The odds ratio (OR) in favour of NRT at final follow-up was 1.99 (95% confidence interval (CI) 1.50 to 2.64). There was no evidence that the effect varied according to length of final follow-up (beta = 0.92, p = 0.28) or duration of initial NRT treatment (beta = 0.99, p > 0.5). The overall relapse rate between the 12 months and final follow-up was 30.0% (95% CI 23.5% to 37.5%). This rate did not differ between NRT and control groups (OR 1.11, 95% CI 0.78 to 1.59), or length of initial NRT treatment. There was also no evidence that it varied according to length of final follow up. Due to relapse, the overall efficacy of NRT treatment in terms of additional ex-smokers declined from 10.7% over and above placebo (6.6% to 14.8%) after one year to 7.2% (3.8% to 11.3%) at an average of 4.3 years follow up. CONCLUSIONS: The relative efficacy of a single course of NRT remains constant over many years. The majority of relapse after 12 months occurs within the first or second year and is not detectable thereafter, suggesting that NRT has a permanent effect on smoking cessation. However, initial relapse after one year has the effect of diminishing the number of ex-smokers that can be ultimately attributed to NRT. Results after only 6-12 months of follow-up, as used in existing reviews and treatment guidelines, will overestimate the lifetime benefit and cost-efficacy of NRT by about 30%. Because the long-term benefit of NRT is modest, tobacco dependence treatment might be better viewed as a chronic disorder, requiring repeated episodes of treatment.

Administration, Cutaneous↗
PubMed2005

Internet-based smoking cessation programs.

OBJECTIVE: To present a smoking cessation website and a reflection on the use of the Internet as a smoking cessation tool. METHODS: A literature review and an Internet survey in 1506 current and former smokers. RESULTS: The Internet may be the only form of smoking cessation support available to many smokers. There is a competition between hundreds of smoking cessation websites, many of which have a similar content. Smoking cessation websites are popular, but little scientific evidence is available on their efficacy. Neither do we know which components of these websites are most effective in motivating and helping smokers quit smoking and avoid relapse. Groups of current and former smokers form spontaneously in discussion forums on the Internet, this is a new feature in the field of addiction treatment. These discussion forums have not yet been the object of much scientific research. CONCLUSION: Research should be conducted to assess the efficacy of smoking cessation website, to identify which of their components are most effective, and to identify subgroups of current and former smokers for whom websites are most effective.

Adult↗
PubMed2005

Comparing the efficacy of two Internet-based, computer-tailored smoking cessation programs: a randomized trial.

BACKGROUND: Online computer-tailored smoking cessation programs have not yet been compared directly. OBJECTIVE: To compare the efficacy of two Internet-based, computer-tailored smoking cessation programs. METHODS: Randomized controlled trial conducted in 2003-2004. Visitors to a smoking cessation website were randomly assigned to either an original online, interactive smoking cessation program or to a modified program. Both programs consisted of tailored, personalized counseling letters based on participants' characteristics, followed by monthly email reminders. The original program was based on psychological and addiction theory, and on preliminary research conducted in the same population. The modified program was shorter and contained more information on nicotine replacement therapy and nicotine dependence, and less information on health risks and coping strategies. In both programs, 1 month and 2 months after entering the study, participants were invited by email to answer the same tailoring questionnaire again in order to receive a second counseling letter. Participants in both programs obtained, on average, 1.2 feedback counseling letters over 2.5 months, and 84% received only 1 feedback letter. The outcome was self-reported smoking abstinence (no puff of tobacco in the previous 7 days), assessed 2.5 months after entry in the program. We report results from intention-to-treat (ITT) analyses, where all non-respondents at follow-up were counted as smokers. RESULTS: The baseline questionnaire was answered by a total of 11969 current (74%) and former (26%) smokers, and the follow-up survey by 4237 people (35%). In an ITT analysis, abstinence rates in baseline current smokers were respectively 10.9% and 8.9% (odds ratio [OR]=1.24, 95% confidence interval [CI]1.08-1.43, P=.003) in the original and modified programs, and 25.2% and 15.7% (OR=1.81, CI 1.51-2.16, P<.001) in baseline former smokers. While we found statistically significant differences in quit rates in smokers in the contemplation stage favoring the original program (OR=1.54, CI 1.18-2.02, P=.002), no between-group differences in quit rates were observed in smokers in the precontemplation (OR=1.07, CI 0.36-3.14, P=.91) and preparation (OR=1.15, CI 0.97-1.37, P=.10) stages of change. CONCLUSIONS: In smokers in the contemplation stage of change and in former smokers, the original program produced higher smoking abstinence rates than the modified program.

Adult↗
PubMed2005

A comparison of the content-, construct- and predictive validity of the cigarette dependence scale and the Fagerström test for nicotine dependence.

BACKGROUND: Research showed that the widely used Fagerstrom test for nicotine dependence (FTND) does not cover important aspects of dependence. A new test, the cigarette dependence scale (CDS-12), covers the main elements in DSM-IV and ICD-10 definitions of dependence. We compared the psychometrics of CDS-12, FTND, and CDS-5 and the heaviness of smoking index (HSI), which are short versions of CDS-12 and FTND, respectively. METHODS: Internet survey in 2002-2003. Participants were invited one month after answering the first survey to answer a second survey on smoking status and withdrawal symptoms. RESULTS: Eight hundred two smokers answered both surveys. Cronbach's alpha coefficients were higher for CDS-12 (0.91) and CDS-5 (0.77) than for FTND (0.68) and HSI (0.63). Among 231 smokers who quit smoking at follow-up, higher baseline CDS-12 scores predicted higher withdrawal ratings at follow-up, for all withdrawal symptoms except appetite. FTND and HSI predicted higher craving in quitters, but did not predict the intensity of other withdrawal symptoms. Neither CDS-5, FTND or HSI predicted smoking cessation, but higher CDS-12 scores marginally predicted smoking cessation at follow-up (area under the receiver operating characteristic (ROC) curve = 0.55, 95% confidence interval = 0.51-0.59). CONCLUSIONS: CDS-12 had better content validity and internal consistency than FTND and was a slightly better predictor of withdrawal symptoms. Unexpectedly, higher (not lower) CDS-12 scores predicted subsequent smoking cessation, perhaps because endorsement of some CDS-12 items implies accepting that one is dependent, which in turn could reflect motivation to quit. CDS-12 may represent an alternative to FTND for measuring cigarette dependence.

Adolescent↗
PubMed2005

Collecting saliva by mail for genetic and cotinine analyses in participants recruited through the Internet.

The authors assessed whether collection by mail of saliva and buccal cells for genetic analysis was feasible in participants recruited through the Internet. In 2003, 14,773 visitors of a smoking cessation website were invited by e-mail to take part in the study. Salivettes (plastic vials containing a cotton roll) were mailed to participants, for collection of saliva and buccal cells. Because of limited resources, the authors stopped recruitment when 392 participants (3% of 14,733) were registered. They received 315 saliva samples back (80% of 392). Salivary cotinine was analyzed in 145 daily smokers. Cotinine concentration could be assessed in 141 samples (97%) (range 0.7-899 ng/ml, median 260 ng/ml). DNA extraction was achieved in all the 285 samples in which it was attempted. Quality of DNA was assessed by optical density measurements and by polymerase chain reaction amplification of a gene coding for the alpha-4 nicotinic receptor, with the detection of a known polymorphism. Successful results were obtained in 235 samples (82% of 285). Thus collecting saliva by mail for cotinine and DNA analysis in participants recruited through the internet produced samples of good quality at a reasonable cost. This approach should be valuable for genetic epidemiology and pharmacogenetic research.

Adult↗
PubMed2005

Evaluation of a poster campaign against passive smoking for World No-Tobacco Day.

Four hundred posters on passive smoking were placed on billboards in the streets of Geneva, Switzerland, for 2 weeks in 2001. We conducted a postal survey before and immediately after the campaign, in Geneva and Neuchatel. The Geneva sample (n = 834) was exposed to the campaign while the Neuchatel sample (n = 1121) acted as a control group. Following the poster campaign, 36% of respondents in Geneva reported having seen posters about smoking prevention, compared to 18% beforehand (P < 0.001). Corresponding figures in Neuchatel were 18% (after) and 13% (before). The difference in before-after change between the target and control groups was significant (P < 0.001). The poster had no effect on cigarette consumption or intention to quit. The poster was widely seen and remembered by the target audience, but the campaign was probably too short and isolated to have an impact on smoking behaviour.

Adolescent↗
PubMed2005

A self-administered questionnaire to measure cigarette withdrawal symptoms: the Cigarette Withdrawal Scale.

Because few tobacco withdrawal scales have been submitted to appropriate validity analyses, we sought to develop and assess the validity of a new, self-administered scale measuring cigarette withdrawal symptoms. We generated the instrument content by conducting a qualitative survey of 404 smokers and ex-smokers. Then we tested 61 items on the Internet in 3,050 smokers and ex-smokers. Subsamples provided comprehensive retest data after 17 days (n = 1218) and smoking status after 41 days (n = 673). The study resulted in a 21-item, six-dimension scale labeled the Cigarette Withdrawal Scale (CWS-21). The six subscales cover the main components of nicotine or tobacco withdrawal in the Diagnostic and Statistical Manual of Mental Disorders and International Statistical Classification of Diseases and Related Health Problems and in qualitative data: Depression-anxiety, craving, irritability-impatience, appetite-weight gain, insomnia, and difficulty concentrating. The six scores had a satisfactory test-retest reliability (r = .60-.71) and a high internal consistency (Cronbach's alpha = .83-.96). The factor structure of the scale was robust in a bootstrap resampling procedure. In ex-smokers, all scores except appetite-weight gain and insomnia predicted relapse at 41-day follow-up. In recent ex-smokers who had quit smoking less than 14 days before baseline, all scores except appetite-weight gain decreased between baseline and the 17-day retest. In baseline ex-smokers who relapsed to smoking at the 17-day retest, appetite-weight gain decreased and craving increased between baseline and retest. CWS-21 is a reliable, valid, multidimensional measure of cigarette withdrawal symptoms that is sensitive to change over time and predicts relapse to smoking.

Adult↗
PubMed2004

Validation of English-language versions of three scales measuring attitudes towards smoking, smoking-related self-efficacy and the use of smoking cessation strategies.

AIMS: To assess the validity of English translations of three scales initially developed in French, measuring perception of the adverse effects of smoking, self-efficacy and the use of smoking cessation strategies. METHODS: Between 1999 and 2001, 5667 people from 97 countries (4724 smokers and 943 ex-smokers) answered the scales on the internet, of which 997 (18%) took part in a follow-up 86 days later. FINDINGS: The factor structures of the scales were generally maintained after translation. Internal consistency coefficients were 0.5-0.9. Test-retest reliability was >0.7 for the "Adverse effects" and self-efficacy scales, but was low (0.2-0.4) for self-change strategies, which probably reflects active use of these strategies in this sample. The translated scales performed adequately in most tests of construct validity. In particular, higher self-efficacy ratings predicted smoking cessation at follow-up, and a lower self-efficacy predicted relapse in baseline ex-smokers. CONCLUSION: The validity of the scales was maintained after translation in English.

Adaptation, Psychological↗
PubMed2004

Asking about quantity and frequency of alcohol consumption before asking the CAGE questions produces lower ratings on the CAGE test.

BACKGROUND: We tested whether asking about alcohol consumption before asking the CAGE questions modified the answers to the CAGE test. METHODS: Randomized trial on a smoking cessation website, in English, in 2003. Half the participants began by answering questions on quantity and frequency of alcohol consumption and then, on a second web page, answered the CAGE questionnaire (format A). The other half answered first the CAGE and then questions on quantity and frequency (format B). RESULTS: The survey was answered by 1213 people. Fewer people gave positive answers to three of the four CAGE questions in format A than in format B. Cut-down, 32% versus 38% (P= 0.01); annoyed, 13% versus 18% (P = 0.02); eye-opener, 5% versus 8% (P = 0.02). Fewer people had a CAGE score >/=2, indicating possible alcoholism, in format A than in format B (26% versus 32%, P = 0.04). This effect was stronger in men (CAGE > or = 2, format A, 29%; format B, 39%; P = 0.03), and it was not statistically significant in women (CAGE > or = 2, format A, 25%; format B, 28%; P = 0.4). CONCLUSION: In an internet survey, asking questions about the quantity and frequency of alcohol consumption before asking the CAGE questionnaire produced fewer positive answers to the CAGE. This effect was observed only in men.

Adult↗
PubMed2004

Associations between smoking prevalence, stages of change, cigarette consumption, and quit attempts across the United States.

BACKGROUND: We tested whether across the 50 U.S. States, smoking prevalence was associated with smoking behavior among smokers. METHODS: We used published data on smoking prevalence, cigarette consumption, and quit attempts by State from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993, 1996, and 1999, and published data on the distribution of smokers by stage of change in each State from the Current Population Survey (CPS). Data were weighted for the population size in each State. RESULTS: For 1993, we found no statistically significant association between smoking prevalence and stages of change. For 1996 and 1999, across the 50 States, each additional percentage point in smoking prevalence was associated with, respectively, 0.62% and 1.19% more smokers in the "precontemplation" stage, that is, smokers not intending to quit smoking (both P < 0.01), with, respectively, 0.82% and 1.21% more "heavy" smokers who smoked 21-40 cigarettes per day (both P </= 0.001), and with, respectively, 1.12% and 0.81% fewer daily smokers who quit smoking for 1+ days in the previous year (both P </= 0.04). CONCLUSIONS: Across the 50 States, a higher prevalence of cigarette smoking was associated with a lower motivation to quit smoking, fewer quit attempts, and higher cigarette consumption among smokers.

Adult↗
PubMed2004

Administering an effective health intervention for smoking cessation online: the international users of Stop-Tabac.

BACKGROUND: The Internet has opened up new possibilities in public health, yet to date, there are few examples of online health interventions that go beyond information provision. This paper describes the users and return rates of an effective intervention for smoking cessation that has gone online. METHODS: Open enrollment of smokers via links and search engines with voluntary follow-up for an Internet-based expert system in French and English. RESULTS: Between June 1998 and March 2001, 18,361 people from 112 countries used the program. When compared to the distribution of smokers in the general population in seven main countries, smokers in the action stage (11%) were overrepresented among online program users. Among the 3591 returnees in the study period (20%), we observed a median time to return of 132.5 days. One of the strongest predictors of return was stage of change with smokers in the action stage being most likely to return (28%) and those in the precontemplation stage least likely (14%). CONCLUSIONS: The reach of an online public health intervention can be impressive in geographical and numerical terms. Although the quality of behavioral data collected was high, the utility of this medium for science should be refined.

Adult↗