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07 décembre 2010

La newsletter de stop-tabac: les sujets clés de l?actualité mondiale sur le tabagisme

Sélection réalisée par Jean-François Etter

Le 7 décembre 2010

 


- Ils vont fumer dehors et partent sans payer
- Des derivatifs de la cytisine ont une forte affinite pour les recepteurs nicotiniques
- Stage-based interventions for smoking cessation (Cochrane)

Ils vont fumer dehors et partent sans payer

Filouterie | Depuis l'interdiction de la fumée dans les lieux publics, des clients s'offrent un bon repas avant de partir, sans régler l'addition.

L'interdiction de fumer, introduite le 31 octobre?2009 à Genève, a mis au jour une nouvelle astuce pour les amateurs de filouterie d'auberge. Quelques établissements genevois en ont déjà fait les frais. Un ou plusieurs clients, aux profils divers, s'attablent dans un restaurant et commandent généralement un bon dîner. Ils sortent même fumer et poursuivent leur festin, histoire de lever le moindre doute qui pourrait tarauder le tavernier. C'est à la fin du repas, au moment du café que la partition s'enraye. Sous prétexte de s'en griller une dernière, ils sortent, restent devant la vitrine un moment et disparaissent soudain.

Une ardoise de 90?francs

Un client m'a récemment laissé une ardoise de 90?francs, déplore Paulin, gérant du restaurant Chez l'autre, à Plainpalais. Il est arrivé vers 9?h et a commandé un café avant de s'installer au bar jusqu'à l'heure de l'apéro. Il a poursuivi au rosé, tranquille en lisant la presse. Vers midi, il s'est attablé pour commander un plat du jour, raconte le restaurateur. C'était un client d'un certain âge, très sympathique. Vers 14?h, il est revenu au comptoir demander un café et un cognac, en demandant qu'on les lui serve en terrasse. Comme il était déjà sorti fumer le matin, on ne s'est pas méfié. Quelques minutes plus tard, il s'était volatilisé. Ça n'arrive qu'avec des clients qu'on ne connaît pas et qui, bien sûr, ne reviendront pas, note Paulin. Mais on peut y perdre beaucoup d'argent.

Beaucoup d'imagination

Si la pratique n'est pas encore très répandue à Genève, en France les cas de filouterie de tabagisme sont courants. Les restaurateurs doivent, malgré tout, faire preuve de tact pour ne pas froisser les clients. C'est un peu délicat de demander aux gens de payer l'addition avant d'aller fumer, reconnaît Paulin. On essaie de surveiller si les gens laissent une veste ou un sac quand ils sortent. Mais impossible de tout contrôler, surtout en plein service.

Même si les cas sont encore isolés dans le canton, les cafetiers sont sur leurs gardes. Les clients malhonnêtes ont souvent beaucoup d'imagination, reconnaît la responsable du Boccalino à Carouge.

Au Café du marché, Jean-Marc Jarle a la chance de bénéficier d'une cour intérieure qui lui permet de s'économiser ce souci. On dirige les clients vers cet espace clos, mais à ciel ouvert, qui leur permet de fumer tranquillement sans quitter l'établissement.

Je ne suis pas étonné

Lors de la campagne contre la fumée passive, Laurent Terlinchamp, président de la Société des cafetiers, restaurateurs et hôteliers de Genève, avait relevé cette conséquence possible. On avait déjà vu le phénomène se développer dans d'autres pays, je ne suis pas étonné que cela arrive aussi ici.

Le président n'a, pour l'heure, pas connaissance de statistiques alarmantes de filouterie d'auberge de ce type. Cela dit, si le phénomène s'intensifie, il conviendra de se s'interroger sur une politique commune à tous les établissements. Mais pour l'heure, chaque restaurateur décide des mesures à mettre en place.

Dans un sondage, réalisé au printemps par Gastro-Fribourg auprès de ses membres, parmi les retombées économiques négatives liées à l'interdiction de fumer, on relevait déjà un certain nombre de clients qui sortent pour fumer et qui, parfois, partent sans payer. Source: Isabel Jan-Hess | 29.11.2010 |http://www.tdg.ch/geneve/actu-geneve/vont-fumer-disparaissent-2010-11-28 (30 11 2010)
(07 12 2010)


Des derivatifs de la cytisine ont une forte affinite pour les recepteurs nicotiniques

Des chercheurs francais ont identifie des derivatifs de la cytisine qui ont une forte affinite pour les recepteurs nicotiniques. Une voie possible vers de nouveaux traitements de la dependance au tabac?

(Ã')-9-Fluorocytisine, (Ã')-9-methylcytisine and (Ã')-9-trifluoromethylcytisine were synthesized from the natural product (Ã')-cytisine. 9-Methyl and 9-trifluoromethyl cytisines display a remarkable affinity at the a4b2 nicotinic receptor subtype (0.2 nM) with a high selectivity versus the a7 nAChR subtype. Comparison of the affinity values suggests that the size of the substituent at the 9 position of (Ã')-cytisine seems more important than electronic factors for efficient binding and selectivity at a4b2 nAChRs.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TF9-511G1MW-3&_user=9565874&_coverDate=09%2F15%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_
sort=d&_docanchor=&view=c&_searchStrId=1485534508&_rerunOrigin=scholar.google&_acct=C000043220&_version=
1&_urlVersion=0&_userid=9565874&md5=e526707d572d730249f7c0e0ab79948a&searchtype=a
(05 10 2010)
(07 12 2010)


Stage-based interventions for smoking cessation (Cochrane)

Cochrane Data Syst Rev - Cahill
Intervention Review
Stage-based interventions for smoking cessation

Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD004492. DOI: 10.1002/14651858.CD004492.pub4.

Editorial group: Cochrane Tobacco Addiction Group.
Publication status and date: New, published in Issue 11, 2010.
Review content assessed as up-to-date: 27 August 2010.
Cahill K, Lancaster T, Green N.

Abstract
Background
The transtheoretical model is the most widely known of several stage-based theories of behaviour. It proposes that smokers move through a discrete series of motivational stages before they quit successfully. These are precontemplation (no thoughts of quitting), contemplation (thinking about quitting), preparation (planning to quit in the next 30 days), action (quitting successfully for up to six months), and maintenance (no smoking for more than six months). According to this influential model, interventions which help people to stop smoking should be tailored to their stage of readiness to quit, and are designed to move them forward through subsequent stages to eventual success. People in the preparation and action stages of quitting would require different types of support from those in precontemplation or contemplation.

Objectives
Our primary objective was to test the effectiveness of stage-based interventions in helping smokers to quit.

Search strategy
We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('stage* of change', 'transtheoretical model*', 'trans-theoretical model*, 'precaution adoption model*', 'health action model', 'processes of change questionnaire*', 'readiness to change', 'tailor*') and 'smoking' in the title or abstract, or as keywords. The latest search was in August 2010.

Selection criteria
We included randomized controlled trials, which compared stage-based interventions with non-stage-based controls, with 'usual care' or with assessment only. We excluded trials which did not report a minimum follow-up period of six months from start of treatment, and those which measured stage of change but did not modify their intervention in the light of it.

Data collection and analysis
We extracted data in duplicate on the participants, the dose and duration of intervention, the outcome measures, the randomization procedure, concealment of allocation, and completeness of follow up.

The main outcome was abstinence from smoking for at least six months. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where reported. Where appropriate we performed meta-analysis to estimate a pooled risk ratio, using the Mantel-Haenszel fixed-effect model.

Main results
We found 41 trials (>33,000 participants) which met our inclusion criteria. Four trials, which directly compared the same intervention in stage-based and standard versions, found no clear advantage for the staging component. Stage-based versus standard self-help materials (two trials) gave a relative risk (RR) of 0.93 (95% CI 0.62 to 1.39). Stage-based versus standard counselling (two trials) gave a relative risk of 1.00 (95% CI 0.82 to 1.22). Six trials of stage-based self-help systems versus any standard self-help support demonstrated a benefit for the staged groups, with an RR of 1.27 (95% CI 1.01 to 1.59). Twelve trials comparing stage-based self help with 'usual care' or assessment-only gave an RR of 1.32 (95% CI 1.17 to 1.48). Thirteen trials of stage-based individual counselling versus any control condition gave an RR of 1.24 (95% CI 1.08 to 1.42). These findings are consistent with the proven effectiveness of these interventions in their non-stage-based versions. The evidence was unclear for telephone counselling, interactive computer programmes or training of doctors or lay supporters. This uncertainty may be due in part to smaller numbers of trials.

Authors' conclusions
Based on four trials using direct comparisons, stage-based self-help interventions (expert systems and/or tailored materials) and individual counselling were neither more nor less effective than their non-stage-based equivalents. Thirty-one trials of stage-based self help or counselling interventions versus any control condition demonstrated levels of effectiveness which were comparable with their non-stage-based counterparts. Providing these forms of practical support to those trying to quit appears to be more productive than not intervening. However, the additional value of adapting the intervention to the smoker's stage of change is uncertain. The evidence is not clear for other types of staged intervention, including telephone counselling, interactive computer programmes and training of physicians or lay supporters. The evidence does not support the restriction of quitting advice and encouragement only to those smokers perceived to be in the preparation and action stages.

Plain language summary

Are stage-based interventions more effective than non-stage-based ones in helping smokers to quit? The transtheoretical model is one of several stage-based theories of behaviour change. It suggests that smokers move through a series of motivational stages before they manage to stop smoking. These are precontemplation (no thoughts of quitting), contemplation (thinking about quitting), preparation (planning to quit in the next 30 days), action (quitting successfully for up to six months), and maintenance (no smoking for more than six months). According to this widely-known theory, programmes which help people to stop smoking should be matched to their stage of readiness to quit. They are designed to move them forward through the stages to eventual success. In this review, we have compared stage-based programmes of smoking cessation with standard (unstaged) programmes, or with 'usual care', or with assessment only. We found 41 stage-based trials, covering more than 33,000 smokers, which measured quit rates at least six months after treatment. Only four of the 41 trials directly compared the same intervention in a standard and a stage-based version. This showed that the stage-based version was neither more nor less effective than the standard one. Eighteen trials which compared stage-based self-help programmes with any control condition showed better success rates for the intervention groups. Thirteen trials of stage-based individual counselling versus any control condition showed a similar benefit for the intervention groups. These findings confirm the known effectiveness of these interventions, whether staged or unstaged. The evidence was less clear on the effects of stage-based telephone counselling, interactive computer programmes or training of doctors and helpers. This uncertainty may be due in part to smaller numbers of trials. We find on the evidence from this review that providing self-help or counselling support to smokers trying to quit is more effective than 'usual care' or simple observation. However, the extra value of fitting that support to the smoker's stage of change is currently unclear. (30 11 2010)
(07 12 2010)


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