台灣南部某村落成功開辦高戒菸成功率戒菸班之經驗

The Experience of Highly Successful Group Therapy for Smoking Cessation Conducted in a Village in Southern Taiwan

背景及目的：目前已經證實有效提供吸菸民眾的戒菸方法包括群體治療、藥物治療、個別諮詢、戒菸電話專線諮詢等，其中群體治療相關研究論文較少，因為不容易執行，所以在臨床上也較少採用；如何使戒菸班在臨床上較為輕易可行且提高成功率，實是刻不容緩之事。方法：針對高雄縣田寮鄉的一個村開辦社區成人戒菸班，預計一年一班，連續三年；課程安排每週一次，每次2小時，以連續六週次35天的時間完成，合計12小時，班員必須至少完成五週次的課程才會列入結訓班員；講師皆為家庭醫學科醫師，課程期間結合尼古丁替代藥物的治療、個別行為諮商。課程結訓後調查三個月、六個月與一年的點戒菸率並做一氧化碳呼氣測試。結果：自2007年起連續三年均成功開辦，合計三班37位吸菸民眾，皆為男性，每班10至17人，平均年齡約65歲，65歲以上老人比例62.2%；戒菸班開課前平均一天菸量約24支，平均菸齡41.3年，平均起始一氧化碳呼氣測試17.8 ppm，平均開始戒菸時間發生在第二週次課程後。課程結訓日平均戒菸成功率83.8%，三個月追蹤平均戒菸成功率81.1%，六個月追蹤平均戒菸成功率78.4%，一年追蹤平均戒菸成功率78.4%。結論：社區吸菸民眾經由戒菸班方式合併醫護人員合作積極介入、個別行為諮詢、尼古丁置換藥物治療等，輔以社會支持，一年追蹤戒菸成功率可以超過七成，遠超過當時一般戒菸班的成功率，並能有效降低一年復吸率；戒菸班招生時若是針對小範圍社區招生，連續在同一社區開辦，可以有效增加該社區吸菸民眾參加戒菸班的意願。

Background: The fact that approximately 20,000 Taiwanese die from cigarette each year testifies to the vital role of smoking cessation in reducing the risk of developing and dying from smokingrelated diseases. One-year cessation rates after a single quit attempt has been found to exceed 30 percent with optimal treatment. Though an intervention with good effectiveness, group smoking cessation counseling is seldom practiced in real life as it is difficult to recruit enough smokers attempting to quit and ensure their participation through the entire course. This study accordingly aimed at proposing standard strategies to enhance the clinical feasibility of smoking cessation group sessions, thereby helping more smokers achieve a higher quit rate. Methods: A stop-smoking class combined with nicotine replacement treatment (NRT) was planned for the resident smokers in a rural village in southern Taiwan. The class lasted for six weeks (in 35 consecutive days); each week covered a two-hour session led by family physicians. Telephone follow-ups were performed on a weekly basis throughout the six-week course. After the class, the study further conducted a 3-month follow-up, a 6-month follow-up, and a 1-year follow-up each of which was coupled with a CO test. Results: A total of 37 male smokers were enrolled for 3 classes within 3 years and all of them completed the courses. Their average age was approximately 65 y/o, and 62% of them were over 65 year old. The avearge smoking quit rate at the end of each course reached 84%, while the average 3-month, 6-month, and 1-year abstinence rates were respectively 81%, 78%, and 78%. Conclusion: This study shows that, with standard operating procedures (SOP) mapped out for subject recruitment, course design, teaching approach, and supporting accessories, smoking cessation group sessions can be expected to more effectively help smokers highly motivated to quit smoking and secure a greater success rate. This intervention experience can be copied and implemented, especially in the same community.