The decision aid increased knowledge of cessation methods and induced a more positive attitude towards these methods. Furthermore, 45% reported increased confidence about being able to quit and 43% said it helped them to choose between treatments. However, no clear effect on usage of treatment aids was found, but the intervention group had more quit attempts (OR=1.52, 95% CI 1.14-2.02) and higher point prevalence abstinence at 6-month follow-up (20.2% versus 13.6%; OR=1.51, 95% CI=1.07-2.11). CONCLUSIONS An aid to help smokers decide to use efficacious treatment when attempting to quit smoking had a positive effect on smoking cessation, while failing to increase the usage of efficacious treatment. This finding lends support to the notion that the mere promotion of efficacious treatments for tobacco addiction might increase the number of quit attempts, irrespective of the actual usage of treatment.

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Este trabajo examina y actualiza los aspectos sanitarios del consumo de tabaco basándose especialmente en estudios llevados a cabo en países europeos, con énfasis en el tabaquismo en el lugar de trabajo. Se revisan los riesgos del consumo de tabaco para la salud en ambos sexos, el impacto en la esperanza de vida, las ventajas del abandono del consumo de tabaco, el patrón social del tabaquismo en las sociedades occidentales y las diferencias sociales en las enfermedades que causa. Se describen también los efectos inmediatos y a largo plazo del consumo involuntario de tabaco, sus consecuencias en el lugar de trabajo, y las técnicas de medida del Aire Contaminado por Humo de Tabaco (ACHT). Palabra clave: Tabaco. Impactos en la salud. Contaminación por humo de tabaco.

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Willemsen et al . [1] reported that an innovative intervention to help smokers decide on the use of efficacious smoking cessation treatments increased quit attempts and point prevalence abstinence. They also concluded that, surprisingly, this occurred despite the fact that the aid 'failed to increase the usage of efficacious treatment'. I think this latter conclusion may be incorrect. This conclusion was evidently based on a comparison of the incidence of use of treatments in intervention versus control groups 'among respondents who made a quit attempt' in which the 95% CI for the difference always included 0. The authors acknowledge that this non-significant difference may be due to the smaller sample size of the subset of quit attempters ( n = 264). When I calculated the odds ratio for use of nicotine replacement therapy (NRT) in intervention versus control it was 1.8 and for bupropion it was 1.4. These are of the same magnitude as the effect of the intervention on quit attempts and abstinence (O R s = 1.5). To me, this suggests that changes in medication use may have been real and, thus, the abovequoted conclusion in the abstract (based on the P < 0.05 rule) may be misleading.One other puzzling finding is that p. 446 states: 'Those who attempted to quit and those who did not make a quit attempt did not differ significantly with respect to the usage of treatment aids'. I would conjecture that this result occurred due the very broad definition of treatment (e.g. including unsolicited brief advice from others). It would be interesting to hear from the authors whether this result occurred when medications were examined. This is of interest because, as overall about 18% of quit attempters in the control group used a medication (data from Table 3), then, based on the above statement, I would assume about 18% of smokers who did not attempt to quit also used a stop smoking treatment in the next 6 months. This level of use of medication by smokers not trying to stop would contradict prior surveys [2] and would suggest widespread misuse of medications. Perhaps the authors could clarify this.

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