[Prevention of smoking from the psychological medicine perspective]

Smoking is a complex socio-psycho-biological behavior with high prevalence and high risk for several diseases. Referring to a widely accepted concept of prevention, the review presents recent psychological and pharmacological strategies to cease smoking with respect to theory, application, and evaluation. Primary prevention, which includes appropriate settings in schools, families, and social groups, seems adequate in preventing people from health problems associated with tobacco-smoke. Although evaluations are rarely found, curricula starting at childhood and intensive training programs for adolescents can be presently recommended. These programs have to take into account specific group characteristics and should focus on active and self-controlled behavior without smoking. Additionally, negative short-term effects of smoking should be emphasized more clearly instead of longterm risks of smoking. The broad diversity of secondary prevention programs for smoking cessation and relapse prevention includes well established and efficient psychological and pharmacological treatments. Flexible combinations of psychotherapeutic and pharmacological strategies (e.g. behavioral skill training programs and nicotine replacement therapy), which also consider the strength of nicotine dependence and withdrawal symptoms, are most promising. For smokers, who continue to smoke despite of health damages (e.g. cardiovascular diseases, cancer), intensive psychotherapeutic regimens (tertiary prevention) are suggested. However, evaluation on this issue is almost missing. In summary, smoking prevention programs can be considered to be cost-effective. Nevertheless, 1 year abstinence rates range only between 20-30%. Furthermore, there is a strong need for psychobiological research on the development of smoking behavior, on long-term follow-up of prevention programs, and on outcome prediction.