• Addiction · Sep 2011

    Randomized Controlled Trial

    Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study).

    • Carmen Cabezas, Mamta Advani, Diana Puente, Teresa Rodriguez-Blanco, Carlos Martin, and ISTAPS Study Group.
    • Subdirecció General de Promoció de la Salut, Direcció General de Salut Publica, Departament de Salut, Barcelona, Spain. carmen.cabezas@gencat.cat
    • Addiction. 2011 Sep 1; 106 (9): 1696-706.

    AimTo evaluate the effectiveness in primary care of a stepped smoking cessation intervention based on the transtheoretical model of change.DesignCluster randomized trial; unit of randomization: basic care unit (family physician and nurse who care for the same group of patients); and intention-to-treat analysis.SettingAll interested basic care units (n = 176) that worked in 82 primary care centres belonging to the Spanish Preventive Services and Health Promotion Research Network in 13 regions of Spain.ParticipantsA total of 2,827 smokers (aged 14-85 years) who consulted a primary care centre for any reason, provided written informed consent and had valid interviews.MeasurementsThe outcome variable was the 1-year continuous abstinence rate at the 2-year follow-up. The main variable was the study group (intervention/control). Intervention involved 6-month implementation of recommendations from a Clinical Practice Guideline which included brief motivational interviews for smokers at the precontemplation-contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help and reinforcing intervention in the maintenance stage. Control group involved usual care. Among others, characteristics of tobacco use and motivation to quit variables were also collected.FindingsThe 1-year continuous abstinence rate at the 2-year follow-up was 8.1% in the intervention group and 5.8% in the control group (P = 0.014). In the multivariate logistic regression, the odds of quitting of the intervention versus control group was 1.50 (95% confidence interval = 1.05-2.14).ConclusionsA stepped smoking cessation intervention based on the transtheoretical model significantly increased smoking abstinence at a 2-year follow-up among smokers visiting primary care centres.© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

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