title: Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study).
abstract: OBJECTIVE
  To evaluate the effectiveness in primary care of a stepped smoking cessation intervention based on the transtheoretical model of change.
  
  
  METHODS
  Cluster 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.
  
  
  METHODS
  All 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.
  
  
  METHODS
  A 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  A 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.
authors.affiliation: Subdirecció General de Promoció de la Salut, Direcció General de Salut Publica, Departament de Salut, Barcelona, Spain. carmen.cabezas@gencat.cat
authors.forename: Carmen
authors.initials: C
authors.lastname: Cabezas
authors.forename: Mamta
authors.initials: M
authors.lastname: Advani
authors.forename: Diana
authors.initials: D
authors.lastname: Puente
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.forename: Carlos
authors.initials: C
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D001944:Breath Tests; D016642:Bupropion / Q000627:therapeutic use; D002248:Carbon Monoxide / Q000032:analysis; D002638:Chewing Gum; D016000:Cluster Analysis; D003376:Counseling; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use; D011320:Primary Health Care; D015397:Program Evaluation / Q000706:statistics & numerical data; D011582:Psychological Theory; D012907:Smoking / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D012923:Social Class; D013030:Spain / Q000453:epidemiology; D018454:Spouses / Q000706:statistics & numerical data; D013997:Time Factors; D057968:Transdermal Patch; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D002638:Chewing Gum; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine; D002248:Carbon Monoxide