title: Continued smoking abstinence in diabetic patients in primary care: a cluster randomized controlled multicenter study.
abstract: OBJECTIVE
  To assess the effectiveness of an intensive smoking cessation intervention based on the transtheoretical model of change (TTM) in diabetic smokers attending primary care.
  
  
  METHODS
  A cluster randomized controlled clinical trial was designed in which the unit of randomization (intervention vs. usual care) was the primary care team. An intensive, individualized intervention using motivational interview and therapies and medications adapted to the patient's stage of change was delivered. The duration of the study was 1 year.
  
  
  RESULTS
  A total of 722 people with diabetes who were smokers (345 in the intervention group and 377 in the control group) completed the study. After 1 year, continued abstinence was recorded in 90 (26.1%) patients in the intervention group and in 67 (17.8%) controls (p=0.007). In patients with smoking abstinence, there was a higher percentage in the precontemplation and contemplation stages at baseline in the intervention group than in controls (21.2% vs. 13.7%, p=0.024). When the precontemplation stage was taken as reference (OR=1.0), preparation/action stage at baseline showed a protective effect, decreasing 3.41 times odds of continuing smoking (OR=0.293 95% CI 0.179-0.479, p<0.001). Contemplation stage at baseline also showed a protective effect, decreasing the odds of continuing smoking (OR=0.518, 95% CI 0.318-0.845, p=0.008).
  
  
  CONCLUSIONS
  An intensive intervention adapted to the individual stage of change delivered in primary care was feasible and effective, with a smoking cessation rate of 26.1% after 1 year.
authors.affiliation: Centre d'Atenció Primària La Llagosta, Institut Català de la Salut (ICS), Barcelona, Spain; Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Sabadell, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain. Electronic address: sperez@ics.gencat.cat.
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Tortosa
authors.affiliation: Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain; Centre d'Atenció Primària La Garriga, Institut Català de la Salut (ICS), Sabadell, Barcelona, Spain. Electronic address: 31540lrr@comb.cat.
authors.forename: Lydia
authors.initials: L
authors.lastname: Roig
authors.affiliation: Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Sabadell, Spain; Departament de Infermeria, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain. Electronic address: jmanresa@idiapjgol.info.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Manresa
authors.affiliation: Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centre d'Atenció Primària Passeig de Sant Joan, Institut Català de la Salut (ICS), Barcelona, Spain. Electronic address: Carlos.Martin@uab.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martin-Cantera
authors.affiliation: Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain. Electronic address: cardiocat@gmail.com.
authors.forename: Elisa
authors.initials: E
authors.lastname: Puigdomènech
authors.affiliation: Centre d'Atenció Primària Badía, Institut Català de la Salut (ICS), Badía del Vallés, Barcelona, Spain. Electronic address: roura@cusido.com.
authors.forename: Pilar
authors.initials: P
authors.lastname: Roura
authors.affiliation: Centre d'Atenció Primària Terrassa Nord, Consorci Sanitari Terrassa, Barcelona, Spain. Electronic address: anarmengol@gmail.com.
authors.forename: Angelina
authors.initials: A
authors.lastname: Armengol
authors.affiliation: Scientific Area, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain. Electronic address: mamtaadvani@gmail.com.
authors.forename: Mamta
authors.initials: M
authors.lastname: Advani
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D011320:Primary Health Care / Q000379:methods*; D012907:Smoking / Q000453:epidemiology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: (identifier NCT00954967).; Diabetes mellitus; Multicenter study; Primary health care; Randomized controlled trial; Smoking cessation