title: Long-term effect of a low-intensity smoking intervention embedded in an adherence program for patients with hypercholesterolemia: Randomized controlled trial.
abstract: OBJECTIVE
  We evaluated the long-term effect of a smoking intervention embedded in an adherence program in patients with an increased risk for cardiovascular disease.
  
  
  METHODS
  Secondary analysis of a randomized controlled trial: In 2002-2004, 8108 patients with hypercholesterolemia were enrolled from general practices in Germany. Patients received a 12-month adherence program and statin medication (intervention) or statin medication only (control). The program aimed to improve adherence to medication and lifestyle by educational material, mailings, and phone calls. Smoking was self-reported at baseline and every 6months during the 3-year follow-up.
  
  
  RESULTS
  In total, 7640 patients were analyzed. At baseline, smoking prevalence was 21.7% in the intervention and 21.5% in the control group. Prevalence decreased in both groups to 16.6% vs. 19.5%, 15.3% vs. 16.8%, and 14.2% vs. 15.6% at the 12-, 24-, and 36-month follow-up. The intervention had a beneficial effect on smoking differing over time (group×time: P=0.005). The effect was largest after 6 and 12months [odds ratios (95% confidence intervals): 0.67 (0.54-0.82) and 0.63 (0.51-0.78)]. The effect decreased until the 18-month follow-up [0.72 (0.58-0.90)] and was not significant after 24months.
  
  
  CONCLUSIONS
  A low-intensity smoking intervention embedded in an adherence program can contribute to smoking cessation although the intervention effect diminished over time.
  
  
  BACKGROUND
  ClinicalTrials.gov (www.clinicaltrials.gov): NCT00379249.
authors.affiliation: Berlin School of Public Health, Charité - Universitätsmedizin Berlin, 13347 Berlin, Germany. Electronic address: rebecca.muckelbauer@charite.de.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Muckelbauer
authors.affiliation: University of Applied Sciences, Oecotrophology, 48149 Münster, Germany. Electronic address: englert@fh-muenster.de.
authors.forename: Heike
authors.initials: H
authors.lastname: Englert
authors.affiliation: Berlin School of Public Health, Charité - Universitätsmedizin Berlin, 13347 Berlin, Germany. Electronic address: nina.rieckmann@charite.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Rieckmann
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany. Electronic address: chih-mei.hettler-chen@charite.de.
authors.forename: Chih-Mei
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Medical Biometry and Epidemiology, University of Hamburg, 20246 Hamburg, Germany. Electronic address: karl.wegscheider@t-online.de.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Center of Rehabilitation Research, University of Potsdam, 14469 Potsdam, Germany. Electronic address: heinz.Voeller@uni-potsdam.de.
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
authors.affiliation: Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, 69120 Heidelberg, Germany. Electronic address: hugo.Katus@med.uni-heidelberg.de.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Medical Biometry and Epidemiology, University of Hamburg, 20246 Hamburg, Germany. Electronic address: stefan.willich@charite.de.
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
authors.affiliation: Berlin School of Public Health, Charité - Universitätsmedizin Berlin, 13347 Berlin, Germany. Electronic address: jacqueline.mueller-nordhorn@charite.de.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Müller-Nordhorn
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005260:Female; D005858:Germany; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012907:Smoking; D016540:Smoking Cessation / Q000379:methods*; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular risk factors; Health promotion; Hypercholesterolemia; Multiple risk factor intervention; Randomized controlled trial; Smoking; Smoking cessation