Effectiveness of a Minimal Contact Smoking Cessation Program for Dutch General Practitioners: A Randomized Controlled Trial

doi:10.1006/pmed.2000.0791

Preventive Medicine

Volume 32, Issue 2, February 2001, Pages 182-190

https://doi.org/10.1006/pmed.2000.0791 Get rights and content

Abstract

Background. Until recently, Dutch general practitioners contributed little to tobacco control. This is due to several factors, among which is the lack of a feasible intervention program for adult smokers. Such a minimal contact behavioral intervention, using the Stage-of-Change concept, is now available. Effective ness was tested in a randomized trial.

Method. Twenty-two general practitioners and their practice assistants were trained in applying the program. In all, 530 smoking patients were enrolled, randomly assigned to either the intervention or the usual treatment condition. Analysis of treatment effects was performed with logistic regression analysis. In a backward stepwise procedure confounding effects of baseline differences were eliminated.

Results. At 12–month follow-up, self-reported abstinence rates (including nonrespondents as smokers) differed significantly between intervention subjects and controls: 13.4 vs 7.3% point prevalence (odds ratio 1.51, P < 0.05). An analysis of consecutive abstinence, defined as being abstinent at both 6- and 12-month follow-up, showed that 8.2% of the intervention group compared to 3.1% of the controls had sustained abstinence for more than 6 months (odds ratio 3.04, P < 0.001).

Conclusions. Results indicate that an effective smoking cessation program for use in Dutch general practice, already shown to be feasible, is now available. Outcomes are generally consistent with recent international literature.

References (46)

JK Ockene
Physician-delivered interventions for smoking cessation: strategies for increasing effectiveness
Prev Med
(1987)
JP Pierce et al.
Cotinine validation of self-reported smoking in commercially run community surveys
J Chron Dis
(1987)
Stivoro
Nationale enque-te naar rookgewoonten (National survey of smoking behavior)
(1991)
Stivoro, Jaarverslag 1996 (Annual Report), The Hague, Neth. Dutch Smoking and Health Foundation,...
ER Seydel
Cancer and the general public: a study of health education on cancer; recommendations for policy and practice
K Gill
Nationaal symposium Roken en Longen (National symposium Smoking and Lungs)
Ned Tijdschr Geneeskunde
(1989)
Schwartz, J, L, Review and evaluation of smoking cessation methods: the United States and Canada, 1987–1985, Bethesda,...
TE Kottke et al.
Attributes of successful smoking interventions in medical practice: a metaanalysis of 39 controlled trials
JAMA
(1988)
NK Janz et al.
Evaluation of a minimal contact smoking cessation intervention in an outpatient setting
Am J Pub Health
(1987)
DM C Wilson et al.
A smoking cessation intervention program for family physicians
Can Med Assoc J
(1987)

MA H Russell et al.

Effects of a general practitioners' advice against smoking

Br Med J

(1979)

RL Richmond et al.

Three year evaluation of a program by general practitioners to help patients to stop smoking

Br Med J

(1986)

K Slama et al.

The effectiveness of two smoking cessation programs for use in general practice: a randomized clinical trial

Br Med J

(1990)

M Fiore et al.

Treating tobacco use and dependence. Clinical Practice Guideline

(2000)

C Silagy et al.

Nicotine replacement therapy for smoking cessation (Cochrane Review)

(1999)

C Silagy et al.

Physician advice for smoking cessation (Cochrane Review)

(1999)

PO Prochaska et al.

Stages and processes of self-change of smoking: toward an integrative model of change

J Consult Clin Psychol

(1983)

M Foets et al.

Een nationale studie van ziekten en verrichtingen in de huisartsenpraktijk (A national study of diseases and interventions in general practice)

(1986)

PF M Verhaak

Dokters in beeld (Docters in view)

(1987)

PF M Verhaak et al.

Meningen over preventie (Opinions about prevention)

(1987)

Stivoro

Nationale enque-te naar rookgewoonten (National survey of smoking behavior)

(1992)

J Broer et al.

Hoe vaak adviseren huisartsen om niet te roken (How often do general practitioners advise patients to quit smoking?)?

(1992)

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^☆: This study was supported with a grant from the Dutch Cancer society (Nederlandse Kankerbestrijding—Koningin Wilhelmina fonds).

²: To whom reprint requests should be addressed at the University of Twente, Department of Communication studies, P.O. Box 217, 7500 AE Enschede, The Netherlands. E-mail: [email protected].

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Regular ArticleEffectiveness of a Minimal Contact Smoking Cessation Program for Dutch General Practitioners: A Randomized Controlled Trial☆

Abstract

Prev Med

J Chron Dis

Nationale enque-te naar rookgewoonten (National survey of smoking behavior)

Cancer and the general public: a study of health education on cancer; recommendations for policy and practice

Nationaal symposium Roken en Longen (National symposium Smoking and Lungs)

Ned Tijdschr Geneeskunde

Attributes of successful smoking interventions in medical practice: a metaanalysis of 39 controlled trials

JAMA

Evaluation of a minimal contact smoking cessation intervention in an outpatient setting

Am J Pub Health

A smoking cessation intervention program for family physicians

Can Med Assoc J

Effects of a general practitioners' advice against smoking

Br Med J

Three year evaluation of a program by general practitioners to help patients to stop smoking

Br Med J

The effectiveness of two smoking cessation programs for use in general practice: a randomized clinical trial

Br Med J

Treating tobacco use and dependence. Clinical Practice Guideline

Nicotine replacement therapy for smoking cessation (Cochrane Review)

Physician advice for smoking cessation (Cochrane Review)

Stages and processes of self-change of smoking: toward an integrative model of change

J Consult Clin Psychol

Een nationale studie van ziekten en verrichtingen in de huisartsenpraktijk (A national study of diseases and interventions in general practice)

Dokters in beeld (Docters in view)

Meningen over preventie (Opinions about prevention)

Nationale enque-te naar rookgewoonten (National survey of smoking behavior)

Hoe vaak adviseren huisartsen om niet te roken (How often do general practitioners advise patients to quit smoking?)?

Regular Article
Effectiveness of a Minimal Contact Smoking Cessation Program for Dutch General Practitioners: A Randomized Controlled Trial☆