Cancer Causes & Control

, Volume 2, Issue 4, pp 239–246 | Cite as

A randomized trial of smoking cessation interventions in general practice in Italy

  • Nereo Segnan
  • Antonio Ponti
  • Renaldo N. Battista
  • Carlo Senore
  • Stefano Rosso
  • Stanley H. Shapiro
  • Daniela Aimar
Research Paper

The purpose of this study was to examine the effectiveness of different practice-based approaches to assist patients of primary care physicians to quit smoking and sustain cessation. Forty-four nonsmoking general practitioners volunteered for the study. After a period of training, they randomized 923 smoking clients, unselected for motivation toward quitting, to four different intervention groups: (i) minimal intervention, consisting of one single counselling session and a brief handout on quitting techniques; (ii) repeated counselling including reinforcing sessions at Months 1, 3, 6, and 9; (iii) repeated counselling and use of nicotine gum; and (iv) repeated counselling and spirometry. Biochemically validated smoking status was assessed at six and 12 months after recruitment. The proportion of verified quitters at 12 months was 4.8 percent among subjects randomized to the minimal intervention group, compared to 5.5 percent, 7.5 percent, and 6.5 percent among those randomized to the three repeated-counselling groups. In no treatment group was the outcome significantly different from that for one-time counselling at the (P<0.05) level. Lack of power, contamination, and low attendance at reinforcing sessions should be taken into account in interpreting the results.

Key words

Biochemical verification counselling, general practice Italy nicotine gum randomized trial smoking cessation spirometry 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fielding JE. Smoking: health effects and control. N Engl J Med 1985; 313(8): 491–555.Google Scholar
  2. 2.
    Bettinghaus EP. Using the mass media in smoking prevention and cessation programs: an introduction to five studies. Prev Med 1988; 17: 503–621.Google Scholar
  3. 3.
    Pederson L. Compliance with physician advice to quit smoking: a review of the literature. Prev Med 1982; 11: 71–84.Google Scholar
  4. 4.
    Ockene JK. Smoking intervention: the expanding role of the physician. Am J Publ Health 1987; 77: 782–3.Google Scholar
  5. 5.
    Greene HL, Goldberg RG, Ockene JK. Cigarette smoking: the physician role in cessation and maintenance. J Gen Intern Med 1988; 3: 75–87.Google Scholar
  6. 6.
    Roemer MT. The value of medical care for health promotion. Commentary. Am J Publ Health 1984; 74: 243–8.Google Scholar
  7. 7.
    Kohn R, White KL, eds. Health Care, an International Study: Use of Physician Service. Geneva: World Health Organization, 1979.Google Scholar
  8. 8.
    Russel MAH, Wilson C, Taylor C, Baker CD. Effect of general practitioner's advice against smoking. Br Med J 1979; 2: 231–5.Google Scholar
  9. 9.
    Jamrozik K, Vessey M, Fowler J, Wald N, Parker J, Vunakis HV. Controlled trial of three different antismoking interventions in general practice. Br Med J 1984; 288: 1499–502.Google Scholar
  10. 10.
    Wilson D, Wood G, Johnston N, Sicurella J. Randomized clinical trial of supportive follow-up for cigarette smokers in family practice. Can Med Assoc J 1982; 126: 127–9.Google Scholar
  11. 11.
    Richmond RL, Webster IW. A smoking cessation programme for use in general practice. Med J Austr 1985; 142: 190–4.Google Scholar
  12. 12.
    Marshall A, Raw M. Nicotine chewing gum in general practice: effect of follow-up appointments. Br Med J 1985; 290: 1397–8.Google Scholar
  13. 13.
    Jamrozik K, Fowler G, Vessey M, Wald N. Placebo controlled trial of nicotine chewing gum in general practice. Br Med J 1984; 289: 794–7.Google Scholar
  14. 14.
    Russell MAH, Merriman R, Stapleton J, Taylor W. Effects of nicotine chewing gum as an adjunct to general practitioner's advice against smoking. Br Med J 1983; 287: 1782–5.Google Scholar
  15. 15.
    Fagerström KO. Effects of nicotine chewing gum and follow-up appointments in physician based smoking cessation. Prev Med 1984; 13: 517–27.Google Scholar
  16. 16.
    Wilson DM, Taylor DW, Gilbert RJ, et al. A randomized trial of a family physician intervention for smoking cessation, JAMA 1988; 260: 1570–85.Google Scholar
  17. 17.
    Porter AMW, McCullough DM. Counselling against cigarette smoking. A controlled trial from a general practice. The Practitioner 1972; 209: 686–9.Google Scholar
  18. 18.
    Thompson RS, Michnich ME, Friedlander L, Gilson B, Grathaus LC, Staser B. Effectiveness of smoking cessation interventions integrated into primary care practice. Med Care 1988; 26: 62–76.Google Scholar
  19. 19.
    Kottke TE, Battista RN, DeFriese GH, Brekke ML. Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials. JAMA 1988; 259: 2883–9.Google Scholar
  20. 20.
    Istituto Centrale di Statistica. Indagine statistica sulle condizioni di salute della popolazione e sul ricorso ai servizi sanitari. Notiziario ISTAT 1987; 8: 17.Google Scholar
  21. 21.
    Morris JF, Temple W. Spirometric ‘lung age’ estimation for motivating smoking cessation. Prev Med 1985; 14: 660–2.Google Scholar
  22. 22.
    Haley NJ, Colosimo SG, Axelrad CM, Harris B, Sepkovic DW. Biochemical validation of self-reported exposure to environmental tobacco smoke. Environmental Research 1989; 49: 127–35.Google Scholar
  23. 23.
    Haley NJ, Axelrad CM, Tilton KA. Validation of selfreported smoking behavior: biochemical analyses of continine and thiocyanate. Am J Publ Health 1983; 73: 1204–7.Google Scholar
  24. 24.
    Riboli E, Preston-Martin R, Saracci R, et al. Exposure of nonsmoking women to environmental tobacco smoke: a 10-country collaborative study. Cancer Causes and Control 1990; 1: 243–52.Google Scholar
  25. 25.
    Negri E, La Vecchia C. Determinants of stopping smoking in Italy: Italian National Health Survey. Am J Publ Health 1989; 79: 1307.Google Scholar
  26. 26.
    Kottke TE, Brekke ML, Solberg LI, Hughes JR. A randomized trial to increase smoking interventions by physicians: doctors helping smokers quit, round I. JAMA 1989; 261: 2101–6.Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd 1991

Authors and Affiliations

  • Nereo Segnan
  • Antonio Ponti
  • Renaldo N. Battista
  • Carlo Senore
  • Stefano Rosso
  • Stanley H. Shapiro
  • Daniela Aimar

There are no affiliations available

Personalised recommendations