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Evidence-based new service package vs. routine service package for smoking cessation to prevent high risk patients from cardiovascular diseases (CVD): study protocol for randomized controlled trial

Myo Nyein Aung12*, Motoyuki Yuasa1, Thaworn Lorga2, Saiyud Moolphate3, Hiroshi Fukuda4, Tsutomu Kitajima5, Hirohide Yokokawa4, Kazuo Minematsu1, Susumu Tanimura6, Yoshimune Hiratsuka7, Koichi Ono8, Prissana Naunboonruang2, Payom Thinuan2, Sachio Kawai9, Yaoyanee Suya10, Somboon Chumvicharana10 and Eiji Marui11

Author Affiliations

1 Department of Public Health, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421, Japan

2 Boromrajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand

3 Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai, Thailand

4 Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan

5 Graduate School of International Cooperation Studies, Kyorin University, Hachioji, Japan

6 Department of Public Health, Hyogo College of Medicine, Nishinomiya, Japan

7 Department of Health and Welfare Services, National Institute of Public Health, Wako, Japan

8 Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan

9 Department of Sport Medicine, Juntendo University School of Health and Sport Science, Inba, Japan

10 Maetha Hospital, Lampang, Thailand

11 Department of Human Arts Sciences, University of Human Arts and Sciences, Saitama, Japan

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Trials 2013, 14:419  doi:10.1186/1745-6215-14-419

Published: 5 December 2013



Smoking cessation is a high-priority intervention to prevent CVD events and deaths in developing countries. While several interventions to stop smoking have been proved successful, the question of how to increase their effectiveness and practicality in developing countries remains. In this study, a newly devised evidence-based smoking cessation service package will be compared with the existing service in a randomized controlled trial within the community setting of Thailand.


This randomized control trial will recruit 440 current smokers at CVD risk because of being diabetic and/or hypertensive. Informed, consented participants will be randomly allocated into the new service-package arm and the routine service arm. The study will take place in the non-communicable disease clinics of the Maetha District Hospital, Lampang, northern Thailand. The new smoking-cessation service-package comprises (1) regular patient motivation and coaching from the same primary care nurse over a 3-month period; (2) monthly application of piCO + smokerlyzer to sustain motivation of smoker’s quitting attempt and provide positive feedback over a 3-month period; (3) assistance by an assigned family member; (4) nicotine replacement chewing gum to relieve withdrawal symptoms. This new service will be compared with the traditional routine service comprising the 5A approach in a 1-year follow-up. Participants who consent to participate in the study but refuse to attempt quitting smoking will be allocated to the non-randomized arm, where they will be just followed up and monitored. Primary outcome of the study is smoking cessation rate at 1-year follow-up proven by breath analysis measuring carbomonoxide in parts per million in expired air. Secondary outcomes are smoking cessation rate at the 6-month follow-up, blood pressure and heart rate, CVD risk according to the Framingham general cardiovascular risk score, CVD events and deaths at the 12-month follow-up, and the cost-effectiveness of the health service packages. Intention-to-treat analysis will be followed. Factors influencing smoking cessation will be analyzed by the structure equation model.


This multicomponent intervention, accessible at primary healthcare clinics, and focusing on the individual as well as the family and social environment, is unique and expected to work effectively.

Trial registration

Current Controlled Trials ISRCTN89315117

Smoking; Smokerlyzer; Family; Thailand; Lampang; CVD; Primary care; Tobacco; ESCAPE trial