Assessing the efficacy and impact of a personalised smoking cessation intervention among type 2 diabetic smokers: study protocol for an open-label randomised controlled trial (DISCGO-RCT)

Carole Clair, Aurélie Augsburger, Priska Birrer, Isabella Locatelli, Joelle Schwarz, Gilbert Greub, Anne Zanchi, Isabelle Jacot-Sadowski, Jardena J Puder, Carole Clair, Aurélie Augsburger, Priska Birrer, Isabella Locatelli, Joelle Schwarz, Gilbert Greub, Anne Zanchi, Isabelle Jacot-Sadowski, Jardena J Puder

Abstract

Introduction: Few studies have assessed the efficacy of smoking cessation interventions in individuals with type 2 diabetes, but interventions adapted to the specific needs of this population are warranted. The aim of this study is to assess the efficacy of a smoking cessation intervention in a population of smokers with type 2 diabetes and to measure the metabolic impact of smoking cessation.

Methods and analysis: The study is an open-label, randomised control trial. Participants recruited from a sanitary region of Switzerland will be randomly allocated to either the intervention or the control arm. The intervention group will have four individual counselling sessions over 12 weeks. Trained research nurses will conduct the behavioural intervention, using motivational interviews and addressing diabetes and gender specificities. The control group will have one short counselling session at baseline and will be given written information on smoking cessation. Both groups will have a follow-up visit at 26 and 52 weeks. Demographic and medical data will be collected at baseline and follow-up, along with blood and urine samples. The primary study outcome is continuous smoking abstinence validated by expired-air carbon monoxide from week 12 to week 52. Secondary study outcomes are continuous and 7-day point prevalence smoking abstinence at 12 and 26 weeks; change in motivation to quit and cigarette consumption; and change in glycosylated haemoglobin levels, body weight, waist circumference and renal function after smoking cessation. In a subsample of 80 participants, change in stool microbiota from baseline will be measured at 3, 8 and 26 weeks after smoking cessation.

Ethics and dissemination: Ethical approval has been obtained by the competent ethics committee (Commission cantonale d'éthique de la recherche sur l'être humain, CER-VD 2017-00812). The results of the study will be disseminated through publications in peer-reviewed journals and conference presentations.

Trial registration numbers: ClinicalTrials.gov NCT03426423 and SNCTP000002762; Pre-results.

Keywords: diabetes & endocrinology; general medicine (see internal medicine); preventive medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Diabetes and Smoking Cessation: a Gender-Oriented Study (DISCGO). Study 3 phase design figure. FUP, follow-up.
Figure 2
Figure 2
Randomised controlled study design with nested microbiota study figure. V, visit.

References

    1. Murray CJL, Lopez AD. Measuring the global burden of disease. N Engl J Med 2013;369:448–57. 10.1056/NEJMra1201534
    1. Gmel G, Kuendig H, Notari L, et al. . Monitorage suisse des addictions - Consommation d'alcool, tabac et drogues illégales en Suisse en 2012. Lausanne, Suisse, 2013.
    1. IDF diabetes atlas, sixth edition. 2013, 2014. Available:
    1. Willi C, Bodenmann P, Ghali WA, et al. . Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2007;298:2654–64. 10.1001/jama.298.22.2654
    1. Haire-Joshu D, Glasgow RE, Tibbs TL, et al. . Smoking and diabetes. Diabetes Care 2004;27 Suppl 1:S74–5. 10.2337/diacare.27.2007.s74
    1. Clair C, Cohen MJ, Eichler F, et al. . The effect of cigarette smoking on diabetic peripheral neuropathy: a systematic review and meta-analysis. J Gen Intern Med 2015;30:1193–203. 10.1007/s11606-015-3354-y
    1. World Health Organisation Who global report: mortality attributable to tobacco, 2012. Available:
    1. Moy CS, LaPorte RE, Dorman JS, et al. . Insulin-Dependent diabetes mellitus mortality. the risk of cigarette smoking. Circulation 1990;82:37–43. 10.1161/01.CIR.82.1.37
    1. Manson JE, Rimm EB, Stampfer MJ, et al. . Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991;338:774–8. 10.1016/0140-6736(91)90664-B
    1. Stamler J, Vaccaro O, Neaton JD, et al. . Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial. Diabetes Care 1993;16:434–44. 10.2337/diacare.16.2.434
    1. Uusitupa MI, Niskanen LK, Siitonen O, et al. . Ten-Year cardiovascular mortality in relation to risk factors and abnormalities in lipoprotein composition in type 2 (non-insulin-dependent) diabetic and non-diabetic subjects. Diabetologia 1993;36:1175–84. 10.1007/BF00401063
    1. Klein R, Moss SE, Klein BE. Relation of ocular and systemic factors to survival in diabetes. Arch Intern Med 1989;149:266–72. 10.1001/archinte.1989.00390020016004
    1. Al-Delaimy WK, Manson JE, Solomon CG, et al. . Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus. Arch Intern Med 2002;162:273–9. 10.1001/archinte.162.3.273
    1. Al-Delaimy WK, Willett WC, Manson JE, et al. . Smoking and mortality among women with type 2 diabetes: the nurses' health study cohort. Diabetes Care 2001;24:2043–8. 10.2337/diacare.24.12.2043
    1. Morrish NJ, Stevens LK, Fuller JH, et al. . Risk factors for macrovascular disease in diabetes mellitus: the London follow-up to the who multinational study of vascular disease in diabetics. Diabetologia 1991;34:590–4. 10.1007/BF00400279
    1. Turner RC, Millns H, Neil HA, et al. . Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23). BMJ 1998;316:823–8. 10.1136/bmj.316.7134.823
    1. Tuomilehto J, Rastenyte D, Jousilahti P, et al. . Diabetes mellitus as a risk factor for death from stroke. prospective study of the middle-aged Finnish population. Stroke 1996;27:210–5. 10.1161/01.str.27.2.210
    1. Eliasson B. Cigarette smoking and diabetes. Prog Cardiovasc Dis 2003;45:405–13. 10.1016/S0033-0620(03)80004-X
    1. Clair C, Meigs JB, Rigotti NA. Smoking behavior among US adults with diabetes or impaired fasting glucose. Am J Med 2013;126:541.e15–541.e18. 10.1016/j.amjmed.2012.11.029
    1. Le Boudec J, Marques-Vidal P, Cornuz J, et al. . Smoking cessation and the incidence of pre-diabetes and type 2 diabetes: a cohort study. J Diabetes Complications 2016;30:43–8. 10.1016/j.jdiacomp.2015.10.005
    1. Corcillo A, Pivin E, Lalubin F, et al. . Glycaemic, blood pressure and lipid goal attainment and chronic kidney disease stage of type 2 diabetic patients treated in primary care practices. Swiss Med Wkly 2017;147:w14459. 10.4414/smw.2017.14459
    1. Kogan AJ. Overcoming obstacles to effective care of type 2 diabetes. Am J Manag Care 2009;15:S255–62.
    1. Solberg LI, Desai JR, O'Connor PJ, et al. . Diabetic patients who smoke: are they different? Ann Fam Med 2004;2:26–32. 10.1370/afm.36
    1. Ruggiero L, Rossi JS, Prochaska JO, et al. . Smoking and diabetes: readiness for change and provider advice. Addict Behav 1999;24:573–8. 10.1016/s0306-4603(98)00086-0
    1. Haire-Joshu D, Heady S, Thomas L, et al. . Depressive symptomatology and smoking among persons with diabetes. Res Nurs Health 1994;17:273–82. 10.1002/nur.4770170406
    1. Cinciripini PM, Wetter DW, Fouladi RT, et al. . The effects of depressed mood on smoking cessation: mediation by postcessation self-efficacy. J Consult Clin Psychol 2003;71:292–301. 10.1037/0022-006X.71.2.292
    1. Malarcher AM, Ford ES, Nelson DE, et al. . Trends in cigarette smoking and physicians' advice to quit smoking among people with diabetes in the U.S. Diabetes Care 1995;18:694–7. 10.2337/diacare.18.5.694
    1. Thresia CU, Thankappan KR, Nichter M. Smoking cessation and diabetes control in Kerala, India: an urgent need for health education. Health Educ Res 2009;24:839–45. 10.1093/her/cyp020
    1. Scemama O, Hamo-Tchatchouang E, Le Faou AL, et al. . Difficulties of smoking cessation in diabetic inpatients benefiting from a systematic consultation to help them to give up smoking. Diabetes Metab 2006;32:435–41. 10.1016/S1262-3636(07)70301-4
    1. Jenssen TG, Tonstad S, Claudi T, et al. . The gap between guidelines and practice in the treatment of type 2 diabetes a nationwide survey in Norway. Diabetes Res Clin Pract 2008;80:314–20.
    1. Glasgow RE, Hampson SE, Strycker LA, et al. . Personal-model beliefs and social-environmental barriers related to diabetes self-management. Diabetes Care 1997;20:556–61. 10.2337/diacare.20.4.556
    1. Fowler PM, Hoskins PL, McGill M, et al. . Anti-smoking programme for diabetic patients: the agony and the ecstasy. Diabet Med 1989;6:698–702. 10.1111/j.1464-5491.1989.tb01260.x
    1. Wakefield M, Roberts L, Rosenfeld E. Prospects for smoking cessation among people with insulin-dependent diabetes. Patient Educ Couns 1998;34:257–66. 10.1016/S0738-3991(98)00043-3
    1. Gaede P, Beck M, Vedel P, et al. . Limited impact of lifestyle education in patients with type 2 diabetes mellitus and microalbuminuria: results from a randomized intervention study. Diabet Med 2001;18:104–8. 10.1046/j.1464-5491.2001.00444.x
    1. Gæde P, Lund-Andersen H, Parving H-H, et al. . Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008;358:580–91. 10.1056/NEJMoa0706245
    1. Jones H, Edwards L, Vallis TM, et al. . Changes in diabetes self-care behaviors make a difference in glycemic control: the diabetes stages of change (disc) study. Diabetes Care 2003;26:732–7. 10.2337/diacare.26.3.732
    1. Kirkman MS, Weinberger M, Landsman PB, et al. . A Telephone-Delivered intervention for patients with NIDDM: effect on coronary risk factors. Diabetes Care 1994;17:840–6. 10.2337/diacare.17.8.840
    1. Hanefeld M, Fischer S, Schmechel H, et al. . Diabetes intervention study: Multi-Intervention trial in newly diagnosed NIDDM. Diabetes Care 1991;14:308–17. 10.2337/diacare.14.4.308
    1. Nagrebetsky A, Brettell R, Roberts N, et al. . Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials. BMJ Open 2014;4:e004107. 10.1136/bmjopen-2013-004107
    1. Iino K, Iwase M, Tsutsu N, et al. . Smoking cessation and glycaemic control in type 2 diabetic patients. Diabetes Obes Metab 2004;6:181–6. 10.1111/j.1462-8902.2004.00329.x
    1. Voulgari C, Katsilambros N, Tentolouris N. Smoking cessation predicts amelioration of microalbuminuria in newly diagnosed type 2 diabetes mellitus: a 1-year prospective study. Metabolism 2011;60:1456–64. 10.1016/j.metabol.2011.02.014
    1. Chaturvedi N, Stevens L, Fuller JH, et al. . Which features of smoking determine mortality risk in former cigarette smokers with diabetes? the world Health organization multinational Study Group. Diabetes Care 1997;20:1266–72. 10.2337/diacare.20.8.1266
    1. Yudkin JS. How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects. BMJ 1993;306:1313–8. 10.1136/bmj.306.6888.1313
    1. Biedermann L, Brülisauer K, Zeitz J, et al. . Smoking cessation alters intestinal microbiota: insights from quantitative investigations on human fecal samples using fish. Inflamm Bowel Dis 2014;20:1496–501. 10.1097/MIB.0000000000000129
    1. Biedermann L, Zeitz J, Mwinyi J, et al. . Smoking cessation induces profound changes in the composition of the intestinal microbiota in humans. PLoS One 2013;8:e59260. 10.1371/journal.pone.0059260
    1. Brook I, Gober AE. Effect of smoking cessation on the microbial flora. Arch Otolaryngol Head Neck Surg 2007;133:135–8. 10.1001/archotol.133.2.135
    1. Vamanu E, Pelinescu D, Sarbu I. Comparative fingerprinting of the human microbiota in diabetes and cardiovascular disease. J Med Food 2016;19:1188–95. 10.1089/jmf.2016.0085
    1. Sattar N. Gender aspects in type 2 diabetes mellitus and cardiometabolic risk. Best Pract Res Clin Endocrinol Metab 2013;27:501–7. 10.1016/j.beem.2013.05.006
    1. Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006;332:73–8. 10.1136/bmj.38678.389583.7C
    1. Yusuf S, Hawken S, Ôunpuu S, et al. . Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet 2004;364:937–52. 10.1016/S0140-6736(04)17018-9
    1. Rich-Edwards JW, Manson JE, Hennekens CH, et al. . The primary prevention of coronary heart disease in women. N Engl J Med 1995;332:1758–66. 10.1056/NEJM199506293322607
    1. MK Y, Lyles CR, Bent-Shaw LA, et al. . Sex disparities in diabetes process of care measures and self-care in high-risk patients. J Diabetes Res 2013;2013:575814.
    1. Ferrara A, Williamson DF, Karter AJ, et al. . Sex differences in quality of health care related to ischemic heart disease prevention in patients with diabetes: the translating research into action for diabetes (triad) study, 2000-2001. Diabetes Care 2004;27:2974–6. 10.2337/diacare.27.12.2974
    1. Ferrara A, Mangione CM, Kim C, et al. . Sex disparities in control and treatment of modifiable cardiovascular disease risk factors among patients with diabetes: translating research into action for diabetes (triad) study. Diabetes Care 2008;31:69–74. 10.2337/dc07-1244
    1. Wexler DJ, Grant RW, Meigs JB, et al. . Sex disparities in treatment of cardiac risk factors in patients with type 2 diabetes. Diabetes Care 2005;28:514–20. 10.2337/diacare.28.3.514
    1. Marques-Vidal P, Cerveira J, Paccaud F, et al. . Smoking trends in Switzerland, 1992-2007: a time for optimism? J Epidemiol Community Health 2011;65:281–6. 10.1136/jech.2009.099424
    1. Fiore MC, Novotny TE, Pierce JP, et al. . Trends in cigarette smoking in the United States. The changing influence of gender and race. JAMA 1989;261:49–55.
    1. Women and smoking : a report of the Surgeon General 2001.
    1. Berlin I, Singleton EG, Pedarriosse A-M, et al. . The modified reasons for smoking scale: factorial structure, gender effects and relationship with nicotine dependence and smoking cessation in French smokers*. Addiction 2003;98:1575–83. 10.1046/j.1360-0443.2003.00523.x
    1. Fulkerson JA, French SA. Cigarette smoking for weight loss or control among adolescents: gender and racial/ethnic differences. J Adolesc Health 2003;32:306–13. 10.1016/S1054-139X(02)00566-9
    1. Meyer KA, Kushi LH, Jacobs DR, et al. . Dietary fat and incidence of type 2 diabetes in older Iowa women. Diabetes Care 2001;24:1528–35. 10.2337/diacare.24.9.1528
    1. Willi C, de Torrente de la Jara G, Closuit A. The specificities of women and tobacco: an overwiew : Tolson KP, Veksler EB, Research Focus on Smoking and Women’s Health. Nova Biomedical, 2008: 199–224.
    1. Pirie PL, Murray DM, Luepker RV. Gender differences in cigarette smoking and quitting in a cohort of young adults. Am J Public Health 1991;81:324–7. 10.2105/AJPH.81.3.324
    1. Robert C, Klesges LMK. Cigarette smoking as a dieting strategy in a university population. Int J Eat Disord 1988;7:413–9.
    1. Toll BA, Salovey P, O'Malley SS, et al. . Message framing for smoking cessation: the interaction of risk perceptions and gender. Nicotine Tob Res 2008;10:195–200. 10.1080/14622200701767803
    1. Browne JL, Ventura A, Mosely K, et al. . ‘I call it the blame and shame disease’: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open 2013;3:e003384 10.1136/bmjopen-2013-003384
    1. Potter L, Wallston K, Trief P, et al. . Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus. J Behav Med 2015;38:863–75. 10.1007/s10865-015-9655-0
    1. Kato A, Fujimaki Y, Fujimori S, et al. . Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study. BMJ Open 2017;7:e013425 10.1136/bmjopen-2016-013425
    1. Gonzalez JS, Shreck E, Psaros C, et al. . Distress and type 2 diabetes-treatment adherence: a mediating role for perceived control. Health Psychology 2015;34:505–13. 10.1037/hea0000131
    1. Krieger N, Sidney S. Racial discrimination and blood pressure: the cardia study of young black and white adults. Am J Public Health 1996;86:1370–8. 10.2105/AJPH.86.10.1370
    1. Krieger N. Discrimination and health inequities. Int J Health Serv 2014;44:643–710. 10.2190/HS.44.4.b
    1. Renn BN, Feliciano L, Segal DL. The bidirectional relationship of depression and diabetes: a systematic review. Clin Psychol Rev 2011;31:1239–46. 10.1016/j.cpr.2011.08.001
    1. Fiore M, Jaén C, Baker T. Treating tobacco use and dependence: 2008 update. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2008.
    1. Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2012;10:CD008286. 10.1002/14651858.CD008286.pub2
    1. Georges A, Galbiati L, Clair C. Smoking in men and women with type 2 diabetes: a qualitative gender-sensitive exploration of barriers to smoking cessation among people with type 2 diabetes. PLoS One 2019;14:e0221783 10.1371/journal.pone.0221783
    1. Cornuz J, Jacot-Sadowski I, Humair JP, et al. . Désaccoutumance Au tabac: Mise jour 2011 (1ère partie). Swiss Medical Forum 2011;11:156–9
    1. Cornuz J, Jacot-Sadowski I, Humair JP, et al. . Désaccoutumance au tabac: Mise jour 2011 (2e partie). Swiss Medical Forum 2011;11:172–6.
    1. Stead LF, Buitrago D, Preciado N, et al. . Physician advice for smoking cessation. Cochrane Database Syst Rev 2013;5:CD000165 10.1002/14651858.CD000165.pub4
    1. Stead LF, Perera R, Bullen C, et al. . Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012;11:CD000146. 10.1002/14651858.CD000146.pub4
    1. Lai DT, Cahill K, Qin Y, et al. . Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010:CD006936. 10.1002/14651858.CD006936.pub2
    1. West R, Hajek P, Stead L, et al. . Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction 2005;100:299–303. 10.1111/j.1360-0443.2004.00995.x
    1. Hughes JR, Keely JP, Niaura RS, et al. . Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res 2003;5:13–26. 10.1080/1462220031000070552
    1. Williams DR, Yan Yu ­, Jackson JS, et al. . Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol 1997;2:335–51. 10.1177/135910539700200305
    1. Williams DR. Measuring discrimination resource. Psychology 1997;2:335–51.
    1. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care 2000;23:943–50. 10.2337/diacare.23.7.943
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–13. 10.1046/j.1525-1497.2001.016009606.x
    1. Hox JJ, Bechger TM. An introduction to structural equation modeling. Fam Sci Rev 1998;11:354–73.
    1. Declaration of Helsinki, version October, 2013. Available:
    1. International Conference on harmonization (ICH, 1996) E6 guideline for good clinical practice. Available:
    1. International Conference on harmonization (ICH, 1997) E8 guideline: general considerations for clinical trials. Available:
    1. Humanforschungsgesetz, HFG Bundesgesetz über die Forschung am Menschen (Bundesgesetz über die Forschung am Menschen, HFG) vom 30. September 2011/ Loi fédérale relative la recherche sur l’être humain (loi relative la recherche sur l’être humain, LRH) du 30 septembre 2011. Available:
    1. Verordnung über klinische Versuche in der Humanforschung (Verordnung über klinische Versuche, KlinV) vom 20. September 2013 / Ordonnance sur les essais cliniques dans le cadre de la recherche sur l’être humain (Ordonnance sur les essais cliniques, OClin) du 20 septembre, 2013. Available:
    1. Heilmittelgesetz HMG Bundesgesetz über Arzneimittel und Medizinprodukte (Heilmittelgesetz, HMG) vom 15. Dezember 2000/Loi fédérale sur les médicaments et les dispositifs médicaux (Loi sur les produits thérapeutiques, Lpt) Du 15 décembre, 2000. Available:
    1. Vaucher P, Bischoff T, Diserens E-A, et al. . Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q. BMJ Open 2012;2:e000692 10.1136/bmjopen-2011-000692
    1. Maruish MEE. User’s manual for the SF-12v2 Health Survey. 3rd ed, 2012.
    1. Fung CSC, Wan EYF, Yu CLY, et al. . Validity and reliability of the 19-item audit of Diabetes-Dependent quality of life (ADDQoL-19) questionnaire in Chinese patients with type 2 diabetes mellitus in primary care. Qual Life Res 2016;25:2373–8. 10.1007/s11136-016-1263-0
    1. Kroenke K, Spitzer RL, Williams JBW, et al. . The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010;32:345–59. 10.1016/j.genhosppsych.2010.03.006
    1. Workgroup on Hypoglycemia, American Diabetes Association Defining and reporting hypoglycemia in diabetes: a report from the American diabetes association Workgroup on hypoglycemia. Diabetes Care 2005;28:1245–9. 10.2337/diacare.28.5.1245
    1. Hudon C, et al. The self-efficacy for managing chronic disease scale – French version: a validation study in primary care. Eur J Pers Cent Healthc 2014;2:533–8. 10.5750/ejpch.v2i4.843
    1. Koegelenberg CFN, Noor F, Bateman ED, et al. . Efficacy of varenicline combined with nicotine replacement therapy vs varenicline alone for smoking cessation: a randomized clinical trial. JAMA 2014;312:155–61. 10.1001/jama.2014.7195
    1. Etter J-F, Le Houezec J, Perneger TV. A self-administered questionnaire to measure dependence on cigarettes: the cigarette dependence scale. Neuropsychopharmacology 2003;28:359–70. 10.1038/sj.npp.1300030
    1. Etter J-F, Hughes JR. A comparison of the psychometric properties of three cigarette withdrawal scales. Addiction 2006;101:362–72. 10.1111/j.1360-0443.2005.01289.x
    1. Etter J-F, Bergman MM, Humair J-P, et al. . Development and validation of a scale measuring self-efficacy of current and former smokers. Addiction 2000;95:901–13. 10.1046/j.1360-0443.2000.9569017.x
    1. IPAQ. Available:
    1. Mäder U, Martin BW, Schutz Y, et al. . Validity of four short physical activity questionnaires in middle-aged persons. Med Sci Sports Exerc 2006;38:1255–66. 10.1249/01.mss.0000227310.18902.28
    1. Bernstein M, Morabia A, Costanza MC, et al. . [Nutritional balance of the diet of the adult residents of Geneva]. Soz Praventivmed 1994;39:333–44. 10.1007/BF01299665
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385–96. 10.2307/2136404
    1. Pelletier R, Ditto B, Pilote L. A composite measure of gender and its association with risk factors in patients with premature acute coronary syndrome. Psychosom Med 2015;77:517–26. 10.1097/PSY.0000000000000186
    1. Vaglio J, Conard M, Poston WS, et al. . Testing the performance of the ENRICHD social support instrument in cardiac patients. Health Qual Life Outcomes 2004;2:24. 10.1186/1477-7525-2-24

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren