Validating the use of veterans affairs tobacco health factors for assessing change in smoking status: accuracy, availability, and approach

Anne C Melzer, Erika A Pinsker, Barbara Clothier, Siamak Noorbaloochi, Diana J Burgess, Elisheva R Danan, Steven S Fu, Anne C Melzer, Erika A Pinsker, Barbara Clothier, Siamak Noorbaloochi, Diana J Burgess, Elisheva R Danan, Steven S Fu

Abstract

Background: Accurate smoking status is key for research purposes, but can be costly and difficult to measure. Within the Veteran's Health Administration (VA), smoking status is recorded as part of routine care as "health factors" (HF)-fields that researchers can query through the electronic health record (EHR). Many researchers are interested in using these fields to track changes in smoking status over time, however the validity of this measure for assessing change is unknown. The primary goal of this project was to examine whether HFs can be used to accurately measure change in tobacco status over time, with secondary goals of assessing the optimum timeframe for assessment and variation in accuracy by site.

Methods: Secondary analysis of the Veterans VICTORY study, a pragmatic smoking cessation randomized controlled trial conducted from 2009 to 2011. Eligible subjects were identified via the EHR using a past 90-day HF indicating current tobacco use (for example: "CURRENT SMOKER", "CURRENTLY USES TOBACCO"). Participants were surveyed at 1 year to determine prolonged smoking abstinence. We identified HFs for tobacco status within +/- 120 days of the follow-up survey mailing date and recorded the temporally closest HF. Among subjects with both measures, we compared the two for agreement using kappa statistics and concordance.

Results: 1713 subjects (33%) had both follow-up survey and HF data, 1594 (31%) had only a survey response, 790 (15%) had only HF and 1026 (20%) had neither. For subjects with both measures, there was 90% concordance and moderate agreement (Kappa 0.48, 95%CI 0.41-0.55, Sensitivity 54.4, 95%CI 41.1-67.7, Specificity 94.3, 95%CI 87.5-100.0).

Conclusions: We found high concordance but only moderate agreement by kappa statistics between HFs and survey data. The difference is likely accounted for by the natural history of quit attempts, in which patients cycle in and out of quit attempts. HFs appear to provide an accurate measure of population level quit behavior utilizing data collected in the course of clinical care.

Trial registration: ClinicalTrials.gov NCT00608426.

Keywords: Behavior change; Electronic health record; Health services; Methods; Smoking; Tobacco cessation.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the following institutional review boards: the Minneapolis VA Medical Center Institutional Review Board, the James A. Haley Veterans Hospital Institutional Review Board, the VA New York Healthcare System Institutional Review Board, and the VA Medical Center G.V. (Sonny) Montgomery Institutional Review Board. Written informed consent was obtained from participants at the time of enrollment.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Results of randomization and availability of health factors
Fig. 2
Fig. 2
Variation in the availability of tobacco status by Health Factor, survey, both and neither by Site

References

    1. CENTERS FOR DISEASE CONTROL AND PREVENTION . The health consequences of smoking–50 years of progress: a report of the surgeon general. Rockville: US DEPARTMENT OF HEALTH AND HUMAN SERVICES; 2014. p. 171.
    1. Siegel RL, Jacobs EJ, Newton CC, et al. Deaths due to cigarette smoking for 12 smoking-related cancers in the United States. JAMA Int Med. 2015;175:1574–1576. doi: 10.1001/jamainternmed.2015.2398.
    1. Barnett PG, Hamlett-Berry K, Sung H-Y, Max W. Health care expenditures attributable to smoking in military veterans. Nicotine Tob Res. 2015;17:586–591. doi: 10.1093/ntr/ntu187.
    1. Fiore MC, Jaen C, Baker TB, Baily WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 update. Rockville: U.S. Department of Health and Human Services. Public Health Service; 2008.
    1. Fiore MC, Jorenby DE, Schensky AE, Smith SS, Bauer RR, Baker TB. Smoking status as the new vital sign: effect on assessment and intervention in patients who smoke. Mayo Clin Proc. 1995;70:209–213. doi: 10.4065/70.3.209.
    1. Rigotti NA, Regan S, Levy DE, Japuntich S, Chang Y, Park ER, et al. Sustained care intervention and postdischarge smoking cessation among hospitalized adults: a randomized clinical trial. JAMA. 2014;312:719–728. doi: 10.1001/jama.2014.9237.
    1. Brown DW, Croft JB, Schenck AP, Malarcher AM, Giles WH, Simpson RJ., Jr Inpatient smoking-cessation counseling and all-cause mortality among the elderly. Am J of Prev Med. 2004;26:112–118. doi: 10.1016/j.amepre.2003.10.004.
    1. Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ. 2008;336:598–600. doi: 10.1136/bmj.39503.582396.25.
    1. Chapman WW, Cohen KB. Current issues in biomedical text mining and natural language processing. J Biomed Inform. 2009;42:757–759. doi: 10.1016/j.jbi.2009.09.001.
    1. VA Utilization profile FY 2016. In: Department of Veterans Affairs Office of planning and policy, National Center for veterans analysis and statistics; 2017. Accessed January 2018: .
    1. McGinnis KA, Brandt CA, Skanderson M, Justice AC, Shahrir S, Butt AA, et al. Validating smoking data from the Veteran's affairs health factors dataset, an electronic data source. Nicotine Tob Res. 2011;13:1233–1239. doi: 10.1093/ntr/ntr206.
    1. Barnett PG, Chow A, Flores NE, Sherman SE, Duffy SA. Changes in veteran tobacco use identified in electronic medical records. Am J of Prev Med. 2017;53:e9–e18. doi: 10.1016/j.amepre.2017.01.009.
    1. Barnett PG, Chow A, Flores NE. Technical report 28 using health factors data for VA health services research. Health Economics Resource Center. 2014; Accessed March 2, 2018:
    1. Ibrahim JG, Chu H, Chen M-H. Missing data in clinical studies: issues and methods. J of Clin Onc. 2012;30:3297–3303. doi: 10.1200/JCO.2011.38.7589.
    1. Fu SS, van Ryn M, Sherman SE, et al. Proactive tobacco treatment and population-level cessation: a pragmatic randomized clinical trial. JAMA Int Med. 2014;174:671–677. doi: 10.1001/jamainternmed.2014.177.
    1. Hughes J. P Keely J, S Niaura R, J Ossip-Klein D, Richmond R, E swan G. Measures of Abstinence in Clinical Trials. 2003; 10.1080/1462220031000070552.
    1. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–1139. doi: 10.1097/01.mlr.0000182534.19832.83.
    1. Alan Stuart KO. Kendall's advanced theory of statistics, 6th edition. 1998.
    1. Allen SS, Bade T, Hatsukami D, Center B. Craving, withdrawal, and smoking urges on days immediately prior to smoking relapse. Nicotine Tob Res. 2008;10:35–45. doi: 10.1080/14622200701705076.
    1. Etter J-F, Schmid F. Effects of large financial incentives for long-term smoking CessationA randomized trial. J Am Coll of Cardiol. 2016;68:777–785. doi: 10.1016/j.jacc.2016.04.066.
    1. Herd N, Borland R. The natural history of quitting smoking: findings from the international tobacco Control (ITC) four country survey. Addiction. 2009;104:2075–2087. doi: 10.1111/j.1360-0443.2009.02731.x.
    1. Petzel R. Department of Veterans Affairs VHA, Washington DC. 2014. National Smoking and tobacco use cessation program: VHA directive 1056.
    1. Emmons KM, Goldstein MG. Smokers who are hospitalized: a window of opportunity for cessation interventions. Prev Med. 1992;21:262–269. doi: 10.1016/0091-7435(92)90024-C.
    1. Cook B, Wayne G, Kafali E, Liu Z, Shu C, Flores M. Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation. JAMA. 2014;311:172–182. doi: 10.1001/jama.2013.284985.
    1. Wong SL, Shields M, Leatherdale S, Malaison E, Hammond D. Assessment of validity of self-reported smoking status. Health Rep. 2012;23:47–53.

Source: PubMed

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