An individually-tailored smoking cessation intervention for rural Veterans: a pilot randomized trial

Mark W Vander Weg, Ashley J Cozad, M Bryant Howren, Margaret Cretzmeyer, Melody Scherubel, Carolyn Turvey, Kathleen M Grant, Thad E Abrams, David A Katz, Mark W Vander Weg, Ashley J Cozad, M Bryant Howren, Margaret Cretzmeyer, Melody Scherubel, Carolyn Turvey, Kathleen M Grant, Thad E Abrams, David A Katz

Abstract

Background: Tobacco use remains prevalent among Veterans of military service and those residing in rural areas. Smokers frequently experience tobacco-related issues including risky alcohol use, post-cessation weight gain, and depressive symptoms that may adversely impact their likelihood of quitting and maintaining abstinence. Telephone-based interventions that simultaneously address these issues may help to increase treatment access and improve outcomes.

Methods: This study was a two-group randomized controlled pilot trial. Participants were randomly assigned to an individually-tailored telephone tobacco intervention combining counseling for tobacco use and related issues including depressive symptoms, risky alcohol use, and weight concerns or to treatment provided through their state tobacco quitline. Selection of pharmacotherapy was based on medical history and a shared decision interview in both groups. Participants included 63 rural Veteran smokers (mean age = 56.8 years; 87 % male; mean number of cigarettes/day = 24.7). The primary outcome was self-reported 7-day point prevalence abstinence at 12 weeks and 6 months.

Results: Twelve-week quit rates based on an intention-to-treat analysis did not differ significantly by group (Tailored = 39 %; Quitline Referral = 25 %; odds ratio [OR]; 95 % confidence interval [CI] = 1.90; 0.56, 5.57). Six-month quit rates for the Tailored and Quitline Referral conditions were 29 and 28 %, respectively (OR; 95 % CI = 1.05; 0.35, 3.12). Satisfaction with the Tailored tobacco intervention was high.

Conclusions: Telephone-based treatment that concomitantly addresses other health-related factors that may adversely affect quitting appears to be a promising strategy. Larger studies are needed to determine whether this approach improves cessation outcomes.

Trial registration: ClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.

Keywords: Nicotine dependence; Rural health; Smoking cessation; Tobacco; Veterans.

Figures

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Enrollment and retention

References

    1. Brown DW. Smoking prevalence among US veterans. J Gen Intern Med. 2010;25(2):147–9. doi: 10.1007/s11606-009-1160-0.
    1. Vander Weg MW, et al. Tobacco use and exposure in rural areas: findings from the behavioral risk factor surveillance system. Addict Behav. 2011;36(3):231–6. doi: 10.1016/j.addbeh.2010.11.005.
    1. American Lung Association . Cutting Tobacco’s rural roots. Washington: American Lung Association; 2012.
    1. Hutcheson TD, et al. Understanding smoking cessation in rural communities. J Rural Health. 2008;24(2):116–24. doi: 10.1111/j.1748-0361.2008.00147.x.
    1. Bennett KJ, Olatosi B, Probst JC. Health disparities: a rural–urban chartbook. Columbia: South Carolina Rural Health Research Center; 2008.
    1. Duffy SA, et al. Risk of smoking and receipt of cessation services among veterans with mental disorders. Psychiatr Serv. 2012;63(4):325–32. doi: 10.1176/appi.ps.201100097.
    1. Cunningham CL, et al. A qualitative evaluation of knowledge of and attitudes toward VA smoking cessation services. J Smok Cessat. 2011;6(2):152–8. doi: 10.1375/jsc.6.2.152.
    1. VA Office of Rural Health. Fact sheet. Washington, DC: VA Office of Rural Health; 2014.
    1. Stead LF, et al. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2013;8:CD002850.
    1. Hollis JF, et al. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tob Control. 2007;16(Suppl 1):i53–9. doi: 10.1136/tc.2006.019794.
    1. Centers for Disease Control and Prevention . Telephone quitlines: a resource for development, implementation, and evaluation. Atlanta: Centers for Disease Control and Prevention; 2004.
    1. Willett JG, et al. Clinical faxed referrals to a tobacco quitline: reach, enrollment, and participant characteristics. Am J Prev Med. 2009;36(4):337–40. doi: 10.1016/j.amepre.2008.12.004.
    1. Hebert KK, et al. Current major depression among smokers using a state quitline. Am J Prev Med. 2011;40(1):47–53. doi: 10.1016/j.amepre.2010.09.030.
    1. Toll BA, et al. A randomized trial for hazardous drinking and smoking cessation for callers to a quitline. J Consult Clin Psychol. 2015;83(3):445–54. doi: 10.1037/a0038183.
    1. Beebe LA, Bush T. Post-cessation weight concerns among women calling a state tobacco quitline. Am J Prev Med. 2015;48(1 Suppl 1):S61–4. doi: 10.1016/j.amepre.2014.09.004.
    1. Bush T, et al. Prevalence of weight concerns and obesity among smokers calling a quitline. J Smok Cessat. 2008;4(5):74–8.
    1. Levine MD, et al. Smoking-related weight concerns and obesity: differences among normal weight, overweight, and obese smokers using a telephone tobacco quitline. Nicotine Tob Res. 2013;15(6):1136–40. doi: 10.1093/ntr/nts226.
    1. Atkins D, Clancy C. Multiple risk factors interventions. Are we up to the challenge? Am J Prev Med. 2004;27(2 Suppl):102–3. doi: 10.1016/j.amepre.2004.04.016.
    1. Hunkeler EM, et al. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ. 2006;332(7536):259–63. doi: 10.1136/.
    1. Unutzer J, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836–45. doi: 10.1001/jama.288.22.2836.
    1. Fortney JC, et al. Telepsychiatry integration of mental health services into rural primary care settings. Int Rev Psychiatry. 2015;27(6):525–39. doi: 10.3109/09540261.2015.1085838.
    1. Hart LG, Larson EH, Lishner DM. Rural definitions for health policy and research. Am J Public Health. 2005;95(7):1149–55. doi: 10.2105/AJPH.2004.042432.
    1. Hatsukami DK, Lando H. Behavioral treatment for smoking cessation. Health Values. 1993;17(2):23–40.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Bush K, et al. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95. doi: 10.1001/archinte.158.16.1789.
    1. Perkins KA, et al. Cognitive-behavioral therapy to reduce weight concerns improves smoking cessation outcome in weight-concerned women. J Consult Clin Psychol. 2001;69(4):604–13. doi: 10.1037/0022-006X.69.4.604.
    1. Lejuez CW, et al. Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. Behav Modif. 2011;35(2):111–61. doi: 10.1177/0145445510390929.
    1. MacPherson L, et al. Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. J Consult Clin Psychol. 2010;78(1):55–61. doi: 10.1037/a0017939.
    1. United States Department of Veterans Affairs and United States Department of Defense. VA/DoD Clinical practice guideline for management of Substance Use Disorders (SUD). Washington, DC: Department of Veterans Affairs and the Department of Defense; 2009.
    1. Enggasser JL, et al. Drinking goal choice and outcomes in a Web-based alcohol intervention: results from VetChange. Addict Behav. 2015;42:63–8. doi: 10.1016/j.addbeh.2014.10.036.
    1. Wing RR, et al. Behavioral self-regulation in the treatment of patients with diabetes mellitus. Psychol Bull. 1986;99(1):78–89. doi: 10.1037/0033-2909.99.1.78.
    1. Damschroder LJ, et al. Small-changes obesity treatment among veterans: 12-month outcomes. Am J Prev Med. 2014;47(5):541–53. doi: 10.1016/j.amepre.2014.06.016.
    1. Gokee LaRose J, et al. Preventing weight gain in young adults: a randomized controlled pilot study. Am J Prev Med. 2010;39(1):63–8. doi: 10.1016/j.amepre.2010.03.011.
    1. Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q) Can J Sport Sci. 1992;17(4):338–45.
    1. Fiore MC, et al. Clinical practice guideline: treating tobacco use and dependenc: 2008 update. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2008.
    1. Sobell LC, Sobell MB. Alcohol timeline followback users’ manual. Toronto: Addiction Research Foundation; 1995.
    1. Sobell LC, et al. Reliability of alcohol abusers’ self-reports of drinking behavior. Behav Res Ther. 1979;17(2):157–60. doi: 10.1016/0005-7967(79)90025-1.
    1. Maisto SA, Sobell MB, Sobell LC. Reliability of self-reports of low ethanol consumption by problem drinkers over 18 months of follow-up. Drug Alcohol Depend. 1982;9(4):273–8. doi: 10.1016/0376-8716(82)90066-7.
    1. Paxton AE, et al. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011;40(1):67–71. doi: 10.1016/j.amepre.2010.10.009.
    1. Topolski TD, et al. The Rapid Assessment of Physical Activity (RAPA) among older adults. Prev Chronic Dis. 2006;3(4):A118.
    1. Biener L, Abrams DB. The contemplation ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol. 1991;10(5):360–5. doi: 10.1037/0278-6133.10.5.360.
    1. Heatherton TF, et al. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict. 1991;86(9):1119–27. doi: 10.1111/j.1360-0443.1991.tb01879.x.
    1. Kerkvliet JL, Wey H, Fahrenwald NL. Cessation among state quitline participants with a mental health condition. Nicotine Tob Res. 2015;17(6):735–41. doi: 10.1093/ntr/ntu239.
    1. Society for Research on Nicotine and Tobacco Subcommittee on Biochemical Verification Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4(2):149–59. doi: 10.1080/14622200210123581.
    1. Velicer WF, et al. Assessing outcome in smoking cessation studies. Psychol Bull. 1992;111(1):23–41. doi: 10.1037/0033-2909.111.1.23.
    1. Noonan D, Jiang Y, Duffy SA. Utility of biochemical verification of tobacco cessation in the Department of Veterans Affairs. Addict Behav. 2013;38(3):1792–5. doi: 10.1016/j.addbeh.2012.11.006.
    1. Nohlert E, Ohrvik J, Helgason AR. Non-responders in a quitline evaluation are more likely to be smokers - a drop-out and long-term follow-up study of the Swedish National Tobacco Quitline. Tob Induc Dis. 2016;14:5. doi: 10.1186/s12971-016-0070-2.
    1. Lindqvist H, et al. Motivational interviewing in an ordinary clinical setting: a controlled clinical trial at the Swedish National Tobacco Quitline. Addict Behav. 2013;38(7):2321–4. doi: 10.1016/j.addbeh.2013.03.002.
    1. Nohlert E, Ohrvik J, Helgason AR. Effectiveness of proactive and reactive services at the Swedish National Tobacco Quitline in a randomized trial. Tob Induc Dis. 2014;12(1):9. doi: 10.1186/1617-9625-12-9.
    1. French DP, Sutton S. Reactivity of measurement in health psychology: how much of a problem is it? What can be done about it? Br J Health Psychol. 2010;15(Pt 3):453–68. doi: 10.1348/135910710X492341.
    1. Carr ECJ, Worth A. The use of the telephone interview for research. Nurs Times Res. 2001;6(1):511–24. doi: 10.1177/136140960100600107.
    1. Herzog AR, Rodgers WL. Interviewing older adults: mode comparison and a telephone resurvey. Public Opin Q. 1988;52(1):84–99. doi: 10.1086/269083.
    1. Worth A, Tierney AJ. Conducting research interviews with elderly people by telephone. J Adv Nurs. 1993;18(7):1077–84. doi: 10.1046/j.1365-2648.1993.18071077.x.
    1. McDonald PW. Population-based recruitment for quit-smoking programs: an analytic review of communication variables. Prev Med. 1999;28(6):545–57. doi: 10.1006/pmed.1998.0479.

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