Smoking Cessation among Female and Male Veterans before and after a Randomized Trial of Proactive Outreach

Elisheva R Danan, Scott E Sherman, Barbara A Clothier, Diana J Burgess, Erika A Pinsker, Anne M Joseph, Siamak Noorbaloochi, Steven S Fu, Elisheva R Danan, Scott E Sherman, Barbara A Clothier, Diana J Burgess, Erika A Pinsker, Anne M Joseph, Siamak Noorbaloochi, Steven S Fu

Abstract

Introduction: Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a proactive outreach intervention.

Methods: We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing proactive outreach with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to proactive outreach versus UC were compared using logistic regression.

Results: Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in proactive outreach as compared with UC. At the 1-year follow-up, men in proactive outreach were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28-2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48-3.99).

Conclusions: Satisfaction with cessation care in VA remains low. Proactive outreach to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.

Trial registration: ClinicalTrials.gov NCT00608426.

Conflict of interest statement

Conflict of interest statement: The authors declare they have no competing interests.

Published by Elsevier Inc.

Figures

Figure 1.
Figure 1.
Proportion of female and male smokers who report 6-month prolonged abstinence at the 1-year follow-up, by treatment arm.

References

    1. Abdullah A, Lam T, Chan S, & Hedley A. (2004). Which smokers use the smoking cessation Quitline in Hong Kong, and how effective is the Quitline? Tobacco Control, 13(4), 415–421.
    1. Abrams DB, Niaura RS, Brown RA, Emmons KM, Goldstein MG, & Monti PM (2003). The tobacco dependence treatment handbook. New York: The Guilford Press.
    1. Babb S. (2017). Quitting smoking among adults—United States, 2000–2015. MMWR Morbidity and Mortality Weekly Report, 65,1457–1464.
    1. Baldwin AS, Rothman AJ, Hertel AW, Linde JA, Jeffery RW, Finch EA, & Lando HA (2006). Specifying the determinants of the initiation and maintenance of behavior change: An examination of self-efficacy, satisfaction, and smoking cessation. Health Psychology, 25(5), 626.
    1. Barnett PG, Hamlett-Berry K, Sung H-Y, & Max W. (2015). Health care expenditures attributable to smoking in military veterans. Nicotine & Tobacco Research, 17(5), 586–591.
    1. Biener L, & Abrams DB (1991). The contemplation ladder: Validation of a measure of readiness to consider smoking cessation. Health Psychology, 10(5), 360.
    1. Brown DW (2010). Smoking prevalence among US Veterans. Journal of General Internal Medicine, 25(2), 147–149.
    1. Caraballo RS, Giovino GA, Pechacek TF, & Mowery PD (2001). Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: Third National Health and Nutrition Examination Survey, 1988–1994. American Journal of Epidemiology, 153(8), 807–814.
    1. Centers for Disease Control and Prevention. (2017). Behavioral Risk Factor Surveillance System Questionnaire.
    1. Cokkinides VE, Ward E, Jemal A, & Thun MJJ (2005). Under-use of smoking-cessation treatments: Results from the National Health Interview Survey, 2000. American Journal of Preventive Medicine, 28(1), 119–122.
    1. Cummins SE, Bailey L, Campbell S, Koon-Kirby C, & Zhu S-H (2007). Tobacco cessation quitlines in North America: A descriptive study. Tobacco Control, 16(Suppl. 1), i9–i15.
    1. Curry SJ, Sporer AK, Pugach O, Campbell RT, & Emery SJ (2007). Use of tobacco cessation treatments among young adult smokers: 2005 National Health Interview Survey. American Journal of Public Health, 97(8), 1464–1469.
    1. Davis RM (1997). Healthcare report cards and tobacco measures. Tobacco Control, 6(Suppl. 1), S70–S77.
    1. Davis TM, Bush KR, Kivlahan DR, Dobie DJ, & Bradley KA (2003). Screening for substance abuse and psychiatric disorders among women patients in a VA Health Care System. Psychiatric Services, 54(2), 214–218.
    1. Dijkstra A, & Vries HD (2000). Self-efficacy expectations with regard to different tasks in smoking cessation. Psychology and Health, 15(4), 501–511.
    1. Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, & Bradley KA (2004). Posttraumatic stress disorder in female veterans: Association with self-reported health problems and functional impairment. Archives of Internal Medicine, 164(4), 394–400.
    1. Duffy SA, Kilbourne AM, Austin KL, Dalack GW, Woltmann EM, Waxmonsky J, & Noonan D. (2012). Risk of smoking and receipt of cessation services among veterans with mental disorders. Psychiatric Services, 63(4), 325–332.
    1. Etter JF, & Perneger TV (2001). Attitudes toward nicotine replacement therapy in smokers and ex-smokers in the general public. Clinical Pharmacology & Therapeutics, 69(3), 175–183.
    1. Farmer MM, Rose DE, Riopelle D, Lanto AB, & Yano EM (2011). Gender differences in smoking and smoking cessation treatment: An examination of the organizational features related to care. Women’s Health Issues, 21(Suppl. 4), S182–S189.
    1. Fiore M. (2008). Treating tobacco use and dependence: 2008 update: Clinical practice guideline. Collingdale, PA: Diane Publishing.
    1. Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, & Koren GJ (2009). Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: Focus on developmental toxicology. Therapeutic Drug Monitoring, 31(1), 14.
    1. Frayne S, Phibbs CS, Saechao F, Maisel NC, Friedman SA, & Finlay A. (2014). Sourcebook: Women Veterans in the Veterans Health Administration. Volume 3. Sociodemographics, Utilization, Costs of Care, and Health Profile. Washington, DC.
    1. Frayne SM, Skinner KM, Sullivan LM, & Freund KM (2003). Sexual assault while in the military: Violence as a predictor of cardiac risk? Violence and Victims, 18(2), 219.
    1. Fu SS, van Ryn M, Nelson D, Burgess DJ, Thomas JL, Saul J, … Joseph AM(2016). Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: A randomised clinical trial. Thorax, 71(5), 446–453.
    1. Fu SS, van Ryn M, Sherman SE, Burgess DJ, Noorbaloochi S, Clothier B, & Joseph AM (2012). Population-based tobacco treatment: Study design of a randomized controlled trial. BMC Public Health, 12(1), 159.
    1. Gilbert H, Sutton S, & Sutherland G. (2005). Who Calls QUIT®? The characteristics of smokers seeking advice via a telephone helpline compared with smokers attending a clinic and those in the general population. Public Health, 119(10), 933–939.
    1. Haas JS, Linder JA, Park ER, Gonzalez I, Rigotti NA, Klinger EV, . Marinacci LX (2015). Proactive tobacco cessation outreach to smokers of low socioeconomic status: A randomized clinical trial. JAMA Internal Medicine, 175(2), 218–226.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, & Robinson J. (1989). Measuring the heaviness of smoking: Using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Addiction, 84(7), 791–800.
    1. Huxley RR, & Woodward M. (2011). Cigarette smoking as a risk factor for coronary heart disease in women compared with men: A systematic review and meta-analysis of prospective cohort studies. Lancet, 378(9799), 1297–1305.
    1. Institute of Medicine (IOM). (2009). Combating tobacco use in military and veteran populations. Washington, DC: Author.
    1. Institute, U. S. N. C. (2017). A socioecological approach to addressing tobacco-related health disparities. Bethesda, MD.
    1. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, & Graffunder CM (2016). Current cigarette smoking among adults—United States, 2005–2015. MMWR Morbidity and Mortality Weekly Report, 65, 1205–1211.
    1. Kehle-Forbes SM, Harwood EM, Spoont MR, Sayer NA, Gerould H, & Murdoch M. (2017). Experiences with VHA care: A qualitative study of US women veterans with self-reported trauma histories. BMC Women’s Health, 17(1), 38.
    1. Kruger J, O’Halloran A, Rosenthal AC, Babb SD, & Fiore MC (2016). Receipt of evidence-based brief cessation interventions by health professionals and use of cessation assisted treatments among current adult cigarette-only smokers: National Adult Tobacco Survey, 2009–2010. BMC Public Health, 16(1), 141.
    1. Ku L, Brantley E, Bysshe T, Steinmetz E, & Bruen BK (2016). How Medicaid and other public policies affect use of tobacco cessation therapy, United States, 2010–2014. Preventing Chronic Disease, 13, E150.
    1. McBride CM, Scholes D, Grothaus LC, Curry SJ, Ludman E, & Albright J. (1999). Evaluation of a minimal self-help smoking cessation intervention following cervical cancer screening. Preventive Medicine, 29(2), 133–138.
    1. McClure JB, Westbrook E, Curry SJ, & Wetter DW (2005). Proactive, motivationally enhanced smoking cessation counseling among women with elevated cervical cancer risk. Nicotine & Tobacco Research, 7(6), 881–889.
    1. Miller C, Wakefield M, & Roberts L. (2003). Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign. Tobacco Control, 12(Suppl. 2), ii53–ii58.
    1. Noonan D, Jiang Y, & Duffy SA (2013). Utility of biochemical verification of tobacco cessation in the Department of Veterans Affairs. Addictive Behaviors, 38(3), 1792–1795.
    1. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, & Kinne S. (1994). The validity of self-reported smoking: A review and meta-analysis. American Journal of Public Health, 84(7), 1086–1093.
    1. Petzel RA (2014). National Smoking and Tobacco Use Cessation Program. (1056). Washington, DC.
    1. Quinn VP, Stevens VJ, Hollis JF, Rigotti NA, Solberg LI, Gordon N, … Zapka J. (2005). Tobacco-cessation services and patient satisfaction in nine nonprofit HMOs. American Journal of Preventive Medicine, 29(2), 77–84.
    1. Rigotti NA, Park ER, Regan S, Chang Y, Perry K, Loudin B, & Quinn V. (2006). Efficacy of telephone counseling for pregnant smokers: A randomized controlled trial. Obstetrics & Gynecology, 108(1), 83–92.
    1. Shadel WG, Elliott MN, Haas AC, Haviland AM, Orr N, Farmer MM, . Cleary PD (2015). Clinician advice to quit smoking among seniors. Preventive Medicine, 70, 83–89.
    1. Sherman SE, Fu SS, Joseph AM, Lanto AB, & Yano EM (2005). Gender differences in smoking cessation services received among veterans. Womens Health Issues, 15(3), 126–133.
    1. Shiffman S, Brockwell SE, Pillitteri JL, & Gitchell JG (2008). Use of smoking-cessation treatments in the United States. American Journal of Preventive Medicine, 34(2), 102–111.
    1. Smith PH, Bessette AJ, Weinberger AH, Sheffer CE, & McKee SA (2016). Sex/genderdifferencesinsmokingcessation:Areview. PreventiveMedicine,92,135–140.
    1. Smith PH, Kasza KA, Hyland A, Fong GT, Borland R, Brady K, . McKee, S. A. (2015). Gender differences in medication use and cigarette smoking cessation: Results from the International Tobacco Control Four Country Survey. Nicotine & Tobacco Research, 17(4), 463–472.
    1. Solomon LJ, Secker-Walker RH, Flynn BS, Skelly JM, & Capeless EL (2000). Proactive telephone peer support to help pregnant women stop smoking. Tobacco Control, 9(Suppl. 3), iii72-iii74.
    1. Stevens VJ, Solberg LI, Quinn VP, Rigotti NA, Hollis JA, Smith KS, . Boyle RG (2005). Relationship between tobacco control policies and the delivery of smoking cessation services in nonprofit HMOs. Journal of the National Cancer Institute Monographs, (35), 75–80.
    1. Suris A, & Lind L. (2008). Military sexual trauma: A review of prevalence and associated health consequences in veterans. Trauma, Violence, &Abuse, 9(4), 250–269.
    1. Swartz SH, Cowan TM, Klayman JE, Welton MT, & Leonard BA (2005). Use and effectiveness of tobacco telephone counseling and nicotine therapy in Maine. American Journal of Preventive Medicine, 29(4), 288–294.
    1. U.S. Department of Health and Human Services. (2001). Women and smoking: A report of the Surgeon General. Rockville, MD: Author.
    1. Ware JE, Snyder MK, Wright WR, & Davies AR (1983). Defining and measuring patient satisfaction with medical care. Evaluation and Program Planning, 6(3–4), 247–263.
    1. Weinberger AH, Esan H, Hunt MG, & Hoff RA (2016). A review of research on smoking behavior in three demographic groups of veterans: Women, racial/ethnic minorities, and sexual orientation minorities. American Journal of Drug and Alcohol Abuse, 42(3), 254–268.
    1. Wright SM, Craig T, Campbell S, Schaefer J, & Humble C. (2006). Patient satisfaction of female and male users of Veterans Health Administration services. Journal of General Internal Medicine, 21(Suppl. 3), S26–S32.
    1. Yeager DS, & Krosnick JA (2010). The validity of self-reported nicotine product use in the 2001 −2008 National Health and Nutrition Examination Survey. Medical Care, 48(12), 1128–1132.
    1. Zickmund SL, Burkitt KH, Gao S, Stone RA, Jones AL, Hausmann LR, .Fine MJ (2018). Racial, ethnic, and gender equity in veteran satisfaction with health care in the Veterans Affairs Health Care System. Journal of General Internal Medicine, 33(3), 305–331.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera