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Streck JM, Bergeria CL, Parker MA, Davis DR, DeSarno M, Sigmon SC, Hughes JR, Gaalema DE, Heil SH, Tidey JW, Stitzer ML, Rothman M, Higgins ST. Response to reduced nicotine content cigarettes among smokers with chronic health conditions. Prev Med Rep 2018; 12:321-329. [PMID: 30416951 PMCID: PMC6224320 DOI: 10.1016/j.pmedr.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/30/2018] [Accepted: 10/13/2018] [Indexed: 12/15/2022] Open
Abstract
Individuals with chronic health conditions persist in smoking despite the presence of smoking-related illness. The aim of this study was to examine whether chronic health conditions moderate response to reduced nicotine content cigarettes (0.4, 2.4, 5.2, 15.8 mg/g of tobacco). This is a secondary analysis of a controlled clinical laboratory study that examined the acute effects of cigarettes varying in nicotine content among individuals especially vulnerable to smoking and tobacco dependence. Participants in the present study were categorized as having 0, 1–2, or ≥3 smoking-related chronic health conditions (i.e., chronic condition severity, CCS). Repeated-measures analysis of variance was used to examine whether CCS moderated response to cigarettes across measures of addiction potential (i.e., concurrent choice testing between nicotine dose pairs, Cigarette Purchase Task (CPT) performance, positive subjective effects), tobacco withdrawal, cigarette craving, and smoking topography. No main effects of CCS or interactions of CCS and nicotine dose were observed for concurrent choice testing, positive subjective effects, tobacco withdrawal, or smoking topography. Main effects of CCS were noted on the CPT with greater CCS being associated with less persistent demand. There was an interaction of CCS and nicotine dose on Factor 1 of the Questionnaire on Smoking Urges with the effects of dose significant only among those with 1–2 chronic conditions. Overall, we see minimal evidence that chronic condition severity affects response to reduced nicotine content cigarettes. A policy that reduces the nicotine content of cigarettes to minimally addictive levels may benefit smokers already experiencing smoking-related chronic conditions.
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Affiliation(s)
- Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Cecilia L Bergeria
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Michael DeSarno
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Matthew Rothman
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
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Duffy SA, Ignacio RV, Kim HM, Geraci MC, Essenmacher CA, Hall SV, Chow A, Pfeiffer PN, Sherman SE, Bohnert KM, Zivin K, Barnett PG. Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration. Tob Control 2018; 28:540-547. [PMID: 30181383 DOI: 10.1136/tobaccocontrol-2018-054473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In 2003, the Veterans Health Administration (VHA) implemented a directive that cessation pharmacotherapy be made available to all who use tobacco and are interested in quitting. Despite the efficacy of cessation pharmacotherapy shown in clinical trials, the generalisability of the results in real-world settings has been challenged. Hence, the specific aim of this study was to determine the effectiveness of cessation pharmacotherapies in the VHA. METHODS This retrospective cohort study used VHA's electronic medical record data to compare quit rates among those who use tobacco and who did vs. did not receive any type of cessation pharmacotherapy. Included were 589 862 Veterans identified as current tobacco users during fiscal year 2011 who had not received cessation pharmacotherapy in the prior 12 months. Following a 6-month period to assess treatment, quit rates among those who were treated versus untreated were compared during the 7-18 months (12 months) post-treatment follow-up period. The estimated treatment effect was calculated from a logistic regression model adjusting for inverse probability of treatment weights (IPTWs) and covariates. Marginal probabilities of quitting were also obtained among those treated versus untreated. RESULTS Adjusting for IPTWs and covariates, the odds of quitting were 24% higher among those treated versus untreated (OR=1.24, 95% CI 1.23 to 1.25, p<0.001). The marginal probabilities of quitting were 16.7% for the untreated versus 19.8% for the treated based on the weighted model. CONCLUSION The increased quit rates among Veterans treated support the effectiveness and continuation of the VHA tobacco cessation pharmacotherapy policy.
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Affiliation(s)
- Sonia A Duffy
- College of Nursing, Ohio State University, Columbus, Michigan, USA.,Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rosalinda V Ignacio
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hyungjin Myra Kim
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark C Geraci
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, Illinois, USA
| | - Carol A Essenmacher
- Department of Veterans Affairs, Battle Creek VA Medical Center, Battle Creek, Michigan, USA
| | - Stephanie V Hall
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Adam Chow
- Department of Veterans Affairs, Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Paul N Pfeiffer
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott E Sherman
- Department of Veterans Affairs, VA New York Harbor Healthcare System, New York, New York, USA.,Department of Population Health, NYU School of Medicine, New York University, New York, USA
| | - Kipling M Bohnert
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Zivin
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul George Barnett
- Department of Veterans Affairs, Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
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3
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Gass JC, Morris DH, Winters J, VanderVeen JW, Chermack S. Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic. J Subst Abuse Treat 2018; 84:1-8. [PMID: 29195588 DOI: 10.1016/j.jsat.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.
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Affiliation(s)
- Julie C Gass
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States.
| | - David H Morris
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jamie Winters
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph W VanderVeen
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Stephen Chermack
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
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4
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Duffy SA, Ronis DL, Ewing LA, Waltje AH, Hall SV, Thomas PL, Olree CM, Maguire KA, Friedman L, Klotz S, Jordan N, Landstrom GL. Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals. Implement Sci 2016; 11:147. [PMID: 27814722 PMCID: PMC5097410 DOI: 10.1186/s13012-016-0511-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 10/17/2016] [Indexed: 01/24/2023] Open
Abstract
Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended). Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended. Conclusions Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation. Trial registration ClinicalTrials.gov, NCT01309217 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0511-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonia A Duffy
- College of Nursing, Ohio State University, Newton Hall, 1585 Neil Ave, Columbus, OH, 43210, USA. .,Veterans Affairs (VA) Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - David L Ronis
- University of Michigan School of Nursing, 400 North Ingalls Building Room 4330, Ann Arbor, MI, 48109-0482, USA
| | - Lee A Ewing
- VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Andrea H Waltje
- Internal Medicine, Brehm Tower, University of Michigan, Room 6115, 1000 Wall Street, Ann Arbor, MI, 48109-5714, USA
| | - Stephanie V Hall
- VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | | | - Christine M Olree
- The Lacks Cancer Center, Mercy Health Saint Mary's, 200 Jefferson SE, Grand Rapids, MI, 49503, USA
| | | | - Lisa Friedman
- Saint Joseph Mercy Health System, 5305 E. Huron River Dr., Ann Arbor, MI, 48106-0995, USA
| | - Sue Klotz
- Saint Mary Mercy Hospital, 36475 Five Mile Road, Livonia, MI, 48154-1988, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Abbott Hall 710 North Lake Shore Drive, Suite 904, Chicago, IL, 60611, USA.,Center for Management of Complex Chronic Care, Hines VA Hospital, 5000 S 5th Ave., Hines, IL, 60141, USA
| | - Gay L Landstrom
- Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03756, USA
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5
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Myers MG, Chen T, Schweizer CA. Factors Associated With Accepting Assistance for Smoking Cessation Among Military Veterans. Nicotine Tob Res 2016; 18:2288-2292. [PMID: 27613903 DOI: 10.1093/ntr/ntw163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/23/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Cigarette smoking remains a significant health risk for Veterans. Increased understanding of factors that influence the tobacco cessation referral process within Veterans Affairs medical facilities is useful for enhancing utilization of smoking cessation treatment. The present study examined the association of demographic and health variables with whether smokers accepted referral for medication and/or tobacco cessation clinic. METHODS Electronic medical record data (2011-2013) were obtained for a sample of US military Veterans who accepted cessation assistance from their health care provider. Demographic and diagnostic variables were examined to identify predictors of the types of assistance accepted (medication only, clinic referral only, or both). RESULTS The sample includes 2941 Veterans, 10.3% female, 19.9% African American, 10.7% Hispanic, and 57.9% non-Hispanic white. Veterans averaged of 50.69 years of age (SD = 14.01), 31.5% had a substance use disorder diagnosis and 54.1% had a psychiatric diagnosis. Demographic and diagnostic information was compared across types of assistance accepted. Significant differences were found between those who accepted medications only and those who accepted either clinic referral or both medication and clinic referral. Veterans in the latter two categories were younger and more likely to have a psychiatric diagnosis than those accepting medication only. Women Veterans were significantly more likely than men to accept clinic referral plus medication. However, in contrast to men, almost none of the variables examined were associated with the type of assistance accepted by women. CONCLUSION These findings indicate significant gender differences in influences on accepting assistance for smoking cessation among Veterans. IMPLICATIONS Existing research identifies factors associated with unassisted quitting. However, little is known regarding the referral process, which is critical in connecting smokers with treatment. The present work is unique in employing electronic medical record data to examine factors associated with accepting different types of smoking cessation treatment referrals. This study represents an initial effort to elucidate the smoking cessation treatment referral process. These findings highlight the need to examine sex specific influences on smoking cessation treatment utilization and the importance of focusing on smokers with psychiatric disorders.
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Affiliation(s)
- Mark G Myers
- Department of Mental Health Service, Veterans Affairs San Diego Healthcare System, San Diego, CA; .,Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Timothy Chen
- Department of Mental Health Service, Veterans Affairs San Diego Healthcare System, San Diego, CA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - C Amanda Schweizer
- Department of Mental Health Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.,Department of Medicine, University of California, Los Angeles, Los Angeles, CA
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Hong O, Duffy SA, Choi SH, Chin DL. The association between occupational exposures and cigarette smoking among operating engineers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2014; 69:172-179. [PMID: 24325748 PMCID: PMC3863785 DOI: 10.1080/19338244.2013.763760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to determine the relationship between occupational exposures and cigarette smoking among operating engineers. A cross-sectional survey was conducted with operating engineers (N = 412) from a midwestern state in the United States. The survey included validated questions on cigarette smoking, occupational exposures, demographics, comorbidities, and health behaviors. About 35% were current smokers. Those exposed to asphalt fumes, heat stress, concrete dust, and welding fumes were less likely to smoke (odds ratio [OR] = .79, 95% confidence interval [CI]: .64-.98). Other factors associated with smoking included younger age (OR = .97, 95% CI: .94-.99), problem drinking (OR = 1.07, 95% CI: 1.03-1.12), lower Body Mass Index (OR = .95, 95% CI: .90-.99), and being separated/widowed/divorced (OR = 2.24, 95% CI: 1.19-4.20). Further investigation is needed for better understanding about job-specific exposure patterns and their impact on cigarette smoking among operating engineers.
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Affiliation(s)
- OiSaeng Hong
- School of Nursing, University of California San Francisco, San Francisco, CA
| | - Sonia A. Duffy
- University of Michigan University of Michigan, Nursing, Otolaryngology, Psychiatry & VA Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | - Seung Hee Choi
- School of Nursing, University of Michigan, Ann Arbor, MI
| | - Dal Lae Chin
- School of Nursing, University of California San Francisco, San Francisco, CA
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7
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Chen T, Kazerooni R, Vannort EM, Nguyen K, Nguyen S, Harris J, Bounthavong M. Comparison of an Intensive Pharmacist-Managed Telephone Clinic With Standard of Care for Tobacco Cessation in a Veteran Population. Health Promot Pract 2013; 15:512-20. [DOI: 10.1177/1524839913509816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose. To evaluate the effectiveness of the Pharmacist-Managed Telephone Tobacco Cessation Clinic (PMTTCC) compared to the standard of care (SOC) at the Veterans Affairs San Diego Healthcare System. Method. A retrospective cohort study was performed investigating the proportion of veterans who quit smoking at 6 months while enrolled in the PMTTCC. Chart review was performed using the Veterans Affairs Computerized Patient Record System. The PMTTCC group included patients who had received medication and counseling from the tobacco cessation pharmacists. The cohort was compared to a matched SOC group who did not receive counseling, only tobacco cessation medication therapy through a primary care provider. The primary outcome for this study was patient-reported tobacco cessation at 6 months. Secondary outcomes were abstinence at 1 and 3 months. Results. A total of 1,006 patients were included in the analysis, 503 patients from the PMTTCC and 503 patients from SOC. The overall study population was 54 years old on average, 92.5% male, 70.0% Caucasian, 45.5% with history of psychiatric conditions, and had an average smoking history of 33-pack years. Patients in the PMTTCC group had statistically significant improvements in abstinence at 6 months versus the SOC group (81/503, 16.1% vs. 48/503, 9.5%; p < .0001). Quitters were older on average versus non-quitters (56.03 vs. 53.65 years; p = .01). Conclusion. Patients enrolled in the PMTTCC had improved tobacco abstinence rates at 6 months compared to SOC. Although the study was not designed to test for causality, the results lend support for using intensive tobacco cessation management in veteran population.
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Affiliation(s)
- Timothy Chen
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
- University of the Pacific, Stockton, CA, USA
| | - Rashid Kazerooni
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
- University of the Pacific, Stockton, CA, USA
| | | | - Khanh Nguyen
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Stacey Nguyen
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jessica Harris
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Mark Bounthavong
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
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8
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Utility of biochemical verification of tobacco cessation in the Department of Veterans Affairs. Addict Behav 2013; 38:1792-5. [PMID: 23261494 DOI: 10.1016/j.addbeh.2012.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/14/2012] [Accepted: 11/12/2012] [Indexed: 11/20/2022]
Abstract
Research on the validity of self-report tobacco use has varied by the population studied and has yet to be examined among smokers serviced by the Department of Veterans Affairs (VA). The purpose of this study was to determine the predictors of returning a biochemical urine test and the specificity and sensitivity of self-reported tobacco use status compared to biochemical verification. This was a sub-analysis of the larger Tobacco Tactics research study, a pre-/post-non-randomized control design study to implement and evaluate a smoking cessation intervention in three large VA hospitals. Inpatient smokers completed baseline demographic, health history and tobacco use measures. Patients were sent a follow-up survey at six-months to assess tobacco use and urine cotinine levels. A total of 645 patients returned six-month surveys of which 578 also returned a urinary cotinine strip at six-months. Multivariate analysis of the predictors of return rate revealed those more likely to return biochemical verification of their smoking status were younger, more likely to be thinking about quitting smoking, have arthritis, and less likely to have heart disease. The sensitivity and specificity of self-report tobacco use were 97% (95% confidence interval=0.95-0.98) and 93% (95% confidence interval=0.84-0.98) respectively. The misclassification rate among self-reported quitters was 21%. The misclassification rate among self-reported tobacco users was 1%. The sensitivity and specificity of self-report tobacco use were high among veteran smokers, yet among self-report quitters that misclassification rate was high at 21% suggesting that validating self-report tobacco measures is warranted in future studies especially in populations that are prone to misclassification.
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9
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Duffy SA, Louzon SA, Gritz ER. Why do cancer patients smoke and what can providers do about it? ACTA ACUST UNITED AC 2012; 9:344-352. [PMID: 23175636 DOI: 10.1016/j.cmonc.2012.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the widespread dissemination of information about the health risks associated with smoking, many cancer patients continue to smoke, which results in a decreased quality of life, an increased probability of cancer recurrence, and a decreased survival time. Efficacious interventions are available to assist cancer patients to quit smoking, yet smoking cessation interventions are often not implemented. This review describes how clinicians, administrators, insurers, and purchasers can encourage a culture of health care in which tobacco cessation interventions are implemented consistent with evidenced-based standards of care. Implementing efficacious tobacco cessation interventions can reduce morbidity and mortality among cancer patients.
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Affiliation(s)
- Sonia A Duffy
- Ann Arbor VA Center for Clinical Management Research, Michigan ; Departments of Otolaryngology, Psychiatry, and School of Nursing, University of Michigan, Ann Arbor
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10
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Karvonen-Gutierrez CA, Ewing LA, Taylor NJ, Essenmacher CA, Duffy SA. Ethnicity predicts perceptions of smoking and smoking cessation among veterans. J Psychiatr Ment Health Nurs 2012; 19:203-10. [PMID: 22074190 DOI: 10.1111/j.1365-2850.2011.01757.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to determine if race/ethnicity predicts motivation to quit smoking and preferences for cessation services among smokers serviced by a primarily psychiatric Veterans Affairs hospital. A self-administered survey was given to a convenience sample of smokers (n=146) at the Battle Creek Veterans Affairs Medical Center. Univariate, bivariate and multivariate regression analyses were calculated to determine the association between race/ethnicity and motivation to quit smoking. Forty-two per cent of the sample was non-white. Non-white patients smoked significantly less cigarettes per day as compared with white patients (P=0.002). In the multivariate analyses, compared with whites, non-whites had 3.5 times greater odds of thinking that quitting smoking was extremely/very important to health (P= 0.01), 4.0 times greater odds of thinking of quitting using tobacco products in the next 30 days (P=0.004) and 3.4 times greater odds of being interested in receiving smoking cessation services (P=0.007). Yet, non-white patients were less likely to be interested in intensive nurse counselling and cessation medications. As the number of non-whites continues to increase in the military, novel strategies may be needed to capitalize on the high motivation to quit smoking and preference for non-traditional interventions among non-white smokers treated in Veterans Affairs hospitals.
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Affiliation(s)
- C A Karvonen-Gutierrez
- Research Health Science, Ann Arbor VA Center for Clinical Management Research, Health Services Research and Development, MI, USA
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11
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Duffy SA, Kilbourne AM, Austin KL, Dalack GW, Woltmann EM, Waxmonsky JA, Noonan D. Risk of smoking and receipt of cessation services among veterans with mental disorders. Psychiatr Serv 2012; 63:325-32. [PMID: 22337005 PMCID: PMC3323716 DOI: 10.1176/appi.ps.201100097] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine rates of smoking and receipt of provider recommendations to quit smoking among patients with mental disorders treated in U.S. Department of Veterans Affairs (VA) treatment settings. METHODS The authors conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients (N=224,193). Logistic regression was used to determine the independent association of mental health diagnosis and the dependent variables of smoking and receipt of provider recommendations to quit smoking. RESULTS Patients with mental disorders had greater odds of smoking, compared with those without mental disorders (p<.05). Those with various mental disorders reported similar rates of receiving services (more than 60% to 80% reported receiving selected services), compared with those without these disorders, except that those with schizophrenia had more than 30% lower odds of receiving advice to quit smoking from their physicians (p<.05). Moreover, those who had co-occurring posttraumatic stress disorder or substance use disorders had significantly greater odds of reporting that they received advice to quit, recommendations for medications, and physician discussions of quitting methods, compared with those without these disorders (p<.05). Older patients, male patients, members of ethnic minority groups, those who were unmarried, those who were disabled or unemployed, and those living in rural areas had lower odds of receiving selected services (p<.05). CONCLUSIONS The majority of patients with mental disorders served by the VA reported receiving cessation services, yet their smoking rates remained high, and selected groups were at risk for receiving fewer cessation services, suggesting the continued need to disseminate cessation services.
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Affiliation(s)
- Sonia A. Duffy
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Amy M. Kilbourne
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Karen L. Austin
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Gregory W. Dalack
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Emily M. Woltmann
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Jeanette A. Waxmonsky
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Devon Noonan
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
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