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

Abstract

BackgroundTobacco 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.MethodsThis 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.ResultsTwelve-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.ConclusionsTelephone-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 registrationClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3493-z) contains supplementary material, which is available to authorized users.

Problem alcohol use among rural head and neck cancer patients at diagnosis: Associations with health‐related quality of life

“…40 Studies have also evaluated the feasibility of concomitantly addressing risky alcohol use and mood management in the context of smoking cessation, including in HNC patients, and have shown promise. 9,41 In this study, tobacco use and depressive symptomatology both were significantly associated with problem alcohol use, suggesting that several patients in this study may have been candidates for such multimodal intervention but requires additional research. Moreover, although only a small number of rural and urban patients reported moderate to severe depressive symptomatology, a considerable number reported mild symptoms, which are not trivial and have been associated with deficits in HNC-specific HRQOL 33 and may also be associated with drinking behavior.…”

“…One study which interviewed rural and urban VA primary care providers on the topic of AUD treatment found that rural providers reported substantial barriers to specialty care referrals for AUD 40 . Studies have also evaluated the feasibility of concomitantly addressing risky alcohol use and mood management in the context of smoking cessation, including in HNC patients, and have shown promise 9,41 . In this study, tobacco use and depressive symptomatology both were significantly associated with problem alcohol use, suggesting that several patients in this study may have been candidates for such multimodal intervention but requires additional research.…”

A Scoping Review of Contemporary Social Work Practice With Veterans

“…Ishani et al (2016) evaluated provision of services by an interdisciplinary team that included social workers, comparing telehealth to treatment as usual. Social workers were involved in a trial of Accelerated Resolution Therapy for treatment of PTSD (Kip et al, 2013), smoking cessation for veterans with PTSD (McFall et al, 2005), smoking cessation for rural veterans (Vander Weg et al, 2016), and means of reducing risky drinking in older adults (Wooten et al, 2017) both as authors and providers of the intervention.…”

Problem alcohol and tobacco use in head and neck cancer patients at diagnosis: associations with health-related quality of life

“…Multimodal interventions for complex behavioral health cases, such as those with concomitant alcohol and smoking issues, may therefore be relevant dependent on the individual patient's needs. Interventions addressing multiple concerns at once have been tested with some success, including those dealing with smoking and drinking and in patients with HNC [21,42]. For example, Duffy and colleagues developed a tailored, multimodal intervention in which patients with HNC were treated for smoking, problem alcohol use, or probable depression, whether alone or in combination as indicated [21].…”