Proactive tobacco treatment for veterans with posttraumatic stress disorder.

Hammett, Patrick J.; Japuntich, Sandra J.; Sherman, Scott E.; Rogers, Erin; Danan, Elizabeth R; Noorbaloochi, Siamak; El-Shahawy, Omar; Burgess, Diana J.; Fu, Steven S.

doi:10.1037/tra0000613

Cited by 5 publications

(2 citation statements)

References 45 publications

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“…However, our first and second year quit rates (19.4% and 16.6%) were similar to 12-month quit rates from a prior study examining targeted smoking cessation outreach to veterans with PTSD. 40 We recognize that a single occurrence of a health factor indicating former or non-smoking does not capture the cyclical nature of quit attempts (ie, multiple successes and failures). Misclassification of smoking cessation should be random with respect to whether a patient improved versus didn't improve PTSD symptoms; thus, the HRs are likely not biased.…”

Section: Limitationsmentioning

confidence: 99%

Increased Smoking Cessation Among Veterans With Large Decreases in Posttraumatic Stress Disorder Severity

Salas

Gebauer

Gillis

et al. 2021

Nicotine &Amp; Tobacco Research

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Background Improvement in posttraumatic stress disorder (PTSD) is associated with better health behavior such as better medication adherence and greater use of nutrition and weight loss programs. However, it is not known if reducing PTSD severity is associated with smoking cessation, a poor health behavior common in patients with PTSD. Methods Veterans Health Affairs (VHA) medical record data (2008 to 2015) were used to identify patients with PTSD diagnosed in specialty care. Clinically meaningful PTSD improvement, was defined as ≥20 point PTSD Checklist (PCL) decrease from the first PCL ≥ 50 and the last available PCL within 12 months and at least 8 weeks later. The association between clinically meaningful PTSD improvement and smoking cessation within 2-years after baseline among 449 smokers was estimated in Cox proportional hazard models. Entropy balancing controlled for confounding. Results On average, patients were 39.4 (SD=12.9) years of age, 86.6% were male and 71.5% were white. We observed clinically meaningful PTSD improvement in 19.8% of participants. Overall, 19.4% quit smoking in year 1 and 16.6% in year 2. More patients with vs. without clinically meaningful PTSD improvement stopped smoking (n=36, cumulative incidence=40.5% vs. 111, cumulative incidence=30.8%; respectively). After controlling for confounding, patients with vs. without clinically meaningful PTSD improvement were more likely to stop smoking within 2-years (HR=1.57; 95%CI:1.04-2.36). Conclusions Patients with clinically meaningful PTSD improvement were significantly more likely to stop smoking. Further research should determine if targeted interventions are needed or whether improvement in PTSD symptoms is sufficient to enable smoking cessation. Implications Patients with PTSD are more likely to develop chronic health conditions such as heart disease and diabetes. Poor health behaviors, including smoking, partly explain the risk for chronic disease in this patient population. Our results demonstrate that clinically meaningful PTSD improvement is followed by greater likelihood of smoking cessation. Thus, PTSD treatment may enable healthier behaviors and reduce risk for smoking related disease.

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Section: Limitationsmentioning

confidence: 99%

Increased Smoking Cessation Among Veterans With Large Decreases in Posttraumatic Stress Disorder Severity

Salas

Gebauer

Gillis

et al. 2021

Nicotine &Amp; Tobacco Research

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“…[14][15][16][17] Proactive approaches to recruitment and telephone counseling in particular are effective in people who smoke with post-traumatic stress disorder (PTSD) and those with SMI. [18][19][20][21] However, the question remains whether the characteristics of the telephone treatment received may impact abstinence outcomes differently depending on the extent of a person's reported mental well-being and functioning. Are all forms of telephone counseling equally effective for all mental health patients?…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of a Telephone Smoking Cessation Program in Mental Health Clinic Patients by Level of Mental Well-Being and Functioning: A Secondary Data Analysis of a Randomized Clinical Trial

Swong,

Nicholson,

Smelson

et al. 2023

Preprint

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Background Few studies have examined the effectiveness of telephone smoking cessation interventions by severity of behavioral health symptoms. Using data from a telephone counseling study, we examined whether abstinence rates varied by level of behavioral health symptoms. Methods The parent study recruited adults who smoke cigarettes (N = 577) referred by mental health providers at six Veterans Health Administration facilities. Participants were randomized to specialized telephone counseling (intervention) or state Quitline referral (control). Participants completed assessments at baseline and 6 months, including the BASIS-24, a self-report measure of behavioral health symptoms and functioning. We used the BASIS-24 median to dichotomize participants as having high or low scores. The primary outcome was 30-day self-reported abstinence at 6 months. We compared groups on outcomes by logistic regression and performed an interaction effect analysis between treatment assignment and groups. Results At baseline, those with high behavioral health symptoms scores reported heavier nicotine dependence and more sedative and/or antidepressant use. At 6 months, participants with low behavioral health symptoms scores in the intervention reported higher rates of 30-day abstinence compared to those in the control arm (26% vs 13%, OR = 2.3, 95% CI = 1.8, 2.9). People with high behavioral health symptoms scores reported no difference in 30-day abstinence between the treatment assignments at 6 months (12% vs. 13%, OR = 1.1, 95% CI = 0.6, 2.0). Conclusions Only participants with low behavioral health symptoms scores reported higher abstinence rates in the intervention compared to the state Quitline. Future research can examine alternative approaches for people with worse mental well-being and functioning. Trial registration The parent study is registered at www.clinicaltrials.govNCT00724308.

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