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35. Veterans who smoke: Do they want to quit and are we helping them?

SE Sherman, VA Center for the Study of Healthcare Provider Behavior, Sepulveda, CA; EM Yano, VA Center for the Study of Healthcare Provider Behavior, Sepulveda, CA; AB Lanto, VA Center for the Study of Healthcare Provider Behavior, Sepulveda, CA; B Simon, VA Center for the Study of Healthcare Provider Behavior, Sepulveda, CA; LV Rubenstein, VA Center for the Study of Healthcare Provider Behavior, Sepulveda, CA

Objectives: There is a pervasive belief that veterans who smoke have been doing so for decades and have little interest in quitting. The extent to which veterans who smoke are interested in quitting has major implications for how to counsel individuals, for what type of programs to offer, and for how likely the VA is to reach its target for lowering smoking prevalence. We examined whether smokers using the VA are interested in quitting. We also examined whether they report receiving smoking cessation counseling and assistance.

Methods: We contacted VA patients from 18 VHA facilities as part of the baseline data collection phase of a multi-site VA smoking cessation quality improvement study in the Southwestern U.S. Patients were randomly selected from lists of all VA patients with at least 3 primary care visits over the previous 18 months. Survey questions were adapted from the California Tobacco Survey, the Medical Outcomes Study and other previously validated sources.

Results: Of the 7706 patients contacted, 1457 (19%) were current smokers, 4420 (57%) were former smokers, and 1829 (24%) had never smoked. Of patients reporting any smoking within the last 12 months, 155 (10%) never expect to quit ("hard core"), 512 (34%) report no intent to quit in the next 6 months ("precontemplation"), 418 (28%) expect to quit in the next 6 months ("contemplation"), and 167 (11%) plan to quit in the next month ("preparation"). 174 (12%) patients reported quitting smoking in the last 6 months ("action") and 80 (5%) had quit 6-12 months ago ("maintenance"). Approximately 85% felt the smoking was harming their health and a comparable number felt addicted to nicotine.

Forty-five percent (657/1457) of the current smokers reported a quit attempt within the last year (hard core 28%, precontemplation 36%, contemplation 59%, preparation 59%). Two-thirds of patients reported that a VA provider had talked with them about cessation within the last year (hard core 61%, precontemplation 62%, contemplation 68%, preparation 69%). Thirty percent of smokers reported that their VA provider referred them to a smoking cessation program within the last year, but only 13% reported actually attending the smoking cessation program. Among those referred to a smoking cessation program, the breakdown by readiness to change was: hard core 21%, precontemplation 25%, contemplation 35%, preparation 44%.

Conclusions: We found approximately half our patients who smoke are interested in quitting in the near future. Nearly half reported at least one quit attempt in the past year. The vast majority felt that smoking was harming their health and that they were addicted to nicotine. VA providers are doing a reasonably good job at advising smokers to quit and assisting them in doing so. Two-thirds of smokers report that a VA provider talked with them about smoking cessation. However, few were referred to a smoking cessation program and even fewer attended.

Impact: These data suggest we are missing many opportunities to counsel and refer smokers interested in quitting. We also clearly need to develop better programs to help more smokers be interested in quitting.