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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1022 — Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs

Duffy SA (Ann Arbor VA Center for Clinical Management Research and the University of Michigan), Ronis DL (Ann Arbor VA Center for Clinical Management Research), Ewing LA (Ann Arbor VA Center for Clinical Management Research), Karvonen-Gutierrez CA (Ann Arbor VA Center for Clinical Management Research), Dalack GW (Ann Arbor VA Medical Center and the University of Michigan), Hicks TE (Richard Roudebush VA Medical Center), Carmody TP (San Francisco VA Medical Center), Flanagan PS (Ann Arbor VA Medical Center), Smith PM (Northern Ontario School of Medicine), Tobacco Tactics Team

Objectives:
The objective of this Service Directed Project was to evaluate the effectiveness of the efficacious, nurse-administered Tobacco Tactics intervention in the Department of Veterans Affairs (VA).

Methods:
This quasi-experimental design compared quit rates among inpatients in the Ann Arbor and Detroit intervention sites to the Indianapolis control site. At the intervention sites, research nurses taught the Tobacco Tactics intervention to nurses. The provider toolkit included: 1) one contact hour for training; 2) PowerPoint presentation on behavioral and pharmaceutical interventions; 3) pocket card “Helping Smokers Quit: A Guide for Clinicians;” 4) pharmaceutical and behavioral protocols; and 5) computerized template for documentation. The physician toolkit included a physician advice statement and pharmaceutical orders. The patient toolkit included: 1) brochure; 2) “Smoking: Getting Ready to Quit” videotape; 3) Tobacco Tactics manual; 4) pharmaceuticals; 5) 1-800-QUIT-NOW help line card; and 6) follow-up telephone calls conducted by Voluntary Services. Inpatient smokers in all facilities were surveyed at baseline and 6 months after discharge about their smoking habits and were asked to return a urinary cotinine test.

Results:
A total of 1,170 inpatient smokers were recruited into the study. The average age was 55.5 years, most were male (95%), not married (75%) and unemployed (83%). Race/ethnicity differed by site; 63% were non-White in Detroit, whereas only 20% in Ann Arbor and 34% in Indianapolis were non-White (p < 0.0001). After adjustment for site and pre- and post-intervention differences (e.g. age, sex, number of cigarettes smoked per day, admitting diagnosis, and thinking that quitting smoking will make them nervous), there were significant improvements in 6-month quit rates for the pre- versus post-intervention time periods in Ann Arbor (p = 0.04) and Detroit (p = 0.0004) compared to the Indianapolis control site.

Implications:
The implementation of the nurse-administered Tobacco Tactics intervention was effective in the VA.

Impacts:
Further dissemination of the Tobacco Tactics intervention has the potential to significantly decrease smoking and smoking-related morbidity among inpatient veterans. Since nurses constitute the largest number of front-line providers, teaching nurses how to conduct smoking education may be the quickest and most efficient strategy to disseminate smoking cessation interventions in the VA.


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