Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website
HSRD Conference Logo



2019 HSR&D/QUERI National Conference Abstract

Printable View

4044 — Impact of Adjunctive Mood Management on Telephone-Based Smoking Cessation Among Veterans with Depression: Results of a Comparative Effectiveness Trial

Lead/Presenter: Jennifer Gierisch,  COIN - Durham
All Authors: Gierisch JM (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC), Fish LJ (Duke University School of Medicine), Calhoun PS (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC) Williams JW Jr.(Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC) Bosworth HB (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC) Olsen, MK(Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC) Jeffreys AS (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC) Berkowitz TSZ (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC) Chapman JG (Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham,NC) Bastian, LA ( Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT

Objectives:
Cigarette smoking is the single greatest cause of preventable deaths in the US. Depression can derail smoking cessation efforts. Smokers with depression may respond better to smoking cessation interventions augmented with mood management counseling than to standard content delivered in cessation counseling. Standard telephone counseling interventions (e.g., quit lines) have high reach but often lack the potency needed to help smokers with depression quit. We conducted Quit Smoking Telehealth (QST), a 2-group, parallel, randomized comparative effectiveness trial, to evaluate 10 sessions of co-delivered behavioral mood management and proactive telephone-delivered smoking cessation counseling compared to contact-equivalent smoking cessation counseling control among smokers with depression.

Methods:
We recruited 350 Veterans with depression and smoking-related chronic medical illnesses from the Durham VA Health Care System who were willing to give quitting a try within 30 days. We randomly assigned 175 to smoking cessation plus adjunctive behavioral mood management (SMK-MM group) and 175 to a contact-equivalent smoking cessation telephone counseling control (SMK-CONTROL). Both groups were offered nicotine replacement therapy telepharmacy. The primary outcome was prolonged abstinence measured at 6 months. Prolonged abstinence is defined as not smoking since a quit date, allowing for a grace period around quit date. Secondary outcomes included change in depressive symptoms as measured by the PHQ-9 (Range 0-27).

Results:
Among 350 randomized participants (mean age, 62 years; 53% Black, 89% male), participation in counseling was high (mean sessions, 5; 47% completed 6 or more sessions). While both groups improved on primary and secondary outcomes, there were no differences in prolonged abstinence (23% SMK-CONTROL; 21% SMK-MM) or change in depression symptom severity at 6 months (3.7 decrease SMK-CONTROL; 4.6 decrease SM-MM).

Implications:
Telephone counseling for Veterans with depression is feasible and produces clinically important smoking cessation rates and decreases in depression severity. However, intensive telephone counseling augmented with a behavioral mood management was no more effective than intensive telephone counseling alone.

Impacts:
Smoking and depressive disorders are highly prevalent in Veterans and frequently co-occur. Intensive telephone counseling for smoking cessation for Veterans with depression is both feasible and effective and can be implemented into VA practice.