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IIR 05-202 – HSR&D Study

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IIR 05-202
Family-Supported Smoking Cessation for Chronically Ill Veterans
Lori Anne Bastian MD MPH
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: July 2007 - June 2011

BACKGROUND/RATIONALE:
Chronic diseases related to tobacco exposure are common among veterans. Persistent tobacco use after being diagnosed with these diseases decreases quality of life and survival. Yet, 30% of veterans with these conditions continue to smoke. Researchers have found that the social environment is important for smokers. In our recent NCI-funded study, 70% of veterans with lung cancer identified at least one family member who smokes and 45% live with a family member who smokes. A family-supported smoking cessation intervention timed to follow a veteran's diagnosis of chronic disease could be effective for helping veterans quit smoking.

OBJECTIVE(S):
The overarching aim of the study was to evaluate in a randomized trial the impact of delivering a family-supported intervention compared to a standard veteran-focused intervention to promote smoking cessation among patients with chronic illness (cancer, heart disease, diabetes, hypertension, or chronic obstructive pulmonary disease). Accordingly, the specific aims were:
AIM 1: To evaluate the impact of a family-supported intervention on rates of abstinence from cigarettes (self-reported 7-day point prevalent abstinence) at 5-month (2 weeks post-intervention) and 12-month follow-ups.
AIM 2: To evaluate the impact of a family-supported self-help intervention on perceived support for quitting smoking at 5-month (2 weeks post-intervention) and 12-month follow-ups.
AIM 3: To measure the impact of smoking cessation on quality of life in veterans with chronic illness.

METHODS:
A total of 471 veterans who smoke were enrolled into this randomized controlled trial. Of these, 236 were randomized to receive a standard intervention whereas the remaining 235 were randomized to receive a family-supported intervention. Those randomized to the standard intervention received a letter from a VA physician encouraging the patient to quit smoking, a self-help cessation kit, nicotine replacement patches, and 5 telephone counseling sessions. Those randomized to the family-supported intervention received the physician letter, a self-help cessation kit, nicotine replacement patches, a tailored support skills booklet and 5 telephone counseling sessions focused on identifying and enlisting social support. The main distinction between the two arms of this study was that the family support intervention helped veterans identify a support person and explained how to increase positive interactions between the veteran and their designated support person in order to facilitate smoking cessation.

FINDINGS/RESULTS:
This study achieved good smoking cessation rates, but found no significant differences in smoking cessation rates between standard and family-supported interventions. At 5 month follow-up, 21% of participants reported quitting smoking, compared to 22% abstinent at 12 month follow-up. At each follow-up, participants who did not complete the survey were considered to be smokers. While there were no significant differences between study arms, these overall cessation rates are higher than those achieved without intervention in the general population.

At both 5 and 12 month interviews, there were no significant differences between study arms regarding perceived support ( = 0.05).

In general, quality of life did not vary significantly among study arms at the 5 or 12 month follow-up. The only exception is that at 5 month, those in the standard arm reported a higher self-rated physical health than those in the family-supported intervention ( = 0.05).

IMPACT:
Veterans with chronic disease who continue to smoke exact a significant burden on the VA health care system. This study showed that proactive telephone counseling for chronically ill veterans is feasible and produces clinically important smoking cessation rates. However, telephone counseling augmented with a family-supported intervention was no more effective than standard telephone counseling. Standard telephone counseling for chronically ill veterans should be implemented into VA practice.

PUBLICATIONS:

Journal Articles

  1. Bastian LA, Fish LJ, Gierisch JM, Rohrer LD, Stechuchak KM, Grambow SC. Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment. Comparative Effectiveness Research. 2012 Jan 1; 2012(2):45-56.
  2. Fish LJ, Gierisch JM, Stechuchak KM, Grambow SC, Rohrer LD, Bastian LA. Correlates of expected positive and negative support for smoking cessation among a sample of chronically ill veterans. Addictive Behaviors. 2012 Jan 1; 37(1):135-8.
  3. Rohrer LD, Gierisch JM, Fish LJ, Blakeney JK, Bastian LA. A five-step guide for moving from observational studies to interventional research for women veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2011 Jul 1; 21(4 Suppl):S98-102.
Journal Other

  1. Bastian LA, Sherman SE. Effects of the wars on smoking among veterans. [Editorial]. Journal of general internal medicine. 2010 Feb 1; 25(2):102-3.
  2. Bastian LA. If it is as simple as AAAAA B C, why don't we do it? Journal of general internal medicine. 2009 Feb 1; 24(2):284-5.
VA Cyberseminars

  1. Gierisch JM, Bastian L, Williams JW. Comparative Effectiveness of Smoking Cessation Treatments for Patients with Depression: A Systematic Review and Meta-Analysis of the Evidence. [Cyberseminar]. 2011 Feb 28.
Conference Presentations

  1. Gierisch JM, Bastian L, Calhoun PS, McDuffie J, Williams JW. A Systematic Review and Meta-Analysis of Smoking Cessation Interventions for Patients With Depression. Paper presented at: National Research Service Award Trainees Research Annual Conference; 2011 Jun 14; Seattle, WA.
  2. Bastian L, Fish LJ, Gierisch JM, Rohrer L, Stechuchak KM, Grambow SC. Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans. Paper presented at: Society of General Internal Medicine Annual Meeting; 2011 May 6; Phoenix, AZ.
  3. Bastian L, Fish LJ, Gierisch JM, Rohrer L, Stechuchak KM, Grambow SC. Gender Differences in Predictors of Smoking Cessation in Veterans with Chronic Disease. Paper presented at: VA Women's Health Research Conference; 2010 Jul 16; Washington, DC.
  4. Rohrer L, Stechuchak KM, Almirall D, Bastian L. Proactive Enrollment of Chronically Ill Veterans into a Telephone-based Smoking Cessation Trial. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.


DRA: Aging, Older Veterans' Health and Care, Health Systems, Substance Abuse and Addiction
DRE: Prevention, Treatment - Observational
Keywords: Behavior (patient), Chronic disease (other & unspecified), Smoking
MeSH Terms: none

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