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RRP 07-307 – HSR&D Study

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RRP 07-307
Facility Level Smoking Cessation Intervention in VISN 11
Sonia A. Duffy PhD MS RN
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: October 2007 - March 2008

BACKGROUND/RATIONALE:
Our currently funded Service Directed Project (SDP) "Inpatient Smoking Cessation: Bringing the Program to the Smoker" is a nurse administered cessation intervention designed for general hospital inpatients, but did not include psychiatric, substance abuse, or outpatient clinics all of whom have asked to be included in this study. As we started to implement the intervention, staff from these units also requested participation in this study. In addition, the Battle Creek VA, which services primarily psychiatric and substance abuse patients who are at high risk for smoking, also expressed interest in participating.

OBJECTIVE(S):
The first objective of this study was to work with providers in our existing study sites to identify how to modify the intervention to meet the needs of mental health, substance abuse, and outpatient clinics. Recognizing the unique needs of Battle Creek's primarily psychiatric population, before exporting the intervention, our second objective was to do a needs assessment and ask staff and patients what they think would work best for them and their facility.

METHODS:
The funded SDP is a pre- post- non-randomized control design. Ann Arbor and Detroit are the intervention sites and Indianapolis is the control site. The evidence-based intervention is packaged into a toolkit for nurses and patients. At the two intervention sites, research nurses teach the intervention to staff using the Tobacco Tactics toolkit.

As a result of this RRP, psychiatric patients and outpatients that smoke were also included in the study in all three study sites. The tobacco cessation training was opened up to any staff that wanted to participate. In addition, data was collected at the Battle Creek VA by conducting anonymous surveys and interviews with hospital staff and patient smokers about how to best implement a tobacco cessation intervention in this primarily psychiatric hospital.

FINDINGS/RESULTS:
In Ann Arbor and Detroit, 204 additional, non-targeted providers participated in the tobacco cessation training including mostly outpatient nurses, but also physicians, respiratory therapists, social workers, and nurse technicians. In Ann Arbor, to date, 48 outpatient subjects (general and psychiatric/substance abuse) and 87 inpatient psychiatric subjects have agreed to participate in the study. In Detroit, 42 inpatient psychiatric patients have been recruited. In Indianapolis, 156 inpatient psychiatric patients have agreed to participate. Preliminary data show that the intervention is actually working better for psychiatric patients than patients housed in general medicine units, although the numbers are small; 0% (n=3) pre-intervention quit at 6 months compared to 12% (n=10) post intervention.

In the primarily psychiatric Battle Creek hospital, patients were surveyed (N=146) and interviewed (N=9). Compared to those without psychiatric disorders, those with psychiatric disorders had a three times higher odds of feeling quitting tobacco was important to their health (p<.05) and a nearly four times higher odds of seriously thinking of quitting in the next 30 days (p<.05). After controlling for age, employment status, and comorbidities, non-Whites were two-and-a-half times more likely to be thinking of quitting in the next 30 days (OR=2.591, p<0.05) and nearly 3 times more likely to be interested in cessation services (OR=2.868, p<0.01) compared to Whites. Patients with a history of high blood pressure, arthritis, lung disease, and stroke were more motivated to quit smoking than those without these disorders.

In addition, Battle Creek staff were surveyed (N=150) and interviewed (N=8) about their demographics, smoking histories, and attitudes about the delivery of cessation services. Almost three-quarters of staff said that they felt that the VA should be doing more to assist patients to quit using tobacco. About one-quarter said that they personally provide cessation services. Over half felt moderately, very, or extremely confident in providing cessation services. Multivariate analyses showed that higher education and, surprisingly, not being a nurse was associated with feeling it was important to provide cessation services. Moreover, ever smokers were less confident than never smokers in their ability to provide smoking services.

IMPACT:
This cessation intervention can be implemented with psychiatric patients and has the potential to be exported to VA psychiatric facilities such as the Battle Creek VA where providers are interested in the provision of cessation. The nurse-delivered smoking cessation intervention has the potential to reduce cardiovascular disease, cancer, and ultimately morbidity and mortality rates in the VA.


PUBLICATIONS:

Journal Articles

  1. Duffy SA, Cohen KA, Choi SH, McCullagh MC, Noonan D. Predictors of obesity in Michigan Operating Engineers. Journal of community health. 2012 Jun 1; 37(3):619-25.
  2. Ewing LA, Karvonen-Gutierrez CA, Noonan D, Duffy SA. Development of the Tobacco Tactics logo: From thumb prints to press. Tobacco induced diseases. 2012 Apr 19; 10(1):6.
  3. Essenmacher C, Karvonen-Gutierrez C, Lynch-Sauer J, Duffy SA. Staff's attitudes toward the delivery of tobacco cessation services in a primarily psychiatric Veterans Affairs hospital. Archives of psychiatric nursing. 2009 Jun 1; 23(3):231-42.
Conference Presentations

  1. Duffy SA. Psychiatric Disorders, but not Substance Abuse Disorders, Predict Motivation for Tobacco Cessation. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 28; Dublin, Ireland.
  2. Duffy SA. Ethnicity Predicts Perceptions of Smoking and Cessation among Veterans. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland.
  3. Duffy SA. Medical Comorbidities Increase Motivation to Quit Smoking. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland.
  4. Duffy SA. Staff attitudes toward the Delivery of Tobacco Cessation for Services in a Psychiatric Veterans Affairs Hospital. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland.


DRA: Substance Abuse and Addiction
DRE: Prevention
Keywords: Smoking
MeSH Terms: none

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