Smoking remains a leading cause of morbidity and mortality, especially among those treated by the Department of Veterans Affairs (VA). While smoking rates among veterans have decreased to 22.2% in recent years, smoking remains a problem in the VA, particularly in Veterans Integrated Service Network (VISN) 11 where 28.2% are current smokers. While efficacious cessation interventions are available, implementation of cessation interventions remains a challenge and new intervention strategies are needed to reach veterans. VA cessation providers met in Atlanta in December 2007 and one recommendation was to develop a cessation website for veterans.
The objective of this proposal was to develop an evidence-based Tobacco Tactics website tailored to veterans based on an intervention tested in the VA. Once developed, the website was pilot tested with 9 veteran smokers.
This was a Phase 1 behavioral clinical trial designed to develop and pilot test a web-based Tobacco Tactics intervention tailored to veteran smokers. First, we outlined the specific content areas to be addressed. Second, we developed the Tobacco Tactics intervention with our web designer. Third, a member of the research team went through the website with 5 veteran smokers obtaining feedback and noting any problems that occurred. Fourth, with human studies approval, we pilot tested the impact of the intervention with 9 veteran smokers recruited to quit smoking using the Tobacco Tactics website. A member of the research team: 1) was available by phone to answer any questions; 2) collected qualitative data on veterans' use of the Tobacco Tactics website; and 3) noted the 30-day quit rate.
Formative evaluation during pre-testing included qualitative feedback on the: 1) ability to accomplish tasks; 2) ability to accomplish goals with skill and speed; 3) ability to operate the system; and 4) satisfaction. For the 9 veteran smokers that actually tried to use the Tobacco Tactics website to quit smoking, we were able to determine: 1) the number of times they signed onto the website; 2) the time spent on the website; and 3) the number of times each module was accessed. Impact evaluation was the 30-day quit rates of the 9 veteran smokers that agreed to use the website.
Based on our pre-testing with 5 veteran smokers, over 27 modifications were made to the website including, but not limited to: 1) making the play button for the video more visible; 2) changing the font color of selected headings from blue so as not to confuse them with a URL link; and 3) changing the wording to be more veteran-centric (e.g. "Smoking causes more deaths than all Americans killed in World War I, World War II, and the Korean and Vietnam wars combined").
To pilot test the Tobacco Tactics website, 13 veterans were approached to recruit 9 that had computer access; 6 of the 9 (66%) veterans accessed the website. All 6 needed prompting to enter the website by a follow-up telephone call. At 30 day follow-up, none of the 6 had quit, however 1 had made a quit attempt. Three of the 6 had cut down on the number of cigarettes, averaging a reduction of 7 cigarettes per day. These results were particularly promising considering that, for this pilot study, none of the veterans were actively seeking cessation services and none received cessation medications. Moreover, 5 respondents rated specific aspects of the website and of these, most found the website easy to read (n=5), enjoyable, (n=4), and easy to navigate (n=4). All 5 rated the website highly on pictures, illustrations, and colors and indicated that they would recommend the website to someone else.
The Tobacco Tactics website tailored to veterans has the capacity to tremendously expand the reach of VA smoking cessation programs, engage more internet savvy Operation Enduring Freedom/Operation Iraqi Freedom veterans and veterans living in remote areas, decrease morbidity and mortality among veterans, and decrease costs associated with delivering cessation services in the VA.
- Duffy SA, Fowler KE, Flanagan PS, Ronis DL, Ewing LA, Waltje AH. The development of the tobacco tactics website. JMIR research protocols. 2013 Jun 28; 2(2):e22.
- Duffy SA. Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; Washington, DC.