Proactive Tobacco Treatment More Successful than Usual Care among Veterans Attempting to Quit Smoking
Tobacco use remains the number one cause of premature death and morbidity in the United States. Most cigarette smokers want to quit smoking, and about 50% make a quit attempt each year, but only 6% achieve long-term cessation. This randomized controlled trial – the Veterans Victory over Tobacco Study – compared the effects of a proactive tobacco cessation care model versus a traditional cessation care model on the use of tobacco treatment and subsequent population-level smoking cessation rates. Veterans from four VAMCs were recruited from 10/09 to 9/10 and were randomized to either usual care (i.e., reactive care) or the proactive care intervention. Veterans in the usual care group (n=2,604) received access to tobacco treatment services from their VAMC. Veterans in the proactive care intervention group (n=2,519) received proactive outreach (mailed invitation materials followed by telephone outreach); and were offered a choice of smoking cessation services (telephone care or in-person care). The primary outcome was six-month prolonged smoking abstinence one year after randomization. Investigators also analyzed baseline demographics, clinical characteristics (i.e., distance to VAMC, comorbid psychiatric conditions), and smoking history.
- Proactive tobacco cessation care that connected smokers to evidence-based telephone or in-person smoking cessation services is effective for increasing long-term, population-level cessation rates. The six-month prolonged smoking abstinence rate at one year was 14% for Veterans in the proactive care group, a significant increase compared to 11% for Veterans in the usual care group, and much higher than the 6% population-level cessation rate of the total US population.
- The proactive care group reported significantly higher rates of behavioral counseling combined with medication treatment compared to usual care (13% versus 5%). There was also a significant increase in receipt of a smoking cessation medication from VA providers among proactive care compared to usual care (35% versus 30%).
- There were no significant differences in the baseline characteristics for demographics, distance to their VAMC, and comorbid smoking-related conditions between the two groups. Also, about 85% of the usual care group and 83% of the proactive care group were daily smokers.
- The follow-up survey response rate was 66%, and there is the potential for non-response bias.
- It is not possible to determine which specific components of the multi-component intervention were responsible for the effectiveness of the intervention; however, all components are ready to implement in actual clinical practice.
- A 3% increase in the population-level cessation rate is highly significant from a public health perspective because all smokers were included regardless of motivational level to quit smoking.
This study was funded by HSR&D (IAB 05-303). Dr. Fu is Director of HSR&D's Center for Chronic Disease Outcomes Research in Minneapolis, MN.
Fu SS, van Ryn M, Sherman S, et al. Proactive Tobacco Treatment and Population-Level Cessation: A Pragmatic Randomized Controlled Trial. JAMA Internal Medicine March 10, 2014;e-pub ahead of print.