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Smoking Cessation Care Received by Veterans with Chronic Obstructive Pulmonary Disease (COPD)
Sherman SE, Lanto AB, Nield M, Yano EM. Smoking Cessation Care Received by Veterans with Chronic Obstructive Pulmonary Disease (COPD). Paper presented at: Society of General Internal Medicine Annual Meeting; 2003 May 2; Vancouver, Canada.
Background Smoking is the main cause of COPD, and smoking cessation is the only effective intervention to slow its progression. We compared the cessation services received by smokers with COPD (COPD smokers) and smokers without COPD (non-COPD smokers) to determine whether COPD smokers received more intensive treatment. Methods As part of a system-level guideline implementation study, we used computer-assisted telephone interviewing to screen and enroll random samples of smokers within 18 VA primary care clinics. Current smokers completed baseline and 12-month follow-up surveys (baseline n = 1,941; 12-months n = 1,080), composed of previously validated questions on smoking habits, history, and attitudes; health and functional status; and sociodemographics. Smokers reporting either emphysema or chronic bronchitis were classified as having COPD at baseline. We used multiple imputation using hot-deck techniques for missing values. We applied enrollment and attrition weights to all observations. We used X² for discrete variables and ANOVA for continuous variables among COPD vs. non-COPD smokers and then controlled for confounding factors such as age and smoking history in multivariate regression. Results COPD smokers (n = 522, 27%) were older, more sedentary, more addicted to nicotine, and had worse physical and mental functioning (all p < 0.001) compared to non-COPD smokers. COPD smokers were also more likely to report that smoking is harming their health (91% vs. 84%, p < 0.001) and to report current problems caused by smoking (86% vs. 68%, p < 0.001). COPD smokers also were more likely to report that within the last year that they had been advised to quit (74% vs. 64%, OR 1.6, 95% CI 1.3-2.0), prescribed nicotine patches (32% vs. 22%, OR 1.7, 95% CI 1.4-2.1), or referred to a smoking cessation program (36% vs. 26%, OR 1.6, 95% CI 1.3-1.9). Receipt of these 3 smoking cessation services at 12-months follow-up was nearly identical to baseline levels. However, the rate of quitting smoking was the same for COPD smokers and non-COPD smokers (9.2% vs. 9.0%). Most of the difference in smoking cessation services received by COPD smokers was for those in the precontemplation stage at baseline. Logistic regression showed that presence of COPD and level of nicotine addiction were independently associated with higher levels of each of these cessation services. Conclusion COPD smokers consistently received more smoking cessation services than non-COPD smokers, yet the quit rate was no higher. This suggests that new approaches may be required, perhaps because the preponderance of extra services received by COPD smokers were for those who were not interested in quitting.