Abstract
BackgroundTobacco use remains prevalent among Veterans of military service and those residing in rural areas. Smokers frequently experience tobacco-related issues including risky alcohol use, post-cessation weight gain, and depressive symptoms that may adversely impact their likelihood of quitting and maintaining abstinence. Telephone-based interventions that simultaneously address these issues may help to increase treatment access and improve outcomes.MethodsThis study was a two-group randomized controlled pilot trial. Participants were randomly assigned to an individually-tailored telephone tobacco intervention combining counseling for tobacco use and related issues including depressive symptoms, risky alcohol use, and weight concerns or to treatment provided through their state tobacco quitline. Selection of pharmacotherapy was based on medical history and a shared decision interview in both groups. Participants included 63 rural Veteran smokers (mean age = 56.8 years; 87 % male; mean number of cigarettes/day = 24.7). The primary outcome was self-reported 7-day point prevalence abstinence at 12 weeks and 6 months.ResultsTwelve-week quit rates based on an intention-to-treat analysis did not differ significantly by group (Tailored = 39 %; Quitline Referral = 25 %; odds ratio [OR]; 95 % confidence interval [CI] = 1.90; 0.56, 5.57). Six-month quit rates for the Tailored and Quitline Referral conditions were 29 and 28 %, respectively (OR; 95 % CI = 1.05; 0.35, 3.12). Satisfaction with the Tailored tobacco intervention was high.ConclusionsTelephone-based treatment that concomitantly addresses other health-related factors that may adversely affect quitting appears to be a promising strategy. Larger studies are needed to determine whether this approach improves cessation outcomes.Trial registrationClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3493-z) contains supplementary material, which is available to authorized users.
Highlights
Tobacco use remains prevalent among Veterans of military service and those residing in rural areas
Background the prevalence of cigarette smoking among adults in the United States (US) continues to decline, rates remain elevated in certain groups including military Veterans [1] and those living in rural areas [2]
Considering that approximately 5.3 million Veterans, representing 24 % of all Veterans living in the US, reside in rural areas [8], this represents a substantial group of individuals who are at increased risk for smoking-related health problems
Summary
Tobacco use remains prevalent among Veterans of military service and those residing in rural areas. The prevalence of cigarette smoking among adults in the United States (US) continues to decline, rates remain elevated in certain groups including military Veterans [1] and those living in rural areas [2]. Considering that approximately 5.3 million Veterans, representing 24 % of all Veterans living in the US, reside in rural areas [8], this represents a substantial group of individuals who are at increased risk for smoking-related health problems. Proactive telephone counseling is efficacious [9] and cost-effective [10] These services are underutilized, with only 1–5 % of eligible smokers receiving this form of treatment [11]. Many referred patients cannot be reached or are reluctant to enroll in quitline counseling [12], suggesting that additional efforts are needed to connect smokers with treatment resources
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