Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment

Abstract

Objectives:Smoking cessation among patients with chronic medical illnesses substantially decreases morbidity and mortality. Chronically ill veteran smokers may benefit from interventions that assist them in harnessing social support from family and friends. Methods: We proactively recruited veteran smokers who had cancer, cardiovascular disease, or other chronic illnesses (diabetes, chronic obstructive pulmonary disease, hypertension) and randomized them to either standard telephone counseling or family-supported telephone counseling focused on increasing support for smoking cessation from family and friends. Participants each received a letter from a Veterans Affairs physician encouraging them to quit smoking, a self-help cessation kit, five telephone counseling sessions, and nicotine replacement therapy, if not contraindicated. The main outcome was 7-day point prevalent abstinence at 5 months. Results: We enrolled 471 participants with mean age of 59.2 (standard deviation [SD] = 7.9) years. 53.0% were white, 8.5% were female, and 55.4% were married/living as married. Overall, 42.9% had cardiovascular disease, 34.2% had cancer, and 22.9% had other chronic illnesses. At baseline, participants were moderately dependent on cigarettes as measured by the Heaviness of Smoking Index (mean = 2.8, SD = 1.6), expressed significant depressive symptoms as measured by the Center for Epidemiological Studies Depression scale (54.8% . 10), and reported high self-efficacy for quitting (mean = 5.7; SD = 1.5). At 5-months follow-up, we found no differences in smoking cessation by arm: 19.8% in the family-supported intervention and 22.0% in the standard arm. The following factors were associated with smoking cessation at 5 months: having cardiovascular disease or other diagnosis compared to cancer, lower nicotine dependence, older age, and higher self-efficacy. Conclusions: This comparative effectiveness trial among chronically ill veterans did not find differences in smoking cessation by type of intervention. Future studies should expand upon our findings and consider tailoring proactive telephone-based interventions based on age and type of disease.

Comparative Effectiveness of an Internet-Based Smoking Cessation Intervention Versus Clinic-Based Specialty Care for Veterans

“…While the evidence for the efficacy of NRT in clinical trials is convincing (Stead et al, 2012), there is growing controversy and concern over the effectiveness of NRT in real world settings. Several recent studies have shown little to no benefit for NRT in the context of effectiveness trials or real world settings (Alpert et al, 2012; Bastian et al,2012; Kotz et al, 2013; Kotz et al, 2014). A recent large, population-based effectiveness study (Cunningham et al, 2016) that examined the effectiveness of simply mailing NRT to smokers found that NRT was associated with significantly higher cessation rates; 7.4% of smokers mailed NRT (without behavioral support) reported abstinence compared to 3% in a control group that received no NRT (bio-verified results suggest 2.8% of smokers in the NRT intervention were abstinent vs. 1% in the control group).…”

“…Interested participants received a tailored dose of NRT and delivery type based on number of cigarettes smoked per day using an established protocol (e.g., Bastian et al, 2012). This could include an 8-week course of nicotine patches and up to two rescue methods (e.g., nicotine lozenge, gum).…”

Impact of Smoking Cessation on Subsequent Pain Intensity Among Chronically Ill Veterans Enrolled in a Smoking Cessation Trial

“…All participants received up to five telephone counseling sessions over a four-month intervention period. 22 Each counseling session included standard content related to smoking cessation (e.g., getting ready for your quit date, how to handle slips) tailored to each participant's needs. The main distinction between the two arms of this comparative effectiveness study was that the family supported intervention was designed to increase positive interactions between the participant and their designated support person to facilitate smoking cessation.…”

“…At five-month follow-up, we found no differences in seven-day point prevalence smoking cessation by arm: 19.8% in the family supported intervention and 22.0% in the standard arm. 22…”

“…Data for these secondary analyses come from a smoking cessation comparative effectiveness trial of a family supported telephone counseling intervention vs. standard telephone counseling for chronically ill veterans (n ¼ 471), the methods of which are described in detail elsewhere. 22 We conducted recruitment from February 2008 to February 2010. To be eligible for this study, patients had to meet all the following criteria: enrolled in the Durham Veteran Affairs Medical Center (VAMC) for ongoing care, receiving treatment for chronic illnesses (i.e., cancer, cardiovascular disease, HTN, diabetes, COPD), currently smoking and planning to quit smoking in the next 30 days, and able to identify a support person.…”