Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment
Lori A Bastian,1–3 Laura J Fish,4 Jennifer, M Gierisch,3,5 Lesley D Rohrer,3 Karen M Stechuchak,3 Steven C Grambow3,6
1Veterans Affairs Connecticut, West Haven, CT, USA; 2Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA; 3Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Duke Comprehensive Cancer Center, 5Department of Medicine, 6Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
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.
Keywords: smoking cessation, veterans, social support, counseling, proactive, family
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