Tailored Tobacco Quitline for Rural Veterans

Iowa City Veterans Affairs Medical Center63 enrolled

Overview

The proposed work is designed to help increase access to tobacco cessation services among rural veterans and to develop more effective treatment services that better address comorbid issues commonly experienced by rural smokers. The objectives are: 1. Study the feasibility of an individually-tailored telephone intervention for rural smokers. 2. Examine the impact of the intervention on tobacco use outcomes. 3. Evaluate the effect of the intervention on issues commonly experienced by rural smokers including depressive symptoms, alcohol use, and weight gain.

Tobacco use remains the leading preventable cause of morbidity and mortality in our society. Results from epidemiologic studies indicate that tobacco use is especially elevated among those living in rural areas. Although interventions exist that are both effective and cost-effective, few rural smokers utilize them during any given quit attempt. A lack of local treatment resources, the travel distance required to obtain treatment, and a reduced tendency to visit primary care on a regular basis all appear to contribute to the lower levels of treatment for nicotine dependence in rural smokers. Smokers frequently experience conditions and concerns that adversely impact their ability to quit smoking. Depression and risky alcohol use, both of which are prevalent among smokers, reduce the likelihood of successfully quitting smoking. Concern about gaining weight, a common consequence of quitting smoking, is also frequently cited by smokers as an important barrier to quitting. Therefore, in order to be most effective, tobacco cessation interventions will need to address these important issues. Presently, treatment for nicotine dependence, risky alcohol use, depression, and weight management is typically delivered separately and without optimal integration among providers, an approach which only serves to fragment care and increase the number of required visits, further reduce rural smokers' access to care. In an effort to address these barriers, the current study will evaluate a telephone intervention for tobacco use that also addresses issues related to risky alcohol use, depressed mood, and postcessation weight gain based on each individual smoker's needs. Results will provide valuable information regarding the potential to more widely implement an individually-tailored telephone intervention for rural smokers.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Conditions

Cigarette Smoking

Interventions

Nicotine replacement therapy - transdermal nicotine patchDRUG

Medication selection will be determined based on individual participant preferences, medical history, and contraindications.

Tailored behavioral interventionBEHAVIORAL

Participants will receive a standard six session cognitive behavioral intervention for smoking cessation combined with supplemental treatment modules based on individual need and preference.

Tobacco quit line referralBEHAVIORAL

Participants assigned to this condition will receive a referral to their state tobacco quit line. The specific behavioral treatment that is provided will differ slightly depending upon the services available through the participant's state of residence.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 99 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Being a veteran * 18 + years of age * Smoke cigarettes on at least a daily basis * Receive primary care from the Iowa City VAMC or Coralville Clinic * Live in a non-metropolitan area (based on RUCA codes) * Be willing to make a quit attempt in the next 30 days * Be capable of providing informed consent * Have access to a telephone (land line or cell phone) * Have a stable residence Exclusion Criteria: * Planning to move within the next 12 months * Presence of a terminal illness * Pregnancy * Unstable psychiatric disorder (e.g., acute psychosis) * Currently pregnant * Incarcerated * Institutionalized

Locations (1)

Iowa City VA Health Care System

Iowa City, Iowa, United States

Outcomes

Primary Outcomes

Treatment Satisfaction

Participants' impressions of and satisfaction with the intervention will be assessed by interview at the end of treatment.

Time frame: End of treatment (seven weeks after baseline)

Secondary Outcomes

Number of Participants Abstinent From Tobacco Use

At the six-month follow-up contact, participants will be questioned regarding self-reported tobacco use over the past seven days (point prevalence abstinence).

Time frame: Six-month follow-up

Alcohol Use

Alcohol use during the previous seven days will be assessed among those receiving the risky alcohol use treatment module and those in the quitline referral condition who would have been eligible for the intervention if assigned to the tailored treatment group.

Time frame: Six-month follow-up

Depressive Symptoms

Depressive symptoms as measured using the Patient Health Questionnaire 9 (PHQ-9). Possible scores range from 0 to 27, with higher scores indicating greater levels of depressive symptoms.

Time frame: Six-month follow-up

Body Weight

Self-reported body weight.

Time frame: Six-month follow-up

Enrollment Rate

The number of participants enrolled will be tracked as a measure of the feasibility of the intervention approached for the entire six-month recruitment period.

Time frame: 6 months after study initiation

Retention

The number of participants who remain in the study throughout the seven-week treatment period will be computed as an indicator of the feasibility of the treatment approach.

Data from ClinicalTrials.gov

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