BACKGROUND/RATIONALE:
Inpatient smoking cessation programs that include counseling and medications have been shown to be efficacious both inside and outside of the VA, yet they have not been implemented in the VA where smoking rates are high.

OBJECTIVE(S):
The objectives of this study were to: 1) determine provider receptivity, barriers, and facilitators to implementing a nurse-administered inpatient smoking cessation intervention by face-to-face contact and surveys; 2) determine patient receptivity, barriers, and facilitators to implementing the intervention by surveys; 3) determine the effectiveness of the intervention compared to usual care using 6-month confirmed cessation; and 4) determine the cost-effectiveness of the intervention compared to usual care.

METHODS:
In this pre- post- non-randomized trial, Ann Arbor and Detroit were the intervention sites and Indianapolis was the control site. At the two intervention sites, research nurses taught the intervention to staff nurses using the Tobacco Tactics toolkit. The nurse toolkit includes: 1) one contact hour for training; 2) a PowerPoint presentation on behavioral and pharmaceutical interventions; 3) a pocket card "Helping Smokers Quit: A Guide for Clinicians" developed by the U.S. Department of Health and Human Services Public Health Service and Tobacco Free Nurses; 4) pharmaceutical and behavioral protocols; and 5) a computerized template for nurse documentation. The patient toolkit includes: 1) a brochure; 2) a videotape; 3) Tobacco Tactics manual; 4) pharmaceuticals; 5) 1-800-QUIT-NOW help line; and 6) volunteer follow-up phone counseling. Coupled with smoking medication sign-off, physicians were reminded to give patients brief advice, namely "quitting smoking is the most important thing you can do for your health." Pre- and post-intervention, smokers in both experimental and control facilities were surveyed at baseline and 6 months after discharge about their smoking habits and the types of cessation services they received while in the hospital.

FINDINGS/RESULTS:
Approximately 96% (210/219) of inpatient nurses in the Ann Arbor site and 57% (159/279) in the Detroit site have been trained to conduct the Tobacco Tactics intervention, with an additional 282 non-targeted personnel spontaneously attending. Overall, there were significant improvements in 6-month quit rates for the pre- versus post-intervention time periods in Ann Arbor (p=0.04) and Detroit (p=0.0004) compared to the Indianapolis control site. Furthermore, 6-month quit rates among patients admitted for psychiatric conditions improved significantly for the pre- versus post-intervention time periods in Ann Arbor (p=0.07) and Detroit (p=0.01) as compared to the Indianapolis control site.

IMPACT:
The Tobacco Tactics intervention is: 1) effective; 2) easy to implement as it is packaged into a Toolkit; 3) easily transportable to other VAs; and 4) once transferred, is sustainable even after the research ends. The data suggest that the intervention is ready for wide-scale dissemination in the VA.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Ewing LA, Karvonen-Gutierrez CA, Noonan D, Duffy SA. Development of the Tobacco Tactics logo: From thumb prints to press. Tobacco induced diseases. 2012 Apr 19; 10(1):6. [view]
2. Noonan D, Karvonen-Gutierrez CA, Duffy SA. Differences in risk perception and quit rates among hospitalized veteran pipe smokers, cigarette smokers, and dual users. Journal of addictions nursing. 2014 Apr 1; 25(2):89-93. [view]
3. Duffy SA, Ronis DL, Titler MG, Blow FC, Jordan N, Thomas PL, Landstrom GL, Ewing LA, Waltje AH. Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial. Trials. 2012 Aug 1; 13(1):125. [view]
4. Duffy SA, Noonan D, Karvonen-Gutierrez CA, Ronis DL, Ewing LA, Waltje AH, Dalack GW, Smith PM, Carmody TP, Hicks T, Hermann C. Effectiveness of the tobacco tactics program for psychiatric inpatient veterans: an implementation study. Archives of psychiatric nursing. 2015 Apr 1; 29(2):120-6. [view]
5. Duffy SA, Ronis DL, Karvonen-Gutierrez CA, Ewing LA, Dalack GW, Smith PM, Carmody TP, Hicks T, Hermann C, Reeves P, Flanagan P. Effectiveness of the tobacco tactics program in the Department of Veterans Affairs. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2014 Oct 1; 48(2):265-74. [view]
6. Karvonen-Gutierrez CA, Ewing LA, Taylor NJ, Essenmacher CA, Duffy SA. Ethnicity predicts perceptions of smoking and smoking cessation among veterans. Journal of psychiatric and mental health nursing. 2012 Apr 1; 19(3):203-10. [view]
7. Vick L, Duffy SA, Ewing LA, Rugen K, Zak C. Implementation of an inpatient smoking cessation programme in a Veterans Affairs facility. Journal of Clinical Nursing. 2013 Mar 1; 22(5-6):866-80. [view]
8. Duffy SA, Karvonen-Gutierrez CA, Ewing LA, Smith PM, Veterans Integrated Services Network 11 Tobacco Tactics Team. Implementation of the Tobacco Tactics program in the Department of Veterans Affairs. Journal of general internal medicine. 2010 Jan 1; 25 Suppl 1:3-10. [view]
9. Duffy SA, Reeves P, Hermann C, Karvonen C, Smith P. In-hospital smoking cessation programs: what do VA patients and staff want and need? Applied Nursing Research. 2008 Nov 1; 21(4):199-206. [view]
10. Duffy SA, Biotti JK, Karvonen-Gutierrez CA, Essenmacher CA. Medical comorbidities increase motivation to quit smoking among veterans being treated by a psychiatric facility. Perspectives in psychiatric care. 2011 Apr 1; 47(2):74-83. [view]
11. Fore AM, Karvonen-Gutierrez CA, Talsma A, Duffy SA. Nurses' delivery of the Tobacco Tactics intervention at a Veterans Affairs Medical Center. Journal of Clinical Nursing. 2014 Aug 1; 23(15-16):2162-9. [view]
12. Duffy SA, Munger A, Karvonen-Gutierrez CA, Piette JD, Kao TA, Veterans Integrated Service Network (VISN) 11 Tobacco Tactics Team. Post-discharge tobacco cessation rates among hospitalized US veterans with and without diabetes. Diabetic medicine : a journal of the British Diabetic Association. 2012 Jul 1; 29(7):e96-101. [view]
13. Duffy SA, Cohen KA, Choi SH, McCullagh MC, Noonan D. Predictors of obesity in Michigan Operating Engineers. Journal of community health. 2012 Jun 1; 37(3):619-25. [view]
14. Noonan D, Duffy SA. Smokeless tobacco use among operating engineers. Journal of addictions nursing. 2012 May 1; 23(2):132-6. [view]
15. Essenmacher C, Karvonen-Gutierrez C, Lynch-Sauer J, Duffy SA. Staff's attitudes toward the delivery of tobacco cessation services in a primarily psychiatric Veterans Affairs hospital. Archives of psychiatric nursing. 2009 Jun 1; 23(3):231-42. [view]
16. Duffy SA, Scholten RL, Karvonen-Gutierrez CA. The relation of tobacco use during hospitalization to post-discharge smoking cessation among US veterans. Preventive medicine. 2010 May 1. [view]
17. Noonan D, Jiang Y, Duffy SA. Utility of biochemical verification of tobacco cessation in the Department of Veterans Affairs. Addictive Behaviors. 2013 Mar 1; 38(3):1792-5. [view]
18. Duffy SA, Louzon SA, Gritz ER. Why do cancer patients smoke and what can providers do about it? Community oncology. 2012 Nov 17; 9(11):344-352. [view]

Conference Presentations

1. Duffy SA. Bringing the Program to the Smoker. Poster session presented at: Albert J. Silverman Research Annual Conference; 2010 May 12; Ann Arbor, MI. [view]
2. Duffy SA. Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs. Poster session presented at: Midwest Nursing Research Society Annual Conference; 2012 Apr 12; Dearborn, MI. [view]
3. Duffy SA. Ethnicity Predicts Perceptions of Smoking and Cessation among Veterans. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland. [view]
4. Duffy SA. Ethnicity Predicts Perceptions of Smoking and Smoking Cessation among Veterans. Poster session presented at: Albert J. Silverman Research Annual Conference; 2010 May 12; Ann Arbor, MI. [view]
5. Duffy SA. Ethnicity Predicts Perceptions of Smoking and Smoking Cessation Among Veterans. Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 27; Baltimore, MD. [view]
6. Duffy SA. Medical Comorbidities Increase Motivation to Quit Smoking. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland. [view]
7. Duffy SA. Medical Comorbidities Increase Motivation to Quit Smoking among Veterans Being Treated by a Psychiatric Facility. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 27; Little Rock, AR. [view]
8. Duffy SA. Medical Comorbidities Increase Motivation to Quit Smoking Among Veterans Being Treated by a Psychiatric Facility. Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 29; Baltimore, MD. [view]
9. Duffy SA. Michigan Operating Engineers: Heart Disease and Cancer in the Making. Poster session presented at: University of Michigan School of Nursing Dean's Lecture and Research Day Conference; 2010 Apr 6; Ann Arbor, MI. [view]
10. Duffy SA. Michigan Operating Engineers: Heart Disease and Cancer in the Making. Poster session presented at: Albert J. Silverman Research Annual Conference; 2010 May 12; Ann Arbor, MI. [view]
11. Duffy SA. Michigan Operating Engineers: Heart Disease and Cancer in the Making. Paper presented at: International Occupational Hygiene Association International Scientific Conference; 2010 Sep 28; Rome, Italy. [view]
12. Duffy SA. Motivation to Quit Smoking among Veterans Diagnosed with Psychiatric and Substance Abuse Disorders. Poster session presented at: Albert J. Silverman Research Annual Conference; 2010 May 12; Ann Arbor, MI. [view]
13. Duffy SA. Psychiatric Disorders, but not Substance Abuse Disorders, Predict Motivation for Tobacco Cessation. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 28; Dublin, Ireland. [view]
14. Duffy SA. Smokeless Tobacco Use among Operating Engineers. Poster session presented at: Midwest Nursing Research Society Annual Conference; 2012 Apr 12; Dearborn, MI. [view]
15. Duffy SA. Staff attitudes toward the Delivery of Tobacco Cessation for Services in a Psychiatric Veterans Affairs Hospital. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland. [view]
16. Duffy SA. The Development of the Veterans Affairs Tobacco Tactics Campaign. Paper presented at: American Academy of Health Behavior Annual Scientific Meeting; 2009 Mar 11; Hilton Head, SC. [view]
17. Duffy SA. The Development of the Veterans Affairs Tobacco Tactics Campaign. Paper presented at: Society for Research on Nicotine and Tobacco / Society for Research Nicotine and Tobacco - Europe Joint Conference; 2009 Apr 27; Dublin, Ireland. [view]
18. Duffy SA. Tobacco Tactics - Facility Level Intervention. Paper presented at: American Academy of Health Behavior Annual Scientific Meeting; 2009 Mar 11; Hilton Head, SC. [view]
19. Duffy SA. Tobacco Tactics Website for Operating Engineers: Preliminary Findings. Paper presented at: University of Michigan School of Nursing Dean's Lecture and Research Day Conference; 2010 Apr 6; Ann Arbor, MI. [view]
20. Duffy SA. Tobacco Tactics Website for Operating Engineers: Preliminary Findings. Poster session presented at: Albert J. Silverman Research Annual Conference; 2010 May 12; Ann Arbor, MI. [view]
21. Duffy SA. Tobacco Tactics: A Facility Level Intervention. Paper presented at: Sigma Theta Tau International Honor Society Region 10 Research Conference; 2010 Apr 16; Ann Arbor, MI. [view]
22. Duffy SA. Tobacco Tactics: Bringing the Program to the Smoker. Paper presented at: University of Michigan School of Nursing Dean's Lecture and Research Day Conference; 2010 Apr 6; Ann Arbor, MI. [view]
23. Duffy SA. Tobacco Tactics-A Facility Level Intervention. Paper presented at: VA QUERI National Meeting; 2008 Dec 10; Phoenix, AZ. [view]
24. Duffy SA. Years of Potential Life Lost Due to Depression Among VA Patients. Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 28; Baltimore, MD. [view]

DRA: Substance Use Disorders
DRE: Treatment - Observational, Prevention
Keywords: Cost effectiveness, Smoking
MeSH Terms: Smoking Cessation