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Publication Briefs

Study Shows Proactive Outreach Helps Veterans with PTSD Overcome Barriers to Getting Treatment to Help Quit Smoking

Despite the decline in smoking over the past several decades, smoking still accounts for nearly half a million premature deaths and $300 billion in healthcare costs and lost productivity each year in the U.S. It is estimated that 22% of Veterans are current smokers and smoking accounts for 11% of all VA inpatient healthcare costs. The health and economic consequences of tobacco use disproportionately impact Veterans with mental health disorders, including PTSD. This was a secondary analysis of a randomized controlled trial (RCT)–conducted from 2013 to 2017–that demonstrated the effectiveness of proactive outreach for increasing smoking abstinence among Veterans using VA mental healthcare services. [Proactive outreach is designed to reduce barriers to smoking cessation treatment through direct engagement with patients.] Using VA's electronic medical record data, investigators in the present study identified RCT participants with (n=355) and without (n=1,583) PTSD and evaluated the proactive outreach intervention for increasing treatment utilization and smoking abstinence among these Veterans. Participants were randomized to the intervention (outreach and facilitated access to evidence-based smoking cessation treatments, including nicotine replacement therapy) or usual care (participants were mailed a list of local smoking cessation services, and had access to cessation treatments). Investigators also examined patient demographics, smoking history, cessation beliefs, and mental health.


  • Compared to usual care, proactive outreach increased combined counseling and nicotine replacement therapy use among Veterans with PTSD (19% vs 1%) and without PTSD (15% vs 2%).
  • For the primary abstinence outcome, Veterans randomized to proactive outreach reported higher rates of 7-day point prevalence abstinence at 12 months in both the PTSD (21% vs 9%) and non-PTSD groups (19% vs 15%).
  • Smokers with and without PTSD were similarly likely to respond to the initial outreach call (74% vs. 75%) and to schedule an appointment for counseling (41% in both groups).


  • Findings suggest that proactive outreach may help overcome barriers to treatment utilization and smoking cessation among Veterans with PTSD. Further, given the documented cost-effectiveness of proactive outreach, future work should focus on the development of strategies to enable more widespread implementation of these interventions.


  • It is not possible to determine which components of the proactive outreach intervention contributed to the heightened rates of treatment utilization and abstinence in this study cohort.

This study was partly funded by HSR&D (IIR 11-291). Dr. Hammett is part of HSR&D’s Center for Care Delivery and Outcomes Research (CCDOR) in Minneapolis, MN; Dr. Fu is Director of CCDOR; Dr. Sherman is part of the VA NY Harbor Healthcare System (Manhattan campus).

Hammett P, Japuntich S, Sherman S, Rogers ES, Danan ER, Noorbaloochi S, El-Shahawy O, Burgess DJ, Fu SS. Proactive Tobacco Treatment for Veterans with Posttraumatic Stress Disorder. Psychological Trauma: Theory, Research, Practice, and Policy. July 2, 2020;epub ahead of print.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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