Background: Research consistently indicates that individuals with psychiatric disorders smoke at rates substantially higher than those of the general population. Despite awareness of the high rates of tobacco use and disproportionate burden of tobacco related disease burden borne by individuals with psychiatric disorders, limited research has addressed this health disparity. In accord with evidence that the majority of smokers with psychiatric disorders express a desire to quit smoking, the VHA has been a national leader for integration of smoking-cessation services in health care settings, and increasingly is addressing tobacco use among veterans with psychiatric disorders. However, rates of treatment utilization by smokers with psychiatric disorders are low; a review of referrals to VA San Diego Healthcare System (VASDHS) tobacco cessation program for veterans with psychiatric disorders indicated that only 16.2% (113 of 638) of patients referred for treatment between August 1, 2012 and July 31, 2013 engaged in smoking cessation treatment within 30 days of referral completion. This is of particular concern as existing research with psychiatric populations indicates that treatment approaches found effective for the general population, including both behavioral and pharmacologic intervention, are also effective for smokers with psychiatric disorders. While a majority of motivated smokers may attempt to quit on their own, putting smokers in contact with structured treatments will likely improve odds of success. As such, engaging smokers with psychiatric disorders in formal treatment for tobacco cessation is an issue of particular importance and relevance to VA. Objectives: The objective of this research project is to develop a brief intervention delivered by telephone to facilitate engagement in outpatient tobacco cessation treatment. Treatment development will be informed by adaptation of an existing, in-person, protocol and qualitative evaluation of facilitators and barriers to participation in tobacco cessation treatment by veterans with psychiatric disorders. The resulting intervention will be utilized in future clinical trials. Primary Aim:The primary aim of this pilot project is to employ a sequential qualitative treatment development procedure in order to adapt for telephone delivery an existing in-person intervention for enhancing tobacco use treatment participation.
The aim i s to produce a manualized treatment protocol and telephone script for intervention delivery. Secondary Aim: to establish participant recruitment and enrollment procedures for a subsequent randomized trial and to obtain preliminary treatment engagement data. Methods: This is a qualitative treatment development project utilizing a sequential design where information from successive phases will be used to refine intervention content and delivery. Participants will include 50 veteran tobacco users with a psychiatric disorder. Participants will be recruited from mental health clinics and from individuals who are referred for outpatient tobacco cessation treatment in the VA San Diego Healthcare System (VASDHS). We will adapt a treatment engagement intervention developed for tobacco users hospitalized for depression. Adaptation of the treatment engagement intervention for telephone delivery will be informed by qualitative study including focus groups and pilot implementation of the intervention along with telephone callback interviews. Focus group interviews will be carried out to explore what veterans consider to be potential barriers and facilitators to participating in an tobacco cessation treatment programs. Callback interviews will be used to refine the final treatment protocol.
The Veterans Health Administration administers the largest mental health care system in the U.S. with approximately 1.5 million veterans enrolled in VA mental health programs. The high rates of cigarette smoking, and the disproportionate burden of tobacco-related morbidity and mortality among individuals with psychiatric disorders highlight the importance of research in this area. Although VA is a leader in implementation of tobacco cessation treatment, treatment utilization rates are low. As such, identifying effective strategies for enhancing treatment utilization is an important first step in reducing the disease burden of tobacco use among veterans with psychiatric disorders. This proposal is thus consistent with HSR&D's mission to promote innovations in the efficiency and accessibility of health services and priority on research relevant to veterans mental and behavioral health.
