Tailored Tobacco Quitline for Rural Veterans

• Treatment satisfaction [ Time Frame: End of treatment (seven weeks after baseline) ] [ Designated as safety issue: No ]
  Participants' impressions of and satisfaction with the intervention will be assessed by interview at the end of treatment.
  
  

• Tobacco use [ Time Frame: Six-month follow-up ] [ Designated as safety issue: No ]
  At the six-month follow-up contact, participants will be questioned regarding self-reported tobacco use over the past seven days (point prevalence abstinence) and any use of tobacco following an initial two-week grace period following the planned quit date (prolonged abstinence).
  
  
• Alcohol use [ Time Frame: Six-month follow-up ] [ Designated as safety issue: No ]
  Alcohol use during the previous seven days will be assessed among those receiving the risky alcohol use treatment module. Based on this information, several metrics of alcohol consumption will be obtained including: 1) average number of drinking days per week, 2) average number of drinks per drinking day, 3) number of drinks per week 4) number of heavy drinking days, and 5) maximum drinks consumed on a single occasion.
  
  
• Depressive symptoms [ Time Frame: Six-month follow-up ] [ Designated as safety issue: No ]
  Depressive symptoms will be assessed among participants who receive the depression treatment using the Patient Health Questionnaire 9 (PHQ-9).
  
  
• Body weight [ Time Frame: Six-month follow-up ] [ Designated as safety issue: No ]
  Change in body weight following smoking cessation will be assessed via self-report and chart review among those receiving the weight management treatment module.
  
  
• Enrollment rate [ Time Frame: 6 months after study initiation ] [ Designated as safety issue: No ]
  The number of participants enrolled each month will be tracked as a measure of the feasibility of the intervention approached for the entire six-month recruitment period.
  
  
• Retention [ Time Frame: End of treatment (seven weeks after baseline) ] [ Designated as safety issue: No ]
  The proportion 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.
  
  
• Treatment attendance [ Time Frame: End of treatment (seven weeks after baseline) ] [ Designated as safety issue: No ]
  The number of treatment calls completed (out of six total) will be calculated for all participants in the Tailored Intervention group as an indicator of the feasibility of the treatment approach.
  
  

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.