Proactive tobacco treatment for individuals with and without a mental health diagnosis: Secondary analysis of a pragmatic randomized controlled trial

Sandra J. Japuntich, Scott E. Sherman, Anne M. Joseph, Barbara Clothier, Siamak Noorbaloochi, Elisheva Danan, Diana Burgess, Erin Rogers, Steven S. Fu

Research output: Contribution to journalArticle

Abstract

Introduction Individuals with (vs. without) mental illness use tobacco at higher rates and have more difficulty quitting. Treatment models for smokers with mental illness are needed. Methods This secondary analysis of the Victory Over Tobacco study [a pragmatic randomized clinical trial (N = 5123) conducted in 2009–2011 of Proactive Care (proactive outreach plus connection to smoking cessation services) vs. Usual Care] tests the effectiveness of treatment assignment in participants with and without a mental health diagnosis on population-level, 6 month prolonged abstinence at one year follow-up. Results Analyses conducted in 2015–6 found that there was no interaction between treatment group and mental health group on abstinence (F(1,3300 = 1.12, p = 0.29)). Analyses stratified by mental health group showed that those without mental illness, assigned to Proactive Care, had a significantly higher population-level abstinence rate than those assigned to Usual Care (OR = 1.40, 95% CI = 1.17–1.67); in those with mental illness, assignment to Proactive Care produced a non-significant increase in abstinence compared to Usual Care (OR = 1.18, 95% CI = 0.98–1.41). Those with mental illness reported more medical visits, cessation advice and treatment (p < 0.001), similar levels of abstinence motivation (p > 0.05), but lower abstinence self-efficacy (p < 0.001). Conclusions Those with a mental health diagnosis benefitted less from proactive outreach regarding tobacco use. VA primary care patients with mental illness may not need additional outreach because they are connected to cessation resources during medical appointments. This group may also require more intensive cessation interventions targeting self-efficacy to improve cessation rates. Clinicaltrials.gov registration # NCT00608426.

Original languageEnglish (US)
Pages (from-to)15-19
Number of pages5
JournalAddictive Behaviors
Volume76
DOIs
StatePublished - Jan 1 2018

Fingerprint

Tobacco
Mental Health
Randomized Controlled Trials
Jejunoileal Bypass
Tobacco Use
Self Efficacy
Pragmatic Clinical Trials
Withholding Treatment
Mentally Ill Persons
Smoking Cessation
Motivation
Primary Health Care
Appointments and Schedules
Anthralin

Keywords

  • Comorbidity
  • Mental health
  • Smoking
  • Tobacco use cessation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Toxicology
  • Psychiatry and Mental health

MeSH PubMed subject areas

  • Journal Article

Cite this

Proactive tobacco treatment for individuals with and without a mental health diagnosis : Secondary analysis of a pragmatic randomized controlled trial. / Japuntich, Sandra J.; Sherman, Scott E.; Joseph, Anne M.; Clothier, Barbara; Noorbaloochi, Siamak; Danan, Elisheva; Burgess, Diana; Rogers, Erin; Fu, Steven S.

In: Addictive Behaviors, Vol. 76, 01.01.2018, p. 15-19.

Research output: Contribution to journalArticle

Japuntich, Sandra J.; Sherman, Scott E.; Joseph, Anne M.; Clothier, Barbara; Noorbaloochi, Siamak; Danan, Elisheva; Burgess, Diana; Rogers, Erin; Fu, Steven S. / Proactive tobacco treatment for individuals with and without a mental health diagnosis : Secondary analysis of a pragmatic randomized controlled trial.

In: Addictive Behaviors, Vol. 76, 01.01.2018, p. 15-19.

Research output: Contribution to journalArticle

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abstract = "Introduction Individuals with (vs. without) mental illness use tobacco at higher rates and have more difficulty quitting. Treatment models for smokers with mental illness are needed. Methods This secondary analysis of the Victory Over Tobacco study [a pragmatic randomized clinical trial (N = 5123) conducted in 2009–2011 of Proactive Care (proactive outreach plus connection to smoking cessation services) vs. Usual Care] tests the effectiveness of treatment assignment in participants with and without a mental health diagnosis on population-level, 6 month prolonged abstinence at one year follow-up. Results Analyses conducted in 2015–6 found that there was no interaction between treatment group and mental health group on abstinence (F(1,3300 = 1.12, p = 0.29)). Analyses stratified by mental health group showed that those without mental illness, assigned to Proactive Care, had a significantly higher population-level abstinence rate than those assigned to Usual Care (OR = 1.40, 95% CI = 1.17–1.67); in those with mental illness, assignment to Proactive Care produced a non-significant increase in abstinence compared to Usual Care (OR = 1.18, 95% CI = 0.98–1.41). Those with mental illness reported more medical visits, cessation advice and treatment (p < 0.001), similar levels of abstinence motivation (p > 0.05), but lower abstinence self-efficacy (p < 0.001). Conclusions Those with a mental health diagnosis benefitted less from proactive outreach regarding tobacco use. VA primary care patients with mental illness may not need additional outreach because they are connected to cessation resources during medical appointments. This group may also require more intensive cessation interventions targeting self-efficacy to improve cessation rates. Clinicaltrials.gov registration # NCT00608426.",
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N2 - Introduction Individuals with (vs. without) mental illness use tobacco at higher rates and have more difficulty quitting. Treatment models for smokers with mental illness are needed. Methods This secondary analysis of the Victory Over Tobacco study [a pragmatic randomized clinical trial (N = 5123) conducted in 2009–2011 of Proactive Care (proactive outreach plus connection to smoking cessation services) vs. Usual Care] tests the effectiveness of treatment assignment in participants with and without a mental health diagnosis on population-level, 6 month prolonged abstinence at one year follow-up. Results Analyses conducted in 2015–6 found that there was no interaction between treatment group and mental health group on abstinence (F(1,3300 = 1.12, p = 0.29)). Analyses stratified by mental health group showed that those without mental illness, assigned to Proactive Care, had a significantly higher population-level abstinence rate than those assigned to Usual Care (OR = 1.40, 95% CI = 1.17–1.67); in those with mental illness, assignment to Proactive Care produced a non-significant increase in abstinence compared to Usual Care (OR = 1.18, 95% CI = 0.98–1.41). Those with mental illness reported more medical visits, cessation advice and treatment (p < 0.001), similar levels of abstinence motivation (p > 0.05), but lower abstinence self-efficacy (p < 0.001). Conclusions Those with a mental health diagnosis benefitted less from proactive outreach regarding tobacco use. VA primary care patients with mental illness may not need additional outreach because they are connected to cessation resources during medical appointments. This group may also require more intensive cessation interventions targeting self-efficacy to improve cessation rates. Clinicaltrials.gov registration # NCT00608426.

AB - Introduction Individuals with (vs. without) mental illness use tobacco at higher rates and have more difficulty quitting. Treatment models for smokers with mental illness are needed. Methods This secondary analysis of the Victory Over Tobacco study [a pragmatic randomized clinical trial (N = 5123) conducted in 2009–2011 of Proactive Care (proactive outreach plus connection to smoking cessation services) vs. Usual Care] tests the effectiveness of treatment assignment in participants with and without a mental health diagnosis on population-level, 6 month prolonged abstinence at one year follow-up. Results Analyses conducted in 2015–6 found that there was no interaction between treatment group and mental health group on abstinence (F(1,3300 = 1.12, p = 0.29)). Analyses stratified by mental health group showed that those without mental illness, assigned to Proactive Care, had a significantly higher population-level abstinence rate than those assigned to Usual Care (OR = 1.40, 95% CI = 1.17–1.67); in those with mental illness, assignment to Proactive Care produced a non-significant increase in abstinence compared to Usual Care (OR = 1.18, 95% CI = 0.98–1.41). Those with mental illness reported more medical visits, cessation advice and treatment (p < 0.001), similar levels of abstinence motivation (p > 0.05), but lower abstinence self-efficacy (p < 0.001). Conclusions Those with a mental health diagnosis benefitted less from proactive outreach regarding tobacco use. VA primary care patients with mental illness may not need additional outreach because they are connected to cessation resources during medical appointments. This group may also require more intensive cessation interventions targeting self-efficacy to improve cessation rates. Clinicaltrials.gov registration # NCT00608426.

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