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Proactive tobacco treatment for individuals with and without a mental health diagnosis: Secondary analysis of a pragmatic randomized controlled trial.
Addict Behav. 2018 Jan; 76:15-19.AB

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, 6month 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.

Authors+Show Affiliations

Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, Providence, RI, United States. Electronic address: Sandra.japuntich@lifespan.org.VA New York Harbor Healthcare System, New York City, NY, United States; New York University School of Medicine, Department of Population Health, New York City, NY, United States.University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, United States.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States.University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, United States; VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States.University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, United States; VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States.VA New York Harbor Healthcare System, New York City, NY, United States; New York University School of Medicine, Department of Population Health, New York City, NY, United States.University of Minnesota Medical School, Department of Medicine, Minneapolis, MN, United States; VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28735036

Citation

Japuntich, Sandra J., et al. "Proactive Tobacco Treatment for Individuals With and Without a Mental Health Diagnosis: Secondary Analysis of a Pragmatic Randomized Controlled Trial." Addictive Behaviors, vol. 76, 2018, pp. 15-19.
Japuntich SJ, Sherman SE, Joseph AM, et al. Proactive tobacco treatment for individuals with and without a mental health diagnosis: Secondary analysis of a pragmatic randomized controlled trial. Addict Behav. 2018;76:15-19.
Japuntich, S. J., Sherman, S. E., Joseph, A. M., Clothier, B., Noorbaloochi, S., Danan, E., Burgess, D., Rogers, E., & Fu, S. S. (2018). Proactive tobacco treatment for individuals with and without a mental health diagnosis: Secondary analysis of a pragmatic randomized controlled trial. Addictive Behaviors, 76, 15-19. https://doi.org/10.1016/j.addbeh.2017.07.024
Japuntich SJ, et al. Proactive Tobacco Treatment for Individuals With and Without a Mental Health Diagnosis: Secondary Analysis of a Pragmatic Randomized Controlled Trial. Addict Behav. 2018;76:15-19. PubMed PMID: 28735036.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proactive tobacco treatment for individuals with and without a mental health diagnosis: Secondary analysis of a pragmatic randomized controlled trial. AU - Japuntich,Sandra J, AU - Sherman,Scott E, AU - Joseph,Anne M, AU - Clothier,Barbara, AU - Noorbaloochi,Siamak, AU - Danan,Elisheva, AU - Burgess,Diana, AU - Rogers,Erin, AU - Fu,Steven S, Y1 - 2017/07/15/ PY - 2017/02/10/received PY - 2017/07/12/revised PY - 2017/07/13/accepted PY - 2017/7/25/pubmed PY - 2018/6/15/medline PY - 2017/7/24/entrez KW - Comorbidity KW - Mental health KW - Smoking KW - Tobacco use cessation SP - 15 EP - 19 JF - Addictive behaviors JO - Addict Behav VL - 76 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, 6month 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. SN - 1873-6327 UR - https://www.unboundmedicine.com/medline/citation/28735036/Proactive_tobacco_treatment_for_individuals_with_and_without_a_mental_health_diagnosis:_Secondary_analysis_of_a_pragmatic_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0306-4603(17)30277-0 DB - PRIME DP - Unbound Medicine ER -