Proactive tobacco treatment for individuals with and without a mental health diagnosis

Secondary analysis of a pragmatic randomized controlled trial

Sandra J. Japuntich, Scott 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
    Health
    Tobacco Use
    Self Efficacy
    Pragmatic Clinical Trials
    Withholding Treatment
    Mentally Ill Persons
    Smoking Cessation
    Therapeutics
    Population
    Primary Health Care
    Appointments and Schedules

    Keywords

    • Comorbidity
    • Mental health
    • Smoking
    • Tobacco use cessation

    ASJC Scopus subject areas

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

    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; 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, SJ, Sherman, S, Joseph, AM, Clothier, B, Noorbaloochi, S, Danan, E, Burgess, D, Rogers, E & Fu, SS 2018, 'Proactive tobacco treatment for individuals with and without a mental health diagnosis: Secondary analysis of a pragmatic randomized controlled trial', Addictive Behaviors, vol. 76, pp. 15-19. https://doi.org/10.1016/j.addbeh.2017.07.024
    Japuntich, Sandra J. ; Sherman, Scott ; 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. 2018 ; Vol. 76. pp. 15-19.
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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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    AU - Clothier, Barbara

    AU - Noorbaloochi, Siamak

    AU - Danan, Elisheva

    AU - Burgess, Diana

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    AU - Fu, Steven S.

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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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    KW - Smoking

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