title: Smoking behavior and delivery of evidence-based care for veterans with spinal cord injuries and disorders.
abstract: OBJECTIVE
  Little is known about those veterans with spinal cord injuries and disorders (SCI/D) who smoke cigarettes. This study identified the factors associated with smoking in this population, motivations for smoking, and the readiness for smoking cessation. Current practices for the delivery of evidence-based tobacco cessation were also examined.
  
  
  METHODS
  Methods included surveys of veterans with SCI/D, medical record reviews of current smokers, and telephone interviews with SCI/D providers.
  
  
  METHODS
  Six Veterans Health Administration facilities with SCI centers and one SCI clinic.
  
  
  METHODS
  Survey data were analyzed for 1210 veterans, 256 medical records were reviewed, and 15 providers served as key informants.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Veterans self-reported smoking status, quit attempts, methods and care received, motivation for smoking, and health care conditions. Medical record review and informant interviews examined the tobacco cessation care provided.
  
  
  RESULTS
  Whereas 22% of the respondents were current smokers; 51% were past smokers. Current smokers more often reported respiratory illnesses and/or symptoms, alcohol use, pain, and depression than past or never smokers, and approximately half made quit attempts in the past year. Smokers received referral to counseling (57%) and/or prescription for medication/nicotine replacement (23%). Key informants identified difficulty of providing follow-up and patients' unwillingness to consider quitting as barriers.
  
  
  CONCLUSIONS
  Veterans with SCi/D who smoke also had other health problems. Providers offer counseling and medication, but often have difficulty following patients to arrange/provide support. Identifying other support methods such as telehealth, considering the use of combination cessation therapies, and addressing other health concerns (e.g., depression) may affect tobacco cessation in this population.
authors.affiliation: Center for Management of Complex Chronic Care and the Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, IL 60141, USA. Frances.Weaver@va.gov
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Bridget
authors.initials: B
authors.lastname: Smith
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Philip
authors.initials: P
authors.lastname: Ullrich
authors.forename: Scott
authors.initials: S
authors.lastname: Miskevics
authors.forename: Barry
authors.initials: B
authors.lastname: Goldstein
authors.forename: Jonathan
authors.initials: J
authors.lastname: Strayer
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
mesh_terms: D000368:Aged; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D013118:Spinal Cord Diseases / Q000453:epidemiology / Q000628:therapy; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*