title: Nicotine dependence and its risk factors among users of veterans health services, 2008-2009.
abstract: BACKGROUND
  Tobacco use is the leading preventable cause of death in the United States and is disproportionately higher among veterans than nonveterans. We examined the prevalence of nicotine dependence and its associated risk factors among veterans who used health services in the US Department of Veterans Affairs (VA) system.
  
  
  METHODS
  Using a case-control design, we compared all VA health service users in fiscal year 2008-2009 (N = 5,031,381) who received a nicotine dependence diagnosis with those who did not. Independent risk and protective factors associated with receiving a nicotine dependence diagnosis were identified using logistic regression analysis. We conducted subgroup analyses on 2 groups of particular policy concern: homeless veterans and veterans who served in Iraq and Afghanistan.
  
  
  RESULTS
  Among all recent VA health service users, 15% (n = 749,353) received a diagnosis of nicotine dependence. Substance abuse, other mental health diagnoses, and homelessness were identified as major risk factors. Veterans who served in Iraq and Afghanistan were not found to be at increased risk compared to veterans from other war eras. Major risk and protective factors within the subgroups of homeless veterans and veterans who served in Iraq and Afghanistan were broadly similar to those in the general VA population.
  
  
  CONCLUSIONS
  Given that other studies have found higher rates of nicotine dependence among veterans, this risk behavior may be underdiagnosed in VA medical records. Veterans who are homeless or have mental health or substance abuse problems are at highest risk and should be targeted for smoking prevention and cessation interventions. These results support, in principle, efforts to integrate smoking cessation programs with mental health and homeless services.
authors: VA New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave, 151D, West Haven, CT 06516, USA. Jack.Tsai@yale.edu
authors: Jack
authors: J
authors: Tsai
authors: Ellen L
authors: EL
authors: Edens
authors: Robert A
authors: RA
authors: Rosenheck
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health