title: Tobacco use trajectories among a large cohort of treated smokers with posttraumatic stress disorder.
abstract: BACKGROUND
  This study identified distinct tobacco use trajectories across 18months in 943 veteran smokers with posttraumatic stress disorder (PTSD) in order to describe quit and relapse patterns, examine associations between trajectory groups on baseline characteristics and cessation service utilization, and explore group differences in mental health outcomes.
  
  
  METHODS
  Veterans who participated in a multisite, randomized trial of integrated smoking cessation care were grouped using k-means clustering based on reported daily tobacco use between baseline and 18months. Four trajectory clusters were identified: no reduction (62%), temporary reduction (11%), late sustained reduction (9%) and early sustained reduction (18%).
  
  
  RESULTS
  Median quit times in the early, late, temporary, and no reduction groups were 451, 141.5, 97, and 2days, respectively. Compared to the early reduction group, the temporary reduction group exhibited higher baseline depression (p<0.01) and anxiety (p<0.01), but did not differ in treatment received, with both groups attending significantly more cessation visits (p<0.001) and more likely to receive recommended pharmacotherapy (p<0.001) than the no reduction group between baseline and 6months. The early reduction group exhibited lower depression relative to the no reduction (p<0.01) and temporary reduction (p<0.01) groups across all assessments between baseline and 18months. Differences were not observed between groups in depressive or PTSD symptom change over time between baseline and 18months.
  
  
  CONCLUSIONS
  Tobacco use trajectories among treated smokers with PTSD vary distinctly. Characteristics of identified subgroups may lead to targeted interventions among smokers with PTSD and potentially other psychiatric disorders.
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States. Electronic address: Carol.Malte@va.gov.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Malte
authors.affiliation: Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC, United States.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Dennis
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
authors.forename: Miles
authors.initials: M
authors.lastname: McFall
authors.affiliation: Veterans Affairs Medical Center, San Francisco, CA, United States; University of California, San Francisco, United States.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Carmody
authors.affiliation: Providence Veterans Affairs Medical Center, Providence, RI, United States.
authors.forename: William
authors.initials: W
authors.lastname: Unger
authors.affiliation: Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
mesh_terms: D016000:Cluster Analysis; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D064424:Tobacco Use / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
keywords: Major depressive disorder; Posttraumatic stress disorder; Relapse; Smoking cessation; Veterans