title: An individually-tailored smoking cessation intervention for rural Veterans: a pilot randomized trial.
abstract: Tobacco use remains prevalent among Veterans of military service and those residing in rural areas. Smokers frequently experience tobacco-related issues including risky alcohol use, post-cessation weight gain, and depressive symptoms that may adversely impact their likelihood of quitting and maintaining abstinence. Telephone-based interventions that simultaneously address these issues may help to increase treatment access and improve outcomes.
  
  
  
  This study was a two-group randomized controlled pilot trial. Participants were randomly assigned to an individually-tailored telephone tobacco intervention combining counseling for tobacco use and related issues including depressive symptoms, risky alcohol use, and weight concerns or to treatment provided through their state tobacco quitline. Selection of pharmacotherapy was based on medical history and a shared decision interview in both groups. Participants included 63 rural Veteran smokers (mean age = 56.8 years; 87 % male; mean number of cigarettes/day = 24.7). The primary outcome was self-reported 7-day point prevalence abstinence at 12 weeks and 6 months.
  
  
  
  Twelve-week quit rates based on an intention-to-treat analysis did not differ significantly by group (Tailored = 39 %; Quitline Referral = 25 %; odds ratio [OR]; 95 % confidence interval [CI] = 1.90; 0.56, 5.57). Six-month quit rates for the Tailored and Quitline Referral conditions were 29 and 28 %, respectively (OR; 95 % CI = 1.05; 0.35, 3.12). Satisfaction with the Tailored tobacco intervention was high.
  
  
  
  Telephone-based treatment that concomitantly addresses other health-related factors that may adversely affect quitting appears to be a promising strategy. Larger studies are needed to determine whether this approach improves cessation outcomes.
  
  
  
  ClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Mail Stop 152, 601 Highway 6 West, Iowa City, IA, 52246, USA. mark-vanderweg@uiowa.edu.|Department of Medicine, University of Iowa, Iowa City, USA. mark-vanderweg@uiowa.edu.|Department of Psychological and Brain Sciences, University of Iowa, Iowa City, USA. mark-vanderweg@uiowa.edu.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Vander Weg
authors.affiliation: Veterans Rural Health Resource Center - Central Region, Iowa City, USA.
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Cozad
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Mail Stop 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.|Department of Psychological and Brain Sciences, University of Iowa, Iowa City, USA.|Veterans Rural Health Resource Center - Central Region, Iowa City, USA.
authors.forename: M Bryant
authors.initials: MB
authors.lastname: Howren
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Mail Stop 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.|Department of Social Work, University of Iowa, Iowa City, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Cretzmeyer
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Mail Stop 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.
authors.forename: Melody
authors.initials: M
authors.lastname: Scherubel
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Mail Stop 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.|Department of Psychiatry, University of Iowa, Iowa City, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Turvey
authors.affiliation: Mental Health and Behavioral Sciences Department, VA Nebraska-Western Iowa Health Care System, Omaha, USA.|University of Nebraska Medical Center Department of Medicine, Omaha, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Grant
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Mail Stop 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.|Department of Medicine, University of Iowa, Iowa City, USA.|Department of Psychiatry, University of Iowa, Iowa City, USA.
authors.forename: Thad E
authors.initials: TE
authors.lastname: Abrams
authors.affiliation: Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Mail Stop 152, 601 Highway 6 West, Iowa City, IA, 52246, USA.|Department of Medicine, University of Iowa, Iowa City, USA.|Department of Epidemiology, University of Iowa, Iowa City, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012424:Rural Population / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D014029:Tobacco Use Disorder / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Nicotine dependence; Rural health; Smoking cessation; Tobacco; Veterans