title: Feasibility and pilot efficacy of a brief smoking cessation intervention delivered by vascular surgeons in the Vascular Physician Offer and Report (VAPOR) Trial.
abstract: BACKGROUND
  This study determined the feasibility and potential efficacy of an evidence-based standardized smoking cessation intervention delivered by vascular surgeons to smokers with peripheral arterial disease.
  
  
  METHODS
  We performed a cluster-randomized trial of current adult smokers referred to eight vascular surgery practices from September 1, 2014, to July 31, 2015. A three-component smoking cessation intervention (physician advice, nicotine replacement therapy, and telephone-based quitline referral) was compared with usual care. The primary outcome was smoking cessation for 7 days, assessed 3 months after the intervention. Secondary outcomes were patients' nicotine dependence and health expectancies of smoking assessed using Patient Reported Outcomes Measurement Information System (PROMIS; RAND Corporation, Santa Monica, Calif).
  
  
  RESULTS
  We enrolled 156 patients (65 in four intervention practices, 91 in four control practices), and 141 (90.3%) completed follow-up. Patients in the intervention and control practices were similar in age (mean, 61 years), sex (68% male), cigarettes per day (mean, 14), and prior quit attempts (77%). All three components of the intervention were delivered to 75% of patients in intervention practices vs to 7% of patients at control practices (P < .001). At 3 months, 23 of 57 patients (40.3%) in the intervention group quit smoking (23 of 56 patients quit who completed follow-up, plus 1 death included in the analysis in the denominator as a smoker), and 26 of 84 patients (30.9%) In the control group quit smoking (26 patients of 84 who completed follow-up, including 2 deaths included in the denominator as smokers). This difference (40.3% quit rate in intervention, 31% quit rate in control; P = .250) was not statistically significant in crude analyses (P = .250) or analyses adjusted for clustering (P = .470). Multivariable analysis showed factors associated with smoking cessation were receipt of physician advice (odds ratio for cessation, 1.96; 95% confidence interval, 1.28-3.02; P < .002) and nicotine replacement therapy (odds ratio, 1.92; 95% confidence interval, 1.43-2.56; P < .001).
  
  
  CONCLUSIONS
  Implementation of a brief, surgeon-delivered smoking cessation intervention is feasible for patients with peripheral arterial disease. A larger trial will be necessary to determine whether this is effective for smoking cessation.
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: philip.goodney@hitchcock.org.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.affiliation: Department of Surgery, University of Alabama, Birmingham, Ala.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Spangler
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Karina
authors.initials: K
authors.lastname: Newhall
authors.affiliation: Department of Surgery, The University of Utah, Salt Lake City, Utah.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.affiliation: Department of Surgery, University of Massachusetts Medical Center, Worcester, Mass.
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.affiliation: Department of Surgery, Louisiana State University Shreveport, Shreveport, La.
authors.forename: Tze-Woei
authors.initials: TW
authors.lastname: Tan
authors.affiliation: Department of Surgery, University of Alabama, Birmingham, Ala; Department of Surgery, University of Florida, Gainesville, Fla.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Beck
authors.affiliation: Department of Surgery, Roper St. Francis Hospital, Charleston, SC.
authors.forename: John H
authors.initials: JH
authors.lastname: Hallett
authors.affiliation: Department of Biomedical Data Science, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
authors.affiliation: RAND Corporation, Boston, Mass.
authors.forename: Maria O
authors.initials: MO
authors.lastname: Edelen
authors.affiliation: Department of Surgery, Northwestern Medical Center, Chicago, Ill.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Hoel
authors.affiliation: The Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.affiliation: Department of Surgery, Boston Medical Center, Boston, Mass.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D003376:Counseling; D003695:Delivery of Health Care; D005240:Feasibility Studies; D005260:Female; D015277:Hotlines; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D000071066:Patient Reported Outcome Measures; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010819:Physician's Role; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D066231:Surgeons; D013997:Time Factors; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome