Tailored Tobacco Quitline for Rural Veterans
Condition: Cigarette Smoking
Study type: Interventional
Phase: Phase 2

Summary: 
      The proposed work is designed to help increase access to tobacco cessation services among
      rural veterans and to develop more effective treatment services that better address comorbid
      issues commonly experienced by rural smokers. The objectives are:

        1. Study the feasibility of an individually-tailored telephone intervention for rural
           smokers.

        2. Examine the impact of the intervention on tobacco use outcomes.

        3. Evaluate the effect of the intervention on issues commonly experienced by rural smokers
           including depressive symptoms, alcohol use, and weight gain.
    

Detailed description: 
      Tobacco use remains the leading preventable cause of morbidity and mortality in our society.
      Results from epidemiologic studies indicate that tobacco use is especially elevated among
      those living in rural areas. Although interventions exist that are both effective and
      cost-effective, few rural smokers utilize them during any given quit attempt. A lack of local
      treatment resources, the travel distance required to obtain treatment, and a reduced tendency
      to visit primary care on a regular basis all appear to contribute to the lower levels of
      treatment for nicotine dependence in rural smokers.

      Smokers frequently experience conditions and concerns that adversely impact their ability to
      quit smoking. Depression and risky alcohol use, both of which are prevalent among smokers,
      reduce the likelihood of successfully quitting smoking. Concern about gaining weight, a
      common consequence of quitting smoking, is also frequently cited by smokers as an important
      barrier to quitting. Therefore, in order to be most effective, tobacco cessation
      interventions will need to address these important issues. Presently, treatment for nicotine
      dependence, risky alcohol use, depression, and weight management is typically delivered
      separately and without optimal integration among providers, an approach which only serves to
      fragment care and increase the number of required visits, further reduce rural smokers'
      access to care.

      In an effort to address these barriers, the current study will evaluate a telephone
      intervention for tobacco use that also addresses issues related to risky alcohol use,
      depressed mood, and postcessation weight gain based on each individual smoker's needs.
      Results will provide valuable information regarding the potential to more widely implement an
      individually-tailored telephone intervention for rural smokers.
    

Intervention name(s): Nicotine replacement therapy - transdermal nicotine patch; Tailored behavioral intervention; Tobacco quit line referral; Nicotine replacement therapy - nicotine gum; Nicotine replacement therapy - nicotine lozenge; Bupropion Sustained Release; Varenicline; Combination pharmacotherapy - transdermal nicotine patch + nicotine gum; Combination pharmacotherapy - transdermal nicotine patch + nicotine lozenge; Combination pharmacotherapy - transdermal nicotine patch + bupropion; Alcohol use risk reduction; Behavioral activation for the treatment of depression; Behavioral management of post-cessation weight gain
Intervention type(s): Drug; Behavioral; Behavioral; Drug; Drug; Drug; Drug; Drug; Drug; Drug; Behavioral; Behavioral; Behavioral
Intervention description(s): Medication selection will be determined based on individual participant preferences, medical history, and contraindications.; Participants will receive a standard six session cognitive behavioral intervention for smoking cessation combined with supplemental treatment modules based on individual need and preference.; Participants assigned to this condition will receive a referral to their state tobacco quit line. The specific behavioral treatment that is provided will differ slightly depending upon the services available through the participant's state of residence.; Medication selection will be determined based on individual participant preferences, medical history, and contraindications; Medication selection will be determined based on individual participant preferences, medical history, and contraindications; Medication selection will be determined based on individual participant preferences, medical history, and contraindications; Medication selection will be determined based on individual participant preferences, medical history, and contraindications; Medication selection will be determined based on individual participant preferences, medical history, and contraindications; Medication selection will be determined based on individual participant preferences, medical history, and contraindications; Medication selection will be determined based on individual participant preferences, medical history, and contraindications; Participants engaging in risky alcohol use may receive this six-session telephone-based behavioral intervention for reducing alcohol use.; Participants with elevated depressive symptoms may receive this six-session telephone-based behavioral activation intervention.; Participants with concerns about gaining weight after quitting smoking may receive this six-session telephone-based behavioral self-management intervention designed to help attenuate post-cessation weight gain.
Other intervention name(s): Zyban; Chantix; Risky alcohol use; Harm reduction; Depression; Weight management
Intervention MeSH terms: Ethanol; Bupropion; Nicotine; Varenicline
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Nicotine dependence; Smoking cessation; Telehealth; Alcohol use; Depression; Body weight