Tech and Telephone Smoking Cessation Treatment for Young Veterans with PTSD
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: The overall goal of this project is to develop a convenient, low-cost telephone-and technology-delivered smoking cessation intervention for young veterans with posttraumatic stress disorder (PTSD). Smoking remains the leading preventable cause of death in the United States, and certain at-risk groups are disproportionately affected by the devastating impact of smoking, such as military veterans and individuals with psychiatric conditions. Young combat veterans smoke at alarmingly high rates ranging from 32-48%, with highest prevalence seen in those with PTSD. Researchers developed an integrated care (IC) treatment that provides coping skills to manage PTSD symptoms while quitting. This approach was found to be highly effective, doubling 12-month quit rates in veteran smokers with PTSD compared to traditional smoking cessation treatment. However, high dropout and poor attendance to office visits limited effectiveness of the treatment, particularly in young veterans. Studies show that young combat veterans are at high risk of inadequate treatment engagement, and face numerous barriers to care, including wait lists for treatment, geographic distance, and stigma of help-seeking. We aim to create an accessible, appealing, and cost-effective technology-and telephone-facilitated intervention that can overcome barriers and is designed specifically for young veterans with PTSD. In the first (Development) phase of the study, we will adapt the IC protocol to be delivered over the telephone. We will also incorporate easily accessible mobile technology components into the manual, including (1) Stay Quit Coach, a companion mobile application (app) to the IC treatment protocol for smokers with PTSD; and (2) a smartphone-compatible mobile carbon monoxide monitor to track reduction of cigarettes during quit attempts. We will assemble a Community Advisory Panel consisting of veteran and nonveteran stakeholders, including young veterans ages 18-39 who are current or former smokers and representatives from community groups that serve young veterans (Student Veterans of America, the VA Innovators Network, Veterans Integration to Academic Leadership, and the Student Veteran Leadership Group). We will conduct focus groups with the advisory panel to gain insights into the acceptability of the modified intervention. In the second (pilot) phase of the study, we will randomize 80 young veteran smokers with PTSD ages 18-39 to receive either (1) the telephone- and technology-facilitated intervention for eight weekly sessions; or (2) a standard of care control condition consisting of the proactive VA Quitline for up to eight weekly sessions. Participants in both groups will be prescribed nicotine replacement therapy using current VA treatment guidelines, based on degree of nicotine dependence and participant preference. The study aims are (1) to examine the feasibility and acceptability of the intervention in young adult veteran smokers with PTSD; (2) to examine the impact of the adapted intervention on treatment retention compared to the VA Quitline. We hypothesize that a higher proportion of the study intervention participants will complete four or more weekly sessions than control participants. As exploratory aims, we will evaluate the impact of the technology- and telephone-intervention on cigarette, e-cigarette, and smokeless tobacco use; nicotine dependence; PTSD symptom severity; and smoking cessation rates at 3 months and 6 months post-baseline. We will collaborate with the advisory panel stakeholders to disseminate results by sharing VA smoking cessation resources and study findings on the national and regional websites, email announcements, and veteran-affiliated community groups and service organizations. The study team will use knowledge gained from the study as a foundation to conduct a larger study to test the efficacy of the intervention in supporting quit attempts in young veterans with PTSD. A targeted telephone and technology intervention for smokers with PTSD would represent a paradigm shift that could overcome barriers while delivering tailored treatment that addresses the unique needs of this population.