Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Community and Behavioral Health, University of Iowa College of Public Health, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America.
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America; Department of Behavioral Sciences and Social Medicine, Florida State University, United States of America; Florida Blue Center for Rural Health Research & Policy, United States of America.
J Subst Use Addict Treat. 2024 Jan;156:209191. doi: 10.1016/j.josat.2023.209191. Epub 2023 Oct 20.
Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain.
The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months.
Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting.
A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.
农村地区居民的吸烟率仍然居高不下。抑郁症状、危险的酒精使用和体重问题常常伴随着吸烟，可能会对戒烟产生不利影响。同时解决这些问题的烟草使用治疗是否会影响戒烟结果尚不确定。
该研究是一项多中心、两组、随机对照试验，涉及主要来自农村地区的退伍军人（N=358），他们在五个退伍军人事务医疗中心之一接受治疗。研究将参与者随机分配到定制电话咨询干预组或转介到他们所在州的戒烟热线。两组都接受了指南推荐的戒烟药物治疗，这些治疗是通过共同决策方法选择的。主要结局是三个月和六个月时自我报告的七天点流行率戒烟率（PPA）。该研究使用唾液可替宁来验证六个月时的自我报告戒烟率。
自我报告的 PPA 在接受定制咨询的参与者中在三个月时显著更高（OR=1.66；95%CI：1.07-2.58），但在六个月时没有（OR=1.35；95%CI：0.85-2.15）。基于参与者是否有升高的抑郁症状、危险的酒精使用和/或对体重增加的担忧的阳性筛查，对治疗组差异进行了事后亚组分析，结果表明，在三个月时定制咨询对戒烟的益处仅限于有≥1 个伴随问题的参与者（OR=2.02；95%CI：1.20-3.42）。生化验证表明报告错误的比例较低。
针对伴随风险因素的定制戒烟干预措施增强了短期戒烟效果，但并未显著提高长期戒烟率。延长治疗时间可能是维持治疗效果所必需的。
