All Vets Aren’t Treated Equally When It Comes to Smoking Cessation

A majority of patients with psychiatric disorders served by the Department of Veterans Affairs (VA) reported receiving smoking-cessation services, yet their smoking rates remained high.

Certain patient subgroups, however, were at risk for receiving fewer smoking-cessation services, suggesting that more education about these services needs to be done.

Those were findings from a study published in the April Psychiatric Services assessing use and outcome of smoking-cessation services among veterans with mental illness.

In the study, researchers at the Veterans Affairs Ann Arbor Center for Clinical Management Research and the departments of psychiatry at the University of Michigan and University of Colorado schools of medicine conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients.

Patients with psychiatric disorders had greater odds of smoking, compared with veterans without such disorders. Those with schizophrenia, bipolar disorder, or unipolar depression had, respectively, a 1.8, 1.5, and 1.2 greater odds of being a current smoker than those without a mental disorder, while veterans with a substance use disorder had a 2.6 greater odds of being a smoker.

Between 60 percent and 80 percent of VA patients with mental illness reported receiving some kind of smoking-cessation services through a physician who advised quitting, recommended medication, or discussed methods for quitting. But patients with schizophrenia had more than 30 percent lower odds of receiving advice on quitting smoking from their physicians.

In addition, those diagnosed with posttraumatic stress disorder (PTSD) or a substance use disorder had significantly greater odds of reporting that they received advice to quit, recommendations for medications, or physician discussions of quitting methods, compared with those without one of these two disorders.

“Several programs are currently being implemented in the VA to assist veterans with smoking cessation, including telephone counseling implementation of a nurse-administered Tobacco Tactics intervention for all inpatient smokers, and smoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians,” the researchers indicated.

“Moreover, the VA has implemented practices to change the culture of smoking in VA hospitals. Indoor smoke-free policies have been in effect since 1992, and most VA facilities have discontinued the practice of selling cigarettes. Although most VA facilities have offered behavioral counseling to employees who smoke, a recent 2010 VA directive made it possible to offer free, over-the-counter nicotine replacement therapy to employees who smoke. These cultural changes, along with continued efforts to improve implementation of smoking cessation interventions for at-risk veterans, have the potential to decrease smoking rates and reduce smoking-related morbidity and mortality among veterans.”

In an editorial accompanying the article, Seth Himmelhoch, M.D., M.P.H., a psychiatrist and associate professor at the University of Maryland School of Medicine, said that health care clinicians must come to terms with the fact that smoking has reached epidemic proportions among their patients. “They must recognize that there is a clear confluence of evidence and policy that makes smoking-cessation interventions affordable, accessible, and effective for their patients who smoke,” he wrote. “The risk associated with maintaining the status quo is no longer acceptable, and bold steps are needed to ensure that smoking-cessation interventions are consistently provided to patients with mental illness who smoke. The lives of our patients depend on it.”

“Risk of Smoking and Receipt of Cessation Services Among Veterans With Mental Disorders” is posted at http://ps.psychiatryonline.org/article.aspx?articleid=564841.