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Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial.

Publication ,  Journal Article
McFall, M; Saxon, AJ; Malte, CA; Chow, B; Bailey, S; Baker, DG; Beckham, JC; Boardman, KD; Carmody, TP; Joseph, AM; Smith, MW; Shih, M-C ...
Published in: JAMA
December 8, 2010

CONTEXT: Most smokers with mental illness do not receive tobacco cessation treatment. OBJECTIVE: To determine whether integrating smoking cessation treatment into mental health care for veterans with posttraumatic stress disorder (PTSD) improves long-term smoking abstinence rates. DESIGN, SETTING, AND PATIENTS: A randomized controlled trial of 943 smokers with military-related PTSD who were recruited from outpatient PTSD clinics at 10 Veterans Affairs medical centers and followed up for 18 to 48 months between November 2004 and July 2009. INTERVENTION: Smoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians (integrated care [IC]) vs referral to Veterans Affairs smoking cessation clinics (SCC). Patients received smoking cessation treatment within 3 months of study enrollment. MAIN OUTCOME MEASURES: Smoking outcomes included 12-month bioverified prolonged abstinence (primary outcome) and 7- and 30-day point prevalence abstinence assessed at 3-month intervals. Amount of smoking cessation medications and counseling sessions delivered were tested as mediators of outcome. Posttraumatic stress disorder and depression were repeatedly assessed using the PTSD Checklist and Patient Health Questionnaire 9, respectively, to determine if IC participation or quitting smoking worsened psychiatric status. RESULTS: Integrated care was better than SCC on prolonged abstinence (8.9% vs 4.5%; adjusted odds ratio, 2.26; 95% confidence interval [CI], 1.30-3.91; P = .004). Differences between IC vs SCC were largest at 6 months for 7-day point prevalence abstinence (78/472 [16.5%] vs 34/471 [7.2%], P < .001) and remained significant at 18 months (86/472 [18.2%] vs 51/471 [10.8%], P < .001). Number of counseling sessions received and days of cessation medication used explained 39.1% of the treatment effect. Between baseline and 18 months, psychiatric status did not differ between treatment conditions. Posttraumatic stress disorder symptoms for quitters and nonquitters improved. Nonquitters worsened slightly on the Patient Health Questionnaire 9 relative to quitters (differences ranged between 0.4 and 2.1, P = .03), whose scores did not change over time. CONCLUSION: Among smokers with military-related PTSD, integrating smoking cessation treatment into mental health care compared with referral to specialized cessation treatment resulted in greater prolonged abstinence. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00118534.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 8, 2010

Volume

304

Issue

22

Start / End Page

2485 / 2493

Location

United States

Related Subject Headings

  • Veterans
  • Treatment Outcome
  • Substance-Related Disorders
  • Stress Disorders, Post-Traumatic
  • Smoking Cessation
  • Smoking
  • Middle Aged
  • Mental Health Services
  • Male
  • Humans
 

Citation

APA
Chicago
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McFall, M., Saxon, A. J., Malte, C. A., Chow, B., Bailey, S., Baker, D. G., … CSP 519 Study Team, . (2010). Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial. JAMA, 304(22), 2485–2493. https://doi.org/10.1001/jama.2010.1769
McFall, Miles, Andrew J. Saxon, Carol A. Malte, Bruce Chow, Sara Bailey, Dewleen G. Baker, Jean C. Beckham, et al. “Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial.JAMA 304, no. 22 (December 8, 2010): 2485–93. https://doi.org/10.1001/jama.2010.1769.
McFall M, Saxon AJ, Malte CA, Chow B, Bailey S, Baker DG, et al. Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial. JAMA. 2010 Dec 8;304(22):2485–93.
McFall, Miles, et al. “Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial.JAMA, vol. 304, no. 22, Dec. 2010, pp. 2485–93. Pubmed, doi:10.1001/jama.2010.1769.
McFall M, Saxon AJ, Malte CA, Chow B, Bailey S, Baker DG, Beckham JC, Boardman KD, Carmody TP, Joseph AM, Smith MW, Shih M-C, Lu Y, Holodniy M, Lavori PW, CSP 519 Study Team. Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial. JAMA. 2010 Dec 8;304(22):2485–2493.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 8, 2010

Volume

304

Issue

22

Start / End Page

2485 / 2493

Location

United States

Related Subject Headings

  • Veterans
  • Treatment Outcome
  • Substance-Related Disorders
  • Stress Disorders, Post-Traumatic
  • Smoking Cessation
  • Smoking
  • Middle Aged
  • Mental Health Services
  • Male
  • Humans