Background: Enhancing access and use of evidence-based tobacco cessation treatments and
eliminating tobacco-related health disparities are top national and VA health services
priorities. The prevalence of tobacco use is greater among Veterans compared to
non-Veterans. From 2010-2015, 29% of women and 21% of male Veterans reported current
cigarette smoking. Evidence-based cessation treatments (EBCTs) such as, tobacco
quitlines, behavioral counseling, and pharmacotherapy, are greatly underutilized by
Veteran smokers. Gaps remain in reaching women Veterans and use of existing social
support networks to enhance use of EBCTs and cessation among Veterans.
Specific Aims. Aim 1: To evaluate the impact of the social support intervention on
Veteran smokers' use of EBCT. Aim 2: To examine the effectiveness of the social support
intervention on the biochemically confirmed 7-day point prevalence cigarette smoking
abstinence. Aim 3: To explore potential moderators (e.g., smoker gender, SP tobacco use
status) of intervention effects on study outcomes. Aim 4: To conduct a process evaluation
assessing implementation outcomes (reach, adoption, fidelity) of the social support
intervention and multilevel factors that may influence implementation.
Methods: The investigators will conduct a pragmatic randomized controlled trial (RCT)
within the national VHA health system to evaluate the effectiveness of a social support
intervention compared with a control condition on utilization of EBCT among VHA-enrolled
smokers. Veteran smokers, regardless of level of readiness to quit, will be identified
nationally using the VHA electronic health record and proactively recruited. Interested
smokers will be asked to identify a support person (SP) who will enroll. Participants
will be randomized as smoker-SP dyads to the intervention (n= 594 dyads) or control
condition (n= 594 dyads). All smokers will receive written resources and information on
EBCTs. All SP participants will receive written materials. SP participants assigned to
the intervention group will additionally receive a 1-call coaching session. Assessments
for dyads in both study groups will be conducted at baseline, 3-, and 6-months
post-randomization.
Innovation and Impact: This project is innovative for evaluating social support networks
as a proactive outreach approach to enhance cessation treatment utilization among Veteran
smokers. The role of social network influences and social support on successful smoking
cessation is established. Based on Cohen's theory of social support, the team developed a
social support intervention for diverse family members, friends, and other adults who
wanted to help a smoker quit. The intervention consists of written materials and a
1-call, 15-25 minute coaching session. It is expected to be especially beneficial for
Veteran smokers who might not otherwise access cessation treatment. Because the prior VHA
trials enrolled about 94% men and the higher smoking rates among women, the investigators
will oversample women to enroll an equal number of men and women smokers. This study
contributes to VA HSR&D's priority initiatives for enhancing treatment access and women's
health and is significant because it will advance research on the role of partnering with
Veterans' families and/or important others to enhance access to VA healthcare and
population-specific treatments, especially women Veterans. The potential reach and public
health impact of an effective social support intervention for the Veteran tobacco user
population is considerable.
Implementation/Next Steps: Next steps depend on the actual results, but the investigators
expect findings to be important to VA leaders, the VA Women's Health Research Consortium
and the Veteran community. The investigators will maintain communication throughout the
project with VA program partners to share findings in a timely manner. The investigators
will collaborate with CCDOR's Veteran Engagement Panel on development of patient-centered
dissemination approaches and recommendations for future intervention adaptations and/or
implementation.