Effectiveness of the tobacco tactics program in the Department of Veterans Affairs.

PURPOSE: The purpose was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs hospitals. METHODS: In this effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in Ann Arbor and Detroit, while Indianapolis was the control site (N = 1,070). Smokers were surveyed and given cotinine tests. The components of the intervention included nurse counseling, brochure, DVD, manual, pharmaceuticals, 1-800-QUIT-NOW card, and post-discharge telephone calls. RESULTS: There were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p = 0.004) and Detroit (p < 0.001) compared to Indianapolis. Pre- versus post-intervention quit rates were 4 % compared to 13 % in Detroit, were similar (6 %) pre- and post-intervention in Ann Arbor, and dropped from 26 % to 12 % in Indianapolis. CONCLUSION: The Tobacco Tactics program, which meets the Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among Veterans.

The development of the tobacco tactics website.

BACKGROUND: Web-based cessation interventions have been shown to reduce tobacco use, be more efficacious than self-help booklets, be more efficacious if they provide tailored messages, and enhance quit rates in conjunction with nicotine replacement therapy. OBJECTIVE: The objective of this study was to usability test and pilot test the Tobacco Tactics website for veterans. METHODS: Both formative and summative evaluations were used across three small successive studies to develop and test the Tobacco Tactics website for veterans, which was based on a prior face-to-face smoking cessation intervention. Once the website was developed, the research team and Web developers usability tested the website with 5 veteran smokers and former smokers. Feedback from the veterans was collected as they navigated each webpage, then used to revise the website. In pilot study 1, 9 veteran smokers were provided access to the website, and given a baseline and 30-day follow-up survey. In pilot study 2, 18 veteran smokers, who were also motivated to quit smoking, were recruited and randomized to either the Tobacco Tactics website plus nicotine replacement therapy or to the 1-800-QUIT-NOW telephone line. RESULTS: As a result of usability testing, more than 27 modifications were made to improve the website. In pilot study 1, 50% (3/6) veterans who entered the website had cut down on the number of cigarettes and 83% (5/6) found the website enjoyable, easy to read, easy to navigate, and would recommend the website to others. In pilot study 2, which included only smokers motivated to quit and also offered nicotine replacement therapy, seven-day point prevalence abstinence at 30-day follow-up was 40% (4/10) in the intervention group compared to 13% (1/8) in the control group. CONCLUSIONS: These preliminary results are promising and suggest the need for wider-scale testing of the Tobacco Tactics website for veterans.

Employee attitudes about moving toward a smoke-free campus at a Veterans Affairs hospital.

BACKGROUND: Although Veterans Affairs (VA) hospitals have been smoke-free inside of buildings since 1991, smoke-free campuses have not been initiated. The purpose of this article is to describe staff attitudes regarding making the VA hospital a smoke-free campus except for the mandated smoking shelters. METHODS: In 2008, a cross-sectional, anonymous survey was conducted with a convenience sample of employees at a Midwestern VA (N = 397). RESULTS: Descriptive statistics showed that the vast number of employees were in support of a smoke-free campus (76%), relocating the smoking shelters (62%), and offering employees assistance to quit smoking (71%). Multivariate analyses showed that those who were nonsmokers, older, women, and higher educated were the greatest supporters of policies to support a smoke-free environment (p < .05). Write-in comments were generally favorable but also revealed employee resistance related to freedom, personal choice, and potential loss in productivity as smokers go further away from the building to smoke. CONCLUSIONS: VA hospitals have unique challenges in implementing smoke-free campus policies.

Safety of outpatient dalteparin therapy in veterans with mechanical heart valves.

STUDY OBJECTIVES: To determine the rate of bleeding and thromboembolic events within 1 month of outpatient dalteparin therapy in veterans with mechanical heart valves, to evaluate potential risk factors associated with these events, and to examine the prescribing patterns of dalteparin in this patient population. DESIGN: Single-center retrospective electronic chart review. SETTING: Large, academically affiliated Veterans Affairs hospital. SUBJECTS: Thirty-eight men with mechanical heart valves who received outpatient prescriptions for dalteparin from October 1, 1998-June 30, 2003. MEASUREMENTS AND MAIN RESULTS: Charts were reviewed for thromboembolic and bleeding events. Demographic, clinical, and drug utilization variables were assessed. The associations of adverse events with potential risk factors, indication for dalteparin therapy, and prescribing clinic were analyzed. Sixty-four dalteparin regimens were evaluated. No thromboembolic events were reported in any case within 1 month after receiving dalteparin for thromboembolic prophylaxis during warfarin interruption for periprocedural anticoagulation or for anticoagulation during an unintentional subtherapeutic international normalized ratio. Bleeding events occurred in 15 (23%) of the 64 regimens. Most bleeding events resolved spontaneously and without intervention. No potential risk factors for bleeding were identified. CONCLUSION: Dalteparin appeared to be a safe, effective means of short-term thromboembolic prophylaxis in this population of ambulatory male veterans with mechanical heart valves. Large, randomized, controlled, prospective trials are warranted.