The author presented findings from a study that aimed to determine the prevalence of smoking among Veterans with major depression in primary care and to identify demographic, psychiatric, psychosocial, and health care use correlates of smoking status

Campbell, Duncan

Chaney, Edmund F.

Harris, Kari J.

Lanto, Andrew B.

Lombardero, Anayansi

Rubenstein, Lisa V.

English

University of Montana

University of Montana ScholarWorks at University of Montana UM Graduate Student Research Conference (GradCon) Apr 13th, 3:30 PM - 3:50 PM Prevalence and Correlates of Smoking Status among Patients with Depression in VA Primary Care Anayansi Lombardero University of Montana - Missoula, anayansi.lombardero@umontana.edu Duncan Campbell University of Montana - Missoula, Duncan.Campbell@mso.umt.edu Kari J. Harris Edmund F. Chaney Andrew B. Lanto See next page for additional authors Follow this and additional works at: https://scholarworks.umt.edu/gsrc Let us know how access to this document benefits you. Lombardero, Anayansi; Campbell, Duncan; Harris, Kari J.; Chaney, Edmund F.; Lanto, Andrew B.; and Rubenstein, Lisa V., "Prevalence and Correlates of Smoking Status among Patients with Depression in VA Primary Care" (2013). UM Graduate Student Research Conference (GradCon). 4. https://scholarworks.umt.edu/gsrc/2013/paperpres3a/4 This Oral Presentation is brought to you for free and open access by ScholarWorks at University of Montana. It has been accepted for inclusion in UM Graduate Student Research Conference (GradCon) by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact scholarworks@mso.umt.edu. Authors' Names Anayansi Lombardero, Duncan Campbell, Kari J. Harris, Edmund F. Chaney, Andrew B. Lanto, and Lisa V. Rubenstein This oral presentation is available at ScholarWorks at University of Montana: https://scholarworks.umt.edu/gsrc/2013/paperpres3a/4 1 Prevalence and Correlates of Smoking Status among Individuals with Depression in Veterans Affairs Primary Care  Anayansi Lombardero The University of Montana April  2013  This project was funded by the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service and the Quality Enhancement Research Initiative (QUERI) (Project nos. MHI 99-375, MNT 01-027, MHQ 10-06).   This project was funded by the Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service and the Quality Enhancement Research Initiative (QUERI) (Project nos. MHI 99-375, MNT 01-027, MHQ 10-06). Overview • Background: Smoking and mental illness  • Smoking and mental illness among Veterans • Research Questions: What do they look like? Are their needs being met?  • Results: Bivariate and multivariate analyses • Discussion 2 3 050100150200250300350400450COMPARATIVE CAUSES of ANNUAL DEATHS in the UNITED STATES Source: CDC              AIDS     Obesity   Alcohol    Motor   Homicide    Drug     Suicide   Smoking                                                             Vehicle                   Induced Individuals with mental illness or substance use disorders • Prevalence of smoking among US military Veterans  • Depression and PTSD most common mental health diagnoses among Veterans2 • Chronic mental illness and smoking  Morbidity and mortality3 • Smoking cessation in VA  4 5 Study Aims 1. To determine the prevalence of smoking among Veterans with major depression in primary care 2. To identify demographic, psychiatric, psychosocial, and health care use correlates of smoking status 6 Hypotheses Depressed smokers will differ from depressed nonsmokers: – Higher degrees of psychiatric illness – Different patterns of health care use  7 Methods • Data Analysis of longitudinal study -- Well-Being Among Veterans Enhancement Study (WAVES), a site randomized test of depression collaborative care.  8 9 Measures Smoking and Demographics • Cigarette Smoking: (2 items) a. 100 cigarettes smoked in a lifetime and b. Current smoking status.   • Demographic characteristics: Gender, age, ethnicity, level of education, relationship status, and current employment status.   10 Mental Health • Depressive symptomatology: PHQ-94 • Alcohol consumption: AUDIT-C5  • Posttraumatic Stress Disorder: PC-PTSD6 • Suicidality: A single item from the PHQ-9 11 Psychosocial  Social support: Eight items from the Medical Outcomes Study Social Support Scale.7 Health and Health Care Utilization • Self-reported health care utilization: Participants reported the frequency of medical care for physical and emotional problems used in the previous six months.  • Amenability to depression treatment:  • Currently in need of depression treatment? • Accept a diagnosis of depression? • Accept depression treatment?   12 13 Results .  Participant Demographics • Mean age = 60 (SD=12). 94% were male, 85.3% Caucasian, 49.4% had less than a high school education, and 60.1% were married. Smoking Rates • 39.8% reported current smoking, and 81.6% reported lifetime smoking (>100 cigarettes). Only 7 (.95) smokers had quit at 6 months, and 16 (2.1%) had quit at 18 months.   Results • Bivariate Comparisons – Demographics – Psychiatric and psychosocial measures – Health utilization patterns • Multivariate Analysis – Variables of statistical and theoretical significance 14 Bivariate Analyses Smokers were more likely to be younger (p<.001), less likely to be married (p<.001) , and more likely to be employed (p=.020).  Smokers also:  Had higher depressive symptomatology (p=.023)  More likely to screen positive for comorbid PTSD (p<.001)   More likely to drink heavily (p <.001)  Less social support (p<.001) 15 16    Bivariate Analyses (cont.)       Health care utilization patterns for smokers:  Higher numbers of hospitalizations for an emotional problem (1.1 vs. 0.4, p =.05)   More likely to have visited a mental health specialist (51.7% vs. 40.8%, p = .003)   More likely to have missed a healthcare appointment   and to have missed medication doses (38.3% vs. 30.3%, p = .02)  More amenable to depression treatment (1.95 vs. 2.3, p<.001)  Bivariate Analyses (cont.)   No significant differences:  Presence of suicidal ideation  17 Multivariate Analyses  18 Concurrent Prediction of Smoking Status (smoker versus nonsmoker) among Veterans with Depression  (n= 761). Discussion & Implications • High smoking rates and low likelihood of quitting. Patients’ health likely to continue to deteriorate • More negative psychiatric and psychosocial characteristics  • Higher number of emotional problem hospital admissions, more mental health specialist visits, and higher alcohol consumption 19 • Intervention efforts in this regard show promise, but:  – Limited research – Integrated tobacco cessation treatment in all three settings – Lower cessation rates than general population in some cases8  20 Limitations and Future Directions • Cross-sectional data, homogeneous sample • Restriction of range in depression scores • Smoking measures • Unique population with unmet needs -- More comprehensive , integrated care in primary care, mental health settings, and substance abuse treatment settings   21 References 1.Centers for Disease Control and Prevention (2008). Smoking attributable mortality, years of  potential life lost, and productivity losses—United States, 2000-2004. Morbidity and  Mortality Weekly Report 45:1226- 28  2. Brancu, M., Straits-Troster, Harold Kudler (2011). Behavioral health conditions among military personnel and veterans: Prevalence and best practices for treatment. NC Med J.; 72(1):54-60  3. Schroeder, S. A., & Morris, C. D. (2010). Confronting a neglected epidemic: Tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health, 31, 297-314.   4. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. The PHQ-9. JGIM. 2001;16:606-13  5. Bush, K., Kivlahan, D. R., McDonel,l M. B., Fihn, S. D, & Bradley, K. A. (1998). The AUDIT Alcohol CosumptionQuestions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 158:1789—95.  6. Prins, A., Ouimette, P., Kimmerling, R., Cameron, Hugelshofer, Shaw-Hegwe, Thraiilkill, Gusman, & Sheikh (2003) The primary care PTSD screen (PC-PTSD): development and operating characteristics. Prim Care Psychiatry. ;9:9—14  7. Sherbourne, C. D, & Stewart, A. L. (1991). The MOS social support survey. Soc Sci Med, 32:705—14.   8. Lancaster T, Stead LF. Individual behavioral counseling for smoking cessation. Cochrane Database Syst Rev. 2005;(2):CD001292  22 Acknowledgements  Duncan Campbell Kari Harris Cameo Borntrager  Laura Boucher Patty O’Brien Graham Payton Patrick Morrison  Kelsey Swingle Dilsa Morris Rosa Leon Leslie Croot Sidney Shaw   23 QUESTIONS? 24 

Prevalence and Correlates of Smoking Status among Patients with Depression in VA Primary Care

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Prevalence and Correlates of Smoking Status among Patients with Depression in VA Primary Care

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