Tobacco Cessation for Veterans With Post Traumatic Stress Disorder (PTSD)

• Self-reported Quit Attempts - The primary outcome is the proportion of veteran's who make a self-reported quit attempt (as defined as a 24-hour point prevalence rate). [ Time Frame: Month 3 and Month 9 ] [ Designated as safety issue: No ]
  

• Self-reported Quit Attempts - Secondary outcomes include: progress in the stages of change as measured by the TTM Stages of Change (short form) questionnaire. This will identify current stage of change for each subject. A seven-day point prevalence [ Time Frame: Month 3 and Month 9 ] [ Designated as safety issue: No ]
  
• Care Coordination: The primary outcome is the veteran's perception of care coordination as measured by the Patient Assessment of Chronic Illness Care (PACIC) [ Time Frame: Month 3 and Month 9 ] [ Designated as safety issue: No ]
  
• Care Coordination: Secondary outcomes include: patient satisfaction surveys regarding MI counseling and Smoking Cessation content [ Time Frame: Month 3 and Month 9 ] [ Designated as safety issue: No ]
  
• PTSD Symptoms: The primary outcome is the level of symptoms related to PTSD [ Time Frame: Month 3 and Month 9 ] [ Designated as safety issue: No ]
  
• PTSD Symptoms secondary outcomes include: Geriatric depression Scale, Suicide Risk, McGill Short Form Pain Questionnaire, SF-12v2 [ Time Frame: Month 3 and Month 9 ] [ Designated as safety issue: No ]
  

Background: Veterans smoke at a higher rate (30%) than the U.S. adult population (21%), and veterans with PTSD have even higher rates of smoking (53-66%). Evidence has shown that any tobacco dependence treatment strategy must be integrated in the health care system because consistent and effective delivery of tobacco cessation requires coordinated interventions. Persistent tobacco users typically cycle through multiple periods of relapse and remission. Veterans with PTSD (279,256 in 2005) who are treated for smoking cessation may need more comprehensive aid to be successful. Failure to appreciate the chronic nature of tobacco dependence may impede comprehensive and consistent treatment. Care management using telehealth has been shown to improve access to care while reducing costs for veterans with chronic diseases and has the potential to coordinate smoking cessation with care for other chronic diseases. Nurses have successfully managed chronic diseases using telehealth by focusing on increasing self-management, positive behaviors and knowledge. Nurses are vital to increasing the level of support in the community through education and motivation and by responding to medical events in order to improve veterans' health.

Objectives: The study is designed to determine if adding motivational counseling and care management using the PTSD Health Buddy to usual care improves smoking quit rates of veterans with PTSD. Specific Aims are to compare: 1) self-reported quit attempts, progression through the stages of change, and quit rates, 2) patient perception of care coordination, and 3) changes in PTSD symptoms in veteran smokers with PTSD who receive a nurse-driven telephonic motivational counseling intervention triggered by responses to stage-based smoking cessation questions in addition to usual care to those who receive usual care only.