Skip to content


Tobacco Induced Diseases

Open Access

Effectiveness of the Tobacco Tactics program in the Department of Veterans Affairs

  • Sonia A Duffy1, 2, 3, 4Email author,
  • David Ronis2,
  • Carrie A Karvonen-Gutierrez1,
  • Lee A Ewing1,
  • Gregory W Dalack4,
  • Patricia M Smith5,
  • Timothy P Carmody6,
  • Thomas Hicks7,
  • Christopher Hermann8,
  • Pamela Reeves8 and
  • Petra Flanagan9
Tobacco Induced Diseases201412(Suppl 1):A12

Published: 6 June 2014


CotinineUrinary CotinineSmoking Cessation ServiceLine CardVeteran Affair Hospital


Smoking cessation interventions during hospitalization have been shown to be efficacious, yet are rarely incorporated into practice. The purpose of this study was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs (VA) hospitals.

Materials and methods

In this quasi-experimental pre- post- comparison effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in the Ann Arbor, MI and Detroit, MI VA hospitals, while the Indianapolis, IN VA hospital was the control site (N=1,070). The Tobacco Tactics nurse toolkit included: 1) one contact hour for training; 2) a PowerPoint presentation on behavioral and pharmaceutical interventions; 3) a pocket card “Helping Smokers Quit: A Guide for Clinicians”; 4) pharmaceutical and behavioral protocols; and 5) a computerized template for nurse documentation. The patient toolkit included: 1) a brochure; 2) a videotape “Smoking: Getting Ready to Quit;” 3) a Tobacco Tactics manual; 4) pharmaceuticals; 5) a 1-800-QUIT-NOW help line card; and 6) post-discharge telephone calls. Smoking patients were surveyed in the hospital and again six-months post-discharge. Urinary cotinine tests were used to verify six-month smoking status.


The average age was 55.3 years, most were male (94%) and not married (76%). After adjustment for the propensity of being assigned to treatment condition, 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 the Indianapolis control site. The intervention was particularly effective in Detroit where pre-intervention quit rates were 4% compared to 13% post-intervention.


This study showed that training staff nurses to integrate smoking cessation services into their routine care may increase quit rates. The Tobacco Tactics program, which meets the newly released (2011) Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among patients admitted to VA hospitals.



Funding was supported by the Department of Veterans Affairs Service Directed Project (SDP 06-003).

Authors’ Affiliations

Ann Arbor VA Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, USA
School of Nursing, University of Michigan, Ann Arbor, USA
Department of Otolaryngology, University of Michigan, Ann Arbor, USA
Department of Psychiatry, University of Michigan, Ann Arbor, USA
Northern Ontario School of Medicine, Lakehead University, Sudbury, Canada
San Francisco VA Medical Center, San Francisco, USA
Richard L. Roudebush VA Medical Center, Indianapolis, USA
John D. Dingell VA Medical Center, Detroit, USA
VA Ann Arbor Healthcare System, Ann Arbor, USA


© Duffy et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.