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J Clin Nurs. 2013 Mar;22(5-6):866-80. doi: 10.1111/j.1365-2702.2012.04188.x. Epub 2012 Aug 9.

Implementation of an inpatient smoking cessation programme in a Veterans Affairs facility.

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Cardiology Service, Jesse Brown VA Medical Center, Chicago, IL, USA.



To test the transportability and implementation of the Tobacco Tactics intervention using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, for inpatient units at the Jesse Brown Veterans Affairs Medical Center.


Smoking rates are high among veterans. While the Department of Veterans Affairs has standardised outpatient cessation clinics, inpatient cessation services, known to be efficacious, are only sporadically provided.


This was a phase 4, pre and postimplementation study of the Tobacco Tactics intervention.


A unique convenience sample of inpatient veteran smokers was recruited both before (n = 54) and after (n = 50) implementation of the Tobacco Tactics programme. Participants completed baseline and 30-day follow-up surveys along with urine cotinine test kits. In addition, staff completed anonymous surveys during the preintervention period (n = 158) and two months after (n = 81) the Tobacco Tactics training. Bivariate analyses compared preintervention vs. postintervention patient and staff characteristics using Chi-square, Fisher's Exact or Student's t-test. p-values <0·05 were considered significant.


Patient-reported receipt of services and satisfaction was 10% higher in the postintervention compared to the preintervention group. Quit rates were 3% higher in the postintervention than in the preintervention group. The mean number of cigarettes smoked per day increased from 13 to 15 in the preintervention group, while the mean number of cigarettes smoked per day decreased from 14 to 9 in the postintervention group. Staff's confidence in their ability to provide cessation services improved greatly posttraining (p = 0·0017) as did self-reported delivery of cessation services (p = 0·0154).


With as little as one-hour training for nurses, the Tobacco Tactics intervention has the potential to be widely disseminated in the Department of Veterans Affairs.


The implementation of inpatient smoking interventions has the potential to improve quit rates and decrease morbidity and mortality in the Department of Veterans Affairs.

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