Prevalence and Correlates of Smoking Status Among Veterans Affairs Primary Care Patients with Probable Major Depressive Disorder

Published in: Addictive Behaviors, v. 39, no. 3, Mar. 2014, p. 538-545

Posted on RAND.org on February 13, 2014

by Anayansi Lombardero, Duncan G. Campbell, Kari J. Harris, Edmund Chaney, Andrew B. Lanto, Lisa V. Rubenstein

Read More

Access further information on this document at Addictive Behaviors

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Questions

  1. How prevalent is smoking among VA primary care patients with major depression?
  2. Do these patients have other characteristics that could complicate success for smoking cessation programs?

In an attempt to guide planning and optimize outcomes for population-specific smoking cessation efforts, the present study examined smoking prevalence and the demographic, clinical and psychosocial characteristics associated with smoking among a sample of Veterans Affairs primary care patients with probable major depression. Survey data were collected between 2003 and 2004 from 761 patients with probable major depression who attended one of 10 geographically dispersed VA primary care clinics. Current smoking prevalence was 39.8%. Relative to nonsmokers with probable major depression, bivariate comparisons revealed that current smokers had higher depression severity, drank more heavily, and were more likely to have comorbid PTSD. Smokers with probable major depression were also more likely than nonsmokers with probable major depression to have missed a health care appointment and to have missed medication doses in the previous 5 months. Smokers were more amenable than non-smokers to depression treatment and diagnosis, and they reported more frequent visits to a mental health specialist and less social support. Alcohol abuse and low levels of social support were significant concurrent predictors of smoking status in controlled multivariable logistic regression. In conclusion, smoking prevalence was high among primary care patients with probable major depression, and these smokers reported a range of psychiatric and psychosocial characteristics with potential to complicate systems-level smoking cessation interventions.

Key Findings

  • VA primary care patients with major depression have double the rates of smoking found in the general population.
  • These smokers have other mental health and psychosocial problems—including alcohol abuse and low levels of social support—that planners need to account for when designing smoking cessation programs.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.