# Identifying Effective Treatment for Veterans Unwilling to Quit Smoking

> **NIH VA I01** · WM S. MIDDLETON MEMORIAL VETERANS HOSP · 2021 · —

## Abstract

Aims and Rationale: Tobacco use is the leading preventable cause of premature death in the United States.
Veterans smoke at a higher rate than the U.S. population (21.6% vs. 15%), and therefore suffer
disproportionately from smoking–related illness. To reduce the enormous health and economic harms of
smoking amongst Veterans, we need a comprehensive approach to engage all Veterans who smoke in
treatment that effectively helps them stop smoking. Unfortunately, most smokers are unwilling to make a quit
attempt at any given time (70%-90%), and we know little about how to effectively engage such smokers in
treatment and help them quit. The standard recommended intervention for such smokers, brief advice to quit,
is far too minimal to mobilize most smokers to make an aided quit attempt. Thus, a critical public health
challenge is to identify successful interventions that motivate smokers to make quit attempts and improve their
likelihood of success when they try. The proposed research will address gaps in smoking treatment by
evaluating Enhanced Chronic Care, an intervention designed to increase treatment engagement and
abstinence amongst Veterans initially unwilling to quit smoking. Enhanced Chronic Care provides ongoing
motivational interventions and interpersonal support designed to promote readiness to change, with facilitated
access to both smoking reduction and cessation treatments that are appropriate for all smokers (both those
willing and unwilling to make quit attempts). Reduction treatment is a notable addition to chronic care since it
can increase the proportion of smokers who enter smoking treatment, and increase quit attempts and
abstinence amongst smokers initially unwilling to quit. Enhanced Chronic Care will be compared with Standard
Care (brief advice to quit once per year) on criteria that are of great clinical and public health importance: long-
term abstinence (primary outcome), treatment reach, cost-effectiveness, and implementation. Such
comprehensive data will permit identification of an optimal smoking treatment strategy for VA clinical practice.
Methods: We will evaluate these interventions using a rigorous 2-arm randomized controlled trial (RCT).
Veterans who smoke daily, but who are not willing to enter smoking cessation treatment (the vast majority of
smokers), will be eligible to participate, with no obligation to quit or reduce their smoking. Participants (N=500)
will be randomized to one of the following treatments: 1) Enhanced Chronic Care (n=250) or 2) Standard Care
(n=250). These intervention conditions will last 2 years to permit analysis of their cumulative impact on
abstinence (primary outcome) and treatment use, and to gather information on factors, including cost-
effectiveness, that could affect the implementation and effectiveness of Enhanced Chronic Care.
Innovation/Significance: This research is highly innovative in that it will be the first study to experimentally
evaluate chronic care for smokers who are u...

## Key facts

- **NIH application ID:** 10041702
- **Project number:** 5I01CX001836-02
- **Recipient organization:** WM S. MIDDLETON MEMORIAL VETERANS HOSP
- **Principal Investigator:** Jessica Megan Cook
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10041702

## Citation

> US National Institutes of Health, RePORTER application 10041702, Identifying Effective Treatment for Veterans Unwilling to Quit Smoking (5I01CX001836-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10041702. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*