United States Department of Veterans Affairs
 Health Care
New Online Possibilities for Quitting Smoking
A man leaning on desk
John Borlik, a Veteran and VA visual information specialist.

“If I could push a button and quit smoking, I would push it. Intellectually I want to quit. But, physiologically and psychologically, it’s much harder.”

John Borlik has smoked for 30 years and has tried to quit at least 5 times. Borlik, a veteran and visual information specialist for VA, said his attempts weren’t just running out of cigarettes and deciding to quit on a whim.

“You can get a prescription, you can get the patch, and you can into the support group — but the thing that works is a strong personal desire to quit smoking,” said Borlik.

Dr. Patrick Calhoun, a clinical psychologist at the Durham VA Medical Center, agrees that for Veterans like Borlik who want to quit, motivation is an essential factor and quitting will never be as simple as pushing a button.

But he and other researchers are exploring options that make the first step clicking a link. They have launched a new study to examine the impact and effectiveness of smokers using online tools to quit. Partnering with QuitNet, a smoking cessation website, the team is comparing the results of the online tools for smokers against traditional care offered at the Smoking Cessation clinic.

Using a database of veterans identified as smokers, the researchers send potential participants a letter. With their acceptance, researchers randomly assign participants to receive regular care or Internet care.

Options for Care

For years, Dr. Calhoun has helped Veterans try to quit smoking. For those who attend the Durham VA Medical Center’s Smoking Cessation Clinic, they have multiple treatment options. They include three 90-minute group counseling sessions, reactive and proactive telephone counseling, and letters to family members or close friends asking for social support.

While research shows that the specialty care VA offers is effective, the problem is getting Veterans to show up for the appointments.

“Attendance rates are as low as 13–14 percent for people that are referred,” said Dr. Calhoun. “From a public health perspective, in terms of the impact on the population, we’re missing the majority of smokers.”

With this four-year study, Dr. Calhoun said one of the goals is to show that care can be improved with more options to connect and assist Veterans — whether in person or online.

QuitNet offers an interactive, mobile path to quitting. The website tailors content and a realistic plan based on the Veteran’s answers to questions and level of motivation. It allows Veterans to set specific goals and target dates for quitting and provides online forums to connect with other users. There are experts available 24/7 to answer questions and provide support.

A week after starting, participants in the online therapy will receive a phone call from Dr. Calhoun’s team and have the option of receiving nicotine replacement therapy with patches or gum.

A Wider Reach

Dr. Calhoun notes that another appeal of using a website is being able to reach a younger population, particularly OEF/OIF veterans.

“There’s evidence that when you’re deployed to a war zone, smoking rates increase,” said Dr. Calhoun. “I think this is great time to catch these folks as many of them want to quit smoking.”

While the study is only in its first year, Dr. Calhoun says there’s promise in the possibilities of providing an application for smart phones and more. The results of the study could help determine whether VA could offer online smoking cessation care by partnering with a current website or creating their own.

Dr. Linda Kinsinger, VA’s Chief Consultant for Preventive Medicine, says this is something they will look at, especially as the My HealtheVet website and its users evolve. My HealtheVet is VA’s e-health website that allows veterans, active duty soldiers, dependents and caregivers to manage their health care.

“My HealtheVet is interested in new ways to be more interactive and we’re really trying to look at all the features and be more engaging with the content,” said Dr. Kinsinger.

And, ultimately, the study is about reaching more patients with care than before.

“The clinic is much more intensive so the quit rate is much higher, but at the clinic you see fewer people,” said Dr. Calhoun. “The internet is a less intensive intervention, but we’re going to reach so many more people that we’re going to have a greater impact.”

For Veterans like John Borlik, quitting and using an online alternative to do it is definitely a possibility.

“If you’ve tried other things that haven’t worked out, you might as well, and personally I would certainly give that a try.”