Original Article

Journal of General Internal Medicine

, Volume 25, Supplement 1, pp 3-10

First online:

Implementation of the Tobacco Tactics Program in the Department of Veterans Affairs

  • Sonia A. DuffyAffiliated withAnn Arbor VA Center for Clinical Management Research (11H)School of Nursing, Departments of Otolaryngology and Psychiatry, , University of Michigan Email author 
  • , Carrie A. Karvonen-GutierrezAffiliated withAnn Arbor VA Center for Clinical Management Research (11H)
  • , Lee A. EwingAffiliated withAnn Arbor VA Center for Clinical Management Research (11H)
  • , Patricia M. SmithAffiliated withNorthern Ontario School of Medicine, Human Sciences Division
  • , Veterans Integrated Services Network (VISN) 11 Tobacco Tactics Team

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Smoking cessation services in the Department of Veterans Affairs (VA) are currently provided via outpatient groups, while inpatient cessation programs have not been widely implemented.


The objective of this paper is to describe the implementation of the Tobacco Tactics program for inpatients in the VA.


This is a pre-/post-non-randomized control study initially designed to teach inpatient staff nurses on general medical units in the Ann Arbor and Detroit VAs to deliver the Tobacco Tactics intervention using Indianapolis as a control group. Coupled with cessation medication sign-off, physicians are reminded to give patients brief advice to quit.


Approximately 96% (210/219) of inpatient nurses in the Ann Arbor, MI site and 57% (159/279) in the Detroit, MI site have been trained, with an additional 282 non-targeted personnel spontaneously attending. Nurses’ self-reported administration of cessation services increased from 57% pre-training to 86% post-training (p = 0.0002). Physician advice to quit smoking ranged between 73–85% in both the pre-intervention and post-intervention period in both the experimental and control group. Volunteers made follow-up telephone calls to 85% (n = 230) of participants in the Ann Arbor site. Hospitalized smokers (N = 294) in the intervention group are reporting an increase in receiving and satisfaction with the selected cessation services following implementation of the program, particularly in regards to medications (p < 0.05).


A large proportion of inpatient nursing staff can rapidly be trained to deliver tobacco cessation interventions to inpatients resulting in increased provision of services.


implementation research smoking cessation veterans