The Role of Whole Health in Enhancing Tobacco Cessation Outcomes for Veterans: A Retrospective Cohort Study.

BACKGROUND

Veterans Health Administration (VHA) has been implementing Whole Health, a patient-centered model of healthcare which emphasizes supporting and empowering patients to take charge of their health and well-being. However, its impact upon tobacco cessation has not been investigated previously.

OBJECTIVE

To conduct a program evaluation of the real-world impact of offering Whole Health services to veterans who are current tobacco users on subsequent tobacco cessation rates and utilization of cessation medications.

DESIGN

This retrospective study identified current tobacco users initiating four types of Whole Health services with potential indications for tobacco cessation. Nearest neighbor propensity score matching was used to identify comparison groups of similar patients engaged in VHA care without exposure to these services.

PARTICIPANTS

VHA patients who utilized at least 1 of the services between 10/1/2016 and 3/1/2023 and were current tobacco users at the time of initial utilization (n = 37,311), and matched comparison patients.

INTERVENTIONS: Whole Health services included three complementary and integrative health (CIH) therapies - mindfulness meditation, acupuncture, and clinical hypnosis - and Whole Health coaching.

MAIN MEASURES: Thirteenth-month sustained tobacco cessation documented in the medical record and cessation medication use within 6 and 12 months of cohort entry.

KEY

RESULTS

Veterans who used meditation (HR = 1.25, 95% CI [1.13, 1.39]), acupuncture (HR = 1.14, 95% CI [1.09, 1.18]), and Whole Health coaching (HR = 1.18, 95% CI [1.08, 1.28]) had higher rates of sustained cessation compared with matched comparison patients. A non-significant association between clinical hypnosis and sustained cessation (HR = 1.12, 95% CI [0.83, 1.50]) was observed. Meditation, clinical hypnosis, and Whole Health coaching were associated with higher cessation medication use, while acupuncture was associated with lower use.

CONCLUSIONS

This study suggests that Whole Health services offered by VHA including meditation, acupuncture, clinical hypnosis, and Whole Health coaching may be an effective means of empowering veterans to reduce their tobacco utilization.