Skip to main content Accessibility help

A Learning Collaborative Model for Implementation of Smoking Cessation among Homeless Veterans

  • Jean C. Beckham (a1) (a2) (a3), Angela C. Kirby (a1) (a2), Nick Tise (a4), Vickie L. Carpenter (a1), Eric A. Dedert (a1) (a2) (a3), J. Murray McNiel (a1) (a3), Jennifer J. Runnals (a1) (a2) and Patrick S. Calhoun (a1) (a2) (a3) (a5)...


We evaluated the feasibility of incorporating integrated care (IC) for smoking cessation into routine care for homeless veterans at seven Department of Veterans Affairs (VA) Medical Centers and the utility of the learning collaborative (LC) model in facilitating implementation. The goal of IC is for clinicians to provide smoking cessation concurrent with other clinical duties. The LC model utilises multidisciplinary teams and recognised field experts to develop methods for accelerating the use of evidence-based treatments. Multidisciplinary teams comprising 34 (of about 175) staff members from seven VA homeless provider teams participated. Via self-report questionnaires, we assessed providers’ perceptions of the LC and the number of providers delivering IC. Nineteen of thirty-four providers (54%) reported delivering IC at the end of training and at 10-months. Providers rated the face-to-face trainings and collaborative team trainings as the most helpful LC components. Barriers to the use of the LC included lack of leadership support and the lack of ability to electronically track progress through the electronic medical record. Additional research, quality improvement, and policy changes at higher administrative levels are needed to identify methods to sustain the use of LC among providers serving homeless veterans.


Corresponding author

Address for correspondence: Jean Beckham, Ph.D., Durham Veterans Affairs Medical Center, 508 Fulton St. (Building 16, Room 57), Durham, NC 27705, USA. Email: or


Hide All
Baggett, T. P., Lebrun-Harris, L. A., & Rigotti, N. A. (2013). Homelessness, cigarette smoking and desire to quit: Results from a US national study. Addiction, 108 (11), 20092018. PMCID: PMC3797258. doi:10.1111/add.12292.
Bryant, J., Boneski, B., Paul, C., McElduff, P., & Attia, J. (2011). A systematic review and meta-analysis of the effectiveness of behavioral smoking cessation interventions in selected disadvantaged groups. Addiction, 106, 15681585. doi:10.111/j.1360-0443.2011.03467.x.
Businelle, M. S., Kendzor, D. E., Kesh, A., Cuate, E. L., Poonawalla, I. B., Reitzel, L. R. et al. (2014). Small financial incentives increase smoking cessation in homeless smokers: A pilot study. Addictive Behaviors, 39 (3), 717720. doi:10.1016/j.addbeh.2013.11.017.
Ebert, L., Malte, C., Hamlett-Berry, K., Beckham, J., McFall, M., & Saxon, A. (2014). Use of a learning collaborative to support implementation of integrated care for smoking cessation for veterans with posttraumatic stress disorder. American Journal of Public Health, 104 (10), 19351942. doi:10.2105/AJPH.2013.301776.
Fiore, M. C., Bailey, W. C., Cohen, S. J., Dorfman, S. F., Goldstein, M. G., & Gritz, E. R. (2010). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services.
Goldade, K., Whembolua, G. L., Thomas, J., Eischen, S., Guo, H., Connett, J. et al. (2011). Designing a smoking cessation intervention for the unique needs of a homeless persons: A community-based randomized clincial trial. Clinical Trials, 8, 744754.
Hall, S. M., & Prochaska, J. J. (2009). Treatment of smokers with co-occurring disorders: Emphasis on integration in mental health and addiction treatment settings. Annual Review of Clinical Psychology, 5, 409431. doi:10.1146/annurev.clinpsy.032408.153614.
Hammett, P., Fu, S. S., Lando, H. A., Owen, G., & Okuyemi, K. S. (2015). The association of military discharge variables with smoking status among homeless veterans. Preventative Medicine, 81, 275280. PMCID: PMC4679596. doi:10.1016/j.ypmed.2015.09.007.
Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (1996). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco: Jossey-Bass Publishers.
McFall, M., Atkins, D. C., Yoshimoto, D., Thompson, C. E., Kanter, E., Malte, C. A. et al. (2006). Integrating tobacco cessation treatment into mental health care for patients with posttraumatic stress disorder. American Journal on Addictions, 15 (5), 336344.
McFall, M., Saxon, A. J., Thompson, C. E., Yoshimoto, D., Malte, C., Straits-Troster, K. et al. (2005). Improving the rates of quitting smoking for veterans with posttraumatic stress disorder. American Journal of Psychiatry, 162, 13111319.
McFall, M., Saxon, A., Malte, C., Chow, B., Bailey, S., Baker, D. et al. (2010). Integrating tobacco cessation into mental health care for posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 304 (22), 24852493. doi:10.1177/1740774507076923.
McGinnis, K. A., Brandt, C. A., Skanderson, M., Justice, A. C., Shahrir, S., Butt, A. A. et al. (2011). Validating smoking data from the veterans affairs health factors dataset, an electronic data source. Nicotine & Tobacco Research, 13 (12), 12331239. PMCID: PMC3223583. doi:10.1093/ntr/ntr206.
Murphy, R. (2011). The learning collaborative framework: A model for implementation and dissemination of best practices. Presented at the North Carolina Institute of Medicine Task Force on the Mental Health, Social, and Emotional Needs of Young Children and their Families, Morrisville, NC.
Okuyemi, K. S., Thomas, J. L., Hall, S., Nollen, N. L., Richter, K. P., Jeffries, S. K. et al. (2006). Smoking cessation in homeless populations: A pilot clinical trial. Nicotine and Tobacco Research, 8, 689699.
Shelley, D., Cantrell, J., Warn, D., Wong, S., Connor, S. E., Scharf, D. M. et al. (2010). Smoking cessation among sheltered homeless: A pilot. American Journal of Health Behavior, 34, 544552.
Sherman, S. E., Joseph, A. M., Yano, E. M., Simon, B. R., Arikian, N. J., Rubenstein, L. V. et al. (2006). Assessing the institutional approach to implementing smoking cessation practice guidelines in veterans health administration facilities. Military Medicine, 171, 8087.
Tsai, J., & Rosenheck, R. A. (2012). Smoking among chronically homeless adults: Prevalance and correlates. Psychiatric Services, 63, 569576. doi:10.1176/
Vijayaraghavan, M., Tieu, L., Ponath, C., Guzman, D., & Kushel, M. (2016). Tobacco cessation behaviors among older homeless adults: Results from the HOPE HOME study. Nicotine & Tobacco Research. doi:10.1093/ntr/ntw040.
Yano, E. M., Rubenstein, L.V., Farmer, M.M., Chernof, B.A., Mittman, B.S., Lanto, A.B. et al. (2008). Targeting primary care referrals to smoking cessation clinics does not improve quit rates: Implementing evidence-based interventions into practice. Health Services Research, 43, 16371661.

A Learning Collaborative Model for Implementation of Smoking Cessation among Homeless Veterans

  • Jean C. Beckham (a1) (a2) (a3), Angela C. Kirby (a1) (a2), Nick Tise (a4), Vickie L. Carpenter (a1), Eric A. Dedert (a1) (a2) (a3), J. Murray McNiel (a1) (a3), Jennifer J. Runnals (a1) (a2) and Patrick S. Calhoun (a1) (a2) (a3) (a5)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed