Running head: VA READINGS 1

VA Rotation Readings and Reflections

Kacy Shaffer

Fontbonne University
VA READINGS 2

Burke, L. E., Wang, J., & Sevick, M. A. (2011). Self-monitoring in weight loss: A systematic

review of the literature. Journal of the American Dietetic Association, 111(1), 92 102.

Typically, behavioral weight loss programs will include decreased energy intake,

increased energy expenditure, and use of behavior strategies. These strategies include goal

setting and self-monitoring such as recording intake and physical activity to increase awareness.

This review includes articles published between 1993 and 2009 focusing on three components of

self-monitoring: diet, exercise, and self-weighing. The findings showed a significant association

between self-monitoring and weight loss. However, there were limitations including reliance on

self-report and lack of diversity in the studies.

The MOVE program focused a lot on goal setting and self-monitoring, which seemed to

be successful for veterans. Getting the participants to use their journals and set goals was more of

a challenge. When asked, many of them had not been using their journal or did not set a SMART

goal for one reason or another. Those who were asked to create a goal aloud in class would, but

there was not enough time to help everyone set a goal in class. They are supposed to write their

own in their journals each week, but it seems as though this is not clear to many of them. They

are also a more diverse population that the white women in most of the studies reviewed.

Burke, R. E. & OGrady, E. T. (2012). Group visits hold great potential for improving diabetes

care and outcomes, but best practices must be developed. Health Affairs, 31(1), 103

109.

Diabetes affects a large portion of the population and can be difficult to manage,

requiring change in behavior, diet, and lifestyle. Some evidence shows that group visits with

other patients, a primary care provider, and transdisciplinary team have potential to improve the

quality, cost, and access for healthcare. They can also improve outcomes, improve patient
VA READINGS 3

satisfaction, provide peer support, and enhance collaboration. There are policy issues that create

a barrier to the adoption of this model on a large scale. Studies are needed to determine best

practices for group visits.

While I was not able to see diabetes group visits at the VA, I did work a lot with the

MOVE program. A few of the participants discussed their diabetes. Many had questions about

carbohydrates. For example, one person asked, what is the difference between calories and

carbohydrates? I am supposed to watch my carbs. Having programs with groups and getting to

talk to a knowledgeable health professional can be helpful for getting questions answered that

there may not be time to go through at a doctors visit.

Farrelly, M. C., Duke, J. C., Davis, K. C., Nonnemaker, J. M., Kamyab, K., Willett, J. G., &

Juster, H. R. (2012). Promotion of smoking cessation with emotional and/or graphic

antismoking advertising. American Journal of Preventative Medicine, 43(5), 475 482.

To promote smoking cessation, evidence shows that antismoking campaigns can be

effective. However, there is less known about how the advertising dose is related to behavior

change, the most effective types of messages, and how televised mass media campaigns impact

populations who are disproportionately affected by tobacco use. This study looked at adult

smokers in New York State and the impact of emotional and graphic antismoking advertisements

on TV on attempts to quit in the past 12 months. They found that exposure to antismoking

advertisements were positively associated with attempting to quit among all smokers. The

emotional and graphic advertisements were more effective than those without strong emotions or

graphics.

This study shows one way to help people quit smoking. While working with the

psychologist who does the smoking cessation class, he shared a lot of his thoughts and opinions
VA READINGS 4

about smoking cessation and what is most effective. It takes more than a desire or attempt to

actually quit for most people. Usually, people will need a strategy to get through the cravings,

such as something to replace it with. These advertising ideas are a nice place to start, but

hopefully they would refer the smokers to some type of smoking cessation program where they

can get strategies to help them be successful. The study talks about providing a telephone

quitline and free nicotine replacement therapy, which is a good start.

Rigotti, N. A. (2012). Strategies to help a smoker who is struggling to quit. JAMA, 308(15), 1573

1580.

There are several strategies to help people quit smoking, which is important because

worldwide, tobacco use is the leading preventable cause of death. Many people lose confidence

in their ability to quit and believe they have tried everything, even though there are many

strategies they may not have tried. Few people who try to quit seek help. Two methods that have

strong evidence for success are behavioral support and pharmacotherapy. Behavioral support

includes counselling to help people overcome the barriers to quitting and manage withdrawal

symptoms, cravings, and tempting situations. The pharmacotherapy includes three categories:

nicotine replacement therapy (NRT), bupropion, and varenicline. There is also strong evidence

for addressing tobacco use in health care settings with brief counselling.

The smoking cessation program at the VA was behavioral support and pharmacotherapy.

It was a group counselling session where strategies for managing withdrawal symptoms,

cravings, and tempting situations were discussed followed by a discussion with a pharmacist.

The pharmacist would give brief education on nicotine replacement therapy (NRT), bupropion,

and varenicline, then the people in the program would choose which one they thought would be

best for them. The psychologist said he has seen a lot of success with this program.
VA READINGS 5

Rodgers, A. (2005). Do u smoke after txt? Results of a randomized trial of smoking cessation

using mobile phone text messaging. Tobacco Control, 14(4), 255 261.

This study looked at the effectiveness of text messaging for a smoking cessation program.

Participants were sent regular, personalized text messages. The text messages were used to

provide support, advice, and distraction for smoking cessation. The intervention showed positive

outcomes, which offers potential for a new way to help smokers quit. I did not hear about any

type of program like this at the VA. It is possibly something for them to consider, if they do not

already have something like this.

Schroeder, S. A. (2012). How clinicians can help smokers to quit. JAMA, 308(15), 1586 1587.

This article discusses effective ways for clinicians to help smokers quit, the main method

being pharmacotherapy. This is supported by evidence, but there are four caveats about the

evidence. The first is that the people in studies tend to be more motivated to quit than the average

smoker. The second is that more extensive counselling is given to both placebo and drug

treatment groups of these studies than what smokers in a real-world setting receive. Third is that

counselling methods are not standardized even though pharmacotherapy is. The fourth caveat is

that most trials exclude those who have a behavioral health issue. There are several factors in

society that play a role in smoking cessation or decreasing the number of cigarettes a person uses

per day. Clinicians can help in several ways such as adopting smoking cessation in their

practices, adopting the Joint Commissions tobacco cessation measures, and acting as an

advocate for tobacco control measures.

Although there are caveats in the evidence, I was able to see and hear about how

pharmacotherapy works in conjunction with behavioral support. According to the psychologist

and the pharmacist who work together in smoking cessation, this is a very effective strategy. It
VA READINGS 6

would be good for more research to consider ways this can improve and become even more

successful for some of the barriers that remain. Regardless, I think they have a good program at

the VA.

Livingston, E. H. & Lynm, C. (2012). Smoking cessation (JAMA patient page). JAMA, 308(15),

1599.

This is a handout that discusses the harmful consequences of smoking, such as damage to

the lungs, emphysema, atherosclerosis, stroke, heart attack, cancer, and early death. It then talks

about behavioral support and pharmacotherapy options. They also talk about electronic cigarettes

and how there is little evidence, then smokeless tobacco and its harmful effects. It gives

resources for more information. We learned about the behavioral support and pharmacotherapy

mostly. This is a good informative handout for someone who is considering quitting and wants to

know some good options.