Prevalence and correlates of smoking status among Veterans Affairs primary care patients with probable Major Depressive Disorder Anayansi Lombardero a, ⁎, Duncan G. Campbell a , Kari J. Harris b , Edmund F. Chaney c,d , Andrew B. Lanto e , Lisa V. Rubenstein e,f a Department of Psychology, The University of Montana, 32 Campus Drive, Missoula, MT 59812, United States b School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Missoula, MT 59812, United States c VA Puget Sound Healthcare System, 1660 S Columbian Way, Seattle, WA 98108, United States d University of Washington School of Medicine, Warren G. Magnuson Health Sciences Center, Box 356340, 1925 N.E. Pacific Street Seattle, WA 98195-6340, United States e VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd #6005, Los Angeles, CA 90073, United States f RAND Health Program, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, United States HIGHLIGHTS • We examine differences between depressed smokers and nonsmokers in VA primary care. • Smoking prevalence is high among depressed primary care patients. • Depressed smokers report more complicated psychosocial characteristics. • These characteristics can complicate systems-level smoking cessation interventions. abstract article info Keywords: Smoking Depression PTSD Veterans Primary care Alcohol misuse In an attempt to guide planning and optimize outcomes for population-specific smoking cessation efforts, the present study examined smoking prevalence and the demographic, clinical and psychosocial characteristics asso- ciated with smoking among a sample of Veterans Affairs primary care patients with probable major depression. Survey data were collected between 2003 and 2004 from 761 patients with probable major depression who attended one of 10 geographically dispersed VA primary care clinics. Current smoking prevalence was 39.8%. Relative to nonsmokers with probable major depression, bivariate comparisons revealed that current smokers had higher depression severity, drank more heavily, and were more likely to have comorbid PTSD. Smokers with probable major depression were also more likely than nonsmokers with probable major depression to have missed a health care appointment and to have missed medication doses in the previous 5 months. Smokers were more amenable than non-smokers to depression treatment and diagnosis, and they reported more frequent visits to a mental health specialist and less social support. Alcohol abuse and low levels of social support were significant concurrent predictors of smoking status in controlled multivariable logistic regression. In conclusion, smoking prevalence was high among primary care patients with probable major depression, and these smokers reported a range of psychiatric and psychosocial characteristics with potential to complicate systems-level smoking cessation interventions. © 2013 Elsevier Ltd. All rights reserved. 1. Introduction Cigarette smoking is the leading preventable cause of morbidity and mortality in the US (Centers for Disease Control, Prevention [CDC], 2004). Roughly 45% of the 443,000 annual deaths attributed to smoking are accounted for by persons with mental illness and substance abuse disorders (Centers for Disease Control and Prevention, 2008a, 2008b; Mauer, 2006). Indeed, tobacco use is the most significant contributor to premature mortality among people with chronic mental illness, who tend to die an average of 25 years earlier (Schroeder & Morris, 2010) and are nearly twice as likely to smoke (41% versus 23%) as those in the general population (Lasser et al., 2000, Rohde, Lewinsohn, Brown, Gau, & Kahler, 2003). These statistics highlight the importance of examining factors with potential to maintain smoking behavior or frustrate attempts at quitting among individuals with mental health conditions who present for treatment in a variety of care settings. Research indicates that smoking status evinces a relationship with common clinical concerns in primary care (PC), including depression, posttraumatic stress disorder (PTSD), and alcohol abuse, and that Addictive Behaviors 39 (2014) 538–545 ⁎ Corresponding author. Tel.: +1 406 243 4521; fax: +1 406 243 6366. E-mail address: anayansilombardero@gmail.com (A. Lombardero). 0306-4603/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.addbeh.2013.10.030 Contents lists available at ScienceDirect Addictive Behaviors