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Telephone Smoking-Cessation Counseling for Smokers in Mental Health Clinics

A Patient-Randomized Controlled Trial
Published:December 17, 2015DOI:https://doi.org/10.1016/j.amepre.2015.10.004

      Introduction

      People with a mental health diagnosis have high rates of tobacco use and encounter limited availability of tobacco treatment targeted to their needs. This study compared the effectiveness of a specialized telephone smoking-cessation intervention developed for mental health patients with standard state quit-line counseling.

      Design

      RCT.

      Setting/participants

      The study was conducted at six Veterans Health Administration facilities in the Northeast U.S. Participants were 577 mental health clinic patients referred by their providers for smoking-cessation treatment.

      Intervention

      From 2010 to 2012, the study implemented a telephone program that included patient referral from a mental health provider, mailed cessation medications, and telephone counseling. Participants were randomized to receive a specialized multisession telephone counseling protocol (n=270) or transfer to their state’s quit-line for counseling (n=307).

      Main outcome measures

      Participants completed telephone surveys at baseline, 2 months, and 6 months. The study’s primary outcome was self-reported 30-day abstinence at 6 months. Secondary outcomes were self-reported 30-day abstinence, counseling satisfaction and counseling content at 2 months, and self-reported use of cessation treatment and quit attempts at 6 months. Logistic regression was used to compare treatment groups on outcomes, controlling for baseline cigarettes per day and site. Inverse probability weighting and multiple imputation were used to handle missing abstinence outcomes. Data were analyzed in 2014−2015.

      Results

      At 6 months, participants in the specialized counseling arm were more likely to report 30-day abstinence (26% vs 18%, OR=1.62, 95% CI=1.24, 2.11). There was no significant group difference in abstinence at 2 months (18% vs 14%, OR=1.31, 95% CI=0.49, 3.49). Participants in the specialized arm were more likely to be assisted with developing a quit plan; receive follow-up calls after quitting; and receive counseling on several domains, including motivation, confidence, smoking triggers, coping with urges, and mental health symptoms (all p<0.05). Specialized counseling participants were more satisfied with treatment and more likely to find the counseling useful (p<0.05).

      Conclusions

      The specialized counseling intervention was more effective at helping patients quit than transfer to a state quit-line. Patients were more satisfied with the specialized counseling program.

      Trial registration

      This study is registered at www.clinicaltrials.gov NCT00724308.
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      References

      1. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis. 2006;3(2):A42. http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm. Accessed October 28, 2015

      2. CDC. Vital signs: current cigarette smoking among adults aged >/=18 years with mental illness—United States, 2009−2011. MMWR Morb Mortal Wkly Rep. 2013;62(5):81−87. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a2.htm?s_cid=mm6205a2_w. Accessed October 28, 2015.

        • Cook B.L.
        • Wayne G.F.
        • Kafali E.N.
        • Liu Z.
        • Shu C.
        • Flores M.
        Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation.
        JAMA. 2014; 311: 172-182https://doi.org/10.1001/jama.2013.284985
      3. 2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline executive summary. Respir Care. 2008;53(9):1217−1222. http://rc.rcjournal.com/content/53/9/1217.full.pdf. Accessed October 28, 2015.

        • American Psychiatric Association
        Practice guideline for the treatment of patients with nicotine dependence.
        Am J Psychiatry. 1996; 153(10): 1-31https://doi.org/10.1176/ajp.153.10.1
        • Lichtenstein E.
        • Zhu S.H.
        • Tedeschi G.J.
        Smoking cessation quitlines: an underrecognized intervention success story.
        Am Psychol. 2010; 65: 252-261https://doi.org/10.1037/a0018598
        • Lukowski A.V.
        • Morris C.D.
        • Young S.E.
        • Tinkelman D.
        Quitline outcomes for smokers in 6 states: rates of successful quitting vary by mental health status.
        Nicotine Tob Res. 2015; 17: 924-930https://doi.org/10.1093/ntr/ntu252
        • Kerkvliet J.L.
        • Wey H.
        • Fahrenwald N.L.
        Cessation among state quitline participants with a mental health condition.
        Nicotine Tob Res. 2015; 17: 735-741https://doi.org/10.1093/ntr/ntu239
      4. Kreinbring BL, Dale L. A quitline experience providing counseling to callers with mental illnesses. Presented at the National Conference on Tobacco or Health, October 24−26, 2007, Minneapolis, MN.

        • Morris C.D.
        • Waxmonsky J.A.
        • May M.G.
        • Tinkelman D.G.
        • Dickinson M.
        • Giese A.A.
        Smoking reduction for persons with mental illnesses: 6-month results from community-based interventions.
        Community Ment Health J. 2011; 47: 694-702https://doi.org/10.1007/s10597-011-9411-z
        • Heffner J.L.
        • Strawn J.R.
        • DelBello M.P.
        • Strakowski S.M.
        • Anthenelli R.M.
        The co-occurrence of cigarette smoking and bipolar disorder: phenomenology and treatment considerations.
        Bipolar Disord. 2011; 13: 439-453https://doi.org/10.1111/j.1399-5618.2011.00943.x
        • Schroeder S.A.
        • Morris C.D.
        Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems.
        Annu Rev Public Health. 2010; 31: 297-314https://doi.org/10.1146/annurev.publhealth.012809.103701
        • el-Guebaly N.
        • Cathcart J.
        • Currie S.
        • Brown D.
        • Gloster S.
        Smoking cessation approaches for persons with mental illness or addictive disorders.
        Psychiatr Serv. 2002; 53: 1166-1170https://doi.org/10.1176/appi.ps.53.9.1166
        • Ziedonis D.M.
        • George T.P.
        Schizophrenia and nicotine use: report of a pilot smoking cessation program and review of neurobiological and clinical issues.
        Schizophr Bull. 1997; 23: 247-254https://doi.org/10.1093/schbul/23.2.247
        • van der Meer R.M.
        • Willemsen M.C.
        • Smit F.
        • Cuijpers P.
        Smoking cessation interventions for smokers with current or past depression.
        Cochrane Database Syst Rev. 2013; 8: Cd006102https://doi.org/10.1002/14651858.cd006102.pub2
        • Hall S.M.
        • Munoz R.F.
        • Reus V.I.
        Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers.
        J Consult Clin Psychol. 1994; 62: 141-146https://doi.org/10.1037/0022-006X.62.1.141
        • Hall S.M.
        • Tsoh J.Y.
        • Prochaska J.J.
        • et al.
        Treatment for cigarette smoking among depressed mental health outpatients: a randomized clinical trial.
        Am J Public Health. 2006; 96: 1808-1814https://doi.org/10.2105/AJPH.2005.080382
        • McFall M.
        • Saxon A.J.
        • Malte C.A.
        • et al.
        Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial.
        JAMA. 2010; 304: 2485-2493https://doi.org/10.1001/jama.2010.1769
        • Ashton M.
        • Miller C.L.
        • Bowden J.A.
        • Bertossa S.
        People with mental illness can tackle tobacco.
        Aust N Z J Psychiatry. 2010; 44: 1021-1028https://doi.org/10.3109/00048674.2010.497753
        • van der Meer R.M.
        • Willemsen M.C.
        • Smit F.
        • Cuijpers P.
        • Schippers G.M.
        Effectiveness of a mood management component as an adjunct to a telephone counselling smoking cessation intervention for smokers with a past major depression: a pragmatic randomized controlled trial.
        Addiction. 2010; 105: 1991-1999https://doi.org/10.1111/j.1360-0443.2010.03057.x
        • Morris C.D.
        • Tedeschi G.J.
        • Waxmonsky J.A.
        • May M.
        • Giese A.A.
        Tobacco quitlines and persons with mental illnesses: perspective, practice, and direction.
        J Am Psychiatr Nurses Assoc. 2009; 15: 32-40https://doi.org/10.1177/1078390308330050
        • Rogers E.
        • Sherman S.
        Quitline services for smokers with mental illness.
        Int J Ment Health. 2011; 49: 85-91https://doi.org/10.2753/IMH0020-7411400105
        • Rogers E.
        • Fernandez S.
        • Gillespie C.
        • et al.
        Telephone care coordination for smokers in VA mental health clinics: protocol for a hybrid type-2 effectiveness-implementation trial.
        Addict Sci Clin Pract. 2013; 8: 7https://doi.org/10.1186/1940-0640-8-7
        • Barron E.B.
        F. Meaning of the Social Security number.
        Soc Secur Bull. 1982; 45: 29-30
        • Eisen S.V.
        • Gerena M.
        • Ranganathan G.
        • Esch D.
        • Idiculla T.
        Reliability and validity of the BASIS-24 Mental Health Survey for whites, African-Americans, and Latinos.
        J Behav Health Serv Res. 2006; 33: 304-323https://doi.org/10.1007/s11414-006-9025-3
        • Rogers E.S.
        • Gillespie C.
        • Zabar S.
        • Sherman S.E.
        Using standardized patients to train telephone counselors for a clinical trial.
        BMC Res Notes. 2014; 7: 341https://doi.org/10.1186/1756-0500-7-341
        • Lane C.
        • Huws-Thomas M.
        • Hood K.
        • Rollnick S.
        • Edwards K.
        • Robling M.
        Measuring adaptations of motivational interviewing: the development and validation of the behavior change counseling index (BECCI).
        Patient Educ Couns. 2005; 56: 166-173https://doi.org/10.1016/j.pec.2004.01.003
        • Al-Delaimy W.K.
        • Edland S.
        • Pierce J.P.
        • Mills A.L.
        • White M.M.
        California Tobacco Survey (CTS). 2008; https://doi.org/10.7910/DVN/25096
        • Heatherton T.F.
        • Kozlowski L.T.
        • Frecker R.C.
        • Rickert W.
        • Robinson J.
        Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day.
        Br J Addict. 1989; 84: 791-799https://doi.org/10.1111/j.1360-0443.1989.tb03059.x
        • DiClemente C.C.
        • Prochaska J.O.
        • Fairhurst S.K.
        • Velicer W.F.
        • Velasquez M.M.
        • Rossi J.S.
        The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change.
        J Consult Clin Psychol. 1991; 59: 295-304https://doi.org/10.1037/0022-006X.59.2.295
        • Seaman S.R.
        • White I.R.
        Review of inverse probability weighting for dealing with missing data.
        Stat Methods Med Res. 2013; 22: 278-295https://doi.org/10.1177/0962280210395740
        • Little R.J.
        • Yosef M.
        • Cain K.C.
        • Nan B.
        • Harlow S.D.
        A hot-deck multiple imputation procedure for gaps in longitudinal data on recurrent events.
        Stat Med. 2008; 27: 103-120https://doi.org/10.1002/sim.2939
      5. Hrywna M, Delnevo C, Williams J, Vorbach U, Ernst G, Gundersen DA. Use of quitline by smokers with mental illness. Presented at the National Conference on Tobacco or Health, October 24−26, 2007, Minneapolis, MN.

        • Tsoi D.T.
        • Porwal M.
        • Webster A.C.
        Interventions for smoking cessation and reduction in individuals with schizophrenia.
        Cochrane Database Syst Rev. 2013; 2: CD007253https://doi.org/10.1002/14651858.cd007253.pub3
        • Evins A.E.
        • Mays V.K.
        • Rigotti N.A.
        • Tisdale T.
        • Cather C.
        • Goff D.C.
        A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia.
        Nicotine Tob Res. 2001; 3: 397-403https://doi.org/10.1080/14622200110073920
        • Alberg A.J.
        • Patnaik J.L.
        • May J.W.
        • et al.
        Nicotine replacement therapy use among a cohort of smokers.
        J Addict Dis. 2005; 24: 101-113https://doi.org/10.1300/J069v24n01_09
        • Bohadana A.
        • Nilsson F.
        • Rasmussen T.
        • Martinet Y.
        Gender differences in quit rates following smoking cessation with combination nicotine therapy: influence of baseline smoking behavior.
        Nicotine Tob Res. 2003; 5: 111-116https://doi.org/10.1080/1462220021000060482
      6. Torres OV, O׳Dell LE. Stress is a principal factor that promotes tobacco use in females. Prog Neuropsychopharmacol Biol Psychiatry. 2015 Apr 22. pii: S0278-5846(15)00071-8. http://dx.doi.org/10.1016/j.pnpbp.2015.04.005. [Epub ahead of print]