Quitline Programs Tailored for Mental Health: Initial Outcomes and Feasibility.

INTRODUCTION: The general efficacy of quitlines has been widely demonstrated, but uncertainty exists regarding how quitlines might best intervene for persons with mental health conditions. A total of 1 in 5 people in the U.S. has a diagnosable psychiatric disorder. These individuals smoke at 2‒4 times the rate of smoking among those without a mental health condition and face high rates of related death and disability. About half of quitline callers self-report a mental health condition, but until recently, quitline protocols tailored to these smokers did not exist. METHODS: This paper provides initial results for tailored mental health programs from the largest quitline providers in the U.S., Optum and National Jewish Health. From 2017 to 2018, cohorts of callers with a mental health condition who enrolled in tailored programs were compared with cohorts with a mental health condition who received standard care. Both mental health programs offered participants additional calls, longer duration of combination nicotine-replacement therapy, and attention to mental health issues. Analyses were conducted in 2018-2019. RESULTS: Findings suggest that callers with a mental health condition benefit from both standard care and tailored mental health services. Tailored programming did well in engaging people with mental health conditions. At the same time, there were no significant differences in abstinence rates when comparing mental health programs with standard care. Mental health cohorts did receive significantly greater service durations, more counseling calls, and longer nicotine-replacement therapy duration. CONCLUSIONS: Tailored mental health quitline programs present a promising framework for testing the services that address psychiatric symptoms as well as other frequent population characteristics such as chronic illness. Implications for increasing reach to the often underserved population with a mental health condition are discussed.

Characteristics of American Indian/Alaskan Native Quitline Callers Across 14 States.

BACKGROUND: American Indians and Alaska Natives (AI/AN) have the highest smoking prevalence (29.2%) of any other racial/ethnic group in the United States and lower quit rates. Comprehensive health care services, including commercial tobacco cessation treatments, are difficult to access for many AI/AN individuals due to poverty, the rural distribution of tribal territories, cultural barriers and the lack of funding for these programs. Due, in part, to these health care gaps, AI/AN communities are disproportionally affected by nicotine dependence and associated chronic medical and psychiatric conditions. METHODS: We report on data from National Jewish Health that provides telephonic tobacco cessation services for 14 states in the United States. We examine how AI/AN callers who were predominately AI callers differ from their counterparts (i.e., callers identifying as other ethnic groups) in terms of demographic characteristics, commercial tobacco use history, rates of emotional or mental health issues, and rates of chronic illness. RESULTS: Findings from the quitline analyses show a higher rate of preadolescent onset of commercial tobacco use in the AI/AN callers. AI/AN callers are also more likely to live with another commercial tobacco user. Results demonstrate that AI/AN callers are disproportionately impacted by mental health challenges, including high levels of stress, anxiety, and depression. Similarly, AI/AN callers report more chronic medical issues including diseases of the lungs and cardiovascular system. CONCLUSIONS: These findings stress the critical need for tailored efforts to better reach AI/AN commercial tobacco users who are considering treatment, in order to make meaningful gains in commercial tobacco cessation for this vulnerable population. IMPLICATIONS: These findings demonstrate the disproportionate impact of commercial tobacco use on the AI/AN population who utilizes quitline services. These data stress the critical need for tailored efforts to better reach AI/AN commercial tobacco users who are considering treatment, in order to make meaningful gains in commercial tobacco cessation for this vulnerable population.

Tobacco User Characteristics and Outcomes Related to Intensity of Quitline Program Use: Results From Minnesota and Pennsylvania.

CONTEXT: Tobacco users in all 50 states have access to quitline telephone counseling and cessation medications. While studies show multiple calls relate to quit success, most participants do not complete a full call series. To date, quitline program use studies have analyzed single factors-such as number of calls or counseling minutes. OBJECTIVE: This study combines multiple factors of quitline program use across 2 states to describe how participants use a 5-call program; assess whether intensity of program use is associated with participant subgroups; and assess whether key outcomes (quitting, satisfaction) are associated with intensity. DESIGN, SETTING, AND PARTICIPANTS: This observational study examines data for quitline participants in Minnesota (n = 2844) and Pennsylvania (n = 14 359) in 2011 and 2012. A subset of participants was surveyed 7 months after registration to assess key outcomes (response rates: Minnesota 65%; Pennsylvania 60%). MAIN OUTCOME MEASURES: Quitline utilization data were used to identify program use variables: nicotine replacement therapy provision, number of counseling calls, number of counseling minutes, days from first to last counseling call, and days from registration to first counseling call. Ten program use groups were created using all 5 program use variables, from lowest (1) to highest (10) intensity. RESULTS: Results were similar for both states. Only 11% of Minnesota and 8% of Pennsylvania participants completed all 5 calls. Intensity of quitline program use was associated with several participant characteristics including health conditions and age. Both quit status and program satisfaction were associated with program use intensity. Quit rates peaked in group 9, participants who received the full 5-call program. CONCLUSIONS: Quitlines should focus on engaging participants in multiple calls to improve quit outcomes. In addition, it is important to leverage multiple program use factors for a fuller understanding of how quitline participants use a program.

Quitline Outcomes for Smokers in 6 States: Rates of Successful Quitting Vary by Mental Health Status.

INTRODUCTION: Tobacco cessation quitlines are generally effective in assisting smokers who want to quit. However, up to half of quitline callers report a history of mental health conditions and/or recent emotional challenges (MH+), and there has been little study of cessation outcomes for this population. Moreover, evidence suggests that callers who expect their MH+ to interfere with quit attempts have less success with quitting. This study compares rates of quitting among MH+ callers and callers with no mental health conditions or recent emotional challenges (MH-). It also compares rates of quitting between those who felt that mental health issues would interfere with their quit attempt (MHIQ+) and those who did not (MHIQ-). METHODS: National Jewish Health collected telephone data from 6 state quitlines. Participants received up to 5 coaching sessions and up to 8 weeks of nicotine replacement therapy. Smoking status was assessed during 3-month and 6-month post-intervention calls in a subset of participants (n = 4,960) for whom follow-up interviews were completed. RESULTS: Participation in follow-up interviews was not significantly different between callers with MH+ and those without MH- (p = .13). However, at follow-up MH+ participants were less likely to report a successful quit compared with MH- (3-month: 31% vs. 43%; 6-month: 33% vs. 43%; both p < .001). Among MH+ participants, those reporting MHIQ+ were significantly less likely to quit compared with those who were MHIQ- (3-month: 24% vs. 34%; 6-month: 26% vs. 35%; both p ≤ .001). CONCLUSIONS: These findings highlight the importance of evaluating both the mental health status of individuals seeking support for smoking cessation as well as the individuals' expectations for success, because they may need more tailored intervention to ensure the potential for better compared with outcomes.