Mental health concerns during the COVID-19 pandemic as revealed by helpline calls.

Mental health is an important component of public health, especially in times of crisis. However, monitoring public mental health is difficult because data are often patchy and low-frequency1-3. Here we complement established approaches by using data from helplines, which offer a real-time measure of 'revealed' distress and mental health concerns across a range of topics4-9. We collected data on 8 million calls from 19 countries, focusing on the COVID-19 crisis. Call volumes peaked six weeks after the initial outbreak, at 35% above pre-pandemic levels. The increase was driven mainly by fear (including fear of infection), loneliness and, later in the pandemic, concerns about physical health. Relationship issues, economic problems, violence and suicidal ideation, however, were less prevalent than before the pandemic. This pattern was apparent both during the first wave and during subsequent COVID-19 waves. Issues linked directly to the pandemic therefore seem to have replaced rather than exacerbated underlying anxieties. Conditional on infection rates, suicide-related calls increased when containment policies became more stringent and decreased when income support was extended. This implies that financial relief can allay the distress triggered by lockdown measures and illustrates the insights that can be gleaned from the statistical analysis of helpline data.

Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned.

BACKGROUND: During the Covid-19 pandemic, a number of hotlines/helplines/call centers was implemented to provide remote services and support public health. The objective of this study was to investigate the characteristics, challenges and lessons learned of implementing Covid-19 hotlines/helplines/call centers during the pandemic. METHODS: PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest databases as well as Google Scholar were searched between 1st January 2020 and 31st December 2023 to retrieve relevant articles published in English. The quality and risk of bias of the studies were assessed using the Appraisal tool for Cross-Sectional Studies (AXIS), the Mixed Methods Appraisal Tool (MMAT), and Critical Appraisal Skills Programme (CASP) Checklist. RESULTS: In total, 43 out of 1440 articles were included in this study. About half of the hotlines/helplines/call centers were launched in March 2020 (n = 19). Providing psychological support (n = 23), reliable information about Covid-19 (n = 10), healthcare advices about Covid-19 (n = 8), and triage (n = 7) were the most common purposes of implementing these services. The most common challenges included a lack of physical examination, unavailability of hotlines/helplines/call centers at the point of need, and delay in updating Covid-19 information. The most common lessons learned were employing qualified staff, providing proper training, and getting feedback from the callers and operators. CONCLUSION: According to the results, most of the Covid-19 hotlines/helplines/call centers were launched in the early months of the pandemic, and about half of them were active seven days a week. Most of the operators were mental health providers and clinicians. The findings show the importance of continuous psychological support during crises, particularly when adequate information about the situation is not available. The challenges experienced by the callers and operators as well as the lessons learned by the service providers also need to be considered for future crises to increase the effectiveness of similar services.

Rapport Building in Written Crisis Services: Qualitative Content Analysis.

BACKGROUND: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE: This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

An analysis of the contents of the young-onset dementia helpline: profiles of clients who consulted the helpline themselves.

BACKGROUND: Young-onset dementia (YOD) community care requires personalised approaches. Yet, the specific details of YOD consultations are unclear. This study explored how initial consultations correlate with client profiles. METHODS: Data from regional YOD helplines were used to analyze the main characteristics of people living with YOD or who had concerns about the possibility of YOD (n = 132). Among several categorical variables, the following were used for analysis: age group, sex, type of living arrangement, employment status, presence of dementia, and content of the consultation. To identify groups of items that frequently occur together, strongly connected rules were identified using association rule analysis with the a priori algorithm. To focus on the characteristics of clients, rules related to client characteristics were extracted based on the type of consultation. RESULTS: A total of 51 rules were identified for the consultations. These rules fell into two categories: (1) consultations for medical matters, which mainly involved employed individuals with undiagnosed dementia, and (2) other consultations on daily life or work, which mainly involved individuals diagnosed with dementia and were characterised by the influence of sex. These rules indicate the importance of medical involvement in confirming the diagnosis and specific individualised care following diagnosis for people living with YOD. CONCLUSION: Clients with or without a dementia diagnosis were consulted differently in the YOD helplines. Before receiving a diagnosis, medical matters were the main theme of consultations, whereas after receiving a diagnosis, adjustments to daily life or work were the main themes. The results of this study suggest that the needs of people living with YOD and the services they require may vary depending on their backgrounds.

Laypeople's activity for seeking telephone number of EMS before and during the COVID-19 outbreak: An analysis of web search data.

OBJECTIVE: To explore trends and patterns of laypeople's activity for seeking telephone number of emergency medical services (EMS) based on analysis of online search traffic, including changes of the search activity with onset of the coronavirus disease 2019 (COVID-19) outbreak, in five countries - the United States of America (USA), India, Brazil, the United Kingdom (UK) and Russia. METHODS: Google Trends (GT) country-level data on weekly relative search volumes (RSV) for top queries to seek EMS number were examined for January 2018-October 2021, including a comparison of RSVs between pre-COVID-19 period (January 2018-October 2019) and COVID-19 period (January 2020-October 2021), and evaluation of temporal associations of RSVs with weekly numbers of new COVID-19 cases. RESULTS: The countries demonstrated diverse patterns of the search activity with significantly different mean RSVs (the USA 1.76, India 10.20, Brazil 2.51, the UK 6.42, Russia 56.79; p < 0.001). For all countries excepting the USA mean RSVs of the COVID-19 period were significantly higher compared with the pre-COVID-19 ones (India +74%, Brazil +148%, the UK +22%, Russia +9%; p ≤ 0.034), and exhibited positive correlations with numbers of new COVID-19 cases, more pronounced for 2021 (India rS = 0.538, Brazil 0.307, the UK 0.434, Russia 0.639; p ≤ 0.045). CONCLUSION: Laypeople's activity for seeking EMS telephone number greatly varies between countries. It clearly responds to the spread of COVID-19 and could be reflective of public need for obtaining emergency help. Further studies are required to establish the role of GT for conducting real-time surveillance of population demand for EMS.

American Indian/Alaska Native Smokers' Utilization of a Statewide Tobacco Quitline: Engagement and Quitting Behaviors From 2008 to 2018.

INTRODUCTION: The objective of this study was to examine access, engagement, and quitting behaviors of American Indian/Alaska Native (AIAN) callers to the California Smokers' Helpline. Telephone counseling is the primary function of the quitline. The overarching theoretical framework for California's quitline is social cognitive theory, although it also utilizes motivational interviewing and cognitive-behavioral strategies. AIMS AND METHODS: AIAN (n = 16 089) and White (n = 173 425) California quitline callers from 2009 to 2018 were compared on their characteristics, engagement, and quitting behaviors. Quitline callers responded to a telephone survey at intake. A random selection was called for evaluation 7 months later (White n = 8194, AIAN n = 764). Data from the 2009 to 2017 California Health Interview Survey (CHIS) were used as a reference point for AIANs (AIAN n = 1373). RESULTS: The quitline and CHIS had similar proportions of AIANs (4.6% vs. 4.3%, respectively). AIAN smokers were more likely than White smokers to report physical (53.6% vs. 44.9%) and mental (65.7% vs. 57.8%) health conditions at intake. AIANs were more likely to participate in counseling than White callers (67.1% vs. 65.7%). Among those who received counseling, AIANs had greater odds than White smokers of making a quit attempt (adjusted odds ratio = 1.39 [1.06, 1.81]) and similar odds of quitting for 180 days (adjusted odds ratio = 0.95 [0.69, 1.31]). CONCLUSIONS: Rates of access, engagement, and quitting suggest that individualized quitline counseling was as effective with AIANs as it was with White smokers. Increasing efforts to refer AIANs to existing state quitlines can help more smokers quit. IMPLICATIONS: This study showed that AIAN smokers were well represented among California quitline callers, even without a targeted campaign. It also found that AIAN smokers engaged in quitline services and were as able to quit as their White counterparts were, even after adjusting for other baseline characteristics. One implication is that public health programs can promote quitlines using broad-based campaigns knowing that they will still motivate AIAN smokers to seek help. Another implication is that a standard, individualized counseling protocol delivered by culturally competent quitline staff can effectively help AIAN smokers to quit.

Beyond Sociodemographic and COVID-19-Related Factors: The Association Between the Need for Psychological and Information Support from School and Anxiety and Depression.

BACKGROUND In addition to sociodemographic and COVID-19- related factors, the needs of school support, including material, psychological and information support, have seldom been discussed as factors influencing anxiety and depression among college students during the COVID-19 pandemic. MATERIAL AND METHODS In this cross-sectional study, 3351 college students from China were surveyed through questionnaires about their sociodemographic and COVID-19 characteristics, the needs of school support, and their experiences with anxiety and depression. RESULTS Anxiety and depression were reported by 6.88% and 10.50% of students, respectively. Married, higher education, non-medical, and urban students had significantly higher risks of anxiety or depression. Additionally, symptoms such as cough and fever, especially when following a possible contact with suspected individuals, quarantine history of a personal contact, going out 1-3 times a week, not wearing a mask, and spending 2-3 hours browsing COVID-19-related information were significantly associated with the occurrence of anxiety or depression. Those who used methods to regulate their emotional state, used a psychological hotline, and who had visited a psychiatrist showed higher anxiety or depression. Those who used online curricula and books, used preventive methods for COVID-19, and who had real-time information about the epidemic situation of the school showed lower anxiety and depression. CONCLUSIONS In addition to sociodemographic and COVID-19-related aspects, students' needs for psychological assistance and information from schools were also associated with anxiety and depression among college students.

Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study.

BACKGROUND: During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. OBJECTIVE: The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. METHODS: Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). RESULTS: A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. CONCLUSIONS: The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases.

Hand Sanitizer in a Pandemic: Wrong Formulations in the Wrong Hands.

BACKGROUND: Households are increasingly stockpiling and producing hand sanitizer amid the coronavirus disease 2019 (COVID-19) pandemic, which can pose an increased risk for unintentional toxicity among children. Despite guidelines for hand sanitizer production published by the World Health Organization, many turn to streaming media for instruction. OBJECTIVE: The purpose of this investigation was to evaluate hand sanitizer formulations and safety precautions discussed in popular do-it-yourself (DIY) YouTube videos, and to assess the frequency of calls to poison control centers for pediatric hand sanitizer exposure before and after the arrival of COVID-19 in the United States. METHODS: The first 100 videos on YouTube with the most views using the search term "DIY hand sanitizer" were evaluated for accuracy compared with the World Health Organization local hand sanitizer production guidelines. The incidence of pediatric hand sanitizer exposure reported to participating U.S. poison control centers from January 2018 through May 2020 was reviewed from the American Association of Poison Control Centers National Poison Data System. The average number of calls between January 2020 and May 2020 was compared, and the average number of calls in March 2020 was compared with March 2019 and March 2018. RESULTS: Of the YouTube videos that met inclusion criteria, 27% discussed the use of at least 96% ethanol or 99.8% isopropyl alcohol, 4.1% incorporated 3% hydrogen peroxide, 82% used glycerol or an alternative humectant, and 4.1% specified the need for distilled or previously boiled water. Most of the videos failed to describe labeling storage containers, 69% of videos encouraged the use of oils or perfumes to enhance hand sanitizer scent, and 2% of videos promoted the use of coloring agents to be more attractive for use among children specifically. There was a significantly increased average number of daily calls to poison control centers regarding unsafe pediatric hand sanitizer exposure since the first confirmed COVID-19 patient in the United States. There was a significantly increased average number of daily calls in March 2020 compared with the previous 2 years. CONCLUSIONS: YouTube may not be an accurate source for effective hand sanitizer concoction. Health care providers and parents should be aware of the increased surge in hand sanitizer exposure among children and should take proper precautionary measures.

Calling for confirmation, reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service.

Understanding the influence of a telephone triage advice service (TTAS) on patients seeking care is critical to realize enhancements in patient care, functioning of emergency departments (EDs), and effectiveness of the health system. This study addresses the question: what influence does a TTAS have on a patient's attendance at an ED and the wider health system? Records from 2016 to 2017 of 12,741 calls from a national TTAS were linked to 72,577 ED presentations to a hospital in regional Australia, retrospectively. Matching criteria included patient within the hospital's statistical local area code, age, gender, and ED attendance within 8 hours of TTAS call. Five statistical analyses of the data were conducted. There were 2857 matches. TTAS patients accessing the ED had a slightly higher proportion of women and a greater proportion of children under 4 years than usual. When TTAS confirmed callers' inclination for ED care, however only up to 69% subsequently attended the ED. When TTAS redirected others initially less inclined to more urgent care, up to 62% attended the ED. TTAS empowers vulnerable patients to access appropriate and timely services and promotes clinical and functional integration of care. Improvements of TTAS can come through investigation of callers' compliance factors.

Patient Satisfaction With Telephone Nursing: A Call for Calm, Clarity, and Competence.

BACKGROUND: Studies of patient satisfaction with telephone nursing can provide a better understanding of callers' needs and inform the improvement of services. PURPOSE: This study described patients' experiences and perceptions of satisfaction with telephone nursing. METHODS: The design was nonexperimental and descriptive, with an inductive approach. Data were collected using open-ended questions in a questionnaire that was dispatched to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden. RESULTS: Patients' satisfaction with telephone nursing was related to calm, clarity, and competence. Calm referred to the nurse remaining calm and composed during the call. Clarity was described as distinct, concrete, and practical advice on how to act, what to observe, and where to seek further assistance. Competence referred to both health care knowledge and caring skills. CONCLUSION: These aspects of nursing are dependent on each other and on-call telephone nursing services, which value patient satisfaction need to target all 3.

Understanding Misdemeanor Enforcement: The Roles of Calls for Service and Community Characteristics.

This study examines the roles of calls for service (i.e., police-related 911 calls) and community characteristics in explaining variation in enforcement rates for low-level, misdemeanor offenses, which make up the large majority of police enforcement activity. The study site is Prince George's County, Maryland, and the unit of analysis is the police department's 65 patrol beats, studied over a 10-year period, during 2006-2015. Overall, misdemeanor enforcement rates vary at the beat level, and that variation can be largely explained using a combination of indicators about community characteristics and calls for service. The findings indicate, though, that the calls for service rate is the most important variable in explaining misdemeanor enforcement variation. These findings inform both future research on police activity, and current policy debates about what drives enforcement rates and the role of discretion in enforcement outcomes.

Male callers to an Australian perinatal depression and anxiety help line-Understanding issues and concerns.

There is increasing recognition of the issues facing men in the perinatal period. Vulnerability factors and issues in the partner relationship contribute to mental health risk and can impact the quality of the father-infant relationship. Yet, there is limited understanding of fathers' help-seeking when they or their partner are experiencing mental health issues in the context of caring for a new baby. The present study examines fathers' contacts with the Perinatal Anxiety and Depression Australia (PANDA) National Helpline. The study reviewed contacts from fathers and their identified needs for assistance, relationship issues, and support needs; 70% of male callers (N = 129) reported concerns about the mother's mental health, and 57% were concerned about relationship breakdown. Significant numbers of men raised issues about their own mental health (43%) and many were concerned about the impact of maternal mental state on the relationship with the infant. When compared to community data, there were elevated rates of concerns about depression and anxiety. Men also described difficulties with the fathering role and with regulating their own feelings of guilt and frustration. These findings highlight the needs of men for support when a mother experiences perinatal problems and also the risk for distress in fathers.

Hay un incremento en el reconocimiento de los asuntos que enfrentan los hombres en el período perinatal.  Los factores de vulnerabilidad y asuntos en la relación con la pareja contribuyen al riesgo de salud mental y pueden tener impacto en la calidad de la relación papá-infante.  Aun así, hay una comprensión limitada acerca de la búsqueda de ayuda por parte de los papás cuando ellos o sus parejas están experimentando asuntos de salud mental en el contexto de cuidar a un nuevo bebé.  El presente estudio examina el contacto de los papás con la línea de ayuda nacional Ansiedad y Depresión Perinatal Australia (PANDA). El estudio revisó contactos de papás y sus identificadas necesidades para la asistencia, asuntos de la relación y necesidades de apoyo: 70% de los varones que llamaron (N = 129) reportaron preocupaciones acerca de la salud mental de la madre y 57% estaban preocupados acerca del rompimiento de la relación.  Un significativo número de hombres presentaron asuntos acerca de su propia salud mental (43%) y muchos estaban preocupados sobre el impacto del estado mental materno en la relación con el infante. Cuando se compara con la información comunitaria, hubo puntajes elevados de preocupaciones acerca de la depresión y la ansiedad. Los hombres también describieron dificultades con el papel de ser padres y con la forma de regular sus propios sentimientos de culpa y frustración.  Estos resultados subrayan las necesidades de los hombres de apoyo cuando una madre experimenta un problema perinatal y también el riesgo de angustia en los papás.

Les problèmes auxquels font face les hommes durant la période périnatale sont de plus en plus reconnus. Des facteurs et des problèmes de vulnérabilité dans la relation au partenaire contribuent au risque de santé mentale et peuvent avoir un impact sur la qualité de la relation père-enfant. Cependant on n'a que des connaissances limitées de l'appel à l'aide des pères lorsqu'ils font ou lorsque leur partenaire fait l'expérience de problèmes de santé mentale dans le contexte du soin à un nouveau-né. Cette étude a examiné les contacts des pères avec la ligne téléphonique nationale australienne pour l'anxiété et la dépression périnatales, abrégée PANDA selon l'anglais. Cette étude a passé en revue les contacts de pères et leurs besoins identifiés d'assistance et de soutien pour des problèmes liés à une relation: 70% des hommes ayant téléphoné (N = 129) ont fait état d'inquiétude à propos de la santé mentale de la mère et 57% étaient inquiets de la désintégration de la relation. Un nombre important d'hommes ont parlé de leur propre santé mentale (43%) et beaucoup d'entre eux étaient inquiets à propos de l'impact de l'état mental maternel sur la relation avec le nourrisson. Comparé aux données communautaires, on a trouvé des niveau élevés d'inquiétude sur la dépression et l'anxiété. Ces hommes ont aussi décrit des difficultés avec le rôle de père et avec la régulation de leurs propres sentiments de culpabilité et de frustration. Ces résultats mettent en évidence les besoins qu'ont les hommes de soutien quand une mère fait l'expérience d'un problème périnatal, et aussi le risque de détresse chez les pères.

[Impact of public health emergency on public psychology: analysis of mental health assistance hotlines during COVID-19 in Zhejiang province].

OBJECTIVE: To analyze the usage of mental health assistance hotline during COVID-19 in Zhejiang province from January 25th to February 29th 2020, and summarize the characteristics of the demand for mental health services and the dynamic changes of public mental health status during COVID-19 pandemic. METHODS: Both quantitative and qualitative methods were used. The calls related to pandemic were divided into four categories: medical, psychological, information and the others. The secondary categories of psychological calls were determined by text analysis. The number of calls were calculated weekly and the number of various types of calls over time were analyzed. We used stratified random sampling method to extract 600 cases of all kinds of calls related to pandemic and conducted a semantic analysis, through marking new, similar combination to form a feature set, then summed up the call content characteristics of each stage. Two hundred callers were followed up to understand how they felt about the call process in four aspects: the waiting time, call duration, the degree of problem-solving and the way to end the call. RESULTS: In a total of 13 746 calls, 8978 were related to pandemic, among which 12.59%(1130/8978) were about medical issues, 26.50%(2379/8978) were about mental health, 27.18%(2440/8978) were about information regarding the pandemic and 33.74%(3029/8978) were about other pandemic related issues. Pandemic situation, relevant policy release, frequency of advertising campaigns were predictors of the number of calls per day during the pandemic (P<0.05 or P<0.01). The number of calls differed by gender and identities of callers (both P<0.05). Finally 181 callers accepted telephone follow-up. Among them, 51.38%(93/181) of the callers thought that the waiting time was too long, 33.15%(60/181) of the callers thought that the call time was insufficient, 80.66%(146/181) of callers believed that the hotline could partially or completely resolve their concerns, and 39.23%(71/181) of the callers said the operator proposed to end the call. CONCLUSIONS: s The changes of the number and content of the mental health assistance hotline calls reflected that the public mental health status experienced four stages during the pandemic: confusion, panic, boredom, and adjustment. The specialized mental health assistance hotlines should be further strengthened, and the efficiency should be improved. Mental health interventions should be tailored and adopted according to the characteristics of the public mental health status at different stages of the pandemic.

Impact of changes in home smoking bans on tobacco cessation among quitline callers.

Home smoking bans may be an effective way to promote tobacco cessation among treatment seeking smokers. Few studies have examined this relationship in a quitline setting. Data were obtained from 14,296 adults who were enrolled in a state quitline between January 2011 and July 2016. This study investigated whether cessation rates varied by changes in home smoking ban implementation between enrollment and 7-month follow-up. The impact of changes in home smoking bans on cessation at follow-up was significantly modified by having other smokers living in the home at follow-up (P < 0.0001). Among callers who did not live with other smokers in the home, the highest odds ratio of 30-day cessation was for callers who reported bans at follow-up only (OR = 10.50, 95%CI: 8.00, 13.70), followed by callers who reported bans at both enrollment and follow-up (OR = 8.02, 95%CI: 6.27, 10.30) and callers who reported bans at enrollment only (OR = 2.06, 95% CI: 1.47, 2.89) compared with callers with no home smoking bans. When callers reported that they lived with other smokers in the home, the effect of home smoking bans on cessation was much smaller. Quitlines should support the implementation of home smoking bans as a part of callers' goal setting activities to achieve tobacco cessation.

Factors Precipitating Calls to a Help Hotline: A Comparison of Whites, Blacks, and Hispanics.

Studies have found that the main reasons provided by problem gamblers for calling a gambling help hotline are financial, legal, or relationship problems, but no study has looked into whether these motivators vary by ethnicity. In particular, this study sought to find if Hispanics were more likely to call due to relationship problems. Using data gathered by the Florida Council on Compulsive Gambling from problem gamblers calling for help (N = 826), it was found that the most common reason for calling the hotline by all ethnic groups was financial. However, among problem gamblers calling for non-financial reasons Hispanics significantly reported calling for relationship problems and Whites due to legal problems. Blacks did not significantly call for non-financial reasons. Possible implications of these findings for education and reaching out to different ethnic groups regarding problem gambling are discussed.

Media Flight Schedules and Seasonality in Relation to Quitline Call Volume.

CONTEXT: Given the high profile, cost, and vulnerability to budget cuts of mass-reach health education campaigns, researchers have cited the need for media buying strategies. OBJECTIVE: The objective of the current study is to fill a gap in the literature by comparing the impact of media flight schedule types in relation to tobacco quitline call volume. DESIGN: The retrospective study was designed to determine whether type of media flight schedule (eg, flighting, continuous, pulsing) impacted number of calls to the Maine Tobacco Helpline, while accounting for number of gross rating points (GRPs), seasonality, holidays, and other factors. SETTING: Maine has 3 designated market areas (DMAs): Portland/Auburn, Bangor, and Presque Isle. MAIN OUTCOME MEASURES: Daily call volume was matched with weekly GRPs. METHODS: A negative binomial regression model was created to examine the relationship among media flight schedules, number of GRPs, and call volume. Gross rating points reflect national networks and local cable TV media buys. A second model examined the association between GRP dose levels and call volume. RESULTS: The number of GRPs was a significant predictor of call volume (P < .001). Weekly number of GRPs within a media flight schedule was the most important indicator for potential effectiveness. Weekly low-dose GRPs were not effective in increasing calls, indicating a minimum threshold. For every 250 GRPs, 29% (or 73) more calls per week were attributed to the media campaigns (P < .001). Weekly quitline call volume was 21% (or 53 calls) lower during the weeks of Christmas, US Thanksgiving, and US Independence Day. CONCLUSION: Type of media flight schedule should be considered in the context of purchasing sufficient weekly, as well as quarterly, rating points to increase tobacco quitline call volume. In addition, our study is the first to quantify and report on lower tobacco quitline call volume during several US holidays.

Spatiotemporal Analysis of Oklahoma Tobacco Helpline Registrations Using Geoimputation and Joinpoint Analysis.

OBJECTIVE: Tobacco quitlines provide free smoking cessation telephone services to smokers interested in quitting tobacco. We aimed to explore spatial and temporal analyses of registrations to the Oklahoma Tobacco Helpline including those of any racial group and American Indians (AI) from January 1, 2006, to June 30, 2017. This will allow tribal and community organizations, such as the Oklahoma Tribal Epidemiology Center, to better implement and evaluate public health prevention efforts at a smaller geographic area using the larger geographic units that are publicly available. DESIGN: Retrospective, descriptive study. SETTING: Oklahoma. PARTICIPANTS: Registrants to the Oklahoma Tobacco Helpline. MAIN OUTCOME MEASURES: To evaluate the spatial distribution of Helpline participants using geoimputation methods and evaluate the presence of time trends measured through annual percent change (APC). RESULTS: We observed increased density of participants in the major population centers, Oklahoma City and Tulsa. Density of AI registrations was higher in the rural areas of Oklahoma where there is a larger tribal presence compared with participants of any racial group. For all racial groups combined, we identified 3 significant trends increasing from July 2008 to March 2009 (APC: 10.9, 95% confidence interval [CI], 0.8-21.9), decreasing from March 2009 to May 2014 (APC: -0.8, 95% CI: -1.1 to -0.4), and increasing from May 2014 to June 2017 (APC: 0.8, 95% CI: 0.0-1.6). The number of AI registrations to the Helpline increased significantly from July 2008 to March 2009 (APC: 12.0, 95% CI: 2.0-22.9) and decreased from March 2009 to June 2014 (APC: -0.7, 95% CI: -1.0 to -0.3). CONCLUSIONS: Results of this project will allow the Helpline to efficiently identify geographic areas to increase registrations and reduce commercial tobacco use among the AI population in Oklahoma through existing programs at the Oklahoma Tribal Epidemiology Center.

[Trends in cancer information services over 25 years : An analysis of inquiries from patients and relatives made to the Cancer Information Service of the German Cancer Research Center from 1992 to 2016]. / Langzeittrends beim Krebsinformationsdienst (KID) des Deutschen Krebsforschungszentrums (DKFZ) : Eine Analyse der Anfragen von Patientinnen und Patienten sowie Angehörigen von 1992 bis 2016.

BACKGROUND: Cancer information services (CISs) are a valuable source of evidence-based information. Previous studies in the field of CISs often investigate only short periods of time. However, there is a need for long-term analyses to identify changes in the use of CISs. OBJECTIVES: The purpose of this study was to analyze trends in the inquiries of patients and surrogate seekers to a CIS. METHOD: We conducted a secondary data analysis of the inquiry records of the German CIS (Krebsinformationsdienst, KID) hosted by the German Cancer Research Center from 1992 until 2016 (N = 545,070). Trends in the number of inquiries were described using the whole sample, while the description of further characteristics is based on a sample (n = 55,046) of patients, their family members, and friends. RESULTS: The inquiries increased in the period examined (1992: 11,344 inquiries; 2016: 34,869 inquiries). Since 2005, a greater share of patients (between 52 and 60%) than surrogate seekers have been contacting the CIS. The mean age of both self-seeking and supported patients increased from under 55 years between 1992 and 2000 up to over 60 years in the year 2016. Breast cancer is at all times the most frequently inquired cancer type (patients: n = 11,319, 39%; surrogate seekers: n = 4173, 17%). Even after the implementation of e­mail as an additional communication channel, the majority of inquirers still prefer contact by phone (between 80 and 98%). CONCLUSIONS: Changes in the utilization of a CIS over time are discussed against the background of structural changes, such as shifts in prevalence rates, family structures, or media environments.

Suicidality among gambling helpline callers: A consideration of the role of financial stress and conflict.

BACKGROUND AND OBJECTIVES: High rates of suicidal ideation and attempts secondary to gambling are well established among those with gambling disorders. The present study explores potential risk factors for suicidal ideation and/attempt among a sample of help-line callers. METHODS: Participants (N = 202) completed measures assessing demographics; gambling behavior; and financial, family/social, employment, substance use, and legal difficulties related to gambling. Bivariate analyses, logistic regression, and mediation analyses were used to explore relationship between predictors and risk of suicidal ideation and attempt. RESULTS: Female gender, gambling severity (including engagement in illegal behaviors), a history of mental health problems, financial problems, and conflict related to gambling were associated with current suicidality in this sample. Mediation analyses revealed that financial problems were associated with increased familial conflict, which was in turn associated with increased suicidality. CONCLUSIONS: Family and social conflict may be one important way in which financial problems confer risk for suicidality among problem gamblers. These results align with findings from the substance use disorder (SUD) literature and highlight one potential factor that may merit further assessment and/or intervention. SCIENTIFIC SIGNIFICANCE: Researchers and clinicians may want to consider the overall level of conflict a patient is experiencing when assessing suicide risk among individuals with gambling problems. Professionals may also want to consider the suitability of interventions to address conflict within the context of gambling treatment. (Am J Addict 2018;27:531-537).