Feasibility and Early Outcomes of a Tailored Quitline Protocol for Smokers With Mental Health Conditions.

INTRODUCTION: Adults with mental health conditions (MHCs) smoke at higher rates, are more nicotine dependent, and have more trouble quitting smoking than those without MHCs. About half of smokers who call state-funded quitlines report MHCs, and those with such conditions have cessation rates 8%-10% lower than those without MHCs. This article describes a clinical pilot of a tailored protocol for quitline callers with MHCs. METHODS: Callers to the Texas Tobacco Quit Line who self-reported MHCs were offered a tailored quitline program, offering up to 12 weeks of combination nicotine replacement (nicotine patch plus gum or lozenge) and seven counseling calls. Characteristics, program engagement, and 7-month outcomes for these pilot participants were compared to callers in the standard Texas Tobacco Quit Line program with and without MHCs not offered the tailored program. RESULTS: Eighty-eight percent of eligible quitline callers accepted enrollment in the tailored pilot. Pilot enrollees (n = 311) had high rates of comorbidity and serious mental illness, including bipolar disorder (59%). Those in the pilot sample participated in more coaching calls and used more nicotine replacement versus comparison groups. Early cessation outcomes showed numerically higher quit rates for pilot participants than those with MHCs in the standard program, but small sample size and low response rates prevent definitive statements about efficacy. CONCLUSIONS: Offering a tailored quitline protocol for callers with MHCs was feasible and acceptable to quitline callers and increased engagement in treatment. A larger study is needed to determine if the protocol increases cessation among this group. IMPLICATIONS: Nearly half of all quitline callers report a MHC. This clinical quality improvement pilot shows that delivering a tailored tobacco cessation program for smokers with MHCs is feasible and acceptable to quitline callers. Participants in the pilot group had higher engagement in treatment, doubling the number of coaching calls received and using more nicotine replacement than comparison groups. Further investigation is needed to determine the effect of this program on cessation rates, although preliminary outcomes are promising.

Development and Validation of the Consumer Health Activation Index.

BACKGROUND: Although there has been increasing interest in patient engagement, few measures are publicly available and suitable for patients with limited health literacy. OBJECTIVE: We sought to develop a Consumer Health Activation Index (CHAI) for use among diverse patients. METHODS: Expert opinion, a systematic literature review, focus groups, and cognitive interviews with patients were used to create and revise a potential set of items. Psychometric testing guided by item response theory was then conducted among 301 English-speaking, community-dwelling adults. This included differential item functioning analyses to evaluate item performance across participant health literacy levels. To determine construct validity, CHAI scores were compared to scales measuring similar personality constructs. Associations between the CHAI and physical and mental health established predictive validity. A second study among 9,478 adults was used to confirm CHAI associations with health outcomes. RESULTS: Exploratory factor analyses revealed a single-factor solution with a 10-item scale. The CHAI showed good internal consistency (alpha = 0.81) and moderate test-retest reliability (ICC = 0.53). Reading grade level was found to be at the 6th grade. Moderate to strong correlations were found with similar constructs (Multidimensional Health Locus of Control, r = 0.38, P < 0.001; Conscientiousness, r = 0.41, P < 0.001). Predictive validity was demonstrated through associations with functional health status measures (depression, r = -0.28, P < 0.001; anxiety, r = -0.22, P < 0.001; and physical functioning, r = 0.22, P < 0.001). In the validation sample, the CHAI was significantly associated with self-reported physical and mental health ( r = 0.31 and 0.32 respectively; both P < 0.001). CONCLUSIONS: The CHAI appears to be a valid, reliable, and easily administered tool that can be used to assess health activation among adults, including those with limited health literacy. Future studies should test the tool in actual use and explore further applications.

Incentives and other factors associated with employee participation in health risk assessments.

OBJECTIVES: Investigate factors associated with employee participation rates in health risk assessments. METHODS: This cross-sectional study using multiple regression analyzed data from 124 employers with 882,275 eligible employees who completed 344,825 health and productivity assessments (HPAs). RESULTS: Incentive value and Communications and Organizational Commitment Level (Com/Org Level) were the strongest predictors of HPA completion rates. Employer size and a Gateway Model were also significant predictors. In addition, a correlation of variables showed other important relationships. To achieve a 50% HPA completion rate, employers with a low Com/Org Level will need an incentive value of approximately $120 whereas employers with a high Com/Org Level only need approximately $40--a difference of $80 dollars. CONCLUSION: This applied study offers empirical evidence to help employers increase their employees' participation in health risk assessments.