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.

Patient compliance with NHS 111 advice: Analysis of adult call and ED attendance data 2013-2017.

The NHS 111 telephone advice and triage service is a vital part of the management of urgent and emergency care (UEC) services in England. Demand for NHS 111 advice has increased since its introduction in 2013, and the service is of particular importance in light of the current pandemic and resulting increased demand for emergency care. Currently, little is known about the effectiveness of NHS 111 in terms of the appropriateness of the advice given, or about the compliance of patients with that advice. We aimed to address this issue by analysing a large linked routine dataset of all NHS 111 calls (n = 3,631,069) and subsequent emergency department (ED) attendances made in the Yorkshire & Humber region from March 2013-March 2017. We found that many patients do not comply with advice, with 11% (n = 289,748) of patients attending ED when they are advised to self-care or seek primary care. We also found that a considerable number of these patients are further classed as urgent (88%, n = 255,931) and a substantial minority (37%, 106,207) are subsequently admitted to hospital. Further, many patients who are sent an ambulance or told to attend ED are classed as non-urgent upon attending ED (9%, n = 42,372). This research suggests that the level at which NHS 111 is currently triaging results in many hundreds of thousands of mis-triaged cases annually. Additionally, patients frequently do not comply with the advice they receive. This has implications for understanding the accuracy and efficiency of triaging systems.

Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial.

BACKGROUND: A high proportion of vocational education students smoke tobacco, have inadequate nutrition (ie, low fruit and vegetable intake), drink alcohol at risky levels, or are physically inactive. The extent to which vocational education students will sign up for proactively offered online and telephone support services for multiple health risk behaviors is unknown. OBJECTIVE: The aim of this study is to examine the uptake of proactively offered online and telephone support services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors, individually and in combination, among vocational education students in the Technical and Further Education (TAFE) setting. The characteristics associated with the uptake of online or telephone services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors were also examined. METHODS: Vocational education students enrolled in a TAFE class in New South Wales, Australia, which ran for 6 months or more, were recruited to participate in a cluster randomized controlled trial from May 2018 to May 2019. In the intervention arm, participants who did not meet the Australian health guidelines for each of the smoking, nutrition, alcohol consumption, and physical activity risk behaviors were provided electronic feedback and proactively offered online and telephone support services. Uptake of support was measured by whether participants signed up for the online and telephone services they were offered. RESULTS: Vocational education students (N=551; mean age 25.7 years, SD 11.1; 310/551, 56.3% male) were recruited into the intervention arm. Uptake of the proactive offer of either online or telephone services was 14.5% (59/406) for fruit and vegetables, 12.7% (29/228) for physical activity, 6.8% (13/191) for smoking, and 5.5% (18/327) for alcohol use. Uptake of any online or telephone service for at least two health behaviors was 5.8% (22/377). Participants who were employed (odds ratio [OR] 0.10, 95% CI 0.01-0.72) and reported not being anxious (OR 0.11, 95% CI 0.02-0.71) had smaller odds of signing up for online or telephone services for smoking, whereas participants who reported not being depressed had greater odds (OR 10.25, 95% CI 1.30-80.67). Participants who intended to change their physical activity in the next 30 days had greater odds (OR 4.01, 95% CI 1.33-12.07) of signing up for online or telephone services for physical activity. Employed participants had smaller odds (OR 0.18, 95% CI 0.06-0.56) of signing up for support services for at least two behaviors. CONCLUSIONS: Although the uptake of proactively offered online and telephone support services is low, these rates appear to be higher than the self-initiated use of some of these services in the general population. Scaling up the proactive offer of online and telephone services may produce beneficial health outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001.

A systematic review examining the characteristics of users of NHS patient medicines helpline services, and the types of enquiries they make.

BACKGROUND AND OBJECTIVE: Patient medicines helpline services (PMHS) are available from some National Health Service Trusts in the UK to support patients following their discharge from hospital. The aim of this systematic review was to examine the available evidence regarding the characteristics of enquirers and enquiries to PMHS, in order to develop recommendations for service improvement. METHODS: Searches were conducted using Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science, on 4 June 2019. Forward and backward citation searches were conducted, and grey literature was searched. Studies were included if they reported any characteristics of enquirers who use PMHS, and/or enquiries received. Study quality was assessed using the Axis tool. A narrative synthesis was conducted, and where appropriate, weighted means (WMs) were calculated. Where possible, outcomes were compared with Hospital Episode Statistics (HES) data for England, to establish whether the profile of helpline users may differ to that of hospital patients. RESULTS: Nineteen studies were included (~4362 enquiries). Risk of bias from assessed studies was 71%. Enquirers were predominantly female (WM=53%; HES mean=57%), elderly (WM=69 years; HES mean=53 years) and enquired regarding themselves (WM=72%). Out of inpatient and outpatient enquirers, 50% were inpatients and 50% were outpatients (WM). Six of 15 studies reported adverse effects as the main enquiry reason. Two of four studies reported antimicrobial drugs as the main enquiry drug class. From two studies, the main clinical origin of enquiries were general surgery and cardiology. Across six studies, 27% (WM) of enquiries concerned medicines-related errors. CONCLUSIONS: Our findings show that PMHS are often used by elderly patients, which is important since this group may be particularly vulnerable to experiencing medicines-related issues following hospital discharge. Over a quarter of enquiries to PMHS may concern medicines-related errors, suggesting that addressing such errors is an important function of this service. However, our study findings may be limited by a high risk of bias within included studies. Further research could provide a more detailed profile of helpline users (eg, ethnicity, average number of medicines consumed), and we encourage helpline providers to use their enquiry data to conduct local projects to improve hospital services (eg, reducing errors). PROSPERO REGISTRATION NUMBER: CRD42018116276.

Tobacco Cessation and Referral to the National Quitline.

Background: Smoking is the leading cause of preventable deaths in the United States. The rates of smoking remain elevated in rural, low income populations in comparison with the rest of the United States. Thus, prompting the process improvement project of implementing the Ask-Advise-Connect (AAC) method to the national quitline in a nurse practitioner-managed clinic for an automotive manufacturing plant in rural Tennessee. Methods: Ask-Advise-Connect method was added to the current smoking cessation program. The employees who utilized the clinic were assessed for smoking status at each visit and subsequently counseled on cessation. Individuals interested in cessation were connected to the national quitline with the AAC method. Pharmaceutical options and nicotine replacement therapy was also offered at no cost to the employee. Findings: In the 4-month period, the clinic provided 102 tobacco cessation counseling visits to workers who smoke. Twenty-four employees enrolled in the cessation program. The participants reported a cessation rate of 12.5% and 21% had a significant decrease in the number of cigarettes smoked. Of the participants, 12.5% (n = 3) engaged in behavioral counseling with the quitline. Conclusion/application to practice: The addition of the AAC method as part of the smoking cessation program had limited success. As smoking cessation is difficult to achieve, any success greater than 7% can be considered an achievement. The 12.5% cessation rate of the participants was above the national average. Thus, demonstrating the benefit of having a workplace cessation program and incorporating the AAC method to the current smoking cessation program.

Psychological crisis intervention response to the COVID 19 pandemic: A Tunisian centralised Protocol.

In order to manage the urgent psychological need for support in response to the anticipated reaction of the population to the COVID-19 pandemic, we developed a new psychological crisis intervention model by implementing a centralised psychological support system for all of Tunisia. We set up a helpline which is accessible throughout the country, including those without access to Internet. This model integrates medical students, child and adolescent psychiatrists, psychiatrists, psychologists and social services to provide psychological intervention to the general population and medical staff. It will make a sound basis for developing a more effective psychological crisis intervention response system.

Texting at a Child Helpline: How Text Volume, Session Length and Duration, Response Latency, and Waiting Time Are Associated with Counseling Impact.

This study investigated the association between formal features, such as text volume, session length and duration, response latency, and waiting time, and the impact of counseling. The analysis was based on 603 text message counseling sessions at a child helpline and connected information about the formal features of the sessions and the effects on clients. The results showed that sessions characterized by more text volume from the counselor in each message, but with fewer messages from beginning to end, were more effective than sessions without these characteristics. Furthermore, session duration was associated with a positive impact, whereas counselor response latency was not. This indicates that clients might benefit from the asynchronous affordance of texting as long as the counselor responds promptly and with dense messages. We also found that the impact measured at end of session predicted the impact measured 2 weeks after the child or young person received counseling.

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 telephone follow-up and 24/7 hotline on 30-day readmission rates following aortic valve replacement -A randomized controlled trial.

BACKGROUND: Thirty-day all-cause readmissions are high after aortic valve replacement (AVR). We aimed to assess the effectiveness of a structured telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause readmission (30-DACR) after AVR, on reducing symptoms of anxiety and depression and on improving perceived health state. METHODS: A prospective randomized controlled trial was conducted. Patients (n = 288) were randomly allocated to either post-discharge usual care or to care that provided TFU and access to a 24/7 hotline after AVR. Ancillary endpoints were time-to-event (readmission), proportion of avoidable versus unavoidable readmissions after AVR, and predictors of 30-DACR after AVR. RESULTS: 30-DACR was 22.3%. The structured TFU and 24/7 hotline intervention failed to reduce 30-DACR rates after AVR (P = 0.274). Symptoms of anxiety were significantly reduced 30 days after surgery (P = 0.031), an effect that did not persist one year after surgery (P = 0.108). Most readmissions occurred before 15 days post-discharge, and 75% of them were deemed to be unavoidable. Pleural drainage before hospital discharge (P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were predictors of 30-DACR after AVR. CONCLUSION: The TFU and 24/7 hotline had no effect on reducing 30-DACR after AVR. However, we did measure reduced symptoms of anxiety the first month after AVR. Anxiety reduction appeared to be an important target for intervention, because we found it to be a risk factor for readmission. Future research should focus on the effectiveness of interventions to prevent avoidable unplanned readmissions. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02522663.

A regional systems intervention for suicide prevention in the Netherlands (SUPREMOCOL): study protocol with a stepped wedge trial design.

BACKGROUND: In the Netherlands, suicide rates showed a sharp incline and this pertains particularly to the province of Noord-Brabant, one of the southern provinces in the Netherlands. This calls for a regional suicide prevention effort. METHODS/DESIGN: Study protocol. A regional suicide prevention systems intervention is implemented and evaluated by a stepped wedge trial design in five specialist mental health institutions and their adherent chain partners. Our system intervention is called SUPREMOCOL, which stands for Suicide Prevention by Monitoring and Collaborative Care, and focuses on four pillars: 1) recognition of people at risk for suicide by the development and implementation of a monitoring system with decision aid, 2) swift access to specialist care of people at risk, 3) positioning nurse care managers for collaborative care case management, and 4) 12 months telephone follow up. Eligible patients are persons attempting suicide or expressing suicidal ideation. Primary outcome is number of completed suicides, as reported by Statistics Netherlands and regional Public Health Institutes. Secondary outcome is number of attempted suicides, as reported by the regional ambulance transport and police. Suicidal ideation of persons registered in the monitoring system will, be assessed by the PHQ-9 and SIDAS questionnaires at baseline and 3, 6, 9 and 12 months after registration, and used as exploratory process measure. The impact of the intervention will be evaluated by means of the RE-AIM dimensions reach, efficacy, adoption, implementation, and maintenance. Intervention integrity will be assessed and taken into account in the analysis. DISCUSSION: The present manuscript presents the design and development of the SUPREMOCOL study. The ultimate goal is to lower the completed suicides rate by 20%, compared to the control period and compared to other provinces in the Netherlands. Moreover, our goal is to provide specialist mental health institutions and chain partners with a sustainable and adoptable intervention for suicide prevention. TRIAL REGISTRATION: Netherlands Trial Register under registration number NL6935 (5 April 2018). This is the first version of the study protocol (September 2019).

Telephone nurses' use of a decision support system: An observational study.

Telephone nurses give advice and support and make assessments based on verbal communication only. Web-based decision support systems are often used to increase patient safety and make medically correct assessments. The aim of the present this study was to describe factors affecting the use of a decision support system and experiences with this system among telephone nurses in Swedish primary health care. Observations and semistructured interviews were conducted. Six registered nurses with at least 1 year of experience of telephone nursing participated. Field notes and interviews were analyzed by qualitative content analysis. The main findings of the present this study were factors that decrease the decision support system use or promote deviation from decision support system use, factors that are positive for decision support system use and the decision support system complicates the work. Underuse and deviations from decision support systems can be a safety risk, because decisions are based on too little information. Further research with observations of telephone nurses' use of decision support systems is needed to develop both telephone nursing and decision support systems.

Mobile Helpline and Reversible Contraception: Lessons From a Controlled Before-and-After Study in Rural India.

BACKGROUND: Researchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India. OBJECTIVE: This study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India. METHODS: We implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed. RESULTS: The current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents' mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline. CONCLUSIONS: A mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India.

Are cancer helplines effective in supporting caregivers? A systematic review.

PURPOSE: The aims of this systematic review were to summarize the profile of caregivers accessing cancer helplines, to evaluate caregiver satisfaction with the helpline service, and to review the evidence base of intervention studies testing the efficacy of community-based cancer helplines in improving caregiver health and well-being. METHODS: Four electronic databases (Medline, CINAHL, PsychINFO, and EMBASE) were systematically searched to identify relevant literature, including all articles published in English until May 2018. Reference lists of accepted papers were reviewed for the inclusion of additional potentially relevant articles, gray literature was excluded. RESULTS: Forty-five publications met the inclusion criteria for this review. Forty-one papers reported on the proportion of caregivers accessing cancer helplines. Twenty-six studies described demographic and clinical characteristics of caregivers and eight reported on call characteristics. Reasons for contacting the service were stated in 21 studies and caregiver satisfaction with the helpline service was assessed in 12 articles. Fourteen studies investigated specific topics of interest (e.g., prevalence of sleep problems, distress screening, or clinical trial participation). Two randomized controlled trials examined the efficacy of cancer helplines in improving caregiver outcomes, with findings showing interventions to be effective in reducing distress and unmet needs, and in increasing positive adjustment. CONCLUSIONS: There is limited scientific evidence regarding the efficacy of cancer helplines to improve caregivers' health and well-being. More intervention studies are needed to examine the benefits of cancer helplines to this study population to ensure structured referral pathways can be established.

The role of responsibility in oncological emergency telephone calls.

BACKGROUND: Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. RESEARCH OBJECTIVE: The aim was to explore the meaning of responsibility as it appeared in patients' or caregivers' experiences of calling an oncological emergency telephone. DESIGN, PARTICIPANTS AND CONTEXT: Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed. ETHICAL CONSIDERATIONS: The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. FINDINGS: Two main themes emerged: (1) to act responsibly as a patient or caregiver was to 'be watchful and alert', 'report symptoms the right way' and 'do crosschecking' and (2) to deal with the burden of responsibility was to 'feel safe when dealing with the burden of responsibility' and 'be relieved from the burden of responsibility'. DISCUSSION: Too much responsibility and a potential imbalance between healthcare professionals' expectations and callers' knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. CONCLUSION: The meaning of responsibility appeared in the participants' capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.

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.

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.

1-800-Externship: The Use of Hotlines as a Training Modality for Future Clinicians.

Mental health on college campuses is a growing issue. Despite a rise in demand for services, counseling centers generally offer assistance during business hours, with a limited number of clinicians. Hotlines can provide an avenue for suicide prevention and intervention while offering training to graduate counseling students. The present study used a qualitative approach to examine the benefits and challenges of using hotlines as a clinical training modality. Interviews with nine graduate students volunteering at a hotline were analyzed using a consensual qualitative research methodology. Several domains were identified, including: three domains related to initial involvement with a clinical training experience at a hotline, four related to the experience of volunteering, and five related to the connection of the clinical training experience to the participant's development as a clinician. Hotlines as a training modality can be used to benefit the community and contribute to the development of future clinicians.