title: Telephone Smoking-Cessation Counseling for Smokers in Mental Health Clinics: A Patient-Randomized Controlled Trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  RCT.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  BACKGROUND
  This study is registered at www.clinicaltrials.gov NCT00724308.
authors.affiliation: VA NY Harbor Healthcare System, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York. Electronic address: erin.rogers2@va.gov.
authors.forename: Erin S
authors.initials: ES
authors.lastname: Rogers
authors.affiliation: Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: David A
authors.initials: DA
authors.lastname: Smelson
authors.affiliation: VA NY Harbor Healthcare System, New York, New York; Division of General Internal Medicine, New York University School of Medicine, New York, New York.
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Gillespie
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Elbel
authors.affiliation: California Breast Cancer Research Program, University of California Office of the President, Oakland, California.
authors.forename: Senaida
authors.initials: S
authors.lastname: Poole
authors.affiliation: Minneapolis VA Medical Center, Minneapolis, Minnesota; Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Hildi J
authors.initials: HJ
authors.lastname: Hagedorn
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Kalman
authors.affiliation: VA NY Harbor Healthcare System, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Krebs
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Yixin
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Binhuan
authors.initials: B
authors.lastname: Wang
authors.affiliation: VA NY Harbor Healthcare System, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Sherman
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services; D008875:Middle Aged; D009042:Motivation; D017060:Patient Satisfaction; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013689:Telephone; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000534:rehabilitation