Nicotine & Tobacco Research, 2015, 735–741 doi:10.1093/ntr/ntu239 Original investigation Advance Access publication November 9, 2014
Original investigation
Cessation Among State Quitline Participants with a Mental Health Condition Downloaded from http://ntr.oxfordjournals.org/ at The University of British Colombia Library on November 16, 2015
Jennifer L. Kerkvliet MA, LPC, NCC, Howard Wey PhD, MS, Nancy L. Fahrenwald, PhD, RN, APHN-BC College of Nursing, South Dakota State University, Brookings, SD Corresponding Author: Jennifer L. Kerkvliet, MA, LPC, NCC, College of Nursing, South Dakota State University, Box 2275, Brookings, SD 57007, USA. Telephone: 605-688-4131; Fax: 605-688-6119; E-mail: [email protected]
Abstract Introduction: Telephone quitlines are an effective treatment option for tobacco cessation in the general population. Many participants who use quitline services have mental health conditions (MHC), yet few published studies have examined the use of quitline services in this population. This study examined the prevalence of MHC among state quitline participants and compared cessation outcomes among those with and without MHC. Methods: Demographic and tobacco use data were collected at enrollment and 7 months postenrollment using standardized assessments for 10,720 eligible participants who enrolled in a state quitline between September, 2010 and August, 2012. Results: The prevalence of self-reported MHC was 19.8% (2,086/10,720 callers). The intent to treat quit rate for participants with a MHC was 16.4% compared to 21.5% for those without a MHC (p < .001), and the responder quit rate was 36.9% for those with a MHC compared to 44.4% for those without (p < .001). The adjusted odds ratio describing the association of MHC status and tobacco cessation was identical for both the intent-to-treat and responder populations, and indicated that participants with MHC were 23% less likely to quit (p < .05). Conclusions: This study identified that participants with MHC accessed a state quitline, but were less likely to quit. The finding was independent of other factors influencing tobacco cessation, such as gender, race, and education. These findings indicate that although quitline services are an option for tobacco cessation among persons with MHC, further research is needed to determine why cessation rates are lower.
Introduction Tobacco use disproportionately impacts persons with mental health conditions (MHC). Although overall rates of smoking have declined over the past years, smoking rates among adults with MHC have declined very little, 1 and are currently estimated at 36.1%. 2 Some estimates report that about 45% of the annual tobacco-related deaths are among smokers with MHC. 3,4
National survey data suggests that persons with MHC may be less likely to quit than those without MHC. An analysis of National Health Interview Survey data reported that smokers who had high levels of non-specific psychological distress were less likely to quit smoking than smokers with less distress.5 Another study using National Comorbidity Survey data found that selfreported quit rates among respondents with current mental illness were lower (30.5%) than those without current mental illness (42.5%).6
© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
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Methods Setting and Participants The South Dakota (SD) QuitLine is a Department of Health program that offers a toll-free telephone cessation service for tobacco users. Participants who request cessation services are offered five proactive coaching sessions delivered by trained health coaches. A tobacco cessation product including NRT in the form of gum, patch or lozenge, or medications, bupropion or varenicline, is provided free of cost for an eight week period. Referral to a physician is required to obtain either of the prescription medications available through the SD QuitLine (bupropion or varenicline). Tobacco users under age 18 and pregnant or nursing women are also referred to a physician for approval and prescription for any cessation product available through the SD QuitLine. Participants requesting one of the NRT options are screened for known medical contraindications including pregnancy, recent cardiac complications, and weight less than 100 pounds, and advised to follow-up with a physician if noted. Medications are delivered in staggered increments following designated coaching sessions and mailed directly to the participant’s
home. All residents of the state who are current tobacco users interested in quitting are eligible to participate at no cost, regardless of insurance status. Most participants (98.4%) self-initiate the enrollment call. The others are directly referred by a healthcare provider, requiring that quitline staff initiate the enrollment call. Participants in both the MHC group and no MHC group were provided the same treatment options. Quitline service data for this study covered a two-year period (September 1, 2010 to August 31, 2012). Total enrollment in this time period was 12,173. Of this cohort, 120 participants did not consent to follow-up and were excluded. Following North American Quitline Consortium (NAQC) procedures for uniform measurement of quit rates, 951 participants who did not receive an evidencebased treatment (i.e., medication or at least one coaching session), and 362 participants who re-enrolled in the service before completing the seven month follow-up, were excluded.17 Participants with missing demographic information were also excluded (n = 20). The composition of the study population was significantly different (p < .05) from the excluded population in age (mean ± SD in years: study, 42.1 ± 14.2; excluded, 38.7 ± 14.5) and in the proportion of persons with MHC (study, 19.5%; excluded, 8.3%), race (Caucasian %/American Indian %/other %: study, 90.4/6.0/3.7; excluded, 81.2/13.6/5.2), education (< high school %/high school %/> high school %: study, 11.4/37.6/51.0; excluded, 16.3/38.6/45.1), duration of tobacco use (0–5 years %/6–10 years %/10 or more years %: study, 6.6/10.0/83.4; excluded, 12.5/13.0/74.5), cigarette use (study, 90.5%; excluded, 88.6%), and receiving Medicaid benefit (study, 13.4%; excluded, 18.4%). The total eligible study population was 10,720 tobacco users (Figure 1).
Procedures At the time of enrollment, quitline coaches collected demographic and tobacco use information using the standard questions from the minimal data set (MDS) for Intake.18 Follow-up evaluation is conducted by trained staff using the NAQC recommended procedures.17 Between 6.5 and 7.5 months after enrolling in the quitline service, all consenting participants are contacted by phone and asked to complete a survey. Items on the survey include all standard questions from the Follow-up MDS,18 as well as state-added questions regarding satisfaction, cessation product use, and reasons for relapse. Seven attempts were made to contact participants on varying days and times before participant was considered lost to follow-up. The data collection procedures were approved by a university Institutional Review Board.
Measures Demographic characteristics included age, gender, race, education, and Medicaid status. To reflect the racial demographics in South Dakota, race was categorized as White, American Indian, and due to small numbers, all other races were grouped as other. Education was categorized as less than high school, high school diploma or GED, and some college or higher. Measurement of Medicaid benefit status was self-report (yes/no). Measures related to tobacco use included duration of use and type of product used. Tobacco use duration was categorized as 0–5 years, 6–10 years, and 10 or more years. Type of tobacco use was categorized as cigarettes only, spit tobacco only, other only, and poly-tobacco use. During the initial coaching session, participants were asked to self-report chronic health conditions by answering “yes” or “no” to each option of the following question, “Have you ever been told you
Downloaded from http://ntr.oxfordjournals.org/ at The University of British Colombia Library on November 16, 2015
Clinical practice guidelines identify that the most effective tobacco dependence treatment options for those with MHC appear to be a combination of counseling and a first-line cessation product (nicotine replacement therapy [NRT], bupropion, or varenicline).7 Telephone quitlines, which often provide both counseling and cessation products, are effective for tobacco cessation in the general population.7–9 Quitlines are already serving those with MHC, with estimates reporting between 19% and 50% of the national quitline call population are participants with MHC.10 In a recent survey of 96% of quitlines in the United States, every quitline reported serving clients with MHC, all had staff trained to work with mentally ill clients, and all advised clients with MHC to discuss cessation with a healthcare provider.11 Despite awareness that many individuals who utilize quitline services have MHC, few published studies have examined the use of quitline services in this population. Hebert and colleagues12 found that persons with major depression utilizing a quitline service were less likely to have quit two months after receiving quitline services than those without major depression (18.5% and 28.4%, respectively). In a second study of quitline participants with major depression, quitline service was compared to quitline service plus mood management sessions, finding six-month cessation rates at 22.3% in the quitline group and 30.5% in the quitline plus group.13 Finally, a small community-based study measured reduction in smoking (vs. cessation) among patients with heterogeneous MHC and reported that 8% of the group using the quitline service achieved a 50% reduction in the number of cigarettes smoked per day.14 No additional studies were identified examining cessation among quitline service participants with MHC. Further research that examines the use of quitline services for tobacco users with mental health concerns is needed.4,15,16 The purpose of this study was to examine the association of self-reported MHC with the use of quitline services and subsequent tobacco cessation. Specific aims were: (a) to examine the prevalence of selfreported MHC among participants in a state quitline over a two year period, (b) to examine the cessation outcomes for those with selfreported MHC, (c) to compare cessation among participants with and without MHC, and (d) to describe satisfaction with services between the two groups.
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have, or have you been treated by a healthcare professional for, any of the following: heart attack? stroke? cancer? diabetes? high blood pressure? high cholesterol? mental health issue (depression, anxiety, bipolar, etc)?” Inclusion in the MHC group was defined as responding “yes” to the mental health option of the question. Substance abuse disorders were not assessed, or included in the MHC group. Participants responding “no” were classified into the no MHC group. The prevalence of self-reported MHC was calculated as the proportion of the total eligible participants. Tobacco cessation was measured seven months after enrollment using the question, “Have you used any tobacco, even a puff or a pinch, in the past 30 days?” The number of callers responding “no” was used as the numerator for the calculation of two versions of point prevalence for 30-day abstinence (30 dpp). Two standard quit rates were calculated by using different denominators.17,18 The responder quit rate, was calculated by dividing the number of respondents answering no to the 30 dpp question by the total number respondents. The intent-to-treat (ITT) quit rate assumed that all those not contacted at the seven month follow-up were using tobacco. The ITT quit rate was calculated by dividing the number of respondents answering no to the 30 dpp question by the total number of eligible respondents. Finally, quit attempt rate was examined using a “yes” response to the question, “in the past seven months, did you stop using tobacco for 24 hr or more because you were trying to quit?”
Data Analysis The characteristics of callers with and without a MHC were compared using the t test for numerical variables and chi-square test for categorical variables. These comparisons were performed for callers at enrollment and for the subset of callers completing a follow-up survey. The unadjusted associations of MHC and the responder and
ITT quit rates were assessed using a z test for the difference of the two quit rate proportions. Confidence intervals were calculated for the proportions estimating the prevalence of callers with MHC and the responder and ITT quit rates. The association of tobacco cessation with MHC, while adjusting for caller characteristics on which measures were available, was evaluated using logistic regression with the log-odds of 30-day abstinence as the dependent variable. Odds ratios were calculated from the coefficient estimates along with 95% confidence intervals. Separate logistic regression analyses were conducted for the ITT population and the responder population. Since the primary interest was the association of MHC and tobacco cessation, two logistic regression models were evaluated: one model containing only the MHC variable to give the odds ratio for the crude association and the second model containing MHC and other covariates on which information was available to give an adjusted odds ratio. The covariates included age, gender, race, education, duration of tobacco use, tobacco type, and Medicaid status for both populations, and in addition, the variable for type of quitline service was included in the model for the responder population. For the responder population, we were interested in comparing the likelihood of tobacco cessation among the types of tobacco cessation service provided, so all paired comparisons were made following logistic regression. For these comparisons, the Bonferroni-adjusted 95% confidence intervals were calculated. The level of significance for statistical tests was 5%. All analyses were conducted using Stata statistical software (version 13.1, StataCorp).
Results Nearly 20% of quitline participants (2,086/10,720) in this two-year consecutive sample self-reported a MHC. Follow-up surveys were
Downloaded from http://ntr.oxfordjournals.org/ at The University of British Colombia Library on November 16, 2015
Figure 1. Flow diagram of SD QuitLine participant follow-up.
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for characteristics of the baseline population were also present in the follow-up population. The proportion of callers with MHC was slightly but significantly greater (p < .05) in the baseline population (19.5%, 95% CI = 18.7, 20.2) than the follow-up population (18.1%, 95% CI = 17.0, 19.2). Selection of quitline services assessed in the follow-up population also varied significantly by MHC status. Those with MHC were more likely to select coaching plus NRT, and less likely to select coaching plus varenicline (p = .001). Coaching without a cessation medication was selected by 8.7% of the MHC population and 7.7% of the no MHC population (p = .3).
Tobacco Cessation Quit attempt rates were examined for the two groups. A small but significant difference in response to this question between the MHC (74.5%) and no-MHC responder populations (70.0%; p = .007) existed. No significant difference between quit attempt rates in the MHC (93.6%) and no-MHC responder populations (93.1%) were noted among the 3,496 (70.8%) of the follow-up population responding to this question.
Table 1. Demographic and Tobacco Use Characteristics of Callers With MHC Versus no Mental Health Condition at Baseline and Follow-Up Mental health condition(s) at baselinea Characteristic N Age (range, 16–86) Gender Male Female Race Caucasian American Indian Other Education Less than high school High school diploma or equivalent Some college or higher Duration of tobacco use 0–5 years 6–10 years 10 or more years Type of tobacco used Cigarettes only Spit tobacco only Other only Polytobacco use Receiving Medicaid benefit Other health conditionc Service type; coaching plus None NRT, single-type NRT, combination Bupropion Varenicline Multiple products
Mental health condition(s) at follow-upa
Yes
No
p value
Yes
No
p valueb
2,086 40.9 ± 13.1
8,634 42.4 ± 14.5
Original investigation
Cessation Among State Quitline Participants with a Mental Health Condition Downloaded from http://ntr.oxfordjournals.org/ at The University of British Colombia Library on November 16, 2015
Jennifer L. Kerkvliet MA, LPC, NCC, Howard Wey PhD, MS, Nancy L. Fahrenwald, PhD, RN, APHN-BC College of Nursing, South Dakota State University, Brookings, SD Corresponding Author: Jennifer L. Kerkvliet, MA, LPC, NCC, College of Nursing, South Dakota State University, Box 2275, Brookings, SD 57007, USA. Telephone: 605-688-4131; Fax: 605-688-6119; E-mail: [email protected]
Abstract Introduction: Telephone quitlines are an effective treatment option for tobacco cessation in the general population. Many participants who use quitline services have mental health conditions (MHC), yet few published studies have examined the use of quitline services in this population. This study examined the prevalence of MHC among state quitline participants and compared cessation outcomes among those with and without MHC. Methods: Demographic and tobacco use data were collected at enrollment and 7 months postenrollment using standardized assessments for 10,720 eligible participants who enrolled in a state quitline between September, 2010 and August, 2012. Results: The prevalence of self-reported MHC was 19.8% (2,086/10,720 callers). The intent to treat quit rate for participants with a MHC was 16.4% compared to 21.5% for those without a MHC (p < .001), and the responder quit rate was 36.9% for those with a MHC compared to 44.4% for those without (p < .001). The adjusted odds ratio describing the association of MHC status and tobacco cessation was identical for both the intent-to-treat and responder populations, and indicated that participants with MHC were 23% less likely to quit (p < .05). Conclusions: This study identified that participants with MHC accessed a state quitline, but were less likely to quit. The finding was independent of other factors influencing tobacco cessation, such as gender, race, and education. These findings indicate that although quitline services are an option for tobacco cessation among persons with MHC, further research is needed to determine why cessation rates are lower.
Introduction Tobacco use disproportionately impacts persons with mental health conditions (MHC). Although overall rates of smoking have declined over the past years, smoking rates among adults with MHC have declined very little, 1 and are currently estimated at 36.1%. 2 Some estimates report that about 45% of the annual tobacco-related deaths are among smokers with MHC. 3,4
National survey data suggests that persons with MHC may be less likely to quit than those without MHC. An analysis of National Health Interview Survey data reported that smokers who had high levels of non-specific psychological distress were less likely to quit smoking than smokers with less distress.5 Another study using National Comorbidity Survey data found that selfreported quit rates among respondents with current mental illness were lower (30.5%) than those without current mental illness (42.5%).6
© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
735
Nicotine & Tobacco Research, 2015, Vol. 17, No. 6
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Methods Setting and Participants The South Dakota (SD) QuitLine is a Department of Health program that offers a toll-free telephone cessation service for tobacco users. Participants who request cessation services are offered five proactive coaching sessions delivered by trained health coaches. A tobacco cessation product including NRT in the form of gum, patch or lozenge, or medications, bupropion or varenicline, is provided free of cost for an eight week period. Referral to a physician is required to obtain either of the prescription medications available through the SD QuitLine (bupropion or varenicline). Tobacco users under age 18 and pregnant or nursing women are also referred to a physician for approval and prescription for any cessation product available through the SD QuitLine. Participants requesting one of the NRT options are screened for known medical contraindications including pregnancy, recent cardiac complications, and weight less than 100 pounds, and advised to follow-up with a physician if noted. Medications are delivered in staggered increments following designated coaching sessions and mailed directly to the participant’s
home. All residents of the state who are current tobacco users interested in quitting are eligible to participate at no cost, regardless of insurance status. Most participants (98.4%) self-initiate the enrollment call. The others are directly referred by a healthcare provider, requiring that quitline staff initiate the enrollment call. Participants in both the MHC group and no MHC group were provided the same treatment options. Quitline service data for this study covered a two-year period (September 1, 2010 to August 31, 2012). Total enrollment in this time period was 12,173. Of this cohort, 120 participants did not consent to follow-up and were excluded. Following North American Quitline Consortium (NAQC) procedures for uniform measurement of quit rates, 951 participants who did not receive an evidencebased treatment (i.e., medication or at least one coaching session), and 362 participants who re-enrolled in the service before completing the seven month follow-up, were excluded.17 Participants with missing demographic information were also excluded (n = 20). The composition of the study population was significantly different (p < .05) from the excluded population in age (mean ± SD in years: study, 42.1 ± 14.2; excluded, 38.7 ± 14.5) and in the proportion of persons with MHC (study, 19.5%; excluded, 8.3%), race (Caucasian %/American Indian %/other %: study, 90.4/6.0/3.7; excluded, 81.2/13.6/5.2), education (< high school %/high school %/> high school %: study, 11.4/37.6/51.0; excluded, 16.3/38.6/45.1), duration of tobacco use (0–5 years %/6–10 years %/10 or more years %: study, 6.6/10.0/83.4; excluded, 12.5/13.0/74.5), cigarette use (study, 90.5%; excluded, 88.6%), and receiving Medicaid benefit (study, 13.4%; excluded, 18.4%). The total eligible study population was 10,720 tobacco users (Figure 1).
Procedures At the time of enrollment, quitline coaches collected demographic and tobacco use information using the standard questions from the minimal data set (MDS) for Intake.18 Follow-up evaluation is conducted by trained staff using the NAQC recommended procedures.17 Between 6.5 and 7.5 months after enrolling in the quitline service, all consenting participants are contacted by phone and asked to complete a survey. Items on the survey include all standard questions from the Follow-up MDS,18 as well as state-added questions regarding satisfaction, cessation product use, and reasons for relapse. Seven attempts were made to contact participants on varying days and times before participant was considered lost to follow-up. The data collection procedures were approved by a university Institutional Review Board.
Measures Demographic characteristics included age, gender, race, education, and Medicaid status. To reflect the racial demographics in South Dakota, race was categorized as White, American Indian, and due to small numbers, all other races were grouped as other. Education was categorized as less than high school, high school diploma or GED, and some college or higher. Measurement of Medicaid benefit status was self-report (yes/no). Measures related to tobacco use included duration of use and type of product used. Tobacco use duration was categorized as 0–5 years, 6–10 years, and 10 or more years. Type of tobacco use was categorized as cigarettes only, spit tobacco only, other only, and poly-tobacco use. During the initial coaching session, participants were asked to self-report chronic health conditions by answering “yes” or “no” to each option of the following question, “Have you ever been told you
Downloaded from http://ntr.oxfordjournals.org/ at The University of British Colombia Library on November 16, 2015
Clinical practice guidelines identify that the most effective tobacco dependence treatment options for those with MHC appear to be a combination of counseling and a first-line cessation product (nicotine replacement therapy [NRT], bupropion, or varenicline).7 Telephone quitlines, which often provide both counseling and cessation products, are effective for tobacco cessation in the general population.7–9 Quitlines are already serving those with MHC, with estimates reporting between 19% and 50% of the national quitline call population are participants with MHC.10 In a recent survey of 96% of quitlines in the United States, every quitline reported serving clients with MHC, all had staff trained to work with mentally ill clients, and all advised clients with MHC to discuss cessation with a healthcare provider.11 Despite awareness that many individuals who utilize quitline services have MHC, few published studies have examined the use of quitline services in this population. Hebert and colleagues12 found that persons with major depression utilizing a quitline service were less likely to have quit two months after receiving quitline services than those without major depression (18.5% and 28.4%, respectively). In a second study of quitline participants with major depression, quitline service was compared to quitline service plus mood management sessions, finding six-month cessation rates at 22.3% in the quitline group and 30.5% in the quitline plus group.13 Finally, a small community-based study measured reduction in smoking (vs. cessation) among patients with heterogeneous MHC and reported that 8% of the group using the quitline service achieved a 50% reduction in the number of cigarettes smoked per day.14 No additional studies were identified examining cessation among quitline service participants with MHC. Further research that examines the use of quitline services for tobacco users with mental health concerns is needed.4,15,16 The purpose of this study was to examine the association of self-reported MHC with the use of quitline services and subsequent tobacco cessation. Specific aims were: (a) to examine the prevalence of selfreported MHC among participants in a state quitline over a two year period, (b) to examine the cessation outcomes for those with selfreported MHC, (c) to compare cessation among participants with and without MHC, and (d) to describe satisfaction with services between the two groups.
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have, or have you been treated by a healthcare professional for, any of the following: heart attack? stroke? cancer? diabetes? high blood pressure? high cholesterol? mental health issue (depression, anxiety, bipolar, etc)?” Inclusion in the MHC group was defined as responding “yes” to the mental health option of the question. Substance abuse disorders were not assessed, or included in the MHC group. Participants responding “no” were classified into the no MHC group. The prevalence of self-reported MHC was calculated as the proportion of the total eligible participants. Tobacco cessation was measured seven months after enrollment using the question, “Have you used any tobacco, even a puff or a pinch, in the past 30 days?” The number of callers responding “no” was used as the numerator for the calculation of two versions of point prevalence for 30-day abstinence (30 dpp). Two standard quit rates were calculated by using different denominators.17,18 The responder quit rate, was calculated by dividing the number of respondents answering no to the 30 dpp question by the total number respondents. The intent-to-treat (ITT) quit rate assumed that all those not contacted at the seven month follow-up were using tobacco. The ITT quit rate was calculated by dividing the number of respondents answering no to the 30 dpp question by the total number of eligible respondents. Finally, quit attempt rate was examined using a “yes” response to the question, “in the past seven months, did you stop using tobacco for 24 hr or more because you were trying to quit?”
Data Analysis The characteristics of callers with and without a MHC were compared using the t test for numerical variables and chi-square test for categorical variables. These comparisons were performed for callers at enrollment and for the subset of callers completing a follow-up survey. The unadjusted associations of MHC and the responder and
ITT quit rates were assessed using a z test for the difference of the two quit rate proportions. Confidence intervals were calculated for the proportions estimating the prevalence of callers with MHC and the responder and ITT quit rates. The association of tobacco cessation with MHC, while adjusting for caller characteristics on which measures were available, was evaluated using logistic regression with the log-odds of 30-day abstinence as the dependent variable. Odds ratios were calculated from the coefficient estimates along with 95% confidence intervals. Separate logistic regression analyses were conducted for the ITT population and the responder population. Since the primary interest was the association of MHC and tobacco cessation, two logistic regression models were evaluated: one model containing only the MHC variable to give the odds ratio for the crude association and the second model containing MHC and other covariates on which information was available to give an adjusted odds ratio. The covariates included age, gender, race, education, duration of tobacco use, tobacco type, and Medicaid status for both populations, and in addition, the variable for type of quitline service was included in the model for the responder population. For the responder population, we were interested in comparing the likelihood of tobacco cessation among the types of tobacco cessation service provided, so all paired comparisons were made following logistic regression. For these comparisons, the Bonferroni-adjusted 95% confidence intervals were calculated. The level of significance for statistical tests was 5%. All analyses were conducted using Stata statistical software (version 13.1, StataCorp).
Results Nearly 20% of quitline participants (2,086/10,720) in this two-year consecutive sample self-reported a MHC. Follow-up surveys were
Downloaded from http://ntr.oxfordjournals.org/ at The University of British Colombia Library on November 16, 2015
Figure 1. Flow diagram of SD QuitLine participant follow-up.
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for characteristics of the baseline population were also present in the follow-up population. The proportion of callers with MHC was slightly but significantly greater (p < .05) in the baseline population (19.5%, 95% CI = 18.7, 20.2) than the follow-up population (18.1%, 95% CI = 17.0, 19.2). Selection of quitline services assessed in the follow-up population also varied significantly by MHC status. Those with MHC were more likely to select coaching plus NRT, and less likely to select coaching plus varenicline (p = .001). Coaching without a cessation medication was selected by 8.7% of the MHC population and 7.7% of the no MHC population (p = .3).
Tobacco Cessation Quit attempt rates were examined for the two groups. A small but significant difference in response to this question between the MHC (74.5%) and no-MHC responder populations (70.0%; p = .007) existed. No significant difference between quit attempt rates in the MHC (93.6%) and no-MHC responder populations (93.1%) were noted among the 3,496 (70.8%) of the follow-up population responding to this question.
Table 1. Demographic and Tobacco Use Characteristics of Callers With MHC Versus no Mental Health Condition at Baseline and Follow-Up Mental health condition(s) at baselinea Characteristic N Age (range, 16–86) Gender Male Female Race Caucasian American Indian Other Education Less than high school High school diploma or equivalent Some college or higher Duration of tobacco use 0–5 years 6–10 years 10 or more years Type of tobacco used Cigarettes only Spit tobacco only Other only Polytobacco use Receiving Medicaid benefit Other health conditionc Service type; coaching plus None NRT, single-type NRT, combination Bupropion Varenicline Multiple products
Mental health condition(s) at follow-upa
Yes
No
p value
Yes
No
p valueb
2,086 40.9 ± 13.1
8,634 42.4 ± 14.5
