Discussion
SECONDARY
This study examines the effectiveness of an intensive telephone intervention for smoking cessation compared to referral to the state Quitline among mental health patients who smoke referred by mental health providers at six VA facilities. We found similarities in many demographic characteristics at baseline, including self-reported race, ethnicity, income, educational attainment, motivation to quit, nor number of cigarettes smoked per day. Regarding differences, people with high behavioral health symptoms scores reported heavier nicotine dependence and were more likely to report current use of sedatives, sleeping pills, and/or antidepressants at baseline. We found a significant interaction effect between behavioral health symptoms scores and treatment assignment. People with low behavioral health symptoms scores in the specialized counseling arm were significantly more likely to report 30-day abstinence at 6 months and to have made a quit attempt compared to people with low behavioral health symptoms scores in the state Quitline counseling arm. People with high behavioral health symptoms scores did not have significantly different abstinence outcomes and did not differ in the likelihood of having made a quit attempt at 6 months based on treatment assignment.The significant interaction effect between behavioral health symptoms score level and treatment assignment has several implications. It adds nuance to existing research that suggests mental health patients benefit from intensive, specialized telephone interventions [There are several limitations to consider. A secondary data analysis is by nature limited by the data collection from the parent study, which relied on self-reported abstinence. BASIS-24 is well-regarded as a measure of behavioral health symptoms and functioning, but a cutoff point for defining categorically a high behavioral health symptoms score has not been validated in the literature. Thus, our use of the overall BASIS-24 score median as a cutoff score to compare patient groups by their level of mental well-being and functioning requires further evaluation longitudinally, and in other clinical and research settings. In addition, only approximately 10% of eligible patients were referred to the parent study, thus raising the question of selection bias among referring providers in favor of people whom they may perceive to be more likely to quit. Finally, the study examined a veteran population that was overwhelmingly male, so the results may not be generalizable to non-veterans and/or females.