Methods
schizophrenia
REGRESSION, SECONDARY
The TeleQuit Mental Health study tested a specialized, multi-session telephone smoking cessation program for mental health patients who smoke (The intervention group was randomized to receive counseling from a VA counselor trained to work with people who have a mental health diagnosis. The VA counselors followed a proactive counseling and relapse-sensitive scheduling protocol created specifically for the study. The content of sessions was based on motivational interviewing and problem-solving therapy that addressed topics such as motivation, comorbid mental health symptoms, coping strategies, medication usage, and relapse prevention. The counselors were trained to proactively discuss the relationship between mental health symptoms and smoking, and to help participants identify mental health-related smoking triggers and coping strategies. The VA counselors also provided ongoing coordination of smoking cessation medications from a VA prescriber and placed notes in the medical record alerting each patient’s referring mental health provider about the patient’s smoking cessation progress. VA counseling involved pre-quit planning (1–6 sessions, 30–60 min each) and post-quit follow-up sessions that followed a manual for consistency and fidelity monitoring (0, 1, 3, 7, 14, 21, and 30 days after their quit date at 10–15 min per session). By comparison, participants randomized to state Quitline counseling received a “warm transfer” to their state Quitline via a three-way call initiated by a research assistant to begin the counseling process. After the three-way call, study staff were not involved in Quitline counseling, which offered standard service that varied state-to-state in terms of the typical number of counseling sessions (ranging from 1 to 6), typical length of first session (ranging from 20 to 45 min), and typical length of follow-up sessions (ranging from 10 to 20 min), as described in the protocol paper for the randomized control trial [Participants completed telephone assessments at baseline, 2 months, and 6 months. Behavioral health symptoms and functioning were measured at baseline using BASIS-24, a 24-item measure that has been validated across race/ethnicity, in outpatient settings, and in patients with schizophrenia [We examined 30-day self-reported smoking abstinence at 6-months as our primary outcome. Non-respondents at 6 months were treated as people who smoke. We had three secondary outcomes: engagement with cessation treatment at 6 months, which included receipt of telephone counseling, self-reported use of cessation medications, and a 24-h quit attempt. For secondary outcomes, we treated non-respondents as not having engaged with cessation treatment at 6 months (i.e., no telephone counseling, not actively using cessation medications, and no ≥ 24 h quit attempts made).We compared demographic, health, and smoking characteristics at baseline between the two groups, defined as high vs. low scores of behavioral health symptoms. Wilcoxon’s rank-sum test was used for continuous variables and Chi-square or Fisher’s exact test for categorical variables. Next, logistic regression was used to compare groups on primary and secondary outcomes, adjusting for baseline cigarettes per day and clustering by site. For each outcome, we tested for an interaction effect between treatment assignment and behavioral health symptoms score category (high vs. low). Finally, we performed multivariable logistic regression to determine the factors associated with high behavioral health symptoms and functioning scores, and report findings as adjusted odds ratios (AOR) with 95% confidence intervals (CIs). All statistical tests were 2 sided with 