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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3106 — Does Quitting Smoking Exacerbate Mental Health Symptoms?: Results From a Telephone Treatment Study

Axtmayer A, and Rogers E, NY Harbor Healthcare System; Sreenivasan K, University of California, Berkeley; Sherman S, NY Harbor Healthcare System, New York University;

Proactive telephone smoking cessation counseling is effective for the general population, but few data measures its effectiveness for smokers with mental illness. We compared the difference in average number of cigarettes smoked per day and mental health functioning before and after receiving at least one counseling session among mental health patients enrolled in a VA smoking cessation telephone care coordination program.

Data are preliminary results of a multi-site VA study evaluating telephone care coordination for VA smokers with mental illness. Mental health providers referred smoking patients via CPRS consult, 58% (421) of whom enrolled in the program. Participants received a smoking cessation educational packet, were offered smoking cessation medications, and were randomized to receive telephone counseling from the VA or State Quitline. Participants completed a structured assessment upon enrollment, and 2 and 6 months following enrollment. The assessment covered number of cigarettes smoked per day (CPD) and recent mental health functioning as measured by the BASIS-24 scale examining 24 symptoms each on a 5-point Likert-type scale. We compared CPD and total BASIS-24 scores at baseline, 2-months and 6-months using a paired t-test.

55 of 421 subjects completed all surveys. There was no significant difference in the average CPD decreased between intervention arms, so we analyzed them together. From baseline to 2 months, participants decreased 6.43 CPD (p <0.0001) while BASIS-24 symptoms did not change (p >.01). From 2-months to 6-months, there was a significant relationship between decrease in smoking and decrease in BASIS-24 scores (1.98CPD, p <0.05; r = 0.28, p <0.05). From enrollment to 6 months there was no significant change in BASIS-24, while average CPD significantly decreased (8.41CPD, p <0.0001).

Referred patients with mental illness significantly decreased average CPD without negatively influencing their mental health. It is unclear whether smoking reduction is a meaningful outcome as abstinence is the ultimate goal of smoking cessation counseling; however, studies report that reduction in cigarettes smoked may lead to eventual abstinence.

Many mental health providers believe that quitting smoking will exacerbate a patient’s mental health symptoms, thus are reluctant to promote smoking cessation. We found no evidence to support this view. All smokers should be offered effective treatment.

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