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Gu D, Xia F, Vijayaraghavan M. Tobacco treatment and policies in mental health and substance use treatment facilities in the US. Drug Alcohol Depend 2025; 271:112639. [PMID: 40073805 DOI: 10.1016/j.drugalcdep.2025.112639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 02/21/2025] [Accepted: 02/23/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND The prevalence of tobacco use among people with mental health and substance use disorders in the US is high. State- and facility-level factors could be associated with the provision of tobacco treatment and tobacco-free grounds policy in mental health and substance use treatment facilities. We estimated the latest prevalence of, and factors associated with tobacco treatment provision and tobacco-free grounds policies in these facilities. METHODS This cross-sectional study used data from the 2021-2022 National Substance Use and Mental Health Services Survey. Two multivariate Poisson regression models with robust standard errors were employed to estimate state- and facility-level factors associated with two outcomes: 1) provision of any tobacco treatment (screening, behavior counseling, or pharmacotherapy), and 2) having a tobacco-free grounds policy. RESULTS Among over 17,300 facilities, 87.2 % provided tobacco treatment, and 38.6 % implemented tobacco-free grounds policies. Private for-profit facilities were less likely to provide tobacco treatment (Adjusted Risk Ratio [ARR] 0.87, 95 % CI 0.86-0.89). Private for-profit and nonprofit facilities, those licensed by state or tribal health agencies, and those in tobacco nation states were less likely to implement tobacco-free grounds policies. In contrast, facilities with opioid treatment programs were more likely to achieve both outcomes. CONCLUSIONS Disparities exist in providing tobacco treatment and tobacco-free ground policies, particularly in privately owned facilities. Payers should incentivize the adoption of tobacco treatment and tobacco-free campus policies, and states should incorporate these requirements into licensure and/or accreditation standards for mental health and substance use treatment facilities.
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Affiliation(s)
- Dian Gu
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, USA.
| | - Fan Xia
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, USA
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West AL, Correll L, Kirschner JH. Reducing tobacco and nicotine use among women in treatment for substance use disorder: evaluation of the knit to quit program. Arts Health 2025; 17:147-162. [PMID: 38420998 DOI: 10.1080/17533015.2024.2321944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Tobacco and nicotine use are prevalent in residential substance use disorder (SUD) treatment programs that serve pregnant and parenting women. This study evaluated a group intervention that integrates knitting instruction, psychoeducation, and social support to improve readiness to quit and reduce tobacco and nicotine use among this population. METHODS Clients and staff in four residential SUD treatment programs were assigned to a six-week group intervention or a wait-list control group. Intervention implementation and preliminary effectiveness were assessed using surveys, interviews, and observational measures. RESULTS From pre- to post-test, knowledge related to tobacco and nicotine use increased and number of cigarettes smoked per day and nicotine dependence decreased, on average. Additionally, the intervention group reported lower levels of nicotine dependence relative to the control group. Participants described knitting as an enjoyable replacement for smoking and a strategy to regulate stress and emotions. CONCLUSIONS Smoking cessation interventions that include knitting are promising and warrant further testing.
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Affiliation(s)
- Allison L West
- Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leeya Correll
- Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ware OD, Geiger GR, Bautista TG, Baca-Atlas MH. Examining Vaping Policies in Substance Use Disorder Treatment Facilities. Tob Use Insights 2025; 18:1179173X251342694. [PMID: 40365601 PMCID: PMC12069957 DOI: 10.1177/1179173x251342694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 04/28/2025] [Accepted: 04/30/2025] [Indexed: 05/15/2025] Open
Abstract
Background Unlike combustible cigarettes, vaping does not produce smoke, creating ambiguity around indoor vaping policies. Vaping policies in substance use disorder treatment facilities may directly impact how an individual engages with treatment. Objective To examine associated factors with vaping policies within substance use disorder treatment facilities in the United States. Design This cross-sectional study used data from the National Substance Use and Mental Health Services Survey to examine data from substance use disorder treatment facilities. Other data included the state percentage of adults who use e-cigarettes from the Behavioral Risk Factor Surveillance System, and state-level indoor e-cigarette restriction policies from the State Tobacco Activity Tracking and Evaluations System. Methods A total of N = 16 042 substance use disorder treatment facilities in 2022 were included. Factors that were examined include [a] state percentages of adults who vape, [b] state indoor vaping restrictions, [c] tobacco use screening in facilities, [d] smoking/tobacco education and counseling in facilities, [e] availability of nicotine pharmacotherapies in facilities, [f] facility smoking policies, [g] availability of outpatient or non-hospital residential treatment, and [h] availability of a treatment program specifically for adolescents or young adults. Facility vaping policies is the outcome variable in this study with three values: [a] vaping is restricted, [b] vaping in designated outdoor area(s), and [c] permissive vaping policies (anywhere outside, designated indoor areas, anywhere inside, anywhere without restriction). Results Vaping policies across all treatment facilities include 45.9% restricted vaping, 45.9% permitted vaping in designated outdoor area(s), and 8.2% had a permissive vaping policy. State-level percentage of adults who use e-cigarettes, state indoor e-cigarette restrictions, facility smoking policies, and services provided by facilities were associated with different vaping policies, ranging from restrictive to permissive policies. Conclusions Various vaping policies exist in substance use disorder treatment facilities. Different vaping policies may have varied impacts on individuals' treatment goals.
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Affiliation(s)
- Orrin D. Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G. Rose Geiger
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tara G. Bautista
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Michael H. Baca-Atlas
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Campbell BK, Le T, McCuistian C, Bonniot C, Delucchi K, Guydish J. Policy and Practice Changes Associated with a Tobacco-Free Initiative in Residential Substance Use Disorder Treatment. J Psychoactive Drugs 2025; 57:203-212. [PMID: 38363096 DOI: 10.1080/02791072.2024.2316278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
A California-sponsored, 18-month, tobacco-free intervention in residential substance use disorder (SUD) programs was associated with increases in tobacco-free grounds and tobacco-related client services. The current study examined whether positive results would be replicated in 11 programs participating subsequently. Program directors (N = 11) completed surveys of tobacco-related policies pre- and post-intervention. Pre- (n = 163) and post-intervention (n = 128) cross-sectional staff surveys examined tobacco-related training, beliefs, practices, smoking policy, and smoking status. Directors reported increases in tobacco-free grounds (from 3 to 8 programs), tobacco-related staff training (1 to 10 programs), tobacco cessation staff services (1 to 9 programs) and nicotine replacement therapy (NRT) provision (6 to 10 programs). At post-intervention, staff were more likely to report smoke-free workplaces (p = 0.008), positive beliefs about treating tobacco use (p = 0.017) and less likely to report current smoking (p = 0.003). Clinical staff were more likely to report tobacco-related training receipt (p = 0.001), program-level NRT provision (p = 0.009) and conducting tobacco-related client services (p < 0.0001) post-intervention. Findings of increases in tobacco-free grounds and tobacco cessation client services corroborated prior results. These and the additional finding of decreases in staff smoking strengthen evidence that initiatives supporting tobacco-free policies can be successfully implemented in SUD treatment.
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Affiliation(s)
- Barbara K Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Catherine Bonniot
- Smoking Cessation Leadership Center, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Druckrey-Fiskaaen KT, Madebo T, Daltveit JT, Vold JH, Furulund E, Chalabianloo F, Gilje Lid T, Fadnes LT. Integrated Nicotine Replacement and Behavioral Support to Reduce Smoking in Opioid Agonist Therapy: A Randomized Clinical Trial. JAMA Psychiatry 2025; 82:406-414. [PMID: 39937506 PMCID: PMC11822603 DOI: 10.1001/jamapsychiatry.2024.4801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 11/27/2024] [Indexed: 02/13/2025]
Abstract
Importance Approximately 85% of individuals receiving opioid agonist therapy for opioid dependence smoke tobacco. Despite the significant health risks associated with smoking-related diseases, there has been limited evaluation of smoking interventions tailored to this population. Objective To determine the effectiveness of an intervention combining nicotine replacement with brief behavioral support in reducing cigarette use. Design, Setting, and Participants This multicenter randomized clinical trial was conducted from April 2022 to October 2023 in 7 specialized opioid agonist therapy clinics in Bergen and Stavanger, Norway. The analyst was blinded to patient groupings. Assessors (study nurses) were not fully blinded to participant allocation. Individuals diagnosed with opioid dependency receiving opioid agonist therapy at participating clinics and smoking at least 1 cigarette per day were eligible for participation. Data analysis was performed from December 2023 through October 2024. Intervention In addition to standard opioid agonist therapy, participants in the intervention group received a 16-week integrated treatment combining nicotine replacement with brief behavioral support. Participants in the control group received only standard opioid agonist therapy. Main Outcomes and Measures The primary outcome was at least a 50% reduction in the number of cigarettes smoked, self-reported as cigarette use in the past 7 days at week 16. The analysis followed intention-to-treat principles. Cigarette use was self-reported as per the timeline-follow-back method. Results Among the 259 participants (mean [SD] age, 48.5 [10.4] years; 80 [30.9%] female), 135 were allocated to the intervention group and 124 to the control group. The odds ratio of at least halving the number of cigarettes smoked was 2.07 (95% CI, 1.14-3.75) in the intervention group compared with the control group. Conclusions and Relevance Providing integrated nicotine replacement and behavioral support at opioid agonist treatment clinics effectively helped opioid-dependent participants reduce the number of cigarettes smoked. Trial Registration ClinicalTrials.gov Identifier: NCT05290025.
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Affiliation(s)
- Karl Trygve Druckrey-Fiskaaen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Research Center for Agonist Treatment of Substance Use Disorders, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tesfaye Madebo
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Tore Daltveit
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jørn Henrik Vold
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Einar Furulund
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Oral Health Centre of Expertise Rogaland, Stavanger, Norway
| | - Fatemeh Chalabianloo
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Research Center for Agonist Treatment of Substance Use Disorders, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Parul P, Joseph B, Datta S, Desousa A, Rahman MA. Through the Lens of Psychiatrists: Understanding Smoking Cessation Behaviour Among People with Serious Mental Illness. Community Ment Health J 2025:10.1007/s10597-025-01460-1. [PMID: 40016407 DOI: 10.1007/s10597-025-01460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/15/2025] [Indexed: 03/01/2025]
Abstract
Smoking among people with Serious Mental Illness (SMI) is a pleading public health concern as the rates are much higher compared to the general population. Although different interventions are available to provide cessation support, there is limited evidence of assessing psychiatrists' perspectives on smoking cessation among people with SMI. The study aims to explore the perspectives of psychiatrists regarding smoking cessation among people with SMI. The study used a qualitative approach. In-depth interviews were conducted with ten psychiatrists, exploring their opinions about smoking and its cessation among people with SMI. Purposive sampling was employed. Data saturation was achieved when no new information was gathered. The verbatim transcripts were analysed using thematic analyses. A total of 14 subthemes emerged under seven themes, highlighting the perspective of psychiatrists in terms of the utilisation of smoking as a coping mechanism among people with SMI. Findings, such as priority of care, time constraints and patient initiative, emphasised the factors impacting cessation. Psychiatrists expressed that support from peers and family members significantly influences smoking cessation among people with SMI. Furthermore, merely engaging in asking, assessing and advicing components from the World Health Organisation 5As scale implied insufficient usage of the 5As tool while discussing cessation. Psychiatrists recognise the impact of cessation on mental health outcomes, like the utilisation of smoking as a coping mechanism. Their experiences and challenges with cessation highlighted time commitment and priority of care while contemplating cessation. The deepened insight provided by our study findings has been instrumental in shaping the content of tailored interventions related to smoking cessation among people with SMI.
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Affiliation(s)
- Parul Parul
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, 3806, Australia.
- School of Nursing, Institute of Health and Management, North Melbourne, VIC, Australia.
| | - Bindu Joseph
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, 3806, Australia
| | - Sunil Datta
- The Royal Melbourne Hospital, Melbourne, Australia
| | - Avinash Desousa
- De Sousa Foundation, Carmel 18, St Francis Ave, Willingdon, Santacruz West, Mumbai, Maharashtra, 400054, India
| | - Muhammad Aziz Rahman
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, 3806, Australia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Martínez C, Pla M, Feliu A, Enríquez M, Saura J, Cabezas C, Colom J, Suelves JM, Mondon S, Barrio P, Andreu M, Raich A, Bernabeu J, Roca X, Narváez M, Fernández E. Clinician's perceptions and experiences with tobacco treatment in people who use cannabis: a qualitative study. Subst Abuse Treat Prev Policy 2025; 20:3. [PMID: 39838401 PMCID: PMC11752777 DOI: 10.1186/s13011-024-00632-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 12/19/2024] [Indexed: 01/23/2025] Open
Abstract
INTRODUCTION Global demand for the treatment of cannabis use disorder has increased significantly, prompting a need to understand effective strategies for addressing concurrent cannabis and tobacco use. This study focuses on clinicians' experiences and perceptions in delivering tobacco cessation services to people who use cannabis. METHODS Fifteen participants (12 females, 3 males) participated in three homogenous focus groups, including two groups with extensive experience in providing tobacco cessation among the substance use population in Catalonia, Spain, and one group of clinicians without such experience. Thematic analysis was conducted to identify key patterns and insights in their discourse, focusing on shared themes and divergences across groups. RESULTS Five main themes and 17 subthemes emerged: Individual characteristics, Clinician characteristics, Models of intervention, Organizational healthcare models, and Health policies. Clinicians stressed the importance of intervention models and the active role of professionals in addressing tobacco use within routine care, as tobacco cessation could mitigate social and chronic stigma among people who use cannabis, especially those engaged in polydrug use. DISCUSSION AND CONCLUSIONS Recommendations included integrating tobacco cessation into all services, reducing healthcare service fragmentation, improving resource accessibility, enhancing clinical documentation, and advocating for stronger population-level tobacco control policies. TRIAL REGISTRATION The ACT-ATAC project has been successfully registered at Clinicaltrials.gov [NCT04841655].
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'OncologiaL'Hospitalet de Llobregat, Barcelona, Spain.
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
- CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.
- Department of Public Health, Maternal Health and Mental Health, School of Nursing. Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, 94158, USA.
| | - Marga Pla
- Department of Public Health, Maternal Health and Mental Health, School of Nursing. Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'OncologiaL'Hospitalet de Llobregat, Barcelona, Spain.
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
- CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.
| | - Marta Enríquez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'OncologiaL'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Saura
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'OncologiaL'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Department of Clinical Sciences. School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Carmen Cabezas
- Public Health Secretariat, Government of Catalonia, Barcelona, Spain
| | - Joan Colom
- Public Health Agency of Catalonia, Barcelona, Spain
| | - Josep M Suelves
- Public Health Agency of Catalonia, Barcelona, Spain
- Universitat Oberta de Catalunya, Barcelona, Spain
| | - Sílvia Mondon
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pablo Barrio
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Magalí Andreu
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antònia Raich
- Mental Health Department, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
| | - Jordi Bernabeu
- Mental Health Department, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
| | - Xavier Roca
- Addictive Behaviors Unit, Psychiatry Department, IIB Sant Pau, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Maite Narváez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'OncologiaL'Hospitalet de Llobregat, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'OncologiaL'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Public Health Secretariat, Government of Catalonia, Barcelona, Spain
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Hichborn E, Turner A, Moore S, Gauthier P, Bell K, Montgomery L, Boggis J, Lambert-Harris C, Saunders E, Dallery J, McLeman B, Marsch L. Technology-Based Interventions in Tobacco Use Treatment Among People Who Identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native: Scoping Review. J Med Internet Res 2024; 26:e50748. [PMID: 39388699 PMCID: PMC11502986 DOI: 10.2196/50748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/17/2024] [Accepted: 08/12/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. OBJECTIVE This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. METHODS This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ≥50% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity-promoting insights from included studies. RESULTS In 85% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58% (15/26) of the studies were race and ethnicity conscious, and 67% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. CONCLUSIONS The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/34508.
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Affiliation(s)
- Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Avery Turner
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sarah Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Phoebe Gauthier
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - LaTrice Montgomery
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jesse Boggis
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Chantal Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Elizabeth Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Jesse Dallery
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, United States
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Rosa N, Feliu A, Ballbè M, Alaustre L, Vilalta E, Torres N, Nieva G, Pla M, Pinet C, Raich A, Mondon S, Barrio P, Andreu M, Suelves JM, Vilaplana J, Enríquez M, Castellano Y, Guydish J, Fernández E, Martínez C. Quitline nurses' experiences in providing telephone-based smoking cessation help to mental health patients: A mixed methods study. J Psychiatr Ment Health Nurs 2024; 31:755-766. [PMID: 38288784 DOI: 10.1111/jpm.13012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 09/04/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The '061 QUIT-MENTAL study' evaluated the efficacy of a proactive telephone-based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non-mental health specialized nurses and other health professionals to provide evidence-based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While the training programme was successful in improving non-mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population. ABSTRACT: Introduction The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long-term viability. The 061 QUIT-MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone-based intervention addressed to mental health patients conducted by non-psychiatric specialized nurses. Aim We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method Mixed methods study: (1) Pre-post evaluation to assess self-reported knowledge, self-efficacy and opinions about smoking cessation. (2) In-depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population-based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population-based interventions to individuals with mental health disorders. Implications for Practice Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population.
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Affiliation(s)
- Nathália Rosa
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Barcelona, Spain
- Campus Docent Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Alaustre
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, Barcelona, Spain
| | - Eva Vilalta
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, Barcelona, Spain
| | - Núria Torres
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, Barcelona, Spain
| | - Gemma Nieva
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marga Pla
- Department of Public Health, Maternal Health and Mental Health, School of Nursing, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Pinet
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antònia Raich
- Mental Health Department, Althaia Xarxa Assistencial Universitària, Manresa, Barcelona, Spain
- Grup de Recerca en Innovació en Salut Mental i Benestar Social (ISaMBeS), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Barcelona, Spain
| | - Sílvia Mondon
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pablo Barrio
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Magalí Andreu
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Maria Suelves
- Public Health Agency of Catalonia, Health Department, Government of Catalonia, Barcelona, Spain
- Universitat Oberta de Catalunya - UOC, Barcelona, Spain
| | - Jordi Vilaplana
- Serra Húnter Fellow/Computer Science Department, University of Lleida, Lleida, Spain
| | - Marta Enríquez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Department of Public Health, Maternal Health and Mental Health, School of Nursing, Universitat de Barcelona, Barcelona, Spain
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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10
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McCuistian C, Lisha NE, Campbell B, Cheng C, Le J, Guydish J. Reducing tobacco use in substance use treatment: The California tobacco free initiative. Addict Behav 2024; 155:108025. [PMID: 38593596 PMCID: PMC11684340 DOI: 10.1016/j.addbeh.2024.108025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND People in substance use disorder (SUD) treatment have a smoking prevalence that is five times higher than the national average. California funded the Tobacco Free for Recovery Initiative, designed to support programs in implementing tobacco-free grounds and increasing smoking cessation services. In the first cohort of the initiative (2018-2020) client smoking prevalence decreased from 54.2% to 26.6%. The current study examined whether similar findings would be replicated with a later cohort of programs (2020-2022). METHOD Cross-sectional survey data were collected from clients in 11 residential SUD treatment programs at baseline (n = 185) and at post intervention (n = 227). Multivariate logistic regression assessed change over time in smoking prevalence, tobacco use behaviors, and receipt of cessation services across the two timepoints. RESULTS Client smoking prevalence decreased from 60.3 % to 40.5 % (Adjusted Odds Ratio [AOR] = 0.46, 95 % CI = 0.27, 0.78; p = 0.004). Current smokers and those who quit while in treatment reported an increase in nicotine replacement therapy (NRT)/pharmacotherapy from baseline to post intervention (31.9 % vs 45.6 %; AOR = 2.22, 95 % CI = 1.08, 4.58; p = 0.031). CONCLUSIONS Like the first cohort, the Tobacco Free for Recovery initiative was associated with decreased client smoking prevalence and an increase in NRT/pharmacotherapy. These findings strengthen the evidence that similar initiatives may be effective in reducing smoking prevalence among people in SUD treatment.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States.
| | - Nadra E Lisha
- Division of General Internal Medicine, School of Medicine University of California, San Francisco 530 Parnassus Ave, San Francisco, CA 94143, United States
| | - Barbara Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States
| | - Christine Cheng
- Smoking Cessation Leadership Center, University of California, San Francisco 490 Illinois Street, 9216, San Francisco, CA 94158, United States
| | - Jennifer Le
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, United States
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11
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Holt AG, Hussong A, Castro MG, Bossenbroek Fedoriw K, Schmidt AM, Prentice A, Ware OD. Smoking Policies of Outpatient and Residential Substance Use Disorder Treatment Facilities in the United States. Tob Use Insights 2024; 17:1179173X241254803. [PMID: 38752184 PMCID: PMC11095085 DOI: 10.1177/1179173x241254803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024] Open
Abstract
Tobacco use is associated with morbidity and mortality. Many individuals who present to treatment facilities with substance use disorders (SUDs) other than tobacco use disorder also smoke cigarettes or have a concomitant tobacco use disorder. Despite high rates of smoking among those with an SUD, and numerous demonstrated benefits of comprehensive SUD treatment for tobacco use in addition to co-occurring SUDs, not all facilities address the treatment of comorbid tobacco use disorder. In addition, facilities vary widely in terms of tobacco use policies on campus. This study examined SUD facility smoking policies in a national sample of N = 16,623 SUD treatment providers in the United States in 2021. Most facilities with outpatient treatment (52.1%) and facilities with residential treatment (67.8%) had a smoking policy that permitted smoking in designated outdoor area(s). A multinomial logistic regression model found that among facilities with outpatient treatment (n = 13,778), those located in a state with laws requiring tobacco free grounds at SUD facilities, those with tobacco screening/education/counseling services, and those with nicotine pharmacotherapy were less likely to have an unrestrictive tobacco smoking policy. Among facilities with residential treatment (n = 3449), those with tobacco screening/education/counseling services were less likely to have an unrestrictive tobacco smoking policy. There is variability in smoking policies and tobacco use treatment options in SUD treatment facilities across the United States. Since tobacco use is associated with negative biomedical outcomes, more should be done to ensure that SUD treatment also focuses on reducing the harms of tobacco use.
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Affiliation(s)
- Alison G. Holt
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hussong
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Gabriela Castro
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Amy Prentice
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Orrin D. Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Bhargava SS, Das S, Priya H, Mishra D, Shivabasappa S, Sood A, Hazarika CR, Gupta PC, Chakma JK, Swasticharan L, Sinha P, Munish VG, Gupta SR. The Burden and Correlates of Waterpipe (Hookah) Smoking among Adolescents and Youth: A Systematic Review. Subst Use Misuse 2023; 59:29-40. [PMID: 37907086 DOI: 10.1080/10826084.2023.2257320] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND This systematic review evaluated the available medical literature on the prevalence and trends of waterpipe tobacco smoking among adolescents and youth in jurisdictionally representative populations. METHODS PubMed, Embase, and Scopus were searched for relevant studies from inception until 31 December 2022 that reported the burden of waterpipe smoking among adolescents and youth (10-24 years of age). We extracted qualitative data on the demographic characteristics, burden, and correlates of waterpipe smoking (PROSPERO ID: CRD42022310982). RESULTS A total of 2,197 articles were screened and 62 were included in the analysis. The majority (29) of the studies was from the United States of America and there were no studies from the south-east Asian region. The prevalence of ever waterpipe smoking among the 10-24 years age group was noted to be 18.16% (95% CI, 18.03-18.29). The prevalence of current (30-day) waterpipe smoking was 6.43% (95% CI, 6.34-6.50). The age of initiation of waterpipe smoking was variable. The prevalence of waterpipe smoking was higher among males, among those who belong to the high- and middle-income groups, and among university students. The common risk factors of waterpipe smoking included cigarette smoking, alcohol, and substance use. Waterpipe smoking resulted in increased susceptibility to the use of conventional forms of tobacco (e.g. smoking) among those who were never smokers. CONCLUSION Waterpipe smoking usage was significantly high among adolescents and young adults. Developing regulatory guidelines for water-pipe smoking, surveillance of its use, intervention, and specific policy frameworks may be considered a public health priority.
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Affiliation(s)
- Stuti Sharad Bhargava
- Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Saibal Das
- Indian Council of Medical Research - Centre for Ageing and Mental Health, Kolkata, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Harsh Priya
- Department of Public Health Dentistry, Centre for Dental Education and Research, All India institute of Medical Sciences, New Delhi, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India institute of Medical Sciences, New Delhi, India
| | - Santhosh Shivabasappa
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Eductaion and Research, Puducherry, India
| | - Anubhuti Sood
- Translational Health Science and Technology Institute, Faridabad, India
| | - Chaya Rani Hazarika
- Socio-Behavioral Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India
| | | | - Joy Kumar Chakma
- Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Leimapokpam Swasticharan
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | | | - Shalini R Gupta
- Department of Oral Medicine and Radiology, Centre for Dental Education and Research, All India institute of Medical Sciences, New Delhi, India
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13
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Pagano A, Le T, Fong T, Reid R, Delucchi K, Guydish J. Gambling, tobacco use, and health among individuals in substance use disorder treatment. Am J Addict 2023; 32:563-573. [PMID: 37543853 DOI: 10.1111/ajad.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/23/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Gambling is highly comorbid with disordered use of tobacco and other drugs, and may increase relapse risk among substance use disorder (SUD) patients. We investigated associations between gambling and tobacco use behaviors among SUD patients to inform clinical care. METHODS Patients (N = 651, 170 female) from 25 residential SUD treatment programs in California completed surveys about tobacco use, health, and gambling. Using multivariate regression, we examined associations between gambling, tobacco use behaviors, and mental and physical health. RESULTS Past-year gamblers were more likely than non-gamblers to be current smokers (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.03, 2.01). Smokers who gambled had higher mean Heaviness of Smoking Index (HSI) scores (mean difference = +0.32, 95% CI = 0.04, 0.60), and more often reported smokeless tobacco use (AOR = 1.73, 95% CI = 1.16, 2.58), compared to non-gambling smokers. Past-year problem gamblers were more likely than all others (non-gamblers and non-problem gamblers) to be current smokers (AOR = 1.44, 95% CI = 1.08, 1.90) and to report high psychosocial stress (AOR = 1.87, 95% CI = 1.34, 2.61). Smokers with problem gambling also had higher HSI scores (mean difference = +0.54, 95% CI = 0.14, 0.95) compared to smokers without problem gambling. DISCUSSION AND CONCLUSIONS Gambling and problem gambling were associated with tobacco use and heavier smoking. SUD patients with gambling comorbidity may be heavier smokers and may need concurrent treatment for tobacco use and problem gambling. SCIENTIFIC SIGNIFICANCE This study provides novel data regarding gambling and tobacco use behaviors among SUD patients.
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Affiliation(s)
- Anna Pagano
- Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Thao Le
- Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Timothy Fong
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Rory Reid
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Kevin Delucchi
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco, California, USA
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14
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Druckrey-Fiskaaen KT, Furulund E, Madebo T, Carlsen SEL, Fadnes LT, Lid TG. A qualitative study on people with opioid use disorders' perspectives on smoking and smoking cessation interventions. Front Psychiatry 2023; 14:1185338. [PMID: 37636821 PMCID: PMC10447904 DOI: 10.3389/fpsyt.2023.1185338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Smoking-related diseases are major contributors to disability and shorter life expectancy among opioid-dependent patients. Smoking prevalence is considerably higher for opioid-dependent persons than among the general population, and only a minority quit smoking in treatment settings. Studies show that pharmacological smoking cessation interventions have modest success rates. This study aimed to investigate patients' receiving opioid agonist therapy perspectives on factors affecting behavior and decisions related to smoking cessation, and their experiences with smoking cessation. Methods This is a qualitative study using semi-structured individual interviews. The participants were asked, among others, to elaborate on the participants' thoughts about smoking, previous attempts to quit tobacco use, and what could prompt a smoking cessation attempt. We analyzed the transcripts with systematic text condensation. The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Opioid-dependent patients receiving opioid agonist therapy in outpatient clinics were invited to participate using a purposive sampling method. In total, fourteen individuals participated in this study. Results We identified six themes which were: (1) reflections on how smoking affected decisions, (2) smoking and its impact on physical and mental health, (3) the economy as a motivator to stop smoking, (4) emotions, desires, and habits related to smoking, (5) knowledge of smoking, smoking cessation, and quit attempts, and (6) social factors influencing the participants' choices and activities. The participants were well informed about the consequences of smoking and had some knowledge and experience in quitting. The participants' pulmonary health was an important motivational factor for change. Withdrawal symptoms, anxiety, and fear of using other substances discouraged several from attempting to quit smoking. In contrast, social support from partners and access to meaningful activities were considered important factors for success. Few reported being offered help from health professionals to make a smoking cessation attempt. Discussion Experiencing social support, being encouraged to quit smoking, and patients' concerns for their physical health were important reasons for wanting to quit smoking. Smoking cessation interventions based on patient preferences and on the behavior change wheel may enable a higher success rate among patients receiving opioid agonist therapy.
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Affiliation(s)
- Karl Trygve Druckrey-Fiskaaen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Einar Furulund
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Tesfaye Madebo
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Siv-Elin Leirvåg Carlsen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lars T. Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Torgeir Gilje Lid
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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Mersha AG, Kennedy M, Eftekhari P, Lee KSK, Upton P, Segan C, Jackson MA, Jennings K, Gould GS. Using the Behaviour Change Wheel and modified Delphi method to identify behavioural change techniques for improving adherence to smoking cessation medications. BMC Public Health 2023; 23:1362. [PMID: 37455312 DOI: 10.1186/s12889-023-16278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Medication adherence is a crucial component of the pharmacological treatment of smoking. Previous interventions targeted to improve adherence to smoking cessation medications (SCMs) were designed using pragmatic approaches. This study aims to develop a comprehensive intervention strategy to improve adherence to SCMs using the Behaviour Change Wheel (BCW) and a modified Delphi method. METHODS Recommendations for the design of intervention strategies were based on the BCW guide and six studies conducted by the research team. Factors related to healthcare providers and consumers (person making a quit attempt) that showed associations with adherence were mapped into the Capability, Opportunity, Motivation, Behaviour (COM-B) model, and corresponding intervention functions and policy categories. Interventions were then represented using the Behaviour Change Technique Taxonomy. Finally, a modified Delphi study using 17 experts was conducted to evaluate the nominated strategies using the Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity (APEASE) criteria. RESULTS Following a stepped approach, an adherence support wheel was designed to guide implementation strategies and programmes. Thirteen intervention strategies were selected. The selected interventions include providing detailed instructions on how to use SCMs; establishing realistic expectations from SCMs; and providing training for healthcare providers regarding comprehensive smoking cessation care with specifics on the provision of adherence support. CONCLUSION The BCW guide and a modified Delphi were applied successfully to design interventions tailored to improve adherence to SCMs. Improving adherence to SCMs requires a comprehensive intervention approach involving various stakeholders. Future research is needed to assess the effectiveness of the nominated intervention strategies.
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Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia.
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Sydney, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Burnet Institute, Melbourne, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
| | - Penney Upton
- University of Canberra, Health Research Institute, 11 Kirianri Street, Bruce, Canberra, ACT, 2601, Australia
| | - Catherine Segan
- Cancer Council Victoria, Victoria, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Melissa A Jackson
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia
- Hunter New England Local Health District Drug & Alcohol Clinical Services, 670 Hunter Street, Newcastle, NSW, 2300, Australia
- Drug & Alcohol Clinical Research Improvement Network, 1 Reserve Road, St Leonards, NSW, 2065, Australia
| | - Kirsty Jennings
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2308, Australia
| | - Gillian Sandra Gould
- Faculty of Health, Southern Cross University, Hogbin Drive, Coffs Harbour, 2450, Australia
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Iyahen EO, Omoruyi OO, Rowa-Dewar N, Dobbie F. Exploring the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from problematic drug or alcohol use: A qualitative systematic review. PLoS One 2023; 18:e0288409. [PMID: 37440505 DOI: 10.1371/journal.pone.0288409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Smoking prevalence and the associated poor health and mortality is significantly higher among people with/recovering from problematic drug or alcohol (PDA) use in comparison with the general population. Evidence from existing systematic reviews shows smoking cessation enhances rather than compromises long-term abstinence from alcohol or drug use. However, these systematic reviews lack important contextual detail around the reasons why uptake of, and successful engagement with existing stop smoking services remains low for people in treatment or recovery from PDA use. This systematic review explores qualitative data on the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from PDA use. This key objective addresses the limited inclusion of qualitative studies in previous systematic reviews on this issue. METHODS A qualitative systematic review was conducted with searches across four electronic databases (PubMed, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). All studies that had a qualitative component about free smoking cessation/reduction programmes for people in treatment or recovery from PDA use were included. Studies that examined electronic smoking or services that required a fee were excluded. Study quality was assessed using National Institute for Health and Care Excellence checklist. Qualitative synthesis involved inductive thematic analysis. (PROSPERO Registration number: CRD42022298521). RESULTS 8809 potentially eligible articles were identified, 72 full texts were screened and ten articles were included for full review. Barriers to uptake and engagement with existing stop smoking services centered on three key themes: perception of public health importance, programme structure, and intervention elements. Facilitators included supportive treatment environment and optimization of support/staff resources for smoking cessation service delivery. CONCLUSION Recommendations included influencing a change in the way people perceive the importance of smoking cessation activities during PDA use treatment or recovery. There was also some emphasis on the need to create the right environment for sustained adherence to treatment or recovery plans, and deliver the interventions within the health system as comprehensive care. The limited qualitative evidence on community-based and outpatient services highlights a research gap.
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Affiliation(s)
| | | | - Neneh Rowa-Dewar
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Guydish J, McCuistian C, Hosakote S, Le T, Masson CL, Campbell BK, Delucchi K. A cluster-randomized trial of a brief multi-component intervention to improve tobacco outcomes in substance use treatment. Subst Abuse Treat Prev Policy 2023; 18:34. [PMID: 37328775 PMCID: PMC10276468 DOI: 10.1186/s13011-023-00539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/07/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Smoking prevalence is high among people in substance use disorder (SUD) treatment, and program interventions to address smoking are often complex and lengthy. This cluster-randomized trial tested whether a brief multi-component intervention impacted tobacco outcomes among staff and clients. METHODS Seven SUD treatment programs were randomly assigned to the multi-component intervention or to waitlist control. The 6-month intervention included a leadership motivation assessment, program incentives, 4 staff training sessions and a leadership learning community session. Survey data were collected from staff and clients at pre- and post-intervention. Outcomes were first compared across condition (intervention vs waitlist control), and then examined pre- to post-intervention with condition collapsed. RESULTS Staff in the intervention (n = 48) and control conditions (n = 26) did not differ at post-intervention on smoking prevalence, self-efficacy to help clients quit, or practices used to help clients quit smoking. Intervention clients (n = 113) did not differ from controls (n = 61) in smoking prevalence or receipt of tobacco services. Pre-post comparisons collapsed across condition showed a decrease in client and staff smoking prevalence, which could not be attributed to the intervention, and a decrease in client receipt of cessation medication. CONCLUSION The brief multi-component intervention did not support changes in smoking prevalence or in tobacco-related services received by clients. Other intervention features are needed to reduce smoking among SUD clients. TRIAL REGISTRATION Randomization occurred at the program level and outcomes measured are program-level measures. Accordingly, the trial is not registered.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Sindhushree Hosakote
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Carmen L. Masson
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, USA
| | - Barbara K. Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Sciences University, Portland, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, USA
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Schnoll RA, Leone FT, Quinn MH, Stevens N, Flitter A, Wileyto P, Kimberly J, Beidas RS, Hatzell J, Siegel SD, Crawford G, Hill N, Deatley T, Ziedonis D. A randomized clinical trial testing two implementation strategies to promote the treatment of tobacco dependence in community mental healthcare. Drug Alcohol Depend 2023; 247:109873. [PMID: 37084508 PMCID: PMC10198962 DOI: 10.1016/j.drugalcdep.2023.109873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION People with serious mental illness (SMI) are more likely to smoke and less likely to receive tobacco treatment. Implementation strategies may address clinician and organizational barriers to treating tobacco in mental healthcare. METHODS A cluster-randomized trial (Clinic N=13, Client N=610, Staff N=222) tested two models to promote tobacco treatment in community mental healthcare: standard didactic training vs. Addressing Tobacco Through Organizational Change (ATTOC), an organizational model that provides clinician and leadership training and addresses system barriers to tobacco treatment. Primary outcomes were changes in tobacco treatment from clients, staff, and medical records. Secondary outcomes were changes in smoking, mental health, and quality of life (QOL), and staff skills and barriers to treat tobacco. RESULTS Clients at ATTOC sites reported a significant increase in receiving tobacco treatment from clinician at weeks 12 and 24 (ps<0.05) and tobacco treatments and policies from clinics at weeks 12, 24, 36, and 52 (ps<0.05), vs. standard sites. ATTOC staff reported a significant increase in skills to treat tobacco at week 36 (p=0.05), vs. standard sites. For both models, tobacco use medications, from clients (week 52) and medical records (week 36), increased (ps<0.05), while perceived barriers decreased at weeks 24 and 52 (ps<0.05); 4.3% of clients quit smoking which was not associated with model. QOL and mental health improved over 24 weeks for both models (ps<0.05). CONCLUSIONS Standard training and ATTOC improve use of evidence-based tobacco treatments in community mental healthcare without worsening mental health, but ATTOC may more effectively address this practice gap.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, United States.
| | - Frank T Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, United States
| | - Mackenzie Hosie Quinn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Nathaniel Stevens
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Alex Flitter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Paul Wileyto
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - John Kimberly
- The Wharton School of Business, University of Pennsylvania, United States
| | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States
| | - Jane Hatzell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Scott D Siegel
- Institute for Research on Equity & Community Health (iREACH) and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System,United States
| | - Grace Crawford
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Naja Hill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Teresa Deatley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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Jafry MZ, Martinez J, Chen TA, Britton M, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Carter BJ, Reitzel LR. Behavioral health care provider's beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A's intervention. Addict Behav Rep 2023; 17:100493. [PMID: 37347047 PMCID: PMC10279772 DOI: 10.1016/j.abrep.2023.100493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/29/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Evidence-based smoking cessation interventions are underused settings where behavioral health treatment is provided, contributing to smoking-related health disparities in this patient group. This study assessed the relationship of provider's beliefs about patients' smoking, perceptions of treatment capability, and knowledge of referral options and their use of the 5A's (Ask, Advise, Assess, Assist, and Arrange) intervention for smoking cessation. Methods Surveys were collected from providers in healthcare settings in Texas where patients receive behavioral health care (N = 86; 9 federally qualified health centers, 16 Local Mental Health Authorities (LMHAs), 6 substance use treatment programs in LMHAs, and 55 stand-alone substance use treatment centers). Logistic regression analyses were used to assess the association between provider's beliefs about patients' concern and desire to quit smoking; perceptions of their confidence, skills, and effectiveness in treating smoking; their knowledge of referral options; and their use of the 5A's with patients who smoked. Results Providers who believed that patients were concerned about smoking and wanted to quit; who perceived themselves as confident in providing cessation care, having the required skills, and being effective in providing advice; and/or who had greater referral knowledge were more likely to use the 5A's with patients who smoked than their (respective) provider counterparts (ps < 0.05). Conclusion Provider-level constructs affect their 5A's provision for patients with behavioral health needs. Future work should train providers to correct misconceptions about patients' interest in quitting, bolster their confidence, and provide referral options to support tobacco provision efforts.
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Affiliation(s)
- Midhat Z. Jafry
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Biology and Biochemistry, Science & Research Building 2, 3455 Cullen Blvd Room 342, Houston, TX 77204, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Jayda Martinez
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
- The University of Texas Health Science Center, School of Public Health, 1200 Pressler St., Houston, TX 77030, USA
| | - Tzuan A. Chen
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Maggie Britton
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Texas Department of State Health Services, Tobacco Prevention and Control Branch, 1100 West 49th Street, Mail Code 1965, Austin, TX 78756, USA
| | - Brian J. Carter
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Lorraine R. Reitzel
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
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Martínez C, Lisha N, McCuistian C, Strauss E, Deluchi K, Guydish J. Comparing client and staff reports on tobacco-related knowledge, attitudes, beliefs and services provided in substance use treatment. Tob Induc Dis 2023; 21:45. [PMID: 36969981 PMCID: PMC10037428 DOI: 10.18332/tid/160974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Smoking is highly prevalent in substance use disorder (SUD) programs, but few studies have explored the tobacco-related attitudes of staff and clients in the same program. The aim of this study was to compare staff and client reports on 10 tobacco-related items and associate them with tobacco measures implemented in the programs. METHODS A cross-sectional survey was conducted in 18 residential SUD programs from 2019 to 2020. Overall, 534 clients and 183 clinical staff self-reported their tobacco use, knowledge, attitudes, beliefs, and practices/services regarding smoking cessation. Ten comparable items were asked of both clients and staff. Differences in their responses were tested using bivariate analyses. We examine the association between selected tobacco-related items on making a quit attempt and planning to quit in the next 30 days. RESULTS In all, 63.7% of clients were current cigarette users versus 22.9% of staff. About half of clinicians (49.4%) said they had the skills to help patients quit smoking, while only 34.0% of clients thought their clinicians had these skills (p=0.003). About 28.4% of staff reported encouraging their patients to use nicotine replacement treatment (NRT), and 23.4% of patients said they had been encouraged to use these products. Client reports of planning a quit attempt were positively correlated with whether both staff and clients reported that the use of NRT was encouraged (clients: r=0.645 p=0.004; staff: r=0.524 p=0.025). CONCLUSIONS A low level of tobacco-related services was provided by staff and received by clients. In programs where smokers were encouraged to use NRT, a higher percentage of smokers planned a quit attempt. Tobacco-related training among staff, and communication about tobacco use with clients, should be improved to make tobacco services more visible and accessible in SUD treatment.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d’Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
| | - Nadra Lisha
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, United States
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, United States
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, United States
| | - Elana Strauss
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
| | - Kevin Deluchi
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, United States
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
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Chaisai C, Chaiyakunapruk N, Thavorn K, Wattanasirichaigoon S, Rungruanghiranya S, Thongphiew A, Lee SWH. Assessment of the real-world impact of the Thai smoking cessation programme on clinical outcomes: protocol for a multicentre prospective observational study. Prim Health Care Res Dev 2022; 23:e71. [PMID: 36354087 PMCID: PMC9706301 DOI: 10.1017/s1463423622000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/17/2022] [Accepted: 08/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Tobacco smoking is the most common preventable cause of morbidity and mortality in the world. In an effort to counteract the harmful consequences of smoking, various tobacco control measures have been implemented, including the use of smoking cessation programmes to reduce the number of new smokers as well as helping current smokers to quit smoking. In Thailand, the SMART Quit Clinic Program (FAH-SAI Clinics) was launched in 2010 to provide smoking cessation services by a multidisciplinary team. There are currently 552 FAH-SAI Clinics established across all 77 provinces of Thailand. AIM This protocol describes a study aiming to evaluate the SMART Quit Clinic Program (FAH-SAI Clinics) in terms of programme performance and clinical outcomes. We hope that the results of the study could be used to improve the current service model and the programme's success. METHOD A multicentre prospective observational study will be conducted. The study will focus on 24 FAH-SAI Clinics across 21 provinces of Thailand. The primary outcomes are seven-day point prevalence abstinence rate and continuous abstinence rate at three and six months. The outcomes will be measured using a self-reported questionnaire and biochemical validated by exhaled carbon monoxide. DISCUSSION This study will be the first real-world study that reports the effectiveness of the well-established smoking cessation programme in Thailand. Findings from this study can help improve the quality of smoking cessation services provided by multidisciplinary teams and other smoking cessation services, especially those implemented in low- and middle-income countries.
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Affiliation(s)
- Chayutthaphong Chaisai
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA
| | - Kednapa Thavorn
- School of Epidemiology and Pubic Health, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Suthat Rungruanghiranya
- Thai Physician Alliance Against Tobacco, Bangkok, Thailand
- Faculty of Medicine, Srinakharinwirot University Ongkharak, Nakornnayok, Thailand
| | - Araya Thongphiew
- Thai Physician Alliance Against Tobacco, Bangkok, Thailand
- Paolo Phaholyothin Hospital (BDMS), Bangkok, Thailand
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- School of Pharmacy, Taylor’s University, Selangor, Malaysia
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Jafry MZ, Reuven SM, Britton M, Chen TA, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Reitzel LR. Providers' Non-Cigarette Tobacco Use Intervention Practices in Relation to Beliefs about Patients, Prioritization of and Skills for Intervention, and Referral Knowledge in Texas Healthcare Centers Providing Care to Persons with Behavioral Health Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14269. [PMID: 36361149 PMCID: PMC9657207 DOI: 10.3390/ijerph192114269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Rates of non-cigarette (colloquially, other) tobacco use is elevated among adults with behavioral health conditions. Little is known about whether behavioral health providers are using brief interventions, including the evidence-based 5As (Ask, Advise, Assess, Assist, and Arrange) for other tobacco use, or what provider factors may be associated with use of these interventions. The current study redressed this gap. Overall, 86 providers in Texas (9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs) that provide a broad range of mental and behavioral health services, 6 substance use treatment programs in LMHAs, and 55 stand-alone substance use treatment programs) took a survey assessing their beliefs regarding (1) patients' concerns about other tobacco use; (2) their desire to quit; (3) importance of intervening on other tobacco use with cessation counseling; (4) perceived skills to intervene; (5) knowledge of referral options for treatment. Logistic regression analyses were conducted to determine the association between each factor and use of the 5As. Results showed that 70.9% of providers asked patients about other tobacco use status, 65.1% advised them to quit, 59.3% assessed quit interest, 54.7% assisted with a quit attempt, and 31.4% arranged a follow-up. Providers who believed patients were concerned about other tobacco use, recognized the importance of offering other tobacco use cessation counseling, believed they had the necessary skills to treat other tobacco use, and possessed knowledge of referral options, respectively, were more likely to deliver the 5As (ps < 0.05). Results add to a limited literature on provider intervention practices for other tobacco use in settings where behavioral health care is provided, highlighting the significance of provider beliefs, perceived skills, and referral knowledge to care delivery. Findings reveal opportunities to increase delivery of the 5As for other tobacco use to behavioral health patients and suggest provider factors that could be targeted to build this capacity.
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Affiliation(s)
- Midhat Z. Jafry
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Biology and Biochemistry, College of Natural Sciences & Mathematics, University of Houston, Science & Research Building 2, 3455 Cullen Blvd Room 342, Houston, TX 77204, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Sean M. Reuven
- College of Medicine, University of Houston, 5055 Medical Circle, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | | | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX 78756, USA
| | - Lorraine R. Reitzel
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
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Taing M, Le K, Britton M, Chen TA, Parent MC, Tamí-Maury I, Leal IM, Rogova A, Kyburz B, Williams T, Patel M, Reitzel LR. Smoking Intervention Practices in Texas Healthcare Centers with Sexual and Gender Minority Patients. HEALTH BEHAVIOR AND POLICY REVIEW 2022; 9:1074-1088. [PMID: 36778530 PMCID: PMC9910434 DOI: 10.14485/hbpr.9.6.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives This study evaluated the use of evidence-based practices (EBPs) for smoking cessation in centers providing behavioral healthcare for patient populations that included some proportion of sexual and gender minorities (SGMs). Methods Healthcare providers from 75 healthcare centers across Texas serving SGMs with behavioral health needs participated in a survey assessing their center's tobacco control policies and practices. Results Nearly half (N = 36) of participating centers had a comprehensive tobacco-free workplace policy, 30.67% employed ≥1 tobacco treatment specialist, 73.91% employed ≥1 prescriber, 80.82% mandated screening for patient tobacco use at intake, and 57.53% provided a template for tobacco use assessments. Overall, 70.67% of providers asked patients about smoking status, 69.33% advised patients to quit, 64.00% assessed patients' interest in quitting, 58.67% assisted patients with quit attempts, and 36.00% arranged follow-up. Providers' ability to tailor interventions for special populations like SGMs ranged from very low/0 to very high/10 (M = 4.63 ± 2.59). Conclusions There are opportunities to improve policy implementation, standardization and usage of evidence-based interventions, and intervention tailoring within settings providing care to SGM patients in Texas to better address their tobacco use inequities.
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Affiliation(s)
- Matthew Taing
- Dell Medical School, University of Texas at Austin, Austin, Texas, United States
| | - Kathy Le
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Maggie Britton
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tzuan A Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States
| | - Michael C Parent
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas, United States
| | - Irene Tamí-Maury
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX, United States
| | - Lorraine R Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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LoParco CR, Chen TA, Martinez Leal I, Britton M, Carter BJ, Correa-Fernández V, Kyburz B, Williams T, Casey K, Rogova A, Lin HC, Reitzel LR. Organization-Level Factors Associated with Changes in the Delivery of the Five A's for Smoking Cessation following the Implementation of a Comprehensive Tobacco-Free Workplace Program within Substance Use Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11850. [PMID: 36231153 PMCID: PMC9565836 DOI: 10.3390/ijerph191911850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Many adults with a substance use disorder smoke cigarettes. However, tobacco use is not commonly addressed in substance use treatment centers. This study examined how provider beliefs about addressing tobacco use during non-nicotine substance use treatment, provider self-efficacy in delivering tobacco use assessments, and perceived barriers to the routine provision of tobacco care were associated with changes in the delivery of the evidence-based five A's for smoking intervention (asking, advising, assessing, assisting, and arranging) at the organizational level. The data were from 15 substance use treatment centers that implemented a tobacco-free workplace program; data were collected before and after the program's implementation. Linear regression examined how center-level averages of provider factors (1) at pre-implementation and (2) post- minus pre-implementation were associated with changes in the use of the five A's for smoking in substance use treatment patients. The results indicated that centers with providers endorsing less agreement that tobacco use should be addressed in non-nicotine substance use treatment and reporting lower self-efficacy for providing tobacco use assessments at pre-implementation were associated with significant increases in asking patients about smoking, assessing interest in quitting and assisting with a quit attempt by post-implementation. Centers reporting more barriers at pre-implementation and centers that had greater reductions in reported barriers to treatment over time had greater increases in assessing patients' interest in quitting smoking and assisting with a quit attempt by post-implementation. Overall, the centers that had the most to learn regarding addressing patients' tobacco use had greater changes in their use of the five A's compared to centers whose personnel were already better informed and trained. Findings from this study advance implementation science and contribute information relevant to reducing the research-to-practice translational gap in tobacco control for a patient group that suffers tobacco-related health disparities.
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Affiliation(s)
- Cassidy R. LoParco
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA
| | | | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA
| | - Anastasia Rogova
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, 1025 E. 7th St., Bloomington, IN 47405, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
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Fokuo JK, McCuistian CL, Masson CL, Gruber VA, Straus E, Wong J, Guydish JR. Pre-implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California. Subst Use Misuse 2022; 57:1345-1355. [PMID: 35621319 PMCID: PMC10083040 DOI: 10.1080/10826084.2022.2079139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Across the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs. METHODS We conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. FINDINGS Themes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors' strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services. CONCLUSION To support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.
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Affiliation(s)
- J Konadu Fokuo
- Mood and Anxiety Disorders Program, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caravella L McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Carmen L Masson
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Valerie A Gruber
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Elana Straus
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Jessie Wong
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Joseph R Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Okoli CTC, Otachi JK, Seng S, Abufarsakh B, Williams LB. Evaluating Simulation-Based Tobacco Treatment Scenarios for Providers Delivering Treatment for People Living With Mental Illnesses. Front Psychiatry 2022; 13:868550. [PMID: 35463520 PMCID: PMC9019225 DOI: 10.3389/fpsyt.2022.868550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People living with mental illnesses (PMI) experience elevated tobacco use and related morbidity and mortality. Despite the availability of effective and safe tobacco treatments along with evidence that PMI are motivated and able to quit successfully, few Mental and behavioral healthcare providers (MHPs) engage PMI in such treatment. MHPs may lack the confidence or skills to engage their clients in tobacco treatment. Currently, there are limited training modalities to prepare MHPs in delivering tobacco treatment for PMI. However, animated scenario-based simulated encounters can bridge this gap to effectively provide tailored MHP training to enhance treatment delivery. Hence, the purpose of this study was to evaluate simulated tobacco treatment education scenarios tailored to MHPs. METHODS For this evaluation, we used a pretest-posttest design to assess changes in MHPs tobacco treatment knowledge and behavioral intentions after viewing simulated treatment encounters. We developed four animated scenarios, using brief tobacco treatment interventions, simulating treatment encounters with PMI. MHPs were primarily recruited from mental or behavioral healthcare facilities and were asked to complete a web-based questionnaire. Their knowledge, views, and experiences in providing tobacco treatment were assessed prior to viewing the animated scenarios. Participants were then asked to evaluate the desirability, acceptability, and applicability of the animated scenarios; and thereafter, their knowledge of and intentions to provide evidence-based tobacco treatment (i.e., ASK, ADVISE, ASSESS, ASSIST, ARRANGE) were again assessed. RESULTS Participants (N = 81) were on average 41.0 years of age, mostly female (79.0%), and non-Hispanic White (86.4%). Nearly a quarter endorsed current tobacco use and few had tobacco treatment training (14.8%). Overall knowledge of tobacco treatment scores significantly increased before and after viewing the videos (M = 3.5 [SD = 1.0] to M = 4.1 [SD = 1.0], p < 0.0001). After viewing the simulated scenario videos, participants endorsed moderate to high mean scores (ranging from 4.0-4.2 on a 0 to 5 scale) on the desirability, acceptability, and applicability of the different animated scenarios. In addition, after viewing the scenarios the proportion of participants who endorsed that they intended to occasionally/very often engage clients in evidence based tobacco treatment were high for ASK (94.9%), followed by ADVISE and ASSESS (84.7% each), followed by ASSIST (81.4%), and ARRANGE (74.6%). Evaluation scores significantly differed by type of animated scenario and participants' work settings and discipline. CONCLUSIONS These findings suggest that the use of brief animated scenarios may be a useful modality to enhance MHPs knowledge acquisition and treatment delivery intentions. Such approaches may be integrated into tobacco treatment trainings for MHPs.
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Affiliation(s)
| | - Janet K Otachi
- College of Social Work, University of Kentucky, Lexington, KY, United States
| | - Sarret Seng
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Bassema Abufarsakh
- College of Nursing, University of Kentucky, Lexington, KY, United States
| | - Lovoria B Williams
- College of Nursing, University of Kentucky, Lexington, KY, United States
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Xie S, Minami H, Kumar DS, Hecht J, Bloom EL, Kahler C, Abrantes A, Price LH, Ondersma S, Brown RA. Readiness to Quit Smoking among Smokers in Substance Use Treatment: Associations with Stress, Substance Use Severity, Relapse Concerns and Gender. JOURNAL OF SUBSTANCE USE 2021; 26:669-676. [PMID: 34899051 DOI: 10.1080/14659891.2021.1879295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Smoking prevalence among individuals in substance use treatment remains higher than in the general population. Given that many smokers in substance use treatment are reluctant to quit smoking, it is important to understand the factors that impede smokers' readiness to quit. The current study used baseline data from a randomized controlled trial involving 60 adult smokers receiving substance use treatment to investigate relations between the severity of substance use problems (SSUP), perceived stress (PS), concerns about relapse (i.e., concerns that quitting smoking would hurt one's recovery process (CR)), and readiness to quit smoking. This study also investigated moderating roles of concerns about relapse and gender. Regression analyses showed a significant main effect of concerns about relapse on readiness to quit in the next 30 days, but no effect for either severity of substance use problems, perceived stress, or the SSUPxCR interaction. There were significant interaction effects between PS and both gender and CR. Among men and those with lower concerns about relapse, higher perceived stress was significantly associated with lower readiness to quit. Findings suggest that psychoeducation to alleviate concerns that quitting smoking could limit substance use recovery could be beneficial. Stress management interventions may be especially beneficial to men.
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Affiliation(s)
- Siwen Xie
- Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458
| | - Haruka Minami
- Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458
| | | | - Jacki Hecht
- University of Texas at Austin, 110 Inner Campus Drive, Austin, TX 78705
| | | | - Christopher Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912
| | - Ana Abrantes
- Butler Hospital and Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906
| | - Lawrence H Price
- Butler Hospital and Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906
| | - Steven Ondersma
- Wayne State University, 71 E. Ferry Avenue, Detroit, MI 48202
| | - Richard A Brown
- University of Texas at Austin, 110 Inner Campus Drive, Austin, TX 78705
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Nitturi V, Chen TA, Martinez Leal I, Correa-Fernández V, Drenner K, Kyburz B, Williams T, Obasi EM, Britton M, Howard M, Rangel R, Sharp J, Smith S, Reitzel LR. Implementation and Outcomes of a Train-the-Trainer Program at Behavioral Health Treatment Centers as a Mechanism to Maintain Organizational Capacity to Address Tobacco Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111635. [PMID: 34770149 PMCID: PMC8583380 DOI: 10.3390/ijerph182111635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Despite prior successful implementation of Taking Texas Tobacco Free (TTTF), an evidence-based tobacco-free workplace program, in local mental health authorities (LMHAs), post-implementation employee attrition necessitated continuing education on tobacco-free policies and tobacco treatment practices. Here, we report on the outcomes of a train-the-trainer program which trained "champions" to deliver tobacco cessation education at their LMHAs. Three LMHAs participated in program implementation via 10 champions, iteratively trained and coached by TTTF. Measures administered evaluated four goals: (1) increase champions' self-efficacy in delivering trainings, (2) achieve program fidelity via TTTF staff evaluation of trainer effectiveness and knowledge increases among attending employees, (3) achieve stakeholder program acceptability, and (4) achieve program adoption via an increase in follow-up trainings. Champions' self-efficacy increased throughout TTTF training. TTTF staff ratings of champion-led trainings met the targeted range for trainer effectiveness; employees had a 28.71% knowledge increase over baseline post-training (p < 0.001). Employees rated champions' training delivery "very good" to "excellent", on average; both champions and employees were, on average, "satisfied" to "extremely satisfied" with the curriculum and training received. There was an increase over baseline in trainings delivered during follow-up, and trainings increased in length and topic coverage. Ultimately, the train-the-trainer program achieved the intended goals, although not all changes were statistically significant, likely at least partially attributable to small sample sizes. Overall, these results suggest that TTTF's train-the-trainer program was successful in its delivery and intention to build capacity for the provision of in-house tobacco education trainings to behavioral health employees/providers. However, further evaluation in additional settings, with more champions, et cetera, is necessary to validate these findings, ensure their replicability, link program implementation with reduced patient tobacco use rates, and assess long-term sustainability.
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Affiliation(s)
- Vijay Nitturi
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
- HEALTH Research Institute, University of Houston, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
- HEALTH Research Institute, University of Houston, Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
- HEALTH Research Institute, University of Houston, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
- HEALTH Research Institute, University of Houston, Houston, TX 77204, USA
| | - Kelli Drenner
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
| | - Bryce Kyburz
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.)
| | | | - Ezemenari M. Obasi
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
- HEALTH Research Institute, University of Houston, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
| | - Molly Howard
- Heart of Texas Region MHMR, Waco, TX 76701, USA; (M.H.); (J.S.)
| | - Rogelio Rangel
- Border Region Behavioral Health Center, Laredo, TX 78041, USA;
| | - Jeni Sharp
- Heart of Texas Region MHMR, Waco, TX 76701, USA; (M.H.); (J.S.)
| | | | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA; (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (K.D.); (E.M.O.); (M.B.)
- HEALTH Research Institute, University of Houston, Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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Le K, Chen TA, Martinez Leal I, Correa-Fernández V, Obasi EM, Kyburz B, Williams T, Casey K, Taing M, O’Connor DP, Reitzel LR. Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10485. [PMID: 34639785 PMCID: PMC8507614 DOI: 10.3390/ijerph181910485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
Although tobacco use is the leading preventable cause of death and is elevated among patients with substance use disorders, many substance use treatment centers (SUTCs) do not offer tobacco use interventions (i.e., screening and treatment). This study examined a key outcome of the implementation of a tobacco-free workplace program that provided education and specialized training to employees; namely, changes in clinician provision of the five As (Asking about tobacco use; Advising to quit; Assessing willingness to quit; Assisting with quitting; Arranging follow-up) from before to after the larger program implementation. The five As are a brief tobacco screening and treatment protocol that was taught as part of the program and that formed the basis for further intervention (e.g., provision of nicotine replacement therapies, Motivational Interviewing to enhance desire and willingness to make a quit attempt). Moreover, we also examined organizational moderators that may have impacted changes in the delivery of the five As over time among clinicians from 15 participating SUTCs. The number of the centers' total and unique annual patient visits; full-time employees; and organizational readiness for implementing change were assessed as potential moderators of change in clinicians' behaviors over time. Clinicians completed pre- and post-program implementation surveys assessing their provision of the five As. Results demonstrated significant increases in Asking (p = 0.0036), Advising (p = 0.0176), Assisting (p < 0.0001), and Arranging (p < 0.0001). SUTCs with higher Change Efficacy (p = 0.025) and lower Resource Availability (p = 0.019) had greater increases in Asking. SUTCs with lower Resource Availability had greater increases in Assessing (p = 0.010). These results help guide tobacco control program implementation to increase the provision of tobacco use interventions (i.e., the five As) to SUTC patients and elucidate Change Efficacy and Resource Availability as organizational factors promoting this clinician behavior change.
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Affiliation(s)
- Kathy Le
- Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Daniel P. O’Connor
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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30
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Larry Davidson
- Department of Psychiatry, School of Medicine at Yale University, New Haven, CT, USA
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31
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Onchonga D, Keraka M, MoghaddamHosseini V, Várnagy Á. Does institutional maternity services contribute to the fear of childbirth? A focus group interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 30:100669. [PMID: 34583286 DOI: 10.1016/j.srhc.2021.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of institutional maternity services offered significantly determine the health outcomes of pregnant women and their infants. OBJECTIVES The study aimed at understanding perceptions and experiences of new mothers diagnosed with the fear of childbirth in Kenya; regarding the institutional maternity services offered and if they contribute to the fear of childbirth (FOC). METHODS This was a qualitative descriptive study. A total of 29 women who had given birth recently in a maternity institution, and had been screened with the fear of childbirth at 32 weeks' gestation period participated in focus group interviews. The Framework for Assessing the Quality of Care of institutional maternity services (FAQC) developed by the University of Southampton was adopted in this study. Thematic analyses were used. RESULTS It was reported that institutional maternity services contributed directly and indirectly to FOC. The direct contribution included the performance of unintended caesarian sections, severe and prolonged labour pains and negative attitude of healthcare providers. The indirect contribution was in form of challenges in the provision of care and the experience of care in the maternity institutions. In the provision of care; human and physical resources, inadequate referral systems, and inadequate management of emergencies were reported. In the experience of care; lack of cognition, respect, dignity, equity and inadequacies in emotional support were reported. CONCLUSION The study identified systemic challenges related to both the provision and the experience of care. Therefore, there is need to astutely analyze all critical steps identified in the FAQC, as this will greatly improve the uptake of institutional maternity services.
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Affiliation(s)
- David Onchonga
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Hungary; School of Public Health, Kenyatta University, Kenya.
| | | | - Vahideh MoghaddamHosseini
- Department of Midwifery, Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Ákos Várnagy
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Hungary
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32
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Implementing Clinical Practice Guidelines for Tobacco Cessation in a Women's Residential Substance Use Treatment Facility. J Addict Nurs 2021; 32:159-164. [PMID: 34060768 DOI: 10.1097/jan.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tobacco is the leading cause of preventable death, and over 200,000 women die each year of diseases caused by tobacco. Women with substance use disorders (SUDs) are disproportionately affected. Smoking prevalence among individuals enrolled in SUD treatment is 2-4 times higher than that of the general population, yet less than half of all treatment facilities offer tobacco treatment services. However, when individuals combine treatment, they have a greater likelihood of long-term abstinence from alcohol and other substances of use. METHODS A quality improvement project was undertaken to implement the U.S. Public Health Service guideline for tobacco cessation in a women's residential substance use treatment facility. Tobacco users were advised on their health risk and recommended to cut down or quit. They were advised that help was available using nicotine replacement therapy, behavioral counseling, or both. RESULTS Upon admission, 67% of clients received brief advice to quit, and 30% participated in an intensive treatment aimed at reducing or eliminating cigarette use. At discharge, counseling participants (n = 21) smoked an average of nine cigarettes per day, reduced from 23, which was statistically significant. IMPLICATIONS FOR PRACTICE Interventions reduced cigarette smoking in a population at a high risk for adverse outcomes related to use. Results suggest that more clients are interested in tobacco treatment than previously estimated. Increased administrative, clinical, and pharmacy support can sustain and further assist clients with cessation efforts.
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Le K, Chen TA, Martinez Leal I, Correa-Fernández V, Obasi EM, Kyburz B, Williams T, Casey K, Brown HA, O’Connor DP, Reitzel LR. Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7597. [PMID: 34300052 PMCID: PMC8305177 DOI: 10.3390/ijerph18147597] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
Tobacco use is disproportionately elevated among patients with substance use disorders relative to the general U.S. population. Tobacco interventions are lacking within substance use treatment centers (SUTCs) due to lack of knowledge and training. This study examined knowledge gain and the organizational factors that might moderate knowledge gains following tobacco education training provided to employees (N = 580) within 15 SUTCs that were participating in a tobacco-free workplace program. The number of total annual patient visits, unique annual patient visits, number of full-time employees, and organizational readiness for implementing change (ORIC) as assessed prior to implementation were examined as potential moderators. Results demonstrated significant knowledge gain (p < 0.001) after training overall; individually, 13 SUTCs had significant knowledge gain (p's < 0.014). SUTCs with fewer total annual patient visits and fewer full-time employees showed greater knowledge gains. The ORIC total score and all but one of its subscales (Resource Availability) moderated knowledge gain. SUTCs with greater initial Change Efficacy (p = 0.029), Valence (p = 0.027), and Commitment (p < 0.001) had greater knowledge gain than SUTCs with lower scores on these constructs; SUTCs with greater Task Knowledge (p < 0.001) regarding requirements for change exhibited less knowledge gain. Understanding the organizational-level factors impacting training effectiveness can inform efforts in organizational change and tobacco control program implementation.
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Affiliation(s)
- Kathy Le
- Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (H.A.B.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (H.A.B.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (H.A.B.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (H.A.B.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (H.A.B.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Haleem A. Brown
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (H.A.B.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Daniel P. O’Connor
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (H.A.B.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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Cuomo RE, Yang JS, Purushothaman VL, Nali M, Li J, Mackey TK. A geospatial analysis of age disparities in resolute localities of tobacco and vaping-specific storefronts in California. Tob Prev Cessat 2021; 7:32. [PMID: 34017926 PMCID: PMC8114581 DOI: 10.18332/tpc/133933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/03/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Concomitant with the popularization of vaping, vape shops have dramatically proliferated over the past years. This study assesses whether vape storefronts in California are significantly associated with density of different age groups, and whether this differs between tobacco storefronts or non-specific tobacco retailers. METHODS Addresses for licensed tobacco retailers were obtained from the California Department of Tax and Fee Administration. Business names and addresses were used to obtain store categories cross-referenced from Yelp. Using a cross-sectional ecological design, stores categorized as ‘Vape Shop’ or ‘Tobacco Shop’ were geolocated and compared with age-related variables from the American Community Survey. Regression was conducted in R to determine relationships between age group concentration, in ventiles, and proportion of tracts with tobacco-specific or vape-specific stores. Geospatial visualization was conducted using ArcGIS. RESULTS We found 848 vape shops, 820 tobacco shops, 419 categorized as both, and 20320 retailers with neither category. Overall, 1800 tobacco and/or vape shops were categorized in 1557 of California’s 23194 census tracts. A positive linear association was found between ventiles of two age categories, 20–24 and 25–34 years, and proportion of tracts with vape-specific or tobacco-specific shops separately. CONCLUSIONS Positive associations were found for ages 20–34 years but not for other ages, suggesting vape shops are strategically located in areas populated by young adults. Location-based targeting increases access, thereby increasing proportion of tobacco users, and could be a critical factor in e-cigarette uptake and use. Further study to identify additional age-related demographic characteristics among clientele of tobacco storefronts is warranted.
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Affiliation(s)
- Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, United States.,Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Joshua S Yang
- Department of Public Health, California State University, Fullerton, United States
| | - Vidya L Purushothaman
- Global Health Policy and Data Institute, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Matthew Nali
- Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, United States
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, United States.,Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
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Abstract
The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.
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Affiliation(s)
- Chad D Morris
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA.
| | - Christine E Garver-Apgar
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA
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Guydish J, Kapiteni K, Le T, Campbell B, Pinsker E, Delucchi K. Tobacco use and tobacco services in California substance use treatment programs. Drug Alcohol Depend 2020; 214:108173. [PMID: 32693199 PMCID: PMC7439769 DOI: 10.1016/j.drugalcdep.2020.108173] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 07/04/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND California has one of the lowest smoking rates in the U.S. However, the California substance use disorder (SUD) treatment system collects no information on tobacco use. We explored smoking prevalence among persons enrolled in 20 residential SUD treatment programs, and whether persons who wanted help with quitting smoking received such help. METHODS Treatment program clients (N = 562) were surveyed about their smoking behavior and about tobacco-related services they received. Self-report smoking status was verified via expired carbon monoxide (CO) measurement. Multivariate analyses assessed whether clients who wanted help with quitting smoking received tobacco-related services (ask, advise, referral, counseling, pharmacotherapy) RESULTS: Using client self-report and expired CO, smoking prevalence in this sample was estimated at 68.9 %. Among smokers, mean cigarettes per day (CPD) was 9.7 (SD = 7.6), 58.8 % had made a quit attempt in the past year, 32.7 % were considering quitting smoking in the next 30 days, and 37.9 % wanted help with quitting. Clients who wanted help with quitting, compared to those not wanting help, were more likely to receive advice on how to quit, and tobacco-related counseling, referral, and pharmacotherapy. CONCLUSION In this study, wanting help with quitting was associated with receiving tobacco related services. Nonetheless, fewer than half of the smokers in SUD treatment wanted help with quitting, and many who wanted help did not receive it. Given the high prevalence of smoking, and associated consequences for both general health and SUD recovery, SUD treatment systems should ensure tobacco-related assessment and intervention for all smokers.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, United States.
| | - Kwinoja Kapiteni
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, United States.
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, United States.
| | - Barbara Campbell
- OHSU/PSU School of Public Health, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, United States.
| | - Erika Pinsker
- California Tobacco Control Program, California Department of Public Health, 1616 Capitol Ave, Sacramento, CA, 95814, United States.
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, United States.
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Onchonga D, Khatatbeh H, Thuranira M, Lennox K, Venkatesh MBR. Assessing the usability of a Willingness to Quit smoking questionnaire in a sample of active tobacco smokers: A qualitative study. J Addict Dis 2020; 39:3-10. [PMID: 32838698 DOI: 10.1080/10550887.2020.1800891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background and objectives: Tobacco products are conceivably the most accessible addictive substances. Its use contributes to numerous negative health outcomes both in the developed and developing world. The objective of the study was to assess the usability of a Willingness to Quit smoking questionnaire; a concise questionnaire used to assess the readiness of active tobacco smokers to stop smoking, and also guiding in constructive conversations between healthcare workers and clients regarding stopping smoking.Methods: In this study, 25 active tobacco smokers and four healthcare workers of different cadres were interviewed. Participants were given the Willingness to Quit smoking questionnaire and asked to fill and comment on its usability, ease of comprehension and plausibility in the healthcare system settings.Results: All the 25 active tobacco smokers demonstrated their readiness to stop smoking. It was reported that the Willingness to Quit smoking questionnaire triggered the intention to stop smoking and effectively guided the interviews between the healthcare workers and clients who had expressed the intention of stopping smoking.Conclusion: The Willingness to Quit smoking questionnaire is a valuable tool in clinical practice as it can be used to prompt tobacco cessation dialogues between healthcare workers and clients attempting to stop smoking.
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Affiliation(s)
- David Onchonga
- Doctoral School of Health Sciences, University of Pécs, Hungary.,County Department of Health Services Samburu-Kenya
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Rojewski AM, Bailey SR, Bernstein SL, Cooperman NA, Gritz ER, Karam-Hage MA, Piper ME, Rigotti NA, Warren GW. Considering Systemic Barriers to Treating Tobacco Use in Clinical Settings in the United States. Nicotine Tob Res 2020; 21:1453-1461. [PMID: 29917118 DOI: 10.1093/ntr/nty123] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/14/2018] [Indexed: 01/19/2023]
Abstract
The Comorbidity Workgroup of the Tobacco Treatment Research Network, within the Society for Research on Nicotine and Tobacco, previously highlighted the need to provide tobacco treatment to patients diagnosed with comorbid physical and mental health conditions. Yet, systemic barriers in the United States health care system prevent many patients who present for medical treatment from getting the evidence-based tobacco treatment that they need. The identified barriers include insufficient training in the epidemiologic impact of tobacco use, related disorders, and pharmacological and behavioral treatment approaches; misunderstanding among clinicians about the effectiveness of tobacco treatment; lack of therapeutic support from clinical staff; insufficient use of health information technology to improve tobacco use identification and treatment; and limited time and reimbursement for clinicians to provide treatment. We highlight three vignettes demonstrating the complexities of practical barriers at the health care system level. We consider each of the barriers in turn and discuss evidence-based strategies that could be implemented in the clinical care of patients with comorbid conditions. In addition, in the absence of compelling data to guide implementation approaches, we offer suggestions for potential strategies and avenues for future research. Implications: Three vignettes highlighted in this article illustrate some systemic barriers to providing tobacco treatment for patients being treated for comorbid conditions. We explore the barriers to tobacco treatment and offer suggestions for changes in training, health care systems, clinical workflow, and payment systems that could enhance the reach and the quality of tobacco treatment within the US health care system.
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Affiliation(s)
- Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ellen R Gritz
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maher A Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
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Parnell A, Box E, Biagioni N, Bonevski B, Anwar-McHenry J, Slevin T, Pettigrew S. Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study. Aust N Z J Public Health 2020; 44:116-120. [PMID: 32050298 DOI: 10.1111/1753-6405.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to explore factors influencing community service organisation (CSO) staff members' willingness to provide tobacco cessation support to clients experiencing disadvantage. METHODS Face-to-face semi-structured interviews were conducted with 29 staff members from seven services in the alcohol and other drugs, homelessness, and mental health sectors in Western Australia. RESULTS The primary barriers to providing cessation support were believing that addressing smoking was not a priority relative to other issues, being a current smoker, and the lack of a formal tobacco cessation program within the organisation. Factors that appeared to be most influential in enabling the delivery of cessation support were organisational processes requiring staff to routinely ask clients about tobacco use, confidence to provide support, and being a past smoker. CONCLUSIONS The introduction of organisational procedures that include routine cessation care should be of high priority in CSOs to help reduce smoking rates among clients. Staff may also benefit from receiving training in the provision of cessation support and education about the importance and feasibility of addressing smoking concurrently with other issues. Implications for public health: The results may inform future efforts to increase the delivery of cessation care to groups of people experiencing disadvantage and comorbidity.
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Affiliation(s)
| | - Emily Box
- Cancer Council WA, Western Australia
| | | | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | | | - Terry Slevin
- School of Psychology, Curtin University, Western Australia.,Public Health Association of Australia, Australian Capital Territory
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Guydish J, Wahleithner J, Williams D, Yip D. Tobacco-free grounds implementation in California residential substance use disorder (SUD) treatment programs. J Addict Dis 2020; 38:55-63. [PMID: 32186480 DOI: 10.1080/10550887.2020.1713687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Smoke-free laws and policies have contributed significantly to the decline in smoking in the U.S, but are not often applied in high-prevalence smoking populations where they are most needed. Smoking among clients in publicly funded substance use disorder (SUD) treatment is 3-4 times higher than the general population, and little is known about tobacco policies programs have adopted. To identify the prevalence of tobacco-free grounds and other smoking policies in California's publicly funded, adult, residential SUD programs. Using a California DHCS contact list of 1,921 publicly funded, non-medical, SUD programs, 362 were eligible to participate in a brief semi-structured phone survey concerning indoor and outdoor smoking for staff and clients and other tobacco policies. Of 259 programs that completed the survey, 28 (10.8%) reported tobacco-free grounds. 91 (35.1%) expressed interest in implementing tobacco-free policies and 23 have plans to do so. Nearly all programs (n = 253, 97.7%) had some policy restricting e-cigarette use, and 110 (43.5%) of these reported a complete ban on e-cigarette use. 124 (47.9%) had policies prohibiting staff and clients smoking together. Most California residential SUD programs allow outdoor smoking for staff and clients and few have adopted tobacco-free grounds policies. Given the reported interest in adopting tobacco-free policies, the high density of smokers in the SUD population, and the association of tobacco-free policies with lower client and staff smoking rates, state licensing and regulatory agencies, as well as county health departments, should work with SUD programs to adopt tobacco-free policies.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Wahleithner
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Denise Williams
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
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Parnell A, Box E, Chapman L, Bonevski B, Anwar-McHenry J, Pettigrew S. Receptiveness to smoking cessation training among community service organisation staff. Health Promot J Austr 2019; 31:418-422. [PMID: 31278872 DOI: 10.1002/hpja.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/25/2019] [Accepted: 07/04/2019] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Smoking rates among people experiencing disadvantage are significantly higher than for the general population. Community service organisations (CSOs) have been suggested as appropriate settings to address tobacco use among this subgroup. This study aimed to (a) assess CSO staff members' interest in receiving smoking cessation training, (b) explore the factors associated with interest and (c) identify preferred cessation support information formats. METHODS An online survey was administered to CSO staff across Australia. Respondents were asked about the main groups targeted by their service, their role in the organisation and their interest in receiving smoking cessation training. Logistic regression analyses were used to identify factors associated with receptiveness to smoking cessation training. RESULTS Of the 242 CSO staff members responding to the survey, 53% were interested in receiving training. Having more frequent contact with clients and working at an organisation supporting people with a mental illness were positively associated with being interested in undertaking training. Online resources were identified as a preferred form of information relating to cessation support provision. CONCLUSIONS CSO staff who have frequent contact with clients may be receptive to training that would enable them to provide smoking cessation support to people experiencing disadvantage. SO WHAT?: CSOs represent an important setting for smoking cessation interventions given their existing relationship with people who have high smoking rates and the apparent receptiveness of CSO staff to participate in such initiatives.
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Affiliation(s)
- Ashleigh Parnell
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Emily Box
- Cancer Council WA, Subiaco, Western Australia, Australia
| | - Lorena Chapman
- Cancer Council WA, Subiaco, Western Australia, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Simone Pettigrew
- School of Psychology, Curtin University, Perth, Western Australia, Australia
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Yip D, Gubner N, Le T, Williams D, Delucchi K, Guydish J. Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment. J Behav Health Serv Res 2019; 47:264-274. [PMID: 31359228 DOI: 10.1007/s11414-019-09669-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined whether living in a Medicaid-expanded state or having health insurance was associated with receipt of smoking cessation services or smoking behaviors among substance use disorder (SUD) treatment clients. In 2015 and 2016, 1702 SUD clients in 14 states were surveyed for health insurance status, smoking cessation services received in their treatment program, and smoking behaviors. Services and behaviors were then compared by state Medicaid expansion and health insurance status independently. Clients in Medicaid-expanded states were more likely to be insured (89.9% vs. 54.4%, p < 0.001) and to have quit smoking during treatment (AOR = 3.77, 95% CI = 2.47, 5.76). Insured clients had higher odds of being screened for smoking status in their treatment program and making quit attempts in the past year. Medicaid expansion supports greater health insurance coverage of individuals in SUD treatment and may enhance smoking cessation.
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Affiliation(s)
- Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA.
| | - Noah Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Denise Williams
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
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Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Wood W, Jauncey M, Salmon AM, McCrabb S, Bonevski B. Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112050. [PMID: 31185619 PMCID: PMC6603950 DOI: 10.3390/ijerph16112050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 12/02/2022]
Abstract
Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF. Staff and client views on the acceptability, facilitators, and barriers to the provision of smoking cessation care were also examined. Methods: This paper presents findings from the qualitative component conducted post-intervention implementation. Face-to-face semi-structured staff interviews (n = 14) and two client focus groups (n = 5 and n = 4) were conducted between September and October 2016. Recruitment continued until data saturation was reached. Thematic analysis was employed to synthesise and combine respondent views and identify key themes. Results: Staff viewed the organizational change intervention as acceptable. Commitment from leadership, a designated champion, access to resources, and the congruence between the change and the facility’s ethos were important facilitators of organizational change. Less engaged staff was the sole barrier to the intervention. Smoking cessation care was deemed suitable. Key facilitators of smoking cessation care included: Written protocols, ongoing training, and visually engaging information. Key barriers of smoking cessation care included: Lack of access to nicotine replacement therapy (NRT) outside of business hours, practical limitations of the database, and concerns about sustainability of NRT. Conclusion: This study develops our understanding of factors influencing the implementation of an organisational change intervention to promote sustainable provision of smoking cessation care in the SIF setting.
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Affiliation(s)
- Eliza Skelton
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
| | - Flora Tzelepis
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
- Hunter New England Local Health District, Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, NSW 2287, Australia.
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales, 22-32 King Street, Randwick, NSW 2031, Australia.
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
| | - William Wood
- Uniting, Sydney Medically Supervised Injecting Centre, 66 Darlinghurst Road, Kings Cross, NSW 2011, Australia.
| | - Marianne Jauncey
- Uniting, Sydney Medically Supervised Injecting Centre, 66 Darlinghurst Road, Kings Cross, NSW 2011, Australia.
| | - Allison M Salmon
- Uniting, Sydney Medically Supervised Injecting Centre, 66 Darlinghurst Road, Kings Cross, NSW 2011, Australia.
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
| | - Billie Bonevski
- School of Medicine and Public Health, The University of Newcastle, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW 2308, Australia.
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Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Wood W, Jauncey M, Salmon AM, McCrabb S, Palazzi K, Bonevski B. Integrating smoking cessation care into routine service delivery in a medically supervised injecting facility: An acceptability study. Addict Behav 2018; 84:193-200. [PMID: 29723802 DOI: 10.1016/j.addbeh.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Among people who inject drugs (PWIDs) the prevalence of tobacco smoking exceeds 80%; making smoking cessation intervention a priority for this population. This study aims to examine staff and client perspectives from a supervised injecting facility regarding: i) whether an organizational change intervention increased rates of smoking cessation care delivery (pre- to post-intervention); and ii) acceptability of the intervention. METHODS A pre-and-post intervention pilot study in a supervised injecting facility was conducted in Sydney, Australia between July 2014-December 2015. The intervention employed an organizational change approach and included six components. Cross-sectional samples of staff (pre n = 27, post n = 22) and clients (pre n = 202, post n = 202) completed online surveys pre and post intervention. RESULTS From pre to post-intervention staff reported smoking cessation practices significantly increased for the provision of verbal advice (30% to 82%; p < 0.001), offer of free or subsidized nicotine replacement therapy (30% to 91%; p < 0.001), referral to a general practitioner (19% to 64%; p = 0.001), and follow-up to check on quit smoking progress (18.5% to 64%; p = 0.001). Significantly more clients reported receiving all smoking cessation strategies post-intervention. Over 85% of staff agreed that it was acceptable to address client smoking as part of usual care and 95% of clients agreed that it was acceptable to be asked by staff about their tobacco smoking. CONCLUSIONS Increasing the provision of smoking cessation care using an organizational change approach is both feasible for staff and acceptable to staff and clients of supervised injecting facilities.
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Weinberger AH, Gbedemah M, Wall MM, Hasin DS, Zvolensky MJ, Goodwin RD. Cigarette use is increasing among people with illicit substance use disorders in the United States, 2002-14: emerging disparities in vulnerable populations. Addiction 2018; 113:719-728. [PMID: 29265574 PMCID: PMC6369915 DOI: 10.1111/add.14082] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/07/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS While cigarette smoking has declined over time, it is not known whether this decline has occurred similarly among individuals with substance use disorders (SUDs) in the United States (US). The current study estimated trends in smoking from 2002 to 2014 among US individuals with and without SUDs. DESIGN Linear time trends of current smoking prevalence were assessed using logistic regression models. SETTING United States; data were drawn from the 2002 to 2014 National Household Survey on Drug Use (NSDUH), an annual US cross-sectional study. PARTICIPANTS A representative, population-based sample of US individuals age 12 yeas and older (total analytical population: n = 723 283). MEASUREMENTS Past-month current smoking was defined as having smoked at least 100 lifetime cigarettes and reporting smoking part or all of at least one cigarette during the past 30 days. Respondents were classified as having any SUD if they met criteria for abuse or dependence for one or more of the following illicit drugs: cannabis, hallucinogens, inhalants, tranquilizers, cocaine, heroin, pain relievers, simulants and sedatives. A second SUD variable included all drugs listed above excluding cannabis use disorder (CUD). An additional variable included respondents who met criteria for cannabis abuse or dependence. FINDINGS Among those with any SUD, the prevalence of smoking did not change from 2002 to 2014 (P = 0.08). However, when CUDs were separated from other SUDs, a significant increase in prevalence of smoking was observed among those with SUDs excluding CUDs (P < 0.001), while smoking decreased among those with CUDs (P < 0.001). Smoking declined among those without SUDs (P < 0.001). In 2014, smoking remained significantly more common among those with any SUD (55.48%), SUDs excluding CUDs (63.34%) and CUDs (51.34%) compared with those without these respective disorders (18.16, 18.55 and 18.64%; P < 0.001). CONCLUSIONS The prevalence of cigarette smoking in the United States increased from 2002 to 2014 among people with substance use disorders (SUDs) excluding cannabis use disorders (CUDs) and declined among those with CUDs and without SUDs. In 2014, the prevalence of smoking was multifold higher among those with SUDs, including CUDs, compared with those without SUDs.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY USA,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX USA,Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA,Institute for Implementation Science in Population Health, The City University of New York, New York, NY USA
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Gentry S, Craig J, Holland R, Notley C. Smoking cessation for substance misusers: A systematic review of qualitative studies on participant and provider beliefs and perceptions. Drug Alcohol Depend 2017; 180:178-192. [PMID: 28910690 DOI: 10.1016/j.drugalcdep.2017.07.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/19/2017] [Accepted: 07/22/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Smoking prevalence among those in substance misuse treatment remains much higher than the general population, despite evidence for effective cessation interventions that do not negatively impact substance misuse outcomes. This systematic review summarises qualitative data on barriers and facilitators to smoking cessation for people in substance misuse treatment, participants' and providers' perceptions about effects of smoking cessation on substance misuse treatment, timing of intervention delivery and aspects of interventions perceived to be effective. METHODS Systematic review of qualitative studies and thematic synthesis of published qualitative data. RESULTS 10939 records and 132 full texts were screened. 22 papers reporting on 21 studies were included. Key themes identified were: strong relationships between smoking and other substance misuse; environmental influences; motivation; mental health; aspects of interventions perceived to be effective/ineffective; barriers and facilitators to intervention implementation; smoking bans/restrictions; and relationships with professionals. Many service users were motivated toward smoking cessation but were not offered support. Some felt interventions should be delivered after substance misuse treatment, whilst others felt concurrent/dual interventions would be beneficial, due to strong associations between smoking and other substances. Treatment providers felt they lacked training and resources for supporting smoking cessation, and were concerned about impact on substance misuse outcomes. CONCLUSIONS Many substance misusers who also smoke are motivated to quit but perceive a lack of support from professionals. Additional training and resources are required to enable professionals to provide the support needed. More research is required to develop enhanced packages of care for this deprived group of smokers.
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Affiliation(s)
- Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Jean Craig
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Guydish J, Yip D, Le T, Gubner NR, Delucchi K, Roman P. Smoking-related outcomes and associations with tobacco-free policy in addiction treatment, 2015-2016. Drug Alcohol Depend 2017; 179:355-361. [PMID: 28844012 PMCID: PMC5600495 DOI: 10.1016/j.drugalcdep.2017.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study assessed changes in smoking-related outcomes in two cross-sectional samples of clients enrolled in addiction treatment and whether tobacco-free grounds policies were associated with smoking-related outcomes. METHOD Clients in 25 programs were surveyed in 2015 (N=1176) and 2016 (N=1055). The samples were compared on smoking prevalence, cigarettes per day (CPD), thinking of quitting, past year quit attempts, staff and clients smoking together, attitudes towards quitting, and tobacco-related services. Second, programs with (n=6) and without (n=17) tobacco-free grounds at both time points were compared on smoking-related outcomes. Last, we examined changes in these measures for two programs that adopted tobacco-free grounds between 2015 and 2016. RESULTS There was one difference across years, such that the mean score for the tobacco Program Service scale increased from 2.37 to 2.48 (p=0.043, effect size=0.02). In programs with tobacco-free grounds policies, compared to those without, both CPD and the rate of staff and clients smoking together were significantly lower. In the two programs where tobacco-free grounds were implemented during study years, client smoking prevalence decreased (92.5% v. 67.6%, p=0.005), the rate of staff and clients smoking together decreased (35.6% v. 4.2%, p=0.031), mean CPD decreased (10.62v. 8.24, p<0.001) and mean tobacco services received by clients increased (2.08v. 3.05, p<0.001). CONCLUSION Addiction treatment programs, and agencies responsible for licensing, regulating and funding these programs, should implement tobacco-free grounds policies.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States.
| | - Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States
| | - Noah R Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, United States
| | - Paul Roman
- Center for Research on Behavioral Health and Human Service Delivery, Owens Institute for Behavioral Research, University of Georgia, Athens, GA 30602, United States
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Rogers ES, Gillespie C, Smelson D, Sherman SE. A Qualitative Evaluation of Mental Health Clinic Staff Perceptions of Barriers and Facilitators to Treating Tobacco Use. Nicotine Tob Res 2017; 20:1223-1230. [DOI: 10.1093/ntr/ntx204] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/05/2017] [Indexed: 11/14/2022]
Affiliation(s)
- Erin S Rogers
- New York University School of Medicine, Department of Population Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY
| | - Colleen Gillespie
- New York University School of Medicine, Department of Medicine, New York, NY
| | - David Smelson
- University of Massachusetts Medical School, Department of Psychiatry, Worcestor, MA
| | - Scott E Sherman
- New York University School of Medicine, Department of Population Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY
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Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, McCrabb S, Palazzi K, Bonevski B. Addressing tobacco in Australian alcohol and other drug treatment settings: a cross-sectional survey of staff attitudes and perceived barriers. Subst Abuse Treat Prev Policy 2017; 12:20. [PMID: 28464898 PMCID: PMC5414160 DOI: 10.1186/s13011-017-0106-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within alcohol and other drug (AOD) services, staff attitudes and beliefs are important influences determining provision of smoking cessation care. This study of AOD staff aimed to examine: a) current attitudes toward smoking cessation care; b) service and staff characteristics associated with unsupportive smoking cessation care attitudes, and c) perceived barriers to providing smoking cessation care. METHODS Between July-October 2014, 506 staff from 31 Australian AOD services completed an online cross-sectional survey which assessed agreement with 6 attitudinal statements (supportive and unsupportive) and 10 perceived barriers to smoking cessation care in the AOD setting. Logistic regressions examined service (sector) and staff (age, gender, smoking status and number of years in AOD field) characteristics associated with unsupportive smoking cessation care attitudes. RESULTS A large proportion agreed with supportive statements: Smoking cessation care should be part of usual care (87%), smoking cessation care is as important as counselling about other drugs (72%) and staff have the organisational support to provide smoking cessation care (58%). Some respondents agreed with unsupportive statements: AOD clients are not interested in addressing their smoking (40%), increasing smoking restrictions would lead to client aggression (23%), smoking is a personal choice and it is not the service's role to interfere (16%). Respondents from non-government managed services, current tobacco smokers (compared to ex-smokers) and those with less AOD experience had higher odds of agreeing with unsupportive smoking cessation care statements. The most frequently identified barriers to providing smoking cessation care were: client inability to afford cessation medicines, insufficient funding and lack of a coordinated treatment approach (all 61%). CONCLUSIONS Overall, staff hold largely supportive smoking cessation care attitudes but perceive a large number of barriers to providing smoking cessation care.
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Affiliation(s)
- Eliza Skelton
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Flora Tzelepis
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
- Hunter New England Local Health District, Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute (HMRI), 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Anthony Shakeshaft
- The University of New South Wales, National Drug and Alcohol Research Centre, 22-32 King Street, Randwick, NSW 2031 Australia
| | - Ashleigh Guillaumier
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Adrian Dunlop
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
- Hunter New England Local Health District, Newcastle Community Health Centre, 670 Hunter Street, Newcastle West, NSW 2302 Australia
| | - Sam McCrabb
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute (HMRI), 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Billie Bonevski
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
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Guydish J, Le T, Campbell B, Yip D, Ji S, Delucchi K. Drug abuse staff and clients smoking together: A shared addiction. J Subst Abuse Treat 2017; 76:64-68. [PMID: 28143680 DOI: 10.1016/j.jsat.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/30/2022]
Abstract
Smoking is endemic in drug abuse treatment populations, and smoking prevalence in this population appears unresponsive to existing tobacco control strategies. Clinical and policy guidelines encourage programs to address smoking among clients, and research has identified key barriers to doing so. This report explores the practice of staff and clients smoking together in drug treatment programs, and how this practice is associated with other tobacco-related measures. Clients (N=1113) were surveyed and program directors were interviewed in a national sample of 24 drug abuse treatment programs affiliated with the NIDA Clinical Trials Network. Clients were asked whether they observed staff and clients smoking together in their program and, using program as the unit of analysis, this measure was tested for its association with client-level and program-level tobacco-related outcomes. Higher rates of staff and client smoking together were associated with higher staff smoking prevalence (p=0.006), lower rates of client thoughts about quitting in the next 30days (p=0.027), more negative client attitudes toward quitting smoking (p=0.004), and with clients receiving fewer tobacco-related services (p=0.024). These findings illuminate an actionable, low cost policy intervention to address smoking in drug abuse treatment, which is to prohibit the practice of staff smoking together with clients. In the interest of the health of clients whom they serve, counselors, program directors, state regulatory agencies, and federal funding agencies should act to end this practice.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States.
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States
| | - Barbara Campbell
- OHSU/PSU School of Public Health, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States
| | - Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States
| | - Suzhe Ji
- Department of Neuroscience, University of Nevada, Reno, 1664 N. Virginia Street, Reno 89557, United States
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave. San Francisco, CA 94143, United States
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