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Yimsaard P, Gravely S, Meng G, Fong GT, Cummings KM, Hyland A, Borland R, Hammond D, Kasza KA, Li L, Quah ACK. Differences in smoking cessation behaviors and vaping status among adult daily smokers with and without depression, anxiety, and alcohol use: Findings from the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Surveys. Int J Ment Health Addict 2024; 22:3433-3450. [PMID: 39735821 PMCID: PMC11670891 DOI: 10.1007/s11469-023-01058-2] [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] [Accepted: 04/19/2023] [Indexed: 12/31/2024] Open
Abstract
This study examined differences in quit attempts, 1-month quit success, and vaping status at follow-up among a cohort of 3709 daily smokers with and without depression, anxiety, and regular alcohol use who participated in both the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Surveys. At baseline, a survey with validated screening tools was used to classify respondents as having no, or one or more of the following: 1) depression, 2) anxiety, and 3) regular alcohol use. Multivariable adjusted regression analyses were used to examine whether baseline (2018) self-report conditions were associated with quit attempts; quit success; and vaping status by follow-up (2020). Results showed that respondents who reported depressive symptoms were more likely than those without to have made a quit attempt (aOR=1.32, 95% CI:1.03-1.70, p=0.03), but were less likely to have quit (aOR=0.55, 95% CI:0.34-0.89, p=0.01). There were no differences in quit attempts or quit success between those with and without self-reported anxiety diagnoses or regular alcohol use. Among successful quitters, respondents with baseline depressive symptoms and self-reported anxiety diagnoses were more likely than those without to report vaping at follow-up (aOR=2.58, 95% CI:1.16-5.74, p=0.02, and aOR=3.35 95% CI:1.14-9.87, p=0.03). In summary, it appears that smokers with depression are motivated to quit smoking but were less likely to manage to stay quit, and more likely to be vaping if successfully quit. As smoking rates are higher among people with mental health conditions, it is crucial for healthcare professionals to identify these vulnerable groups and offer tailored smoking cessation support and continued support during their quit attempt.
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Affiliation(s)
- Pongkwan Yimsaard
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Ron Borland
- School of Psychological Sciences, The University of Melbourne, VIC, Australia
| | - David Hammond
- School of Public Health, University of Waterloo, Waterloo, ON, Canada
| | - Karin A. Kasza
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Lin Li
- School of Psychological Sciences, The University of Melbourne, VIC, Australia
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
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Martinez Leal I, Martinez J, Britton M, Chen TA, Correa-Fernández V, Kyburz B, Nitturi V, Obasi EM, Drenner K, Williams T, Casey K, Carter BJ, Reitzel LR. Collaborative Learning: A Qualitative Study Exploring Factors Contributing to a Successful Tobacco Cessation Train-the-Trainer Program as a Community of Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7664. [PMID: 35805323 PMCID: PMC9266255 DOI: 10.3390/ijerph19137664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
Individuals with behavioral health conditions account for 50% of annual smoking-related deaths, yet rarely receive tobacco dependence treatment within local mental health authorities (LMHAs). As lack of training and knowledge are key barriers to providing tobacco dependence treatment, Taking Texas Tobacco-Free (TTTF) developed an iterative, 4-6-months train-the-trainer program to embed expertise and delivery of sustained education on tobacco-free workplace policies and practices in participating centers. We explore the employee "champions'" train-the-trainer program experiences using a community of practice (CoP) model to identify key contributors to successful program implementation. Across 3 different LMHAs, we conducted semi-structured individual and group interviews online at 2 time points. We interviewed each champion twice (except for 1 champion who dropped out between measurements); pre-implementation (3 group interviews; N = 4 + 4 + 3 = 11 champions); post-implementation (7 individual interviews and 1 group interview; 7 + 3 = 10 champions). Therefore, 11 champions participated in pre- and post-implementation interviews from July 2020-May 2021. Guided by an iterative, thematic analysis and constant comparison process, we inductively coded and summarized data into themes. Five factors contributed to successful program implementation: value of peer support/feedback; building knowledge, champion confidence, and program ownership; informative curriculum, adaptable to targeted populations; staying abreast of current tobacco/nicotine research and products; and TTTF team responsiveness and practical coaching/assistance. Champions reported the TTTF train-the-trainer program was successful and identified attitudes and CoP processes that effectively built organizational capacity and expertise to sustainably address tobacco dependence. Study findings can guide other agencies in implementing sustainable tobacco-free training programs.
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Affiliation(s)
- Isabel Martinez Leal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Jayda Martinez
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Maggie Britton
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- 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; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- 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; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Vijay Nitturi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- 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; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Teresa Williams
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, Austin, TX 78703, USA; (B.K.); (T.W.); (K.C.)
| | - Brian J. Carter
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (J.M.); (M.B.); (T.A.C.); (V.C.-F.); (V.N.); (E.M.O.); (K.D.); (B.J.C.); (L.R.R.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
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Trapl ES, VanFrank B, Kava CM, Trinh V, Land SR, Williams RS, Frost E, Babb S. Smoking and cessation behaviors in patients at federally funded health centers - United States, 2014. Drug Alcohol Depend 2021; 221:108615. [PMID: 33652378 PMCID: PMC11001259 DOI: 10.1016/j.drugalcdep.2021.108615] [Citation(s) in RCA: 4] [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: 11/03/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Federally funded health centers (HCs) provide care to the most vulnerable populations in the U.S., including populations with disproportionately higher smoking prevalence such as those with lower incomes. METHODS This study compared characteristics of adult HC patients, by cigarette smoking status, and assessed smoking cessation-related behaviors using 2014 Health Center Patient Survey data; analysis was restricted to adults with data on cigarette smoking status (n = 5583). Chi-square and logistic regression analyses were conducted. RESULTS Overall, 28.1 % were current smokers and 19.2 % were former smokers. Current smokers were more likely to report fair/poor health (48.2 %) and a high burden of behavioral health conditions (e.g., severe psychological distress 23.9 %) versus former and never smokers. Most current smokers reported wanting to quit in the past 12 months (79.0 %) and receiving advice to quit from a healthcare professional (78.7 %). In a multivariable model, age <45, non-white race, COPD diagnosis, and past 3-month marijuana use were significantly associated with desire to quit. Few former smokers (15.2 %) reported using cessation treatment, though use was higher among those who quit within the previous year (30.6 %). CONCLUSIONS Although most current smokers reported a desire to quit, low uptake of evidence-based treatment may reduce the number who attempt to quit and succeed. Given the burden of tobacco use, future efforts could focus on identifying and overcoming unique personal, healthcare professional, or health system barriers to connecting them with cessation treatments. Increasing access to cessation treatments within HCs could reduce smoking-related disparities and improve population health.
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Affiliation(s)
- Erika S Trapl
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA.
| | - Brenna VanFrank
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
| | - Christine M Kava
- Health Promotion Research Center, Department of Health Services, University of Washington School of Public Health, 3980 15th Avenue NE, Seattle, WA, 98105, USA
| | - Vinh Trinh
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephanie R Land
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Elizabeth Frost
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephen Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
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Gubner NR, Williams DD, Le T, Garcia W, Vijayaraghavan M, Guydish J. Smoking related outcomes before and after implementation of tobacco-free grounds in residential substance use disorder treatment programs. Drug Alcohol Depend 2019; 197:8-14. [PMID: 30743196 PMCID: PMC6440856 DOI: 10.1016/j.drugalcdep.2019.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study examined the impact of a tobacco-free grounds (TFG) policy and the California $2.00/pack tobacco tax increase on tobacco use among individuals in residential substance use disorder (SUD) treatment. METHODS We conducted three cross-sectional surveys of clients enrolled in three residential SUD treatment programs. Wave 1 (Pre-TFG) included 190 clients, wave 2 (post-TFG and pre-tax increase) included 200 clients, and wave 3 (post-tax increase) included 201 clients. Demographic and tobacco-use characteristics were first compared between waves using bivariate comparisons. Regression models were used to compare each outcome with survey wave as the predictor, while adjusting for demographic characteristics and nesting of participants within programs. RESULTS Odds of clients being current smokers was lower (AOR = 0.43, 95%CI = 0.30,0.60) after implementation of TFG compared to baseline. Adjusted mean ratio (AMR) for cigarettes per day was lower post-TFG compared to baseline (AMR = 0.70, CI = 0.59, 0.83). There were no differences, across waves, in tobacco-related knowledge, attitudes, or services received by program clients, or use of nicotine replacement therapy. Increased cigarette taxation was not associated with reductions in client smoking. CONCLUSION Implementation of a TFG policy was associated with a lower prevalence of client smoking among individuals in residential SUD treatment. Increased state cigarette excise taxes were not associated with a further reduction in client smoking in the presence of TFG policies, though this may have been confounded by relaxing of the TFG policy. SUD treatment programs should promote TFG policies and increase tobacco cessation services for clients.
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Affiliation(s)
- Noah R Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA; Department of Psychiatry and Weill Institute for Neuroscience, University of California San Francisco, CA, USA.
| | - Denise D Williams
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA
| | | | - Maya Vijayaraghavan
- Division of General Internal Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA; Department of Psychiatry and Weill Institute for Neuroscience, University of California San Francisco, CA, USA
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Marynak K, VanFrank B, Tetlow S, Mahoney M, Phillips E, Jamal, MBBS A, Schecter A, Tipperman D, Babb S. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities - United States, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:519-523. [PMID: 29746451 PMCID: PMC5944973 DOI: 10.15585/mmwr.mm6718a3] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Persons with mental or substance use disorders or both are more than twice as likely to smoke cigarettes as persons without such disorders and are more likely to die from smoking-related illness than from their behavioral health conditions (1,2). However, many persons with behavioral health conditions want to and are able to quit smoking, although they might require more intensive treatment (2,3). Smoking cessation reduces smoking-related disease risk and could improve mental health and drug and alcohol recovery outcomes (1,3,4). To assess tobacco-related policies and practices in mental health and substance abuse treatment facilities (i.e., behavioral health treatment facilities) in the United States (including Puerto Rico), CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed data from the 2016 National Mental Health Services Survey (N-MHSS) and the 2016 National Survey of Substance Abuse Treatment Services (N-SSATS). In 2016, among mental health treatment facilities, 48.9% reported screening patients for tobacco use, 37.6% offered tobacco cessation counseling, 25.2% offered nicotine replacement therapy (NRT), 21.5% offered non-nicotine tobacco cessation medications, and 48.6% prohibited smoking in all indoor and outdoor locations (i.e., smoke-free campus). In 2016, among substance abuse treatment facilities, 64.0% reported screening patients for tobacco use, 47.4% offered tobacco cessation counseling, 26.2% offered NRT, 20.3% offered non-nicotine tobacco cessation medications, and 34.5% had smoke-free campuses. Full integration of tobacco cessation interventions into behavioral health treatment, coupled with implementation of tobacco-free campus policies in behavioral health treatment settings, could decrease tobacco use and tobacco-related disease and could improve behavioral health outcomes among persons with mental and substance use disorders (1-4).
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