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Siddiqi AD, Carter BJ, Chen TA, Martinez Leal I, Britton M, Correa-Fernández V, Rogova A, Kyburz B, Williams T, Reitzel LR. Initial leadership concerns and availability of tobacco cessation services moderate changes in employee-reported concerns about tobacco-free workplace policy implementation over time. Transl Behav Med 2024:ibae019. [PMID: 38757794 DOI: 10.1093/tbm/ibae019] [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: 05/18/2024] Open
Abstract
Tobacco-free workplace policies (TFWPs) are underused evidence-based interventions that reduce the elevated use of tobacco among substance use treatment center (SUTC) employees and patients. SUTC employees' anticipated concerns about stakeholder pushback are barriers to TFWP adoption. Examination of discrepancies between anticipated and actualized employee-reported TFWP concerns arising from coworkers, patients, and community members in the context of leadership concerns and tobacco cessation care availability for employees may inform strategies to increase TFWP uptake. This study analyzed changes in employee-reported TFWP concerns from before to after a comprehensive tobacco-free workplace intervention that included TFWP implementation, using Chi-square/Fisher's exact tests. Preimplementation leadership policy concerns and tobacco cessation care availability were examined as moderators in generalized linear mixed models. Overall, 452 employees and 13 leaders provided data from 13 SUTCs collectively serving >82 000 patients annually. Results revealed significant decreases over time in employee-reported concerns about TFWP resistance from coworkers. Moderation analyses indicated that employee-anticipated concerns from coworkers and patients, respectively, were less likely to be actualized in SUTCs where leadership endorsed preimplementation TFWP concerns, whereas employee-reported patient concerns rose over time in SUTCs where leadership had no initial implementation concerns. Additionally, employee-anticipated concerns from coworkers were overestimated in SUTCs that did not offer tobacco cessation care to employees. Results supporting the nonactualization of anticipated employee concerns following TFWP implementation can be used to engage other SUTCs for TFWP adoption. Furthermore, moderation effects may suggest that center characteristics translate to greater attention to rollout, ultimately enhancing TFWP stakeholder acceptance.
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Affiliation(s)
- Ammar D Siddiqi
- Department of Biosciences, Rice University, 6100 Main Street, Houston, TX 77005, USA
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Brian J Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- Feinberg School of Medicine, Northwestern University, 420 E Superior Street, Chicago, IL 60611, USA
| | - Tzuan A Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- Division of Research, HEALTH Research Institute, University of Houston, 4349 Martin Luther King Boulevard, Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA
| | | | - Lorraine R Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
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Britton M, Rogova A, Chen TA, Martinez Leal I, Kyburz B, Williams T, Patel M, Reitzel LR. Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study. Prev Med Rep 2023; 35:102256. [PMID: 37752980 PMCID: PMC10518765 DOI: 10.1016/j.pmedr.2023.102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/18/2023] [Accepted: 05/19/2023] [Indexed: 09/28/2023] Open
Abstract
Patients with behavioral health conditions have disproportionately high tobacco use rates and face significant barriers to accessing evidence-based tobacco cessation services. Tobacco quitlines are an effective and accessible resource, yet they are often underutilized. We identify knowledge, practices, and attitudes towards the Texas Tobacco Quitline (TTQL) within behavioral healthcare settings in Texas. Quantitative and qualitative data were collected in 2021 as part of a statewide needs assessment in behavioral healthcare settings. Survey respondents (n = 125) represented 23 Federally Qualified Health Centers, 29 local mental health authorities (LMHAs), 12 substance use treatment programs in LMHAs, and 61 standalone substance use treatment centers (26 people participated in qualitative interviews). Over half of respondents indicated familiarity with the TTQL and believed that the TTQL was helpful for quitting. Qualitative findings reveal potential concerns about inconsistency of services, long wait time, and the format of the quitline. About half of respondents indicated that their center promoted patient referral to TTQL, and few indicated that their center had an electronic referral system with direct TTQL referral capacity. Interview respondents reported overall lack of systematic follow up with patients regarding their use of the TTQL services. Findings suggest the need for (1) increased TTQL service awareness among healthcare providers; (2) further investigation into any changes needed to better serve patients with behavioral health conditions who use tobacco; and (3) electronic health record integration supporting direct referrals and enhanced protocols to support patient follow up after TTQL referral.
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Affiliation(s)
- Maggie Britton
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Tzuan A. Chen
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Bryce Kyburz
- Integral Care, 1430 Collier St, Austin, TX 78704, United States
| | - Teresa Williams
- Integral Care, 1430 Collier St, Austin, TX 78704, United States
| | - Mayuri Patel
- Texas Department of State Health Services, Tobacco Prevention and Control Branch, 1100 West 49th Street, Mail Code 1965, Austin, TX 78756, United States
| | - Lorraine R. Reitzel
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
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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: 0] [Impact Index Per Article: 0] [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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