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Tian J, Zhang L, Zhao X, Yang L. Knowledge, attitude, and practice of psoriasis patients toward their diseases: a web-based, cross-sectional study. Front Med (Lausanne) 2024; 11:1288423. [PMID: 38660417 PMCID: PMC11040075 DOI: 10.3389/fmed.2024.1288423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Objective To investigate the knowledge, attitude, and practice (KAP) of psoriasis patients toward the disease. Methods A web-based cross-sectional study was conducted among psoriasis patients who were diagnosed at the outpatient of Shaanxi Provincial People's Hospital in March 2023. A self-designed questionnaire was administered for data collection and KAP assessment. Results A total of 526 valid questionnaires were included, including 257 males (48.86%) psoriasis patients. Their mean KAP scores were 8.09 ± 3.60 (possible range: 0-12), 31.94 ± 4.61 (possible range: 10-50), and 51.92 ± 8.83 (possible range: 15-75), respectively. Pearson's correlation analysis showed a positive correlation between knowledge and attitude (r = 0.186, p < 0.001), a positive correlation between knowledge and practice (r = 0.313, p < 0.001), and a negative correlation between attitude and practice (r = -0.181, p < 0.001). Moreover, structural equation model showed that medication (β = 2.74, 95% CI: 2.17, 3.32, p < 0.001) has significantly positive effect on knowledge. Education (β = 0.56, 95% CI: 0.31, 0.81, p < 0.001) and duration of psoriasis (β = 1.01, 95% CI: 0.54, 1.49, p < 0.001) have significantly positive effect on attitude. Knowledge (β = 1.03, 95% CI: 0.80, 1.26, p < 0.001) and medication (β = 4.59, 95% CI: 2.78, 6.40, p < 0.001) has significantly positive effect on practice, while attitude (β = -0.41, 95% CI: -0.57, -0.26, p < 0.001) and duration of psoriasis (β = -2.53, 95% CI: -3.49, -1.57, p < 0.001) exhibit significantly negative effect on practice. Conclusion Psoriasis patients have good knowledge, positive attitude, and proactive practice toward the disease. Education, medication, duration of psoriasis might have effect on their KAP.
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Affiliation(s)
- Jun Tian
- Department of Dermatology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Lei Zhang
- Department of Dermatology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Xiangrong Zhao
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Xi’an, China
| | - Li Yang
- Department of Dermatology, Shaanxi Provincial People’s Hospital, Xi’an, China
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El-Hage D, Gao CX, Bedi G, Guerin A, Francey S, Stavely H, Rickwood D, Telford N, McGorry P, Thompson A, Brown E. Correlates of substance use in a large naturalistic cohort of young people with early and emerging psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1447-1456. [PMID: 36808500 PMCID: PMC10460356 DOI: 10.1007/s00127-023-02436-w] [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: 07/29/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Substance use remains a barrier to recovery for young people accessing early intervention services for psychosis. While correlates of use have been explored in populations experiencing a first episode of psychosis (FEP), sample sizes have been small and less research assesses cohorts at ultrahigh risk of psychosis (UHR). METHODS This study uses data from a naturalistic cohort including UHR and FEP participants (N = 1252) to elucidate clinical correlates of use in the past 3 months of any illicit substance, amphetamine-type stimulants (ATS), cannabis, and tobacco. Moreover, network analysis based on use of these substances and additionally alcohol, cocaine, hallucinogens, sedatives, inhalants, and opioids was completed. RESULTS Young people with FEP used substances at significantly higher rates than those at UHR. High concurrence of use was seen between substances. In the FEP group, participants who had used any illicit substance, ATS, and/or tobacco had increased positive symptoms and decreased negative symptoms. Young people with FEP who used cannabis had increased positive symptoms. In the UHR group, participants who had used any illicit substance, ATS, and/or cannabis in the past 3 months showed decreased negative symptoms compared to those who had not. CONCLUSION A distinct clinical picture of more florid positive symptoms and alleviated negative symptoms seen in those who use substances in the FEP group appears muted in the UHR cohort. Treating young people at UHR in early intervention services represents the earliest opportunity to address substance use early to improve outcomes.
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Affiliation(s)
- D El-Hage
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - C X Gao
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - G Bedi
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - A Guerin
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - S Francey
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - H Stavely
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - D Rickwood
- Headspace National, Melbourne City, VIC, Australia
- University of Canberra, Bruce, ACT, Australia
| | - N Telford
- Headspace National, Melbourne City, VIC, Australia
| | - P McGorry
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - A Thompson
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Ellie Brown
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
- Orygen, 35 Poplar Road, Parkville, VIC, Australia.
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Daumit GL, Evins AE, Cather C, Dalcin AT, Dickerson FB, Miller ER, Appel LJ, Jerome GJ, McCann U, Ford DE, Charleston JB, Young DR, Gennusa JV, Goldsholl S, Cook C, Fink T, Wang NY. Effect of a Tobacco Cessation Intervention Incorporating Weight Management for Adults With Serious Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:895-904. [PMID: 37378972 PMCID: PMC10308301 DOI: 10.1001/jamapsychiatry.2023.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
Importance Tobacco smoking drives markedly elevated cardiovascular disease risk and preventable death in persons with serious mental illness, and these risks are compounded by the high prevalence of overweight/obesity that smoking cessation can exacerbate. Guideline-concordant combined pharmacotherapy and behavioral smoking cessation treatment improves abstinence but is not routinely offered in community settings, particularly to those not seeking to quit smoking immediately. Objective To determine the effectiveness of an 18-month pharmacotherapy and behavioral smoking cessation intervention incorporating weight management and support for physical activity in adults with serious mental illness interested in quitting smoking within 1 or 6 months. Design, Setting, and Participants This was a randomized clinical trial conducted from July 25, 2016, to March 20, 2020, at 4 community health programs. Adults with serious mental illness who smoked tobacco daily were included in the study. Participants were randomly assigned to intervention or control, stratified by willingness to try to quit immediately (within 1 month) or within 6 months. Assessors were masked to group assignment. Interventions Pharmacotherapy, primarily varenicline, dual-form nicotine replacement, or their combination; tailored individual and group counseling for motivational enhancement; smoking cessation and relapse prevention; weight management counseling; and support for physical activity. Controls received quitline referrals. Main Outcome and Measures The primary outcome was biochemically validated, 7-day point-prevalence tobacco abstinence at 18 months. Results Of the 298 individuals screened for study inclusion, 192 enrolled (mean [SD] age, 49.6 [11.7] years; 97 women [50.5%]) and were randomly assigned to intervention (97 [50.5%]) or control (95 [49.5%]) groups. Participants self-identified with the following race and ethnicity categories: 93 Black or African American (48.4%), 6 Hispanic or Latino (3.1%), 90 White (46.9%), and 9 other (4.7%). A total of 82 participants (42.7%) had a schizophrenia spectrum disorder, 62 (32.3%) had bipolar disorder, and 48 (25.0%) had major depressive disorder; 119 participants (62%) reported interest in quitting immediately (within 1 month). Primary outcome data were collected in 183 participants (95.3%). At 18 months, 26.4% of participants (observed count, 27 of 97 [27.8%]) in the intervention group and 5.7% of participants (observed count, 6 of 95 [6.3%]) in the control group achieved abstinence (adjusted odds ratio [OR], 5.9; 95% CI, 2.3-15.4; P < .001). Readiness to quit within 1 month did not statistically significantly modify the intervention's effect on abstinence. The intervention group did not have significantly greater weight gain than the control group (mean weight change difference, 1.6 kg; 95% CI, -1.5 to 4.7 kg). Conclusions and Relevance Findings of this randomized clinical trial showed that in persons with serious mental illness who are interested in quitting smoking within 6 months, an 18-month intervention with first-line pharmacotherapy and tailored behavioral support for smoking cessation and weight management increased tobacco abstinence without significant weight gain. Trial Registration ClinicalTrials.gov Identifier: NCT02424188.
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Affiliation(s)
- Gail L. Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Edgar R. Miller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J. Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- College of Health Professions, Towson University, Towson, Maryland
| | - Una McCann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel E. Ford
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne B. Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Joseph V. Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tyler Fink
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Dickerson F, Goldsholl S, Yuan CT, Dalcin A, Eidman B, Minahan E, Gennusa III JV, Mace E, Cullen B, Evins AE, Cather C, Wang NY, McGinty EM, Daumit GL. Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Pilot Study (Preprint). JMIR Res Protoc 2022; 12:e44787. [PMID: 37171851 DOI: 10.2196/44787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and is the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI, but few receive this treatment. Mental health providers have extensive experience working with clients with SMI and frequent treatment contacts, making them well positioned to deliver smoking cessation treatment. However, few mental health providers feel adequately trained to deliver this treatment, and many providers believe that smokers with SMI are not interested in quitting or have concerns about the safety of smoking cessation pharmacotherapy, despite substantial evidence to the contrary. OBJECTIVE We present the protocol for the pilot "IMPACT" (Implementing Action for Tobacco Smoking Cessation Treatment) study, which aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. METHODS We are using a prepost observational design to examine the effects of an implementation intervention designed to improve mental health providers' delivery of the following four evidence-based practices related to smoking cessation treatment: (1) assessment of smoking status, (2) assessment of willingness to quit, (3) behavioral counseling, and (4) pharmacotherapy prescribing. To overcome key barriers related to providers' knowledge and self-efficacy of smoking cessation treatment, the study will leverage implementation strategies including (1) real-time and web-based training for mental health providers about evidence-based smoking cessation treatment and motivational interviewing, including an avatar practice module; (2) a tobacco smoking treatment protocol; (3) expert consultation; (4) coaching; and (5) organizational strategy meetings. We will use surveys and in-depth interviews to assess the implementation intervention's effects on providers' knowledge and self-efficacy, the mechanisms of change targeted by the intervention, as well as providers' perceptions of the acceptability, appropriateness, and feasibility of both the evidence-based practices and implementation strategies. We will use data on care delivery to assess providers' implementation of evidence-based smoking cessation practices. RESULTS The IMPACT study is being conducted at 5 clinic sites. More than 50 providers have been enrolled, exceeding our recruitment target. The study is ongoing. CONCLUSIONS In order for persons with SMI to realize the benefits of smoking cessation treatment, it is important for clinicians to implement evidence-based practices successfully. This pilot study will result in a set of training modules, implementation tools, and resources for clinicians working in community mental health clinics to address tobacco smoking with their clients. Trial Registration: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. TRIAL REGISTRATION ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44787.
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Evins AE, Cather C. Addressing Barriers to Provision of First-Line Pharmacotherapy for Tobacco Use Disorder. Psychiatr Serv 2022; 74:429-430. [PMID: 36349495 DOI: 10.1176/appi.ps.20220467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston
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6
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Evins AE, Cather C, Maravic MC, Reyering S, Pachas GN, Thorndike AN, Levy DE, Fung V, Fischer MA, Schnitzer K, Pratt S, Fetters MD, Deeb B, Potter K, Schoenfeld DA. A Pragmatic Cluster-Randomized Trial of Provider Education and Community Health Worker Support for Tobacco Cessation. Psychiatr Serv 2022; 74:365-373. [PMID: 36349498 DOI: 10.1176/appi.ps.20220187] [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: 11/11/2022]
Abstract
OBJECTIVE Individuals with serious mental illness have a high prevalence of tobacco use disorder and related early mortality but underutilize smoking cessation medication. The authors determined whether clinician-delivered education to primary care providers regarding safety, efficacy, and importance of cessation medication (provider education [PE]) alone or combined with community health worker (CHW) support would increase tobacco abstinence in this population, compared with usual care. METHODS All adult current tobacco smokers receiving psychiatric rehabilitation for serious mental illness through two community agencies in Greater Boston were eligible, regardless of readiness to quit smoking. Primary care clinics were cluster randomized to PE or usual care, with a nested, participant-level randomization to CHW or no CHW in PE-assigned clinics. The primary outcome was blindly assessed, biochemically verified tobacco abstinence at year 2. RESULTS Overall, 1,010 eligible participants were enrolled. PE was delivered to providers in 53 of 55 assigned clinics; 220 of 336 CHW-assigned participants consented to CHW support. Year 2 abstinence rates were significantly higher among participants assigned to PE+CHW versus usual care (12% vs. 5%; adjusted odds ratio [AOR]=2.40, 95% confidence interval [CI]=1.20-4.79) or PE alone (12% vs. 7%; AOR=1.84, 95% CI=1.04-3.24). No effect of PE alone on abstinence was detected. Compared with participants assigned to usual care, those assigned to PE+CHW had greater odds of varenicline use (OR=2.77, 95% CI=1.61-4.75), which was associated with higher year 2 abstinence (OR=1.97, 95% CI=1.16-3.33). CONCLUSIONS Combined PE and CHW tobacco cessation support increased tobacco abstinence rates among adults with serious mental illness.
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Affiliation(s)
- A Eden Evins
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Corinne Cather
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Melissa Culhane Maravic
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sally Reyering
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Gladys N Pachas
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Anne N Thorndike
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Douglas E Levy
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Vicki Fung
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael A Fischer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kristina Schnitzer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sarah Pratt
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael D Fetters
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Bianca Deeb
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kevin Potter
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - David A Schoenfeld
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
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Campbell BK, Le T, McCuistian C, Hosakote S, Kapiteni K, Guydish J. Implementing tobacco-free policy in residential substance use disorders treatment: Practice changes among staff. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100033. [PMID: 36845887 PMCID: PMC9948912 DOI: 10.1016/j.dadr.2022.100033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
Introduction Implementing tobacco-free policies in substance use disorders (SUD) treatment may reduce tobacco-related, health disparities. This study examined adoption of tobacco-related policy and practices in six residential programs participating in a California-sponsored, 18-month, tobacco-free policy intervention. Methods Directors (N=6) completed surveys of tobacco-related policies before and after the intervention. Staff completed cross-sectional surveys assessing tobacco-related training, beliefs, practices, workplace smoking policy, tobacco cessation program services, and smoking status pre- (n=135) and post-intervention (n=144). Results Director surveys indicated no programs had tobacco-free grounds, one provided tobacco-related staff training, and two provided nicotine replacement therapy (NRT) pre-intervention. At post-intervention, 5 programs had implemented tobacco-free grounds, 6 provided tobacco cessation training, and 3 provided NRT. Across all programs, staff were more likely to report smoke-free workplaces (AOR = 5.76, 95% CI1.14,29.18) post- versus pre-intervention. Staff positive beliefs towards addressing tobacco use were higher post-intervention (p<0.001). Odds of clinical staff reporting tobacco-related training participation (AOR = 19.63, 95% CI14.21,27.13) and program-level provision of NRT (AOR = 4.01, 95% CI 1.54, 10.43) increased post- versus pre-intervention. Clinical staff reporting they provided tobacco cessation services were also higher post-intervention (p= 0.045). There were no changes in smoking prevalence or quit intention among smoking staff. Conclusion A tobacco-free policy intervention in SUD treatment was associated with implementation of tobacco-free grounds, tobacco-related training among staff, more positive staff beliefs towards and delivery of tobacco cessation services to clients. The model may be improved with greater emphasis on staff policy awareness, facilitating availability of NRT, and reducing staff smoking.
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Affiliation(s)
- Barbara K. Campbell
- Division of General & Internal Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA,Corresponding author at: Division of General & Internal Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
| | - Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
| | - Sindhushree Hosakote
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
| | - Kwinoja Kapiteni
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA
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