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Flores A, Wiener RS, Hon S, Wakeman C, Howard J, Virani N, Mattus B, Foreman AG, Singh J, Rosen L, Bulekova K, Kathuria H. Sustainability of an Opt-Out Electronic-Health Record-Based Tobacco Treatment Consult Service at a Large Safety-Net Hospital: A 6-Year Analysis. Nicotine Tob Res 2024; 26:1081-1088. [PMID: 38320328 DOI: 10.1093/ntr/ntae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Our safety-net hospital implemented a hospital-based tobacco treatment intervention in 2016. We previously showed the intervention, an "opt-out" Electronic Health Record (EHR)-based Best Practice Alert (BPA)+ order-set that triggers consultation to an inpatient Tobacco Treatment Consult (TTC) service for all patients who smoke, improves smoking abstinence. We now report on sustainability, 6 years after inception. AIMS AND METHODS We analyzed data collected between July 2016-June 2022 of patients documented as "currently smoking" in the EHR. Across the 6 years, we used Pearson's correlation analysis to compare Adoption (clinician acceptance of the BPA+ order-set, thus generating consultation to the TTC service); Reach (number of consultations completed by the TTC service); and Effectiveness (receipt of pharmacotherapy orders between patients receiving and not receiving consultations). RESULTS Among 39 558 adult admissions (July 2016-June 2022) with "currently smoking" status in the EHR for whom the BPA triggered, clinicians accepted the TTC order set on 50.4% (19 932/39 558), though acceptance varied across services (eg, Cardiology [71%] and Obstetrics-Gynecology 12%]). The TTC service consulted on 17% (6779/39 558) of patients due to staffing constraints. Consultations ordered (r = -0.28, p = .59) and completed (r = 0.45, p = .37) remained stable over 6-years. Compared to patients not receiving consultations, patients receiving consultations were more likely to receive pharmacotherapy orders overall (inpatient: 50.8% vs. 35.1%, p < .0001; at discharge: 27.1% vs. 10%, p < .0001) and in each year. CONCLUSIONS The "opt-out" EHR-based TTC service is sustainable, though many did not receive consultations due to resource constraints. Health care systems should elevate the priority of hospital-based tobacco treatment programs to increase reach to underserved populations. IMPLICATIONS Our study shows that opt-out approaches that utilize the EHR are a sustainable approach to providing evidence-based tobacco treatment to all hospitalized individuals who smoke, regardless of readiness to stop smoking and clinical condition.
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Affiliation(s)
- Adriana Flores
- Division of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Stephanie Hon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Cornelia Wakeman
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Jinesa Howard
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Nikita Virani
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bruce Mattus
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alexis Gallardo Foreman
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Johar Singh
- Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Linda Rosen
- Clinical Data Warehouse, Boston Medical Center, Boston, MA, USA
| | - Katia Bulekova
- Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Hasmeena Kathuria
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Abushamma S, Chen LS, Chen J, Smock N, Pham G, Chen CH. Enabling tobacco treatment for gastroenterology patients via a novel low-burden point-of-care model. BMC Health Serv Res 2024; 24:752. [PMID: 38902682 PMCID: PMC11188289 DOI: 10.1186/s12913-024-11092-y] [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: 04/24/2023] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND & AIM Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers' practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics. METHODS An online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention. RESULTS 91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36-27.47%, RR = 1.90, 95% CI 1.60-2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26-2.82, p = .0021). CONCLUSION Smoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.
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Affiliation(s)
- Suha Abushamma
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA.
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingling Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Chien-Huan Chen
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA
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Cummings KM, Talbot V, Roberson A, Bliss AA, Likins E, Brownstein NC, Stansell S, Adams-Ludd D, Harris B, Louder D, McCutcheon E, Zebian R, Rojewski AM, Toll BA. Implementation of an "opt-out" tobacco treatment program in six hospitals in South Carolina. BMC Health Serv Res 2024; 24:741. [PMID: 38886764 PMCID: PMC11184783 DOI: 10.1186/s12913-024-11205-7] [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] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Describe the screening, referral, and treatment delivery associated with an opt-out tobacco treatment program (TTP) implemented in six hospitals varying in size, rurality and patient populations. METHODS Between March 6, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to six hospitals affiliated with the Medical University of South Carolina were screened for smoking status. The hospitals ranged in size from 82 to 715 beds. Those currently smoking were automatically referred to one of two tobacco treatment options: 1) Enhanced care (EC) where patients could receive a bedside consult by a trained tobacco treatment specialist plus an automated post-discharge follow-up call designed to connect those smoking to the South Carolina Quitline (SCQL); or 2) Basic care (BC) consisting of the post-discharge follow-up call only. An attempt was made to survey patients at 6-weeks after hospitalization to assess smoking status. RESULTS Smoking prevalence ranged from 14 to 49% across the six hospitals; 6,000 patients were referred to the TTP.The delivery of the bedside consult varied across the hospitals with the lowest in the Charleston hospitals which had the highest caseload of referred patients per specialist. Among patients who received a consult visit during their hospitalization, 50% accepted the consult, 8% opted out, 3% claimed not to be current smokers, and 38% were unavailable at the time of the consult visit. Most of those enrolled in the TTP were long-term daily smokers.Forty-three percent of patients eligible for the automated post-discharge follow-up call answered the call, of those, 61% reported smoking in the past seven days, and of those, 34% accepted the referral to theSCQL. Among the 986 of patients surveyed at 6-weeks after hospitalization quit rates ranged from 20%-30% based on duration of reported cessation and were similar between hospitals and for patients assigned to EC versus BC intervention groups. CONCLUSION Findings demonstrate the broad reach of an opt-out TTP. Elements of treatment delivery can be improved by addressing patient-to-staffing ratios, improving systems to prescribe stop smoking medications for patients at discharge and linking patients to stop smoking services after hospital discharge.
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Affiliation(s)
- K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | | | - Avery Roberson
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Asia A Bliss
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Emily Likins
- University of Pikeville, Kentucky College of Osteopathic Medicine, Pikeville, USA
| | - Naomi C Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Stephanie Stansell
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - Demetress Adams-Ludd
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - Bridget Harris
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - David Louder
- MUSC Health Alliance, Medical University of South Carolina, Charleston, USA
| | | | - Rami Zebian
- MUSC Health Florence Division, Florence, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
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Verdone JE, Marciniak ET, Deepak J. Tobacco treatment in the setting of lung cancer screening. Curr Opin Pulm Med 2024; 30:3-8. [PMID: 37933671 DOI: 10.1097/mcp.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Lung cancer screening by low-dose CT is an increasingly implemented preventive medicine tool. Screening for lung cancer is incomplete without addressing problematic tobacco use, the greatest modifiable risk factor in the development of lung cancer. This review describes recent work related to lung cancer screening and treatment of tobacco use in that context. RECENT FINDINGS Implementation of lung cancer screening demonstrates socioeconomic disparities in terms of adherence to screening as well as likelihood of successful tobacco dependence treatment. Active tobacco dependence is a common comorbidity for patients undergoing lung cancer screening. The optimal implementation of tobacco dependence treatment in the context of lung cancer screening is still an area of active investigation. SUMMARY Treatment of tobacco dependence at time of lung cancer screening is a major opportunity for clinicians to intervene to reduce the major modifiable risk factor for lung cancer, tobacco use. Providing comprehensive tobacco dependence treatment is most effective using combination pharmacologic and behavioral interventions. Practices providing comprehensive treatment will benefit from accurate documentation for billing and coding and supplementing with external resources such as state Quit Lines.
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Affiliation(s)
- James E Verdone
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Palmer AM, Carpenter MJ, Rojewski AM, Haire K, Baker NL, Toll BA. Nicotine replacement therapy for vaping cessation among mono and dual users: A mixed methods preliminary study. Addict Behav 2023; 139:107579. [PMID: 36549102 PMCID: PMC9872945 DOI: 10.1016/j.addbeh.2022.107579] [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: 06/28/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Many adults express interest in e-cigarette cessation; however, there are few empirically tested interventions for quitting vaping. This study seeks to (1) evaluate reasons for quitting e-cigarettes in treatment-seeking adults, and (2) assess the feasibility and acceptability of nicotine replacement therapy (NRT) for e-cigarette cessation. Adult daily e-cigarette users completed qualitative interviews about quitting e-cigarettes, then were randomized to either 28-day supply of combination NRT (21 mg patches, 4 mg lozenges) + supportive booklet or Quitline referral. Primary aims were feasibility (number who enrolled) and acceptability (NRT use, adverse side effects). Exploratory aims evaluated abstinence (7-day point-prevalence) at end of treatment. Of the 30 participants who were enrolled, 50 % (n = 15) were dual users, and 50 % (n = 15) were mono-vapers, 26.6 % (n = 8) of whom were former smokers. Participants reported seeking treatment due to health concerns, dependence, stigma, and cost. Anticipated challenges of quitting vaping were withdrawal, negative mood, sensorimotor habits, and convenience. Most completed the end of treatment survey (n = 24; 80 %). Participants who received NRT reported using the patch M = 10.89 days and lozenges M = 6.39 days, with few days of adverse effects (M = 2.67). At end of treatment, 6/18 (33.3 %; 6 mono and 0 dual users) in the intervention group reported abstinence from vaping, compared to 0 in the control group (Fisher = 5.00, p =.057). In conclusion, adults are interested in quitting e-cigarettes due to negative consequences of use and are willing to use pharmacotherapy. Future research should confirm these results in a larger trial, address cigarette smoking in dual users, and aim to disseminate treatments.
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Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Matthew J Carpenter
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kayla Haire
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Rojewski AM, Palmer AM, Toll BA. Treatment of Tobacco Dependence in the Inpatient Setting. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Eakin MN, Bauer SE, Carr T, Dagli E, Ewart G, Garfield JL, Jaspers I, Kher S, Leone FT, Melzer AC, Moazed F, Moraes TJ, Reddy KP, Upson D, Kathuria H. Policy Recommendations to Eliminate Tobacco Use and Improve Health from the American Thoracic Society Tobacco Action Committee. Ann Am Thorac Soc 2022; 19:157-160. [PMID: 34347555 PMCID: PMC10285748 DOI: 10.1513/annalsats.202104-493ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah E. Bauer
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas Carr
- American Lung Association, Chicago, Illinois
| | - Elif Dagli
- Marmara University, Health Institute Association, Istanbul, Turkey
| | - Gary Ewart
- American Thoracic Society, Washington, DC
| | - Jamie L. Garfield
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ilona Jaspers
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sucharita Kher
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Frank T. Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne C. Melzer
- Section of Pulmonary, Allergy, Critical Care and Sleep, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Farzad Moazed
- Division of Pulmonary and Critical Care Medicine, Alameda Health System, Oakland, California
| | - Theo J. Moraes
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Krishna P. Reddy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Dona Upson
- Pulmonary, Critical Care and Sleep Medicine, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico; and
| | - Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
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Sanford BT, Toll BA, Palmer AM, Foster MG, Cummings KM, Stansell S, Rojewski AM. Tobacco Treatment Outcomes for Hospital Patients With and Without Mental Health Diagnoses. Front Psychiatry 2022; 13:853001. [PMID: 35722554 PMCID: PMC9199856 DOI: 10.3389/fpsyt.2022.853001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of mental health conditions is higher in cigarette smokers than nonsmokers. However, those with diagnosed mental health disorders are understudied within general inpatient hospital settings. This study seeks to evaluate how having a mental health diagnosis influences response to a brief opt-out inpatient tobacco treatment intervention. METHODS Data included 4,153 admitted patients who completed a tobacco treatment visit. Post-discharge self-reported abstinence was obtained via response to an automated call 1-month after discharge. Mental health co-morbidities were assessed by reviewing electronic medical records. Logistic regression was used to assess associations between having a mental health diagnosis and patients' smoking history, interest in quitting smoking, and post-discharge abstinence. RESULTS Overall 34.1% of patients were diagnosed with mental health disorders, most commonly depression or substance use disorders. Patients with a diagnosed mental health disorder were more likely to report a history of long-term heavy smoking and were less likely to express an interesting in remaining abstinent from smoking after hospitalization. An intent-to-treat analysis using logistic regression analysis found lower rates of self-reported smoking abstinence in those with a mental health disorder compared to those without (9 vs. 13.2%, p < 0.001). CONCLUSIONS Patients with a history of mental health diagnoses, such as depression or substance use disorders, was associated with lower rates of smoking abstinence in patients after hospitalization. Hospital based opt-out smoking cessation programs have shown to be generally effective and efficient. However, certain subpopulations may require tailored intervention in order to improve treatment outcomes. Future research is needed to develop brief, effective tobacco treatment for hospital patients with comorbid mental health diagnoses.
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Affiliation(s)
- Brandon T Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Madeline G Foster
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - K Michael Cummings
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Stephanie Stansell
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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Roughgarden KL, Toll BA, Tanner NT, Frazier CC, Silvestri GA, Rojewski AM. Tobacco Treatment Specialist Training for Lung Cancer Screening Providers. Am J Prev Med 2021; 61:765-768. [PMID: 34226091 PMCID: PMC8541897 DOI: 10.1016/j.amepre.2021.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/26/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Kelly L Roughgarden
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Benjamin A Toll
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Nichole T Tanner
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, South Carolina; Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Cassie C Frazier
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Gerard A Silvestri
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina; Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Alana M Rojewski
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
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