|
1
|
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: 5] [Impact Index Per Article: 2.5] [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.
Collapse
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
| |
Collapse
|
|
2
|
Taing M, Nitturi V, Chen TA, Kyburz B, Martinez Leal I, Correa-Fernández V, Obasi EM, Williams T, Casey K, O’Connor DP, Koshy L, Britton M, Drenner K, Reitzel LR. Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:239. [PMID: 35010499 PMCID: PMC8744608 DOI: 10.3390/ijerph19010239] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/03/2021] [Accepted: 12/24/2021] [Indexed: 05/25/2023]
Abstract
Tobacco use is exceedingly high among individuals receiving care for opioid addiction, but not commonly addressed by clinicians in treatment settings. Taking Texas Tobacco Free (TTTF) is a comprehensive tobacco-free workplace (TFW) program that builds treatment centers' capacity to address tobacco use with evidence-based tobacco cessation policies and practices. Here, we examine the process and outcomes of TTTF's implementation within 7 opioid addiction centers. Program goals were structured according to the RE-AIM framework. Pre- and post-implementation data were collected from client facing and non-client facing employees to assess changes in education, training receipt, knowledge, and intervention behaviors, relative to program goals. Centers reported tobacco screenings conducted and nicotine replacement therapy (NRT) delivered through 6 months post-implementation. Overall, 64.56% of employees participated in TTTF-delivered tobacco education, with a 54.9% gain in tobacco control and treatment knowledge (p < 0.0001), and significant increases in exposure to education about tobacco use and harms among individuals with opioid use disorder (p = 0.0401). There were significant gains in clinicians' receipt of training in 9/9 tobacco education areas (ps ≤ 0.0118). From pre- to post-implementation, there were mean increases in the use of the 5A's (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with statistically significant gains seen in NRT provision/referral (p < 0.0001). Several program goals were achieved or exceeded; however, 100% center participation in specialized clinical trainings was among notable exceptions. One program withdrew due to competing pandemic concerns; all others implemented comprehensive TFW policies. Overall, TTTF may have improved participating opioid treatment centers' capacity to address tobacco use, although study limitations, including lower post-implementation evaluation response rates, suggest that results require replication in other opioid addiction treatment settings.
Collapse
Affiliation(s)
- Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Vijay Nitturi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Daniel P. O’Connor
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA
| | - Litty Koshy
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Maggie Britton
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| | - Kelli Drenner
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (M.T.); (V.N.); (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.B.); (K.D.)
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA; (D.P.O.); (L.K.)
| |
Collapse
|
|
3
|
Le K, Chen TA, Martinez Leal I, Correa-Fernández V, Obasi EM, Kyburz B, Williams T, Casey K, Taing M, O’Connor DP, Reitzel LR. Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10485. [PMID: 34639785 PMCID: PMC8507614 DOI: 10.3390/ijerph181910485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
Although tobacco use is the leading preventable cause of death and is elevated among patients with substance use disorders, many substance use treatment centers (SUTCs) do not offer tobacco use interventions (i.e., screening and treatment). This study examined a key outcome of the implementation of a tobacco-free workplace program that provided education and specialized training to employees; namely, changes in clinician provision of the five As (Asking about tobacco use; Advising to quit; Assessing willingness to quit; Assisting with quitting; Arranging follow-up) from before to after the larger program implementation. The five As are a brief tobacco screening and treatment protocol that was taught as part of the program and that formed the basis for further intervention (e.g., provision of nicotine replacement therapies, Motivational Interviewing to enhance desire and willingness to make a quit attempt). Moreover, we also examined organizational moderators that may have impacted changes in the delivery of the five As over time among clinicians from 15 participating SUTCs. The number of the centers' total and unique annual patient visits; full-time employees; and organizational readiness for implementing change were assessed as potential moderators of change in clinicians' behaviors over time. Clinicians completed pre- and post-program implementation surveys assessing their provision of the five As. Results demonstrated significant increases in Asking (p = 0.0036), Advising (p = 0.0176), Assisting (p < 0.0001), and Arranging (p < 0.0001). SUTCs with higher Change Efficacy (p = 0.025) and lower Resource Availability (p = 0.019) had greater increases in Asking. SUTCs with lower Resource Availability had greater increases in Assessing (p = 0.010). These results help guide tobacco control program implementation to increase the provision of tobacco use interventions (i.e., the five As) to SUTC patients and elucidate Change Efficacy and Resource Availability as organizational factors promoting this clinician behavior change.
Collapse
Affiliation(s)
- Kathy Le
- Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Daniel P. O’Connor
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| |
Collapse
|
|
4
|
Guillaumier A, Skelton E, Tzelepis F, D'Este C, Paul C, Walsberger S, Kelly PJ, Palazzi K, Bonevski B. Patterns and predictors of nicotine replacement therapy use among alcohol and other drug clients enrolled in a smoking cessation randomised controlled trial. Addict Behav 2021; 119:106935. [PMID: 33848758 DOI: 10.1016/j.addbeh.2021.106935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Nicotine replacement therapy (NRT) use to support client smoking quit attempts is low and inconsistent at alcohol and other drug (AOD) treatment services. This study examined predictors of any NRT use and combination NRT use among AOD clients who were smokers. METHODS The study was part of a cluster-RCT of an organisational change intervention to introduce smoking cessation support as part of routine treatment in 32 AOD services. The intervention provided AOD services with free NRT and training. Service clients completed baseline (n = 896), 8-week (n = 471) and 6.5-month (n = 427) follow-up surveys. Mixed-model logistic regression examined whether baseline socio-demographic and smoking variables were associated with single and combination NRT use. RESULTS At 8-weeks follow-up 57% (n = 269/471), and at 6.5-months 33% (n = 143/427) of participants reported using at least one form of NRT. Odds of NRT use at 8-weeks follow-up were greater among participants from treatment vs control group (OR = 3.69, 95%CI 1.8-7.4; p < 0.001), higher vs lower nicotine dependence (OR = 1.74 95%CI 1.1-2.8; p = 0.024), or those motivated to quit (OR = 1.18 95%CI 1.0-1.4; p = 0.017). At 6.5-months, only the treatment arm remained significant. Combination NRT use at the 8-week follow-up was higher among those in treatment vs control group (OR = 2.75 95%CI 1.4-5.6; p = 0.005), or with higher vs lower nicotine dependence (OR = 2.12 95%CI 1.2-3.8; p = 0.014). No factors were associated with combination NRT use at 6.5-months. CONCLUSIONS An organisational change intervention that supplied AOD services with NRT training and products to provide to clients during treatment significantly increases client single form and combination NRT use in the short term.
Collapse
Affiliation(s)
| | | | - Flora Tzelepis
- The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Hunter New England Population Health, Wallsend, Australia
| | - Catherine D'Este
- The University of Newcastle, Callaghan, Australia; Australian National University, Canberra, Australia
| | - Christine Paul
- The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | - Peter J Kelly
- The University of Wollongong, Illawarra Health and Medical Research Institute, School of Psychology, Northfields Avenue, Wollongong, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | | |
Collapse
|
|
5
|
Streck JM, Kalkhoran S, Bearnot B, Gupta PS, Kalagher KM, Regan S, Wakeman S, Rigotti NA. Perceived risk, attitudes, and behavior of cigarette smokers and nicotine vapers receiving buprenorphine treatment for opioid use disorder during the COVID-19 pandemic. Drug Alcohol Depend 2021; 218:108438. [PMID: 33271434 PMCID: PMC7687365 DOI: 10.1016/j.drugalcdep.2020.108438] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cigarette smoking may increase the risk of COVID-19 complications, reinforcing the urgency of smoking cessation in populations with high smoking prevalence such as individuals with opioid use disorder (OUD). Whether the COVID-19 pandemic has altered perceptions, motivation to quit, or tobacco use among cigarette smokers and nicotine e-cigarette vapers with OUD is unknown. METHODS A telephone survey was conducted in March-July 2020 of current cigarette smokers or nicotine vapers with OUD who were stable on buprenorphine treatment at five Boston (MA) area community health centers. The survey assessed respondents' perceived risk of COVID-19 due to smoking or vaping, interest in quitting, quit attempts and change in tobacco consumption during the pandemic. RESULTS 222/520 patients (43 %) completed the survey, and 145 were asked questions related to COVID-19. Of these, 61 % smoked cigarettes only, 13 % vaped nicotine only, and 26 % were dual users. Nearly 80 % of participants believed that smoking and vaping increased their risk of COVID-19 infection or complications. Smokers with this belief reported an increased interest in quitting (AOR 4.6, 95 % CI:1.7-12.4). Overall, 49 % of smokers and 42 % of vapers reported increased interest in quitting due to the pandemic; 24 % and 20 %, respectively, reported attempting to quit since the pandemic. However, 35 % of smokers and 27 % of vapers reported increasing smoking and vaping, respectively, during the pandemic. CONCLUSIONS Most patients with OUD believed that smoking and vaping increased their vulnerability to COVID-19, half reported increased interest in quitting, but others reported increasing smoking and vaping during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Joanna M. Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Corresponding author at: Tobacco Research and Treatment Center, Departments of Medicine and Psychiatry, Massachusetts General Hospital/Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114, USA
| | - Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Benjamin Bearnot
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Priya S. Gupta
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kelly M. Kalagher
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Wakeman
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
6
|
Abstract
While prevalence of tobacco use in the US general population is declining, prevalence among those with opioid use disorder (OUD) remains high and results in excessive tobacco-related disease and premature mortality. Among smokers with OUD, tobacco cessation rates are negligible without treatment. However, both low-intensity behavioral interventions and more intensive motivational interventions yield negligible cessation rates. While contingency management has potent short-term cessation effects, effects are not maintained at post-intervention follow-up. Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with OUD. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared with standard treatment regimens. Targeting the unique challenges faced by smokers with OUD, including nicotine-opioid interactions and poor medication adherence, has potential to improve cessation outcomes, but further research is needed to optimize intervention efficacy among smokers with OUD.
Collapse
|
|
7
|
Nahvi S, Arnsten JH. Missed opportunities to test the neuropsychiatric safety--and efficacy--of varenicline among smokers with substance use disorders. Drug Alcohol Depend 2018; 185:245-247. [PMID: 30369710 PMCID: PMC6201286 DOI: 10.1016/j.drugalcdep.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shadi Nahvi
- Departments of Medicine, and of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine / Montefiore Medical Center, 111 East 210th Street, Bronx, NY, USA,
| | - Julia H. Arnsten
- Departments of Medicine, of Psychiatry & Behavioral Sciences, and of Epidemiology & Population Health, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA,
| |
Collapse
|
|
8
|
Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, McCrabb S, Palazzi K, Bonevski B. Smoking cessation care provision in Australian alcohol and other drug treatment services: A cross-sectional survey of staff self-reported practices. J Subst Abuse Treat 2017; 77:101-106. [DOI: 10.1016/j.jsat.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
|
|
9
|
Knudsen HK. Implementation of smoking cessation treatment in substance use disorder treatment settings: a review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:215-225. [PMID: 27314884 DOI: 10.1080/00952990.2016.1183019] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The high prevalence of smoking among individuals receiving treatment for substance use disorder (SUD) has led to repeated calls for integrating smoking cessation treatment into these settings. OBJECTIVES This review summarizes key findings from the research on the implementation of smoking cessation in SUD treatment. METHODS PubMed searches of articles published from 2000 to 2015 yielded 48 empirical studies that focused on the delivery of smoking cessation in the US specialty SUD treatment settings in which organizations and counselors were the unit of analysis. Most studies used observational designs to gather data from organizations and counselors. Organizational studies show that few SUD treatment programs offer cessation counseling or pharmacotherapy. Organizational barriers include limited training, inadequate resources, and cultural norms that do not recognize smoking cessation as part of the organization's mission. Smoking cessation services are more likely to be available in medically oriented treatment settings, larger treatment programs, those offering a broader array of comprehensive services, and those that are more reliant on fee-for-service reimbursement (e.g., insurance, Medicaid). Surveys of counselors also show very low implementation. Counselors' personal skills and attitudes, their perceptions of managerial and coworker support for smoking cessation, and the availability of resources and reimbursement to support these services are correlated with implementation. State policies requiring treatment programs to offer tobacco treatment increase both adoption and implementation, yet these services continue to reach only modest percentages of the patients. CONCLUSIONS Few studies have tested specific implementation strategies. Such research is needed to determine how to accelerate the diffusion of these evidence-based practices to the SUD treatment field.
Collapse
Affiliation(s)
- Hannah K Knudsen
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
| |
Collapse
|
|
10
|
Guydish J, Gruber VA, Le T, Tajima B, Andrews KB, Leo H, Zura SK, Miller R, Tsoh JY. A Pilot Study of a Readiness Group to Increase Initiation of Smoking Cessation Services among Women in Residential Addiction Treatment. J Subst Abuse Treat 2016; 63:39-45. [PMID: 26825975 DOI: 10.1016/j.jsat.2015.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
This study implemented a smoking cessation readiness group (RG) in two women-focused residential substance abuse treatment programs, with the aim of engaging women in smoking cessation services. The primary outcome was defined as attending at least one cessation group after the RG ended. The RG combined features of the Expert Systems (ES) approach with a practice quit attempt. ES is an interactive system which tailors intervention to the smokers' stage of change, while the practice quit attempt rehearses the process of quitting smoking. As a secondary aim we tested whether incentives, used to promote participation and engagement in the RG, would increase initiation of smoking cessation services. Participants (N=75) were women smokers enrolled in two residential programs, and intention to quit smoking was not required for participation. Twelve participant cohorts were randomly assigned to receive the RG with or without incentives. Following the RG intervention, 38.7% of participants (n=29) attended at least one smoking cessation session. Both the number of RG sessions attended and a successful practice quit attempt predicted the later use of cessation services, while incentives did not. From pre- to post-RG, participants reported decreased cigarettes per day (CPD: 11.8 vs. 7.6, p<.0001) and decreased nicotine dependence as measured by the Heaviness Smoking Index (HSI: 2.3 vs. 1.8, p<.001). The 3-session group-format RG intervention was associated with initiation of smoking cessation services and with changes in smoking behavior.
Collapse
Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), USA
| | | | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), USA
| | - Barbara Tajima
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), USA
| | - K Blakely Andrews
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), USA
| | | | | | | | | |
Collapse
|
|
11
|
Knudsen HK, Roman PM. Medicaid, Private Insurance, and the Availability of Smoking Cessation Interventions in Substance Use Disorder Treatment. Psychiatr Serv 2015; 66:1213-20. [PMID: 26234332 PMCID: PMC4630091 DOI: 10.1176/appi.ps.201400451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Integration of smoking cessation services in substance use disorder treatment would benefit many patients. Although prior studies have identified organizational characteristics associated with delivery of these services, less is known regarding associations between financial factors and the availability of smoking cessation services. This study examined whether reliance on Medicaid and private insurance revenues is associated with the availability of a formal counseling-based smoking cessation program and medications (sustained-release bupropion, varenicline, and nicotine replacement) within U.S. specialty treatment organizations. METHODS Administrators of a national sample of 372 treatment organizations participated in face-to-face structured interviews from October 2011 to December 2013. Participants provided data regarding smoking cessation services, revenue sources, and other organizational characteristics. Multiple imputation was used to address missing data, and models were estimated by using logistic regression with adjustment for clustering of organizations within states. RESULTS Greater reliance on Medicaid revenues was positively associated with the odds of offering counseling-based smoking cessation programs, sustained-release bupropion, varenicline, and nicotine replacement. For example, a 10-percentage point increase in Medicaid revenues was associated with a 12% increase in the odds of offering a smoking cessation program. Reliance on private insurance revenues was positively associated with the odds of offering the three medications. CONCLUSIONS The findings point to future potential increases in the availability of smoking cessation services in the context of expanding insurance coverage under health care reform. Longitudinal research will be needed to examine whether this impact is realized.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Dr. Knudsen is with the Department of Behavioral Science, University of Kentucky, Lexington (e-mail: ). Dr. Roman is with the Department of Sociology and the Owens Institute for Behavioral Research, University of Georgia, Athens
| | - Paul M Roman
- Dr. Knudsen is with the Department of Behavioral Science, University of Kentucky, Lexington (e-mail: ). Dr. Roman is with the Department of Sociology and the Owens Institute for Behavioral Research, University of Georgia, Athens
| |
Collapse
|
|
12
|
Substance Use Disorder Counselors' Reports of Tobacco Cessation Services Availability, Implementation, and Tobacco-related Knowledge. J Adolesc Health 2015; 57:327-33. [PMID: 26299559 PMCID: PMC4548273 DOI: 10.1016/j.jadohealth.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Adolescence is a prime developmental stage for early tobacco cessation (TC) intervention. This study examined substance use disorder counselors' reports of the availability and implementation of TC services (behavioral treatments and pharmacotherapies) in their treatment programs and the relationship between their tobacco-related knowledge and implementation of TC services. METHODS Survey data were collected in 2012 from 63 counselors working in 22 adolescent-only treatment programs. Measures included 15 TC behavioral treatments, nine TC pharmacotherapies, and three tobacco-related knowledge scales (morbidity/mortality, modalities and effectiveness, pharmacology). RESULTS First, nine of the 15 behavioral treatments are reported as being available by more than half of counselors; four of the 15 behavioral treatments are used by counselors with more than half of adolescents. Of the nine pharmacotherapies, availability of the nicotine patch is reported by almost 40%, buproprion by nearly 30%, and clonidine by about 21% of counselors. Pharmacotherapies are used by counselors with very few adolescents. Second, counselors' tobacco-related knowledge varies based on the knowledge scale examined. Third, we only find a significant positive relationship between counselors' implementation of TC behavioral treatments and TC modalities and effectiveness knowledge. DISCUSSION Findings suggest that more behavioral treatments should be made available in substance use disorder treatment programs considering that they are the main treatment recommendation for adolescents. Counselors should be encouraged to routinely use a wide range of available behavioral treatments. Finally, counselors should be encouraged to expand their knowledge of TC modalities and effectiveness because of the relationship with behavioral treatments implementation.
Collapse
|
|
13
|
McClure EA, Campbell ANC, Pavlicova M, Hu M, Winhusen T, Vandrey RG, Ruglass LM, Covey LS, Stitzer ML, Kyle TL, Nunes EV. Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study. J Subst Abuse Treat 2015; 53:39-46. [PMID: 25595301 PMCID: PMC4414703 DOI: 10.1016/j.jsat.2014.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The majority of patients enrolled in treatment for substance use disorders (SUDs) also use tobacco. Many will continue to use tobacco even during abstinence from other drugs and alcohol, often leading to smoking-related illnesses. Despite this, little research has been conducted to assess the influence of being a smoker on SUD treatment outcomes and changes in smoking during a treatment episode. METHODS In this secondary analysis, cigarette smoking was evaluated in participants completing outpatient SUD treatment as part of a multi-site study conducted by the National Drug Abuse Treatment Clinical Trials Network. Analyses included the assessment of changes in smoking and nicotine dependence via the Fagerström Test for Nicotine Dependence during the 12-week study among all smokers (aim #1), specifically among those in the experimental treatment group (aim #2), and the moderating effect of being a smoker on treatment outcomes (aim #3). RESULTS Participants generally did not reduce or quit smoking throughout the course of the study. Among a sub-set of participants with higher baseline nicotine dependence scores randomized to the control arm, scores at the end of treatment were lower compared to the experimental arm, though measures of smoking quantity did not appear to decrease. Further, being a smoker was associated with poorer treatment outcomes compared to non-smokers enrolled in the trial. CONCLUSIONS This study provides evidence that patients enrolled in community-based SUD treatment continue to smoke, even when abstaining from drugs and alcohol. These results add to the growing literature encouraging the implementation of targeted, evidence-based interventions to promote abstinence from tobacco among SUD treatment patients.
Collapse
Affiliation(s)
- Erin A McClure
- Medical University of South Carolina School of Medicine, 67 President St., Charleston, SC, 29425, United States.
| | - Aimee N C Campbell
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States; Mount Sinai St. Luke's Hospital, Department of Psychiatry and Behavioral Health, 1111 Amsterdam Avenue, New York, NY 10025, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, CUMC, Columbia University, 722W. 168th street, New York, NY 10032, United States
| | - Meichen Hu
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Theresa Winhusen
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, United States
| | - Ryan G Vandrey
- Johns Hopkins University, School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States
| | - Lesia M Ruglass
- The City College of New York, CUNY, 160 Convent Avenue, New York, NY 10031, United States
| | - Lirio S Covey
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Maxine L Stitzer
- Johns Hopkins University, School of Medicine, 5510 Nathan Shock Dr., Baltimore, MD 21224, United States
| | - Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson St., Orlando, FL 32804, United States
| | - Edward V Nunes
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| |
Collapse
|
|
14
|
Maintenance of tobacco cessation programmes in public hospitals in Catalonia, Spain. Addict Behav 2015; 42:136-9. [PMID: 25462661 DOI: 10.1016/j.addbeh.2014.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/13/2014] [Accepted: 11/19/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The provision of smoking cessation interventions in hospitals has been strongly recommended. The aim of this study is to determine the maintenance of smoking cessation programmes for inpatients and hospital workers in hospitals of Catalonia (Spain) seven years after the implementation of a Tobacco Cessation Programme. METHODS A cross-sectional survey was conducted in all hospitals that offer public service in Catalonia, Spain (n=73). An online questionnaire was sent to all coordinators of the smoke-free hospital project or managers of each hospital. The survey included questions about the type of hospital, type of programmes implemented and availability and source of smoking cessation drugs. RESULTS Responses to the questionnaire were submitted by 58 hospitals (79.5%). 74% and 93.1% of the hospitals had smoking cessation programmes for inpatients and workers, respectively. Most of the hospitals maintained the programmes and started routinely buying smoking cessation drugs after a period of receiving them free-of-charge. However, 17.2% of the hospitals refused to buy these drugs and 24% never had these drugs available. CONCLUSIONS Through a supportive Tobacco Cessation Programme, most hospitals have smoking cessation programmes for both patients and workers. Most of them have incorporated smoking cessation drugs as a regular resource in their services' portfolio. The lack of these resources may jeopardise the maintenance of well-established programmes in hospitals.
Collapse
|
|
15
|
Guydish J, Yu J, Le T, Pagano A, Delucchi K. Predictors of Tobacco Use Among New York State Addiction Treatment Patients. Am J Public Health 2015; 105:e57-e64. [PMID: 25393179 DOI: 10.2105/ajph.2014.302096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. We used admissions data from the New York State addiction treatment system to assess patient self-reported tobacco use and factors associated with tobacco use. Methods. We compared prevalence of tobacco use in the state addiction treatment system with that of a national sample of people receiving addiction treatment and with that of the New York general population in 2005 to 2008. A random effects logistic model assessed relationships between patient- and program-level variables and tobacco use. Results. Prevalence of tobacco use in the New York treatment system was similar to that in national addiction treatment data and was 3 to 4 times higher than that in the general population. Co-occurring mental illness, opiate use, methadone treatment, and being a child of a substance-abusing parent were associated with higher rates of tobacco use. Conclusions. We call on federal leadership to build capacity to address tobacco use in addiction treatment, and we call on state leadership to implement tobacco-free grounds policies in addiction treatment systems.
Collapse
Affiliation(s)
- Joseph Guydish
- Joseph Guydish and Thao Le are with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Jiang Yu is with the School of Social Welfare, University at Albany, State University of New York. Anna Pagano and Kevin Delucchi are with the Department of Psychiatry, University of California, San Francisco
| | | | | | | | | |
Collapse
|
|
16
|
Eby LT, Laschober TC, Muilenburg JL. Sustained, new, never, and discontinued tobacco cessation services adopters. J Subst Abuse Treat 2014; 49:8-14. [PMID: 25178991 DOI: 10.1016/j.jsat.2014.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/21/2014] [Accepted: 07/29/2014] [Indexed: 11/17/2022]
Abstract
This study examined longitudinal adoption patterns of tobacco cessation (TC) counseling and TC pharmacotherapy in substance use disorder treatment programs and baseline predictors (program characteristics and program culture) of these patterns 12-months later. Telephone survey data were collected in 2010 from 685 randomly sampled program administrators working in geographically representative treatment programs across the U.S. Regarding TC counseling, about 41% of programs never adopt, 33% sustain, and 27% change adoption patterns. Concerning TC pharmacotherapy, about 62% of programs never adopt, 19% sustain, and 18% change adoption patterns. The three most consistent predictors of counseling adoption patterns are TC reimbursement, TC financial resource availability, and smoking culture. For TC pharmacotherapy adoption patterns, the most consistent predictors include profit status, TC reimbursement, level of care, TC financial resource availability, and smoking culture. Findings provide insights into program characteristics and program culture as both potential barriers and facilitators of longitudinal TCS adoption.
Collapse
Affiliation(s)
- Lillian T Eby
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA; Industrial-Organizational Psychology Program, 325 Psychology Building, Athens, GA 30602, USA.
| | - Tanja C Laschober
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA
| | - Jessica L Muilenburg
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Department of Health Promotion and Behavior, 325 Psychology Building, Athens, GA 30602, USA
| |
Collapse
|
|
17
|
Malekshahi T, Tioleco N, Ahmed N, Campbell ANC, Haller D. Misuse of atypical antipsychotics in conjunction with alcohol and other drugs of abuse. J Subst Abuse Treat 2014; 48:8-12. [PMID: 25216812 DOI: 10.1016/j.jsat.2014.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/08/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022]
Abstract
Non-medical use of atypical antipsychotics by substance abusers has been reported in the literature, although no detailed studies exist. Among 429 addiction treatment inpatients screened, 73 (17.0%) reported misuse of antipsychotics with alcohol, opioids, cocaine, methamphetamine and/or cannabis; 39 (9.1%) within the past year. Of past year misusers, 25 (64.1%) were interviewed. Most were male (76.0%), non-Caucasian (56.0%), and polysubstance abusers (84.0%). Quetiapine, the most abused drug (96.0%), was obtained primarily from doctors (52.0%) and family/friends (48.0%). Reasons for use included to "recover" from other substances (66.7%), "enhance" the effects of other substances (25.0%), and "experiment" (20.8%). The most frequently reported positive effect was "feeling mellow" (75.0%); negative effects were consistent with antipsychotic use (e.g., feeling thirsty, trouble concentrating). Compared to a normative sample of inpatient substance abusers, ASI composite scores were higher. Findings suggest that physicians should assess for use/misuse of atypical antipsychotics among patients with addiction.
Collapse
Affiliation(s)
- Tara Malekshahi
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA
| | - Nina Tioleco
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA
| | - Nahima Ahmed
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA
| | - Aimee N C Campbell
- Mount Sinai St. Luke's and Roosevelt Hospitals, New York, NY, USA; Columbia University Medical Center, College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA.
| | - Deborah Haller
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
|
18
|
Eby LT, Laschober TC, Muilenburg JL. Understanding counselors' implementation of tobacco cessation services with patients. J Subst Abuse Treat 2014; 47:314-20. [PMID: 25082757 DOI: 10.1016/j.jsat.2014.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/15/2014] [Accepted: 06/18/2014] [Indexed: 01/30/2023]
Abstract
This study aimed to understand substance use disorder counselors' implementation of evidence-based tobacco cessation services (TCS) with their patients who smoke. Drawing from an established adoption of innovations framework, we investigated the association between counselors' perceptions of the availability of TCS (both pharmacotherapies and behavioral treatments) in their treatment program and the implementation of TCS (both pharmacotherapies and behavioral treatments) with their patients who smoke and whether this association is moderated by the strength of an organization's climate for implementation and the fit of the innovation with users' values. Data were collected in 2010 from 682 counselors working in 239 treatment programs across the U.S. that offer evidence-based TCS. Mixed-effect models showed that perceived availability of TCS was related with greater TCS implementation. This relationship was moderated by several indicators of climate for implementation but not by the fit of the innovation with users' values.
Collapse
Affiliation(s)
- Lillian T Eby
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA; Industrial-Organizational Psychology Program, 325 Psychology Building, Athens, GA 30602, USA.
| | - Tanja C Laschober
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA.
| | - Jessica L Muilenburg
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Department of Health Promotion and Behavior, 325 Psychology Building, Athens, GA 30602, USA.
| |
Collapse
|
|
19
|
Organizational factors as predictors of tobacco cessation pharmacotherapy adoption in addiction treatment programs. J Addict Med 2014; 8:59-65. [PMID: 24365803 DOI: 10.1097/adm.0000000000000008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study investigated 3 organizational factors (ie, counseling staff clinical skills, absence of treatment program obstacles, and policy-related incentives) as predictors of tobacco cessation pharmacotherapy (TCP) adoption (comprised of the 9 available TCPs) in addiction treatment programs using the innovation implementation effectiveness framework. METHODS Data were obtained in 2010 from a random sample of 1006 addiction treatment program administrators located across the United States using structured telephone interviews. RESULTS According to program administrator reports, TCP is adopted in approximately 30% of treatment programs. Negative binomial regression results show that fewer treatment program obstacles and more policy-related incentives are related to greater adoption of TCP. Counter to prediction, clinical skills are unrelated to TCP adoption. CONCLUSIONS Our findings suggest that organizational factors, on the basis of established theoretical frameworks, merit further examination as facilitators of the adoption of diverse TCP in addiction treatment programs.
Collapse
|
|
20
|
Muilenburg JL, Laschober TC, Eby LT. Climate for innovation, 12-step orientation, and tobacco cessation treatment. J Subst Abuse Treat 2013; 46:447-55. [PMID: 24355811 DOI: 10.1016/j.jsat.2013.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/10/2013] [Accepted: 10/29/2013] [Indexed: 11/30/2022]
Abstract
This study examined the relationship between (1) three indicators of climate for innovation (clinician skills, absence of program obstacles, policy-related incentives) and adoption extensiveness of both behavioral treatments for tobacco cessation (TC) and system-level support for TC in substance use disorder treatment programs, (2) a program's 12-step treatment orientation and adoption extensiveness, and (3) whether 12-step treatment orientation moderates the relationship between climate for innovation and adoption extensiveness. Data were obtained from a random sample of 1006 program administrators. Hierarchical regression results showed that both absence of program obstacles and policy-related incentives are positively related to adoption extensiveness. Twelve-step treatment orientation is neither related to adoption extensiveness nor a moderator of the relationship between climate for innovation and adoption extensiveness. Although the adoption of both behavioral treatments for TC and system-level support for TC is not extensive, we conclude that a 12-step treatment orientation neither hampers nor promotes adoption extensiveness.
Collapse
Affiliation(s)
- Jessica L Muilenburg
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Department of Health Promotion and Behavior, 325 Psychology Building, Athens, GA 30602, USA.
| | - Tanja C Laschober
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA.
| | - Lillian T Eby
- University of Georgia, 325 Psychology Building, Athens, GA 30602, USA; Owens Institute for Behavioral Research, 325 Psychology Building, Athens, GA 30602, USA; Industrial-Organizational Psychology Program, 325 Psychology Building, Athens, GA 30602, USA.
| |
Collapse
|
|
21
|
The prevalence and correlates of single cigarette selling among urban disadvantaged drug users in Baltimore, Maryland. Drug Alcohol Depend 2013; 132:466-70. [PMID: 23578589 PMCID: PMC3737406 DOI: 10.1016/j.drugalcdep.2013.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/26/2013] [Accepted: 03/09/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Selling of single cigarettes, also known as loosies, is a public health concern. Loosies allow for those with fewer resources to buy cigarettes without having to purchase a pack. Selling of loosies may cue smoking behaviors. In the US, socioeconomically disadvantaged populations have high rates of smoking and illicit drug use and the selling of loosies appears to be linked to the urban informal economy. We examined the proportion and frequency of cigarette selling and roles in the informal economy associated with selling loosies among a sample of urban drug users. METHODS There were 801 participants, recruited by community outreach, assessed at baseline, who were enrolled in an HIV prevention intervention for drug users. RESULTS Most (89%) smoked cigarettes in the prior 30 days, of whom 92% smoked daily. Self-reported selling of cigarettes was common with 58% reporting that they had sold cigarettes within the last six months; 20.4% reported selling cigarettes a few times a week and 7.4% reported daily selling of cigarettes. In a stepwise regression model, four sources of income were associated with frequent cigarette selling: providing street security (OR=2.214, 95% CI 1.177-4.164), selling food stamps (OR=1.461, 95% CI 1.003-2.126), pawning items (OR=2.15, 95% CI 1.475-3.135), and selling drugs (OR=1.634, 95% CI 1.008-2.648). CONCLUSION There is a high rate of selling loosies among urban substance users. The wide availability of loosies may promote smoking. Smoking cessation programs with drug treatment and economic development programs may help to reduce economic pressures to sell loosies.
Collapse
|
|
22
|
McClure EA, Acquavita SP, Dunn KE, Stoller KB, Stitzer ML. Characterizing smoking, cessation services, and quit interest across outpatient substance abuse treatment modalities. J Subst Abuse Treat 2013; 46:194-201. [PMID: 23988192 DOI: 10.1016/j.jsat.2013.07.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/14/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
The majority of individuals seeking treatment for substance use disorders are cigarette smokers, yet smoking cessation is rarely addressed during treatment. Conducting a detailed smoking-related characterization of substance abuse treatment patients across treatment modalities may facilitate the development of tailored treatment strategies. This study administered a battery of self-report instruments to compare tobacco use, quit attempts, smoking knowledge and attitudes, program services, and interest in quitting among smoking patients enrolled in opioid replacement therapy (ORT) versus non-opioid replacement (non-ORT). ORT compared with non-ORT participants smoked more heavily, had greater tobacco dependence, and endorsed greater exposure to smoking cessation services at their treatment programs. Favorable attitudes towards cessation during treatment were found within both groups. These data identify several potential clinical targets, most notably including confidence in abstaining and attitudes toward cessation pharmacotherapies that may be addressed by substance abuse treatment clinics.
Collapse
Affiliation(s)
- Erin A McClure
- Medical University of South Carolina School of Medicine, Charleston, SC 29407, USA.
| | | | | | | | | |
Collapse
|
|
23
|
Eby LTDT, Laschober TC. Perceived implementation of the Office of Alcoholism and Substance Abuse Services (OASAS) tobacco-free regulation in NY State and clinical practice behaviors to support tobacco cessation: a repeated cross-sectional study. J Subst Abuse Treat 2013; 45:83-90. [PMID: 23375360 DOI: 10.1016/j.jsat.2013.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 12/22/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
This study measured substance use disorder clinicians' perceptions regarding the implementation extensiveness of the Office of Alcohol and Substance Abuse Services (OASAS) tobacco-free regulation, passed in New York State in July of 2008, at three time-points and across organizations with varying characteristics. Repeated cross-sectional data were collected from clinicians approximately 4months pre-regulation (time 0, n=362), 10-12months post-regulation (time 1, n=462), and 20-24months post-regulation (time 2, n=509). Clinician perceptions of implementation extensiveness (number of required policies in effect), use of tobacco cessation-related intake procedures, and use of guideline recommended counseling for treating tobacco dependence are significantly greater at time 1 and time 2 compared to time 0. Additionally, differences are found in perceived implementation extensiveness based on hospital-based status, profit status, and level of care offered, although the pattern of effects differed some over the three time-points under investigation.
Collapse
Affiliation(s)
- Lillian T de Tormes Eby
- Industrial-Organizational Psychology Program, 325 Psychology Building, Athens, GA 30602, USA.
| | | |
Collapse
|
|
24
|
Knudsen HK, Muilenburg J, Eby LT. Sustainment of smoking cessation programs in substance use disorder treatment organizations. Nicotine Tob Res 2012; 15:1060-8. [PMID: 23132659 DOI: 10.1093/ntr/nts242] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The majority of individuals who enter substance use disorder (SUD) treatment also use tobacco. Integrating smoking cessation services into SUD treatment may have substantial public health benefits, but few studies have examined whether organizations offering counseling-based smoking cessation programs sustain them over time. METHODS This study examines sustainment of smoking cessation programs using 2 waves of data collected from 150 SUD treatment organizations. Data were collected in 2006-2008 and 2009-2010 using face-to-face interviews, telephone interviews, and mailed surveys. Logistic regression models of sustainment were estimated with administrators' attitudes toward smoking cessation and organizational barriers as covariates. RESULTS About 60.2% of these SUD treatment organizations sustained their counseling-based smoking cessation programs at follow-up. Sustainment was significantly more likely when administrators' baseline attitudes about the impact of smoking cessation on recovery were more supportive (odds ratio, OR = 1.84; 95% confidence interval, CI = 1.13-3.01; p =.015) and when programs were accredited (OR = 3.95, 95% CI = 1.65-9.50, p =.002). Worsening over time of barriers encompassing staff interest, staff skills, and competing treatment demands were negatively associated with sustainment (OR = 0.58, 95% CI = 0.42-0.81, p =.001). CONCLUSIONS These findings provided empirical support for theoretical perspectives regarding the importance of leadership and staff expertise in promoting sustainment of innovations over time. Although the majority of SUD treatment organizations sustained their smoking cessation programs, the 40% rate of discontinuation is concerning and highlights the ongoing challenges faced by tobacco control efforts in substance abuse treatment.
Collapse
Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-0086, USA.
| | | | | |
Collapse
|
|
25
|
Guydish J, Tajima B, Kulaga A, Zavala R, Brown LS, Bostrom A, Ziedonis D, Chan M. The New York policy on smoking in addiction treatment: findings after 1 year. Am J Public Health 2012; 102:e17-25. [PMID: 22420814 DOI: 10.2105/ajph.2011.300590] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed changes in smoking prevalence and other measures associated with the July 2008 New York Office of Alcoholism and Substance Abuse Services tobacco policy, which required that all publicly funded addiction treatment programs implement smoke-free grounds, have "no evidence" of smoking among staff, and make tobacco dependence treatment available for all clients. METHODS In a random sample of 10 programs, staff and clients were surveyed before the policy and 1 year later. Measures included tobacco-related knowledge, attitudes, and practices used by counselors and received by clients. RESULTS Client smoking decreased from 69.4% to 62.8% (P = .044). However, response to the policy differed by program type. Outpatient programs showed no significant changes on any of the staff and client survey measures. In methadone programs, staff use of tobacco-related practices increased (P < .01), client attitudes toward tobacco treatment grew more positive (P < .05), and clients received more tobacco-related services (P < .05). Residential clients were more likely to report having quit smoking after policy implementation (odds ratio = 4.7; 95% confidence interval = 1.53, 14.19), but they reported less favorable attitudes toward tobacco treatment (P < .001) and received fewer tobacco-related services from their program (P < .001) or their counselor (P < .001). CONCLUSIONS If supported by additional research, the New York policy may offer a model that addiction treatment systems can use to address smoking in a population where it has been prevalent and intractable. Additional intervention or policy supports may be needed in residential programs, which face greater challenges to implementing tobacco-free grounds.
Collapse
Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | | | | | | | | | | | | | | |
Collapse
|
|
26
|
Wiltsey Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci 2012; 7:17. [PMID: 22417162 PMCID: PMC3317864 DOI: 10.1186/1748-5908-7-17] [Citation(s) in RCA: 727] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 03/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. METHODS Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. RESULTS Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. CONCLUSIONS Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.
Collapse
Affiliation(s)
- Shannon Wiltsey Stirman
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - John Kimberly
- Department of Healthcare Management, The Wharton School of the University of Pennsylvania, Philadelphia, PA, USA
| | - Natasha Cook
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Amber Calloway
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Frank Castro
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Martin Charns
- VA Boston Healthcare System, Boston, MA, USA
- VA Center for Organization, Leadership, and Management Research, Boston, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|