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Bada F, Mansfield ME, Okui L, Montebatsi M, DiClemente C, Tapera R, Ikgopoleng K, Mokonopi S, Magidson JF, Onukwugha E, Ndwapi N, Himelhoch S, Mbongwe B, Charurat M. Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial. Implement Sci Commun 2024; 5:53. [PMID: 38720363 PMCID: PMC11077839 DOI: 10.1186/s43058-024-00588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. METHODS BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. DISCUSSION BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. CLINICAL TRIAL REGISTRATION NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.
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Affiliation(s)
- Florence Bada
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Megan E Mansfield
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Milton Montebatsi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Carlo DiClemente
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Roy Tapera
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Kaizer Ikgopoleng
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Selebaleng Mokonopi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Jessica F Magidson
- Department of Psychology and the Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, Maryland, USA
| | - Eberechukwu Onukwugha
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Ndwapi Ndwapi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Seth Himelhoch
- Department of Psychiatry, University of Kentucky School of Medicine, Lexington, KY, USA
| | - Bontle Mbongwe
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Man Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Kollath-Cattano C, Thrasher JF, Salloum RG, Albano AW, Jindal M, Durkin M, Strayer SM. Evaluation of a smoking cessation patient decision aid that integrates information about e-cigarettes. Nicotine Tob Res 2021; 23:1880-1888. [PMID: 33984145 DOI: 10.1093/ntr/ntab095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/10/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smokers increasingly use e-cigarettes to try to quit smoking, even more than recommended cessation methods. However, few smokers discuss the range of cessation options with their physicians. Decision aids can inform smokers about smoking cessation options, including evidence about e-cigarettes, and encourage smokers to engage in shared decision making with their physician. This study aimed to evaluate a smoking cessation decision aid that included e-cigarette risks and benefits. METHODS Adult smokers were recruited from primary care clinics for two research phases: 1. usability and acceptability testing of the decision aid (n=37); and 2. pre/post study that compared usual care (n=90) with implementation of the decision aid in clinics (n=90). For the latter, outcome measures included frequency of clinical discussions of readiness to quit, methods to quit in general, and of specific cessation methods, in addition to decisional conflict, communication satisfaction, and overall patient satisfaction. RESULTS Smokers indicated high usability and acceptability of the decision aid. In the pre/post evaluation, decision aid implementation was associated with higher rates of smokers: being asked if they were ready to quit smoking (89% vs. 67%, respectively; p<0.001); discussing methods for smoking cessation in general (81% vs. 48%; p<0.001); and discussing specific cessation methods (NRT 55% vs. 26%, p<0.001; prescription medications 26% vs. 12%, p=0.022). Decision aid use was also associated with higher overall patient satisfaction with the physician visit. CONCLUSIONS Smoking cessation decision aids that incorporate information about e-cigarettes are acceptable among smokers and can lead to evidence-based clinical discussions about smoking cessation. IMPLICATIONS Smokers use e-cigarettes more than recommended cessation methods when they are trying to quit smoking, yet few physicians discuss the risks and benefits of e-cigarettes with their patients who smoke. This study presents preliminary findings about the feasibility and usability of a clinically based iPad-delivered smoking cessation decision aid that integrates information about e-cigarettes. Although promising, further research with randomized designs, larger samples, and longer-term follow-up is needed to determine whether this type of intervention can effectively promote cessation of all tobacco products and, for those not ready to quit smoking, the use of e-cigarettes for harm reduction.
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Affiliation(s)
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | | | - Meenu Jindal
- Department of Internal Medicine, Prisma Health, Greenville
| | - Martin Durkin
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia
| | - Scott M Strayer
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond
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Greenberg MR, Greco NM, Batchelor TJ, Miller AH, Doherty T, Aziz AS, Yee SZ, Arif F, Crowley LM, Casey EW, Kruklitis RJ. Physician-directed smoking cessation using patient "opt-out" approach in the emergency department: A pilot program. J Am Coll Emerg Physicians Open 2020; 1:782-789. [PMID: 33145519 PMCID: PMC7593453 DOI: 10.1002/emp2.12176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Using a physician-directed, patient "opt-out" approach to prescriptive smoking cessation in the emergency department (ED) setting, we set out to describe patient actions as they related to smoking cessation behaviors. METHODS A convenience sample of smokers at 2 Pennsylvania hospital EDs who met inclusion/exclusion criteria were approached to participate in a brief intervention known as screening, treatment initiation, and referral (STIR) counseling that included phone follow-up. Demographic information, current smoking status, and specific physician prescription and follow-up recommendations were collected. Approximately 3 months later, patients were contacted to determine current smoking status and actions taken since their ED visit. RESULTS One hundred six patients were approached and 7 (6.6%) opted out of the intervention. Patients who did not opt out were evaluated for appropriate use of smoking cessation-related medications; 35 (35.4%) opted out of the prescription(s) and 6 (6.1%) were not indicated. Twenty-one (21.2%) patients opted out of ambulatory referral follow-ups with primary care and/or tobacco treatment program; one (1.0%) was not indicated for referral. Nineteen (32.8%) patients who received prescription(s) for smoking cessation-related medications initially also followed the prescription(s). Seventeen (22.1%) patients participated in referral follow-up. CONCLUSION In this small ED pilot, using the STIR concepts in an opt-out method, few smokers opted out of the smoking cessation intervention. About one-third of the patients declined prescriptions for smoking cessation-related medications and less than one-quarter declined ambulatory referrals for follow-up. These findings support a willingness of patients to participate in STIR and the benefits of intervention in this setting.
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Affiliation(s)
- Marna Rayl Greenberg
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Natalie M. Greco
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Timothy J. Batchelor
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Andrew H.F. Miller
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Theodore Doherty
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Ali S. Aziz
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Stephanie Z. Yee
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Faiza Arif
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | - Lauren M. Crowley
- Department of Emergency and Hospital MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
| | | | - Robert J. Kruklitis
- Department of MedicineLehigh Valley Hospital and Health Network/University of South Florida Morsani College of MedicineLehigh Valley CampusAllentownPennsylvaniaUSA
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Holla N, Brantley E, Ku L. Physicians' Recommendations to Medicaid Patients About Tobacco Cessation. Am J Prev Med 2018; 55:762-769. [PMID: 30344039 DOI: 10.1016/j.amepre.2018.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/31/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Smoking is highly prevalent among low-income Medicaid beneficiaries and tobacco-cessation benefits are generally available. Nonetheless, use of cessation medications or counseling remains low, and many clinicians are hesitant to urge smokers to quit. This study examines the extent to which physicians provide advice to Medicaid patients about quitting. METHODS Data from the 2014-2015 Nationwide Adult Medicaid Consumer Assessment of Health Plans survey were merged with state Medicaid policy variables and analyzed in 2017-2018. Multivariate regression models examined factors associated with smoking status, physician advice to quit smoking, and discussion of cessation medications or other strategies, as well as patients' ratings of their personal physicians. RESULTS Almost one third (29%) of adult Medicaid beneficiaries smoke. Almost four fifths of smokers with a personal doctor (77%) say their doctor at least sometimes advised quitting and almost half of smokers discussed cessation medications (48%), or another strategy, such as counseling (42%). Smokers' ratings of satisfaction with their physicians and their health plans rose as the frequency of smoking recommendations increased. Those in Medicaid managed care plans smoked more, but received less advice about cessation medications than those in fee-for-service care. CONCLUSIONS Clinicians and Medicaid managed care plans can improve their efforts to motivate Medicaid patients to try to quit smoking. These findings indicate that patients value prevention-oriented advice and give better ratings to physicians and health plans that offer more support and advice about cessation.
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Affiliation(s)
- Nikhil Holla
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Erin Brantley
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Leighton Ku
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
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Winpenny E, Elliott MN, Haas A, Haviland AM, Orr N, Shadel WG, Ma S, Friedberg MW, Cleary PD. Advice to Quit Smoking and Ratings of Health Care among Medicare Beneficiaries Aged 65. Health Serv Res 2017; 52:207-219. [PMID: 27061081 PMCID: PMC5264017 DOI: 10.1111/1475-6773.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To examine the relationship between physician advice to quit smoking and patient care experiences. DATA SOURCE The 2012 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. STUDY DESIGN Fixed-effects linear regression models were used to analyze cross-sectional survey data, which included a nationally representative sample of 26,432 smokers aged 65+. PRINCIPAL FINDINGS Eleven of 12 patient experience measures were significantly more positive among smokers who were always advised to quit smoking than those advised to quit less frequently. There was an attenuated but still significant and positive association of advice to quit smoking with both physician rating and physician communication, after controlling for other measures of care experiences. CONCLUSIONS Physician-provided cessation advice was associated with more positive patient assessments of their physicians.
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Affiliation(s)
- Eleanor Winpenny
- MRC Epidemiology Unit and the Centre for Diet and Activity Research (CEDAR)Cambridge UniversityCambridgeUK
| | | | - Ann Haas
- RAND HealthRAND CorporationPittsburghPA
| | - Amelia M. Haviland
- RAND HealthRAND CorporationPittsburghPA
- Statistics, Heinz School of Public Policy and ManagementCarnegie Mellon UniversityPittsburghPA
| | | | | | - Sai Ma
- Center for Medicare & Medicaid InnovationCenters for Medicare & Medicaid ServicesBaltimoreMD
| | | | - Paul D. Cleary
- School of Public HealthYale School of Public HealthNew HavenCT
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Pelletier JH, Strout TD, Baumann MR. A systematic review of smoking cessation interventions in the emergency setting. Am J Emerg Med 2014; 32:713-24. [DOI: 10.1016/j.ajem.2014.03.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/17/2022] Open
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Choi NG, DiNitto DM. Role of New Diagnosis, Social Isolation, and Depression in Older Adults’ Smoking Cessation. THE GERONTOLOGIST 2014; 55:793-801. [DOI: 10.1093/geront/gnu049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/14/2014] [Indexed: 11/13/2022] Open
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Choo EK, Sullivan AF, LoVecchio F, Perret JN, Camargo CA, Boudreaux ED. Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers. Addict Sci Clin Pract 2012; 7:4. [PMID: 22966410 PMCID: PMC3414814 DOI: 10.1186/1940-0640-7-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 03/15/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling. METHODS ED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling. RESULTS Three hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r=0.09), gender (average Likert score=2.75 for men, 2.42 for women), education (average Likert score=2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r=0.10) were significant at the p<0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling. CONCLUSIONS In this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options.
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Affiliation(s)
- Esther K Choo
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 55 Claverick Street, 2nd Floor, Providence, RI 02903, USA
| | - Ashley F Sullivan
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA
| | - Frank LoVecchio
- Department of Emergency Medicine, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85006, USA
| | - John N Perret
- Department of Emergency Medicine, LSU Health Sciences Center/Earl K. Long Medical Center, 5825 Airline Highway, Baton Rouge, LA 70805, USA
| | - Carlos A Camargo
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA
| | - Edwin D Boudreaux
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA
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Rega PP, Roberts SM, Khuder S, Boardley D, Brickman K, Regent C. The delivery of a health promotion intervention by a public health promotion specialist improves patient satisfaction in the emergency department. Acad Emerg Med 2012; 19:313-7. [PMID: 22435864 DOI: 10.1111/j.1553-2712.2012.01293.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objective was to introduce a public health promotion specialist (PHPS) into the hospital emergency department (ED) to provide a brief health promotion intervention to patients and to determine the effect of the initiative on patient satisfaction. METHODS Patients in the intervention group were offered and received a 5- to 10-minute presentation about exercise, heart health, healthy eating on a budget, or weight control by a trained PHPS. Patients in the control group received usual ED care. Both groups completed the patient satisfaction instrument. Ordinal logistic regression models were used to compare the two groups on patient satisfaction questions and to identify predictors of the likelihood of patients referring others to the ED. RESULTS Subjects in the intervention group were more likely to rate the services as great in areas of patient satisfaction such as provider listening, staff being friendly and helpful, comfort and safety, and privacy. Those in the intervention group were three times more likely than those in the control group to state that they would refer others to the ED. CONCLUSIONS Health promotion and disease prevention interventions carried out by PHPS in the ED can improve patient satisfaction.
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Affiliation(s)
- Paul P Rega
- Department of Public Health and Preventive Medicine, University of Toledo, OH, USA
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Anders ME, Sheffer CE, Barone CP, Holmes TM, Simpson DD, Duncan AM. Emergency department-initiated tobacco dependence treatment. Am J Health Behav 2011; 35:546-56. [PMID: 22040616 PMCID: PMC3716374 DOI: 10.5993/ajhb.35.5.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. METHODS The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. RESULTS Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment. CONCLUSIONS An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients.
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Affiliation(s)
- Michael E Anders
- Department of Respiratory and Surgical Technology, College of Health Related Professions, University of Arkansas for Medical Sciences, Little Rock, USA.
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McCabe CT, Woodruff SI, Zúñiga ML. Sociodemographic and substance use correlates of tobacco use in a large, multi-ethnic sample of emergency department patients. Addict Behav 2011; 36:899-905. [PMID: 21561718 DOI: 10.1016/j.addbeh.2011.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 02/09/2011] [Accepted: 04/13/2011] [Indexed: 11/24/2022]
Abstract
Strong evidence suggests marked disparities among ethnic minorities in relation to tobacco use. To date, a majority of the data available discusses tobacco use in the general population. Using a sample of Latino, non-Latino Black (NLB), and non-Latino White (NLW) patients presenting to the emergency departments, the present study examined sociodemographic and substance use correlates of past 3-month tobacco use. Over 48,000 patients were interviewed as part of a screening and brief intervention program in southern California. Overall, although NLB adults reported the greatest prevalence of tobacco use compared to NLWs and Latinos (43% vs. 34% and 22% respectively), associations between tobacco use, demographics and substance use were similar across groups. Males, younger individuals, those with lower income, and being at higher risk for alcohol and drug use were more likely to report recent tobacco use. Future tobacco interventions in emergency settings should highlight these specific risk factors for Latinos, NLBs, and NLWs.
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Affiliation(s)
- Cameron T McCabe
- Center for Alcohol and Drug Studies, San Diego, CA 92120, United States.
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Woodruff SI, Zúñiga ML, Lawrenz J. Ethnoracial differences in emergency department patients' tobacco use. Nicotine Tob Res 2011; 13:1037-44. [PMID: 21742651 DOI: 10.1093/ntr/ntr128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This study examined ethnoracial differences in lifetime and recent tobacco use and related problems in a large convenience sample of Latino, Black, and Non-Latino White emergency department (ED) patients. In addition, ED patients' use rates were compared with those of a statewide sample. METHODS Trained bilingual/bicultural health educators screened almost 53,000 ED patients in 8 ED/trauma units throughout San Diego County over a 2-year period. Measures included sociodemographic characteristics and tobacco use measures from the Alcohol, Smoking, and Substance Involvement Screening Test brief screening instrument. RESULTS A consistent finding was the lower prevalence of tobacco use among Latino patients compared with Black and Non-Latino White patients. Compared with their general population counterparts, Non-Latino White, Latino, and Black patients were more likely to have used tobacco in their lifetime and on a daily basis. CONCLUSIONS Results indicate the high tobacco risk status of ED patients, regardless of ethnicity. More work is needed to develop effective approaches for ED-initiated tobacco interventions for patients in various racial/ethnic groups. Offering tobacco cessation support in opportune venues such as the ED holds great potential to improve accessibility to public health interventions for many underserved communities who may not have regular interaction with a primary care provider.
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Affiliation(s)
- Susan I Woodruff
- Center for Alcohol and Drug Studies, School of Social Work, San Diego State University, 6386 Alvarado Ct. Suite 224, San Diego, CA 92120, USA.
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Daube M, Jelinek GA. Smoking out tobacco: A vital preventive role for emergency departments. Emerg Med Australas 2010; 22:260-2. [DOI: 10.1111/j.1742-6723.2010.01318.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tong EK, Strouse R, Hall J, Kovac M, Schroeder SA. National survey of U.S. health professionals' smoking prevalence, cessation practices, and beliefs. Nicotine Tob Res 2010; 12:724-33. [PMID: 20507899 DOI: 10.1093/ntr/ntq071] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco dependence treatment efforts have focused on primary care physicians (PCPs), but evidence suggests that they are insufficient to help most smokers quit. Other health professionals also frequently encounter smokers, but their smoking prevalence, cessation practices, and beliefs are less well known. METHODS The study included 2,804 subjects from seven health professional groups: PCPs, emergency medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists, and pharmacists. Outcomes included self-reported smoking status, smoking cessation practices, and beliefs. Multivariate regression was used to examine factors associated with health professionals (except pharmacists) self-reportedly performing the "5 A's": asking, advising, assessing, assisting, or arranging follow-up about tobacco. RESULTS Health professionals have a low smoking prevalence (<6%), except nurses (13%). Many health professionals report asking (87.3%-99.5%) and advising (65.6%-94.9%) about smoking but much less assessing smokers' interest (38.7%-84.8%), assisting (16.4%-63.7%), and arranging follow-up (1.3%-23.1%). Controlling for health professional and practice demographics, factors positively associated in the multivariate analyses with self-reportedly performing multiple components of the 5 A's include awareness of the Public Health Service guidelines, having had cessation training, and believing that treatment was an important professional responsibility. Negative associations include the health professional being a current smoker, not being a PCP, being uncomfortable asking patients if they smoke, believing counseling was not an appropriate service, and reporting competing priorities. CONCLUSION U.S. health professionals report not fully performing the 5 A's. The common barriers and facilitators identified may help inform strategies for increasing the involvement of all health professionals in conducting tobacco dependence treatments.
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Affiliation(s)
- Elisa K Tong
- Division of General Internal Medicine, University of California, Davis Medical Center, 4150 V Street, Suite 2400, Sacramento, CA 95817, USA.
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