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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]
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Skelton E, Tzelepis F, Shakeshaft A, Guillaumier A, Dunlop A, McCrabb S, Palazzi K, Bonevski B. Addressing tobacco in Australian alcohol and other drug treatment settings: a cross-sectional survey of staff attitudes and perceived barriers. Subst Abuse Treat Prev Policy 2017; 12:20. [PMID: 28464898 PMCID: PMC5414160 DOI: 10.1186/s13011-017-0106-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within alcohol and other drug (AOD) services, staff attitudes and beliefs are important influences determining provision of smoking cessation care. This study of AOD staff aimed to examine: a) current attitudes toward smoking cessation care; b) service and staff characteristics associated with unsupportive smoking cessation care attitudes, and c) perceived barriers to providing smoking cessation care. METHODS Between July-October 2014, 506 staff from 31 Australian AOD services completed an online cross-sectional survey which assessed agreement with 6 attitudinal statements (supportive and unsupportive) and 10 perceived barriers to smoking cessation care in the AOD setting. Logistic regressions examined service (sector) and staff (age, gender, smoking status and number of years in AOD field) characteristics associated with unsupportive smoking cessation care attitudes. RESULTS A large proportion agreed with supportive statements: Smoking cessation care should be part of usual care (87%), smoking cessation care is as important as counselling about other drugs (72%) and staff have the organisational support to provide smoking cessation care (58%). Some respondents agreed with unsupportive statements: AOD clients are not interested in addressing their smoking (40%), increasing smoking restrictions would lead to client aggression (23%), smoking is a personal choice and it is not the service's role to interfere (16%). Respondents from non-government managed services, current tobacco smokers (compared to ex-smokers) and those with less AOD experience had higher odds of agreeing with unsupportive smoking cessation care statements. The most frequently identified barriers to providing smoking cessation care were: client inability to afford cessation medicines, insufficient funding and lack of a coordinated treatment approach (all 61%). CONCLUSIONS Overall, staff hold largely supportive smoking cessation care attitudes but perceive a large number of barriers to providing smoking cessation care.
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Affiliation(s)
- Eliza Skelton
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Flora Tzelepis
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
- Hunter New England Local Health District, Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute (HMRI), 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Anthony Shakeshaft
- The University of New South Wales, National Drug and Alcohol Research Centre, 22-32 King Street, Randwick, NSW 2031 Australia
| | - Ashleigh Guillaumier
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Adrian Dunlop
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
- Hunter New England Local Health District, Newcastle Community Health Centre, 670 Hunter Street, Newcastle West, NSW 2302 Australia
| | - Sam McCrabb
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute (HMRI), 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Billie Bonevski
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308 Australia
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Spencer L, Pagell F, Hallion ME, Adams TB. Applying the Transtheoretical Model to Tobacco Cessation and Prevention: A Review of Literature. Am J Health Promot 2016; 17:7-71. [PMID: 12271754 DOI: 10.4278/0890-1171-17.1.7] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To comprehensively review all published, peer-reviewed research on the Transtheoretical Model (TTM) and tobacco cessation and prevention by exploring the validity of its constructs, the evidence for use of interventions based on the TTM, the description of populations using TTM constructs, and the identification of areas for further research. The three research questions answered were: “How is the validity of the TTM as applied to tobacco supported by research?” “How does the TTM describe special populations regarding tobacco use?” “What is the nature of evidence supporting the use of stage-matched tobacco interventions?” Data Source. Computer Database search (PsychInfo, Medline, Current Contents, ERIC, CINAHL-Allied Health, and Pro-Quest Nursing) and manual journal search. Inclusion/Exclusion Criteria. All English, original, research articles on the TTM as it relates to tobacco use published in peer-reviewed journals prior to March 1, 2001, were included. Commentaries, editorials, and books were not included. Data Extraction and Synthesis. Articles were categorized as TTM construct validation, population descriptions using TTM constructs, or intervention evaluation using TTM constructs. Summary tables including study design, research rating, purpose, methods, findings, and implications were created. Articles were further divided into groups according to their purpose. Considering both the findings and research quality of each, the three research questions were addressed. Results. The 148 articles reviewed included 54 validation studies, 73 population studies, and 37 interventions (some articles fit two categories). Overall, the evidence in support of the TTM as applied to tobacco use was strong, with supportive studies being more numerous and of a better design than nonsupportive studies. Using established criteria, we rated the construct validity of the entire body of literature as good; however, notable concerns exist about the staging construct. A majority of stage-matched intervention studies provided positive results and were of a better quality than those not supportive of stage-matched interventions; thus, we rated the body of literature using stage-matched tobacco interventions as acceptable and the body of literature using non–stage-matched interventions as suggestive. Population studies indicated that TTM constructs are applicable to a wide variety of general and special populations both in and outside of the United States, although a few exceptions exist. Conclusions. Evidence for the validity of the TTM as it applies to tobacco use is strong and growing; however, it is not conclusive. Eight different staging mechanisms were identified, raising the question of which are most valid and reliable. Interventions tailored to a smoker's stage were successful more often than nontailored interventions in promoting forward stage movement. Stage distribution is well-documented for U.S. populations; however, more research is needed for non-U.S. populations, for special populations, and on other TTM constructs.
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Affiliation(s)
- Leslie Spencer
- Department of Health and Exercise Science, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA.
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Guydish J, Tajima B, Chan M, Delucchi KL, Ziedonis D. Measuring smoking knowledge, attitudes and services (S-KAS) among clients in addiction treatment. Drug Alcohol Depend 2011; 114:237-41. [PMID: 21055884 PMCID: PMC3062722 DOI: 10.1016/j.drugalcdep.2010.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Addiction treatment programs are increasingly working to address prevalent and comorbid tobacco dependence in their service populations. However at present there are few published measurement tools, with known psychometric properties, that can be used to assess client-level constructs related to tobacco dependence in addiction treatment settings. Following on previous work that developed a staff-level survey instrument, this report describes the development and measurement characteristics of the smoking knowledge, attitudes and services (S-KAS) for use with clients in addiction treatment settings. METHOD 250 clients enrolled in residential drug abuse treatment programs were surveyed. Summary statistics were used to characterize both the participants and their responses, and exploratory factor analysis (EFA) was used to examine the underlying factor structure. RESULTS Examination of the rotated factor pattern indicated that the latent structure was formed by one knowledge factor, one attitude factor, and two "service" factors reflecting program services and clinician services related to tobacco dependence. Standardized Cronbach's alpha coefficients for the four scales were, respectively, .57, .75, .82 and .82. CONCLUSIONS The proposed scales have reasonably good psychometric characteristics, although the knowledge scale leaves room for improvement, and will allow researchers to quantify client knowledge, attitudes and services regarding tobacco dependence treatment. Researchers, program administrators, and clinicians may find the S-KAS useful in changing organizational culture and clinical practices related to tobacco addiction, help in program evaluation studies, and in tracking and improving client motivation.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA.
| | - Barbara Tajima
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco USA
| | - Mable Chan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco USA
| | - Kevin L. Delucchi
- Department of Psychiatry, University of California, San Francisco USA
| | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School & UMass Memorial Medical Center, 55 Lake Avenue North, Worchester, Massachusettes 01655 USA
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Friend KB, Levy DT. Adoption of Tobacco Treatment Interventions by Substance-abuse-treatment Clinicians. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000105038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Friend KB, Colby S. Healthcare providers’ use of brief clinical interventions for adolescent smokers. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630600650639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Baca CT, Yahne CE. Smoking cessation during substance abuse treatment: What you need to know. J Subst Abuse Treat 2009; 36:205-19. [DOI: 10.1016/j.jsat.2008.06.003] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
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Bledsoe LK, Birkimer JC. Smoking cessation: two pilot studies exploring the use of continuous response format algorithm to identify subgroups within stage. Subst Use Misuse 2004; 39:527-50. [PMID: 15115212 DOI: 10.1081/ja-120030056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Stage of change is typically assessed with a series of yes or no questions, a categorical response format staging algorithm. We revised that algorithm by using, instead, the same questions with 7-point agreement scales covering the first three stages with a sample of smokers. Participants were 141 persons enrolled in introductory psychology classes at the University of Louisville during the fall and spring semesters of 1994. Our continuous response format scores showed expected correlations with modified decisional balance scale scores. In addition, the continuous response format algorithm identified substantial differences in intention to quit sometime and in the next 30 days among participants classified as precontemplators by the categorical system. Analyses from an additional small sample (N = 56) demonstrated relationships between the continuous response format scores and Processes of Change as well as Decisional Balance Scale scores within categorical stages. Subgroups of smokers within stages differ on their attitudes toward changing and on the change strategies they are using. These subgroups can be identified with the continuous response format algorithm.
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Affiliation(s)
- Linda K Bledsoe
- Kent School of Social Work, University of Louisville, Louisville, Kentucky 40292, USA.
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Marques ACPR, Campana A, Gigliotti ADP, Lourenço MTC, Ferreira MP, Laranjeira R. Consenso sobre o tratamento da dependência de nicotina. BRAZILIAN JOURNAL OF PSYCHIATRY 2001. [DOI: 10.1590/s1516-44462001000400007] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Têm sido atribuídas à dependência de nicotina 20% das mortes nos EUA. Estudos têm mostrado que 30% a 50% das pessoas que começam a fumar escalam para um uso problemático. Nos últimos 20 anos, a educação e a persuasão não foram suficientes para promover uma mudança política, cultural e social relacionada ao comportamento de fumar. As intervenções para interromper o uso de tabaco ainda não estão integradas às rotinas dos serviços de saúde no mundo. A falta de estratégias de integração, de tempo disponível para acoplar ações assistenciais mais específicas e mesmo a percepção dos profissionais de saúde de que os tratamentos para a dependência de nicotina são pouco efetivos são algumas das barreiras apontadas. Assim, elaborar um consenso sobre a dependência de nicotina teve como objetivos: • levantar dados epidemiológicos relevantes relacionados ao uso do tabaco no mundo e no Brasil; • revisar as ações gerais e centrais da nicotina; • elaborar um protocolo de triagem mínimo para serviços de atenção primária à saúde; • recomendar diretrizes básicas de avaliação, diagnóstico e tratamento para todos os níveis de atenção à saúde em relação à dependência de nicotina; • fornecer sugestões para a abordagem de grupos especiais de pacientes: adolescentes, gestantes, idosos, pacientes em regime de internação, obesos e pacientes com comorbidades psiquiátricas, cardiovasculares e respiratórias.
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McCorry F, Garnick DW, Bartlett J, Cotter F, Chalk M. Developing performance measures for alcohol and other drug services in managed care plans. Washington Circle Group. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 2000; 26:633-43. [PMID: 11098426 DOI: 10.1016/s1070-3241(00)26054-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Monitoring the quality and availability of alcohol and other drug (AOD) services must be a central tenet of any health-related performance measurement system. The Washington Circle Group (WCG), which was convened by the Center for Substance Abuse Treatment Office of Managed Care in March 1998, has developed a core set of performance measures for AOD services for public- and private-sector health plans. It is also collaborating with a broad range of stakeholders to ensure widespread adoption of these performance measures by health plans, private employers, public payers, and accrediting organizations. CORE PERFORMANCE MEASURES Four domains were identified, with specific measures developed for each domain: (1) prevention/education, (2) recognition, (3) treatment (including initiation of alcohol and other plan services, linkage of detoxification and AOD plan services, treatment engagement, and interventions for family members/significant others), and (4) maintenance of treatment effects. CONTINUING EFFORTS Four measures that are based on administrative information from health plans and two measures that require a consumer survey of behavioral health care are undergoing extensive pilot testing. The WCG has reached out to a broad range of stakeholders in performance measurement and managed care to acquaint them with the measures and to promote their investigation and adoption. As results of pilot testing become available, these outreach efforts will continue. CONCLUSIONS Performance measures for AOD services need to become an integral part of a comprehensive set of behavioral and physical health performance measures for managed care plans.
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Affiliation(s)
- F McCorry
- Clinical Services Unit, New York State Office of Alcoholism and Substance Abuse, Albany, New York, USA
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