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Feliu A, Ravara S, Papadakis S, Enriquez M, Antón L, Saura J, Company A, Romero O, Ripoll R, Ruz A, Precioso J, Pascoal I, Videira L, Correia C, Ferreira S, Fernández E, Martínez C. Factors associated with changes in inpatients' smoking pattern during hospitalization and one month after discharge: A cohort study. J Nurs Scholarsh 2021; 54:332-344. [PMID: 34755457 DOI: 10.1111/jnu.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. OBJECTIVES The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. METHODS A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25-item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi-square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. RESULTS Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical-surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). CONCLUSIONS Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence-based tobacco cessation programs at the organizational-level, including post-discharge active quitting smoking support. CLINICAL RELEVANCE Three-quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Sofia Ravara
- CICS-UBI, Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,CISP-ENSP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro Hospitalar Universitário da Cova da Beira, EPE, Covilhã, Portugal
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Marta Enriquez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Antón
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.,Catalan Network for Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Saura
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Assumpta Company
- E-oncologia, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Romero
- E-oncologia, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ruth Ripoll
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Angels Ruz
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Precioso
- Centro de Investigação em Estudos da Criança, Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Ivone Pascoal
- Serviço de Pneumologia. Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Lídia Videira
- Centro Hospitalar Universitário da Cova da Beira, EPE, Covilhã, Portugal
| | - Claudia Correia
- Centro de Investigação em Estudos da Criança, Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Soraia Ferreira
- CISP-ENSP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Abstract
The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.
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Affiliation(s)
- Chad D Morris
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA.
| | - Christine E Garver-Apgar
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA
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3
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Muller AE, Skurtveit S, Clausen T. Performance of the WHOQOL-BREF among Norwegian substance use disorder patients. BMC Med Res Methodol 2019; 19:44. [PMID: 30832564 PMCID: PMC6399843 DOI: 10.1186/s12874-019-0690-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is an established outcome measure of substance use disorder treatment. The WHOQOL-BREF is the gold standard tool, but its appropriateness for particularly vulnerable patient populations must be further explored. This article examines the scaling qualities of the WHOQOL-BREF in a Norwegian substance use disorder population, and explores relationships with social and health variables. METHODS 107 participants in a larger national treatment study provided data during structured interviews. Item responses, responsiveness, and domain scaling qualities are reported. General linear models identified correlates of impaired QoL. RESULTS Three out of four domains exhibited acceptable scaling qualities, while the social relationships domain had low internal validity. 59% of the variance in physical health QoL was explained in our model by the negative main or interaction effects of depression, unemployment, social isolation, smoking, residential treatment, and weight dissatisfaction. 52% of the variance in psychological health QoL was explained by depression and being single. Depression also had significant main effects in social relationships QoL (R2 = .27) and environment QoL (R2 = .39), and social isolation and exercise had further interaction effects in environment QoL. CONCLUSIONS After one year in treatment, the impact of low social contact in reducing QoL, rather than specific substance use patterns, was striking. The social relationships domain is the shortest in the WHOQOL-BREF, yet social variables were important in other areas of QoL. Social support could benefit from more attention in treatment, as a lack of social support seems to be a strong risk factor for poor QoL in various domains. The WHOQOL-BREF exhibits otherwise satisfactory measurement characteristics and is an appropriate tool among this population.
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Affiliation(s)
- Ashley Elizabeth Muller
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0315 Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Pb 4044 Nydalen, 0403 Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0315 Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Heath, Pb 4044 Nydalen, 0403 Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0315 Oslo, Norway
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Hunter SB, Ober AJ, McCullough CM, Storholm ED, Iyiewuare PO, Pham C, Watkins KE. Sustaining alcohol and opioid use disorder treatment in primary care: a mixed methods study. Implement Sci 2018; 13:83. [PMID: 29914524 PMCID: PMC6006923 DOI: 10.1186/s13012-018-0777-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Efforts to integrate substance use disorder treatment into primary care settings are growing. Little is known about how well primary care settings can sustain treatment delivery to address substance use following the end of implementation support. METHODS Data from two clinics operated by one multi-site federally qualified health center (FQHC) in the US, including administrative data, staff surveys, interviews, and focus groups, were used to gather information about changes in organizational capacity related to alcohol and opioid use disorder (AOUD) treatment delivery during and after a multi-year implementation intervention was executed. Treatment practices from the intervention period were compared to practices after the intervention period to examine whether the practices were sustained. Data from staff surveys and interviews were used to examine the factors related to sustainment. RESULTS The two clinics sustained multiple components of AOUD care 1 year following the end of implementation support, including care coordination, psychotherapy, and medication-assisted treatment. Some of the practices were modified over time, for example, screening became less frequent by design, while use of care coordination and psychotherapy for AOUDs expanded. Participants identified staff training and funding for medications as key challenges to sustaining treatment. CONCLUSIONS Following a multi-year implementation intervention, a large FQHC continued to deliver AOUD treatment. Access to external funding and staff support appeared to be critical elements for sustaining care over time. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01810159.
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Affiliation(s)
- Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Erik D Storholm
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Chau Pham
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
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Weinberger AH, Gbedemah M, Wall MM, Hasin DS, Zvolensky MJ, Goodwin RD. Cigarette use is increasing among people with illicit substance use disorders in the United States, 2002-14: emerging disparities in vulnerable populations. Addiction 2018; 113:719-728. [PMID: 29265574 PMCID: PMC6369915 DOI: 10.1111/add.14082] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/07/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS While cigarette smoking has declined over time, it is not known whether this decline has occurred similarly among individuals with substance use disorders (SUDs) in the United States (US). The current study estimated trends in smoking from 2002 to 2014 among US individuals with and without SUDs. DESIGN Linear time trends of current smoking prevalence were assessed using logistic regression models. SETTING United States; data were drawn from the 2002 to 2014 National Household Survey on Drug Use (NSDUH), an annual US cross-sectional study. PARTICIPANTS A representative, population-based sample of US individuals age 12 yeas and older (total analytical population: n = 723 283). MEASUREMENTS Past-month current smoking was defined as having smoked at least 100 lifetime cigarettes and reporting smoking part or all of at least one cigarette during the past 30 days. Respondents were classified as having any SUD if they met criteria for abuse or dependence for one or more of the following illicit drugs: cannabis, hallucinogens, inhalants, tranquilizers, cocaine, heroin, pain relievers, simulants and sedatives. A second SUD variable included all drugs listed above excluding cannabis use disorder (CUD). An additional variable included respondents who met criteria for cannabis abuse or dependence. FINDINGS Among those with any SUD, the prevalence of smoking did not change from 2002 to 2014 (P = 0.08). However, when CUDs were separated from other SUDs, a significant increase in prevalence of smoking was observed among those with SUDs excluding CUDs (P < 0.001), while smoking decreased among those with CUDs (P < 0.001). Smoking declined among those without SUDs (P < 0.001). In 2014, smoking remained significantly more common among those with any SUD (55.48%), SUDs excluding CUDs (63.34%) and CUDs (51.34%) compared with those without these respective disorders (18.16, 18.55 and 18.64%; P < 0.001). CONCLUSIONS The prevalence of cigarette smoking in the United States increased from 2002 to 2014 among people with substance use disorders (SUDs) excluding cannabis use disorders (CUDs) and declined among those with CUDs and without SUDs. In 2014, the prevalence of smoking was multifold higher among those with SUDs, including CUDs, compared with those without SUDs.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY USA,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY USA,New York State Psychiatric Institute, New York, NY USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX USA,Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA,Institute for Implementation Science in Population Health, The City University of New York, New York, NY USA
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6
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Gass JC, Morris DH, Winters J, VanderVeen JW, Chermack S. Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic. J Subst Abuse Treat 2018; 84:1-8. [PMID: 29195588 DOI: 10.1016/j.jsat.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.
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Affiliation(s)
- Julie C Gass
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States.
| | - David H Morris
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jamie Winters
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph W VanderVeen
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Stephen Chermack
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
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Rogers ES, Gillespie C, Smelson D, Sherman SE. A Qualitative Evaluation of Mental Health Clinic Staff Perceptions of Barriers and Facilitators to Treating Tobacco Use. Nicotine Tob Res 2017; 20:1223-1230. [DOI: 10.1093/ntr/ntx204] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/05/2017] [Indexed: 11/14/2022]
Affiliation(s)
- Erin S Rogers
- New York University School of Medicine, Department of Population Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY
| | - Colleen Gillespie
- New York University School of Medicine, Department of Medicine, New York, NY
| | - David Smelson
- University of Massachusetts Medical School, Department of Psychiatry, Worcestor, MA
| | - Scott E Sherman
- New York University School of Medicine, Department of Population Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY
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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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Weinberger AH, Platt J, Esan H, Galea S, Erlich D, Goodwin RD. Cigarette Smoking Is Associated With Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. J Clin Psychiatry 2017; 78:e152-e160. [PMID: 28234432 PMCID: PMC5800400 DOI: 10.4088/jcp.15m10062] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 03/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Little is known about the relationship between cigarette smoking and long-term outcomes for substance use disorder (SUD). The current study examined the association between smoking and SUD relapse among adults with remitted SUDs. METHODS Analyses were conducted on respondents who completed Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions and met DSM-IV criteria for substance abuse and dependence prior to but not during the year before the Wave 1 interview (n = 5,515). Relationships between smoking status (Wave 2 smoking vs nonsmoking among Wave 1 smokers; Wave 2 smoking vs nonsmoking among Wave 1 nonsmokers) and Wave 2 substance use and SUD relapse were examined using logistic regression analyses. Analyses were adjusted for demographics, psychiatric and alcohol use disorders, nicotine dependence, and SUD severity. RESULTS In the fully adjusted models, continued smoking at Wave 2 among Wave 1 smokers was associated with significantly greater odds of substance use (OR = 1.56, 95% CI, 1.10-2.20) and SUD relapse (OR = 2.02, 95% CI, 1.65-2.47) compared to Wave 2 nonsmoking. In the fully adjusted model, smoking at Wave 2 among Wave 1 nonsmokers was associated with significantly greater odds of SUD relapse compared to Wave 2 nonsmoking (OR = 4.86, 95% CI, 3.11-7.58). CONCLUSIONS Continued smoking among smokers and smoking initiation among nonsmokers were associated with greater odds of SUD relapse. More research is needed to examine the timing of SUD relapse in relation to smoking behaviors. Incorporating smoking cessation and prevention efforts into substance abuse treatment may improve long-term substance use outcomes for adult smokers with SUDs.
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Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461 USA,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | - Jonathan Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Hannah Esan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461 USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 USA
| | - Debra Erlich
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367 USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA,Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367 USA
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10
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Martínez C, Company A, Guillen O, Margalef M, Arrien MA, Sánchez C, Cáceres de León P, Fernández E. Adaptation, Implementation Plan, and Evaluation of an Online Tobacco Cessation Training Program for Health Care Professionals in Three Spanish-Speaking Latin American Countries: Protocol of the Fruitful Study. JMIR Res Protoc 2017; 6:e7. [PMID: 28128731 PMCID: PMC5303198 DOI: 10.2196/resprot.6487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/21/2016] [Accepted: 11/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tobacco cessation training programs to treat tobacco dependence have measureable effects on patients' smoking. Tobacco consumption in low- and middle-income countries (LMICs) is high and slowly decreasing, but these countries usually lack measures to face the epidemic, including tobacco cessation training programs for health professionals and organizations. Based on a previous online smoking cessation training program for hospital workers in Spain, the Fruitful Study aims to increase smoking cessation knowledge, attitudes, self-confidence, and performance interventions among health care professionals of three Spanish-speaking low- and middle-income Latin American and Caribbean (LAC) countries. OBJECTIVE The purpose of this paper is to describe the methodology and evaluation strategy of the Fruitful Study intended to adapt, implement, and test the effectiveness of an online, evidence-based tobacco cessation training program addressed to health professionals from Bolivia, Guatemala, and Paraguay. METHODS This study will use a mixed-methods design with a pre-post evaluation (quantitative approach) and in-depth interviews and focus groups (qualitative approach). The main outcomes will be (1) participants' attitudes, knowledge, and behaviors before and after the training; and (2) the level of implementation of tobacco control policies within the hospitals before and after the training. RESULTS To date, adaptation of the materials, study enrollment, and training activities have been completed. During the adaptation, the main mismatches were language background and content adaptation. Several aids were developed to enable students' training enrollment, including access to computers, support from technicians, and reminders to correctly complete the course. Follow-up data collection is in progress. We have enrolled 281 hospital workers. Results are expected at the beginning of 2017 and will be reported in two follow-up papers: one about the formative evaluation and the other about the summative evaluation. CONCLUSIONS There is a need to learn more about the cultural and content elements that should be modified when an online tobacco cessation training program is adapted to new contexts. Special attention should be given to the personal and material resources that could make the implementation possible. Results from the Fruitful Study may offer a new approach to adapting programs to LMICs in order to offer education solutions with the use of emerging and growing communication technologies. CLINICALTRIAL Clinicaltrials.gov NCT02718872; https://clinicaltrials.gov/ct2/show/NCT02718872 (Archived by WebCite at http://www.webcitation.org/6mjihsgE2).
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Affiliation(s)
- Cristina Martínez
- Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet del Llobregat, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.,Universitat Internacional de Catalunya, Medicine and Health Sciences School, Sant Cugat del Vallés, Spain
| | - Assumpta Company
- Institut Català d'Oncologia-ICO, Training Unit, L'Hospitalet de Llobregat, Spain
| | - Olga Guillen
- Institut Català d'Oncologia-ICO, Training Unit, L'Hospitalet de Llobregat, Spain
| | - Mercè Margalef
- Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet de Llobregat, Spain
| | - Martha Alicia Arrien
- Management Department, Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia
| | - Claudia Sánchez
- Public Health Department, Ministerio de Salud y Pública y Bienestar Social, Asuncion, Paraguay
| | - Paula Cáceres de León
- Radiation Oncology Department, Instituto de Cancerología y Hospital Dr. Bernardo, Guatemala, Guatemala
| | - Esteve Fernández
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.,Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet de Llobregat, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, L'Hospitalet del Llobregat, Spain
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- Management Department, Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia.,Public Health Department, Ministerio de Salud y Pública y Bienestar Social, Asuncion, Paraguay.,Radiation Oncology Department, Instituto de Cancerología y Hospital Dr. Bernardo, Guatemala, Guatemala
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11
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Bhattacharya A, Vilardaga R, Kientz JA, Munson SA. Lessons from Practice: Designing Tools to Facilitate Individualized Support for Quitting Smoking. ACM TRANSACTIONS ON COMPUTER-HUMAN INTERACTION : A PUBLICATION OF THE ASSOCIATION FOR COMPUTING MACHINERY 2017; 2017:3057-3070. [PMID: 29123362 PMCID: PMC5675113 DOI: 10.1145/3025453.3025725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Many health care providers, with a variety of trainings, counsel clients on quitting smoking on a day-to-day basis. In their clinical practice, they draw from and adapt guidelines and research-based strategies to fit individual client situations and challenges. Designers of technologies to support quitting smoking can learn from these real world practices to create tools that better adapt to individual differences. We present findings from interviews with 28 providers with diverse experiences in smoking cessation counselling. Through analysis of their individualization strategies, challenges, and perceptions of technology, we find that providers: (1) individualize context appropriate coping strategies by involving clients in brainstorming, (2) emphasize the need to support nicotine withdrawal in clients, (3) mitigate social triggers and mediate social support for clients, and (4) need to navigate dependencies with other providers for managing medications and comorbid health conditions of clients. With this empirical understanding, we extend the discussion on the design of technology to support quitting smoking, highlight current barriers to individualization, and suggest future opportunities to address these barriers.
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Affiliation(s)
- Arpita Bhattacharya
- Human Centered Design and Engineering, DUB Group, University of Washington, Seattle, USA
| | - Roger Vilardaga
- Psychiatry and Behavioral Sciences, Duke University, Durham, USA
| | - Julie A Kientz
- Human Centered Design and Engineering, DUB Group, University of Washington, Seattle, USA
| | - Sean A Munson
- Human Centered Design and Engineering, DUB Group, University of Washington, Seattle, USA
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12
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McHugh RK, Votaw VR, Fulciniti F, Connery HS, Griffin ML, Monti PM, Weiss RD. Perceived barriers to smoking cessation among adults with substance use disorders. J Subst Abuse Treat 2016; 74:48-53. [PMID: 28132700 DOI: 10.1016/j.jsat.2016.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/06/2016] [Accepted: 12/28/2016] [Indexed: 11/19/2022]
Abstract
The majority of adults seeking substance use disorder treatment also smoke. Smoking is associated with greater substance use disorder severity, poorer treatment outcome, and increased mortality among those with substance use disorders. Yet, engaging this population in smoking cessation treatment is a significant challenge. The aim of this study was to examine perceived barriers to smoking cessation among treatment-seeking adults with alcohol or opioid use disorder. Additionally, we examined whether anxiety sensitivity - a known risk factor for barriers to smoking cessation in the general population - was associated with more barriers to smoking cessation in this sample. A sample of 208 adults was recruited for a one-time study and completed self-report measures of anxiety sensitivity and perceived barriers to smoking cessation. Results indicated that the most common barriers were anxiety (82% of the sample), tension/irritability (76%), and concerns about the ability to maintain sobriety from their primary substance of abuse (64%). Those who reported more barriers also reported lower confidence in the ability to change their smoking behavior. Higher anxiety sensitivity was associated with more perceived barriers to smoking cessation, even when controlling for cigarette dependence severity. These results suggest that there are several perceived barriers to smoking cessation among treatment-seeking adults with substance use disorders. In addition to psychoeducational interventions aimed to modify negative beliefs about smoking cessation, anxiety sensitivity may be a promising therapeutic target in this population.
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Affiliation(s)
- R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Victoria R Votaw
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Francesca Fulciniti
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Margaret L Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Providence, RI 02903, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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13
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Quitting smoking during substance use disorders treatment: Patient and treatment-related variables. J Subst Abuse Treat 2016; 73:40-46. [PMID: 28017183 DOI: 10.1016/j.jsat.2016.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/19/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022]
Abstract
Although individuals in substance use disorders (SUD) treatment continue to smoke at high rates, regulatory, policy and programming changes promoting tobacco cessation are being implemented and some patients quit successfully. We examined associations of smoking patterns, tobacco advertising receptivity, anti-tobacco message awareness, health risk perception, attitudes towards addressing smoking and availability of smoking cessation services with quitting smoking during SUD treatment. Surveys were completed by 1127 patients in 24 programs chosen randomly, stratified by program type (residential, methadone maintenance, outpatient), from among publicly funded, adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network. Among respondents who had been in SUD treatment for at least one month, there were 631 current smokers and 52 former smokers who reported quitting smoking during treatment for at least one month prior to survey completion; these respondents comprised our sample (N=683). Results showed that participants who reported health concerns as a reason for quitting were 1.27 times more likely to have quit during treatment (p=0.015) than those reporting health concerns affected quitting a little or not at all. Additionally, participants who reported that smoking cessation was part of their personal treatment plan during SUD treatment were 1.08 times more likely to have quit during treatment (p<0.001). Participants in methadone treatment were 49% less likely to report successfully quitting during treatment than those in outpatient treatment (95%CI: 0. 35-0.75, p<0.001). Leveraging health concerns about smoking and including smoking cessation in an individualized treatment plan may help increase smoking cessation during SUD treatment.
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14
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Sheals K, Tombor I, McNeill A, Shahab L. A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses. Addiction 2016; 111:1536-53. [PMID: 27003925 PMCID: PMC5025720 DOI: 10.1111/add.13387] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/25/2015] [Accepted: 03/07/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS People with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally placed to deliver interventions, but their attitudes may prevent this. This systematic review therefore aimed to identify and estimate quantitatively MHPs attitudes towards smoking and main barriers for providing smoking cessation support and to explore these attitudes in-depth through qualitative synthesis. METHODS The online databases AMED, EMBASE, Medline, PsychINFO, HMIC and CINAHL were searched in March 2015 using terms relating to three concepts: 'attitudes', 'mental health professionals' and 'smoking cessation'. Quantitative or qualitative studies of any type were included. Proportions of MHPs' attitudes towards smoking and smoking cessation were pooled across studies using random effects meta-analysis. Qualitative findings were evaluated using thematic synthesis. RESULTS Thirty-eight studies including 16 369 participants were eligible for inclusion. Pooled proportions revealed that 42.2% [95% confidence interval (CI) = 35.7-48.8] of MHPs reported perceived barriers to smoking cessation interventions, 40.5% (95% CI = 30.4-51.0) negative attitudes towards smoking cessation and 45.0% (95% CI = 31.9-58.4) permissive attitudes towards smoking. The most commonly held beliefs were that patients are not interested in quitting (51.4%, 95% CI = 33.4-69.2) and that quitting smoking is too much for patients to take on (38%, 95% CI = 16.4-62.6). Qualitative findings were consistent with quantitative results, revealing a culture of smoking as 'the norm' and a perception of cigarettes as a useful tool for patients and staff. CONCLUSIONS A significant proportion of mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions; many report a lack of time, training and confidence as main barriers to addressing smoking in their patients.
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Affiliation(s)
- Kate Sheals
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Ildiko Tombor
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience UK Centre for Tobacco and Alcohol Studies, London, UKKing's College LondonLondonUK
| | - Lion Shahab
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
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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: 62] [Impact Index Per Article: 7.8] [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.
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Affiliation(s)
- Hannah K Knudsen
- a Department of Behavioral Science and Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA
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Pagano A, Tajima B, Guydish J. Barriers and Facilitators to Tobacco Cessation in a Nationwide Sample of Addiction Treatment Programs. J Subst Abuse Treat 2016; 67:22-9. [PMID: 27296658 DOI: 10.1016/j.jsat.2016.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/12/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Smoking rates among addiction treatment clients are 3-4 times higher than those of the general population. Recent studies indicate that ceasing tobacco use during treatment may improve recovery outcomes. Across the United States, publicly funded addiction treatment programs vary widely in terms of their tobacco policies and tobacco cessation services offered to clients. METHODS The study reported here is the qualitative component of a larger study. Twenty-four programs were recruited from a random sample of publicly funded programs participating in the NIDA Clinical Trials Network. Semi-structured interviews were administered by phone to program directors. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. FINDINGS While all directors expressed interest in helping clients to quit smoking, they cited numerous barriers to implementing tobacco policies and services. These included smoking culture, client resistance, lack of resources, staff smoking, and environmental barriers. Directors also cited several factors that they believed would support tobacco cessation. These included financial support, enhanced leadership, and state mandates against smoking in addiction treatment programs. CONCLUSION Addiction treatment programs are beginning to place more emphasis on tobacco cessation during treatment. However, furthering this goal requires substantial infrastructural and cultural change. These qualitative study findings may help to inform Single State Agencies (SSAs) to support publicly funded addiction treatment programs in their tobacco cessation efforts. In order to maximize effectiveness, state-level policies regarding tobacco cessation during treatment should be informed by ongoing dialogue between service providers and SSAs.
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Affiliation(s)
- Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation (PIRE), Oakland, CA, 94612.
| | - Barbara Tajima
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, 94118
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, 94118
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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.
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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
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Koch JR, Breland A. Behavioral Healthcare Staff Attitudes and Practices Regarding Consumer Tobacco Cessation Services. J Behav Health Serv Res 2015; 44:399-413. [DOI: 10.1007/s11414-015-9477-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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: 5] [Impact Index Per Article: 0.6] [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.
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Laschober TC, Muilenburg JL, Eby LT. Factors Linked to Substance Use Disorder Counselors' (Non)Implementation Likelihood of Tobacco Cessation 5 A's, Counseling, and Pharmacotherapy. ACTA ACUST UNITED AC 2015; 4. [PMID: 26005696 DOI: 10.4172/2324-9005.1000134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY BACKGROUND Despite efforts to promote the use of tobacco cessation services (TCS), implementation extensiveness remains limited. This study investigated three factors (cognitive, behavioral, environmental) identified by social cognitive theory as predictors of substance use disorder counselors' likelihood of use versus non-use of tobacco cessation (TC) 5 A's (ask patients about tobacco use, advise to quit, assess willingness to quit, assist in quitting, arrange for follow-up contact), counseling, and pharmacotherapy with their patients who smoke cigarettes. METHODS Data were collected in 2010 from 942 counselors working in 257 treatment programs that offered TCS. Cognitive factors included perceived job competence and TC attitudes. Behavioral factors encompassed TC-related skills and general training. External factors consisted of TC financial resource availability and coworker TC attitudes. Data were analyzed using logistic regression models with nested data. RESULTS Approximately 86% of counselors used the 5 A's, 76% used counseling, and 53% used pharmacotherapy. When counselors had greater TC-related skills and greater general training they were more likely to implement the 5 A's. Implementation of counseling was more likely when counselors had more positive attitudes toward TC treatment, greater general training, greater financial resource availability, and when coworkers had more positive attitudes toward TC treatment. Implementation of pharmacotherapy was more likely when counselors had more positive attitudes toward TC treatment, greater general training, and greater financial resource availability. CONCLUSION Findings indicate that interventions to promote TCS implementation should consider all three factors simultaneously as suggested by social cognitive theory.
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Affiliation(s)
- 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
| | - 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
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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.
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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
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Martínez C, Fu M, Martínez-Sánchez JM, Antón L, Fernández P, Ballbè M, Andrés A, Riccobene A, Sureda X, Gallart A, Fernández E. Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys. BMC Public Health 2014; 14:1228. [PMID: 25427959 PMCID: PMC4289238 DOI: 10.1186/1471-2458-14-1228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws. METHODS Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law). RESULTS Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project. CONCLUSIONS A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.
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Affiliation(s)
- Cristina Martínez
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Marcela Fu
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Jose María Martínez-Sánchez
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Biostatistic Unit, Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Laura Antón
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Paz Fernández
- />Nursing Research Unit, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199–203, L’Hospitalet de Llobregat (Barcelona), Spain, 08908 Barcelona, Spain
| | - Montse Ballbè
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona - IDIBAPS, C. Villarroel 170, 08036 Barcelona, Spain
- />Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
| | - Ana Andrés
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Department of Methodology for the Behavioural Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Riccobene
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Xisca Sureda
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
| | - Albert Gallart
- />Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, Sant Cugat del Valles, 08915 Barcelona, Spain
| | - Esteve Fernández
- />Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d’Oncologia-ICO, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L’Hospitalet 199-203, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- />Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, L’Hospitalet del Llobregat, 08907 Barcelona, Spain
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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.
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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
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25
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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.
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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
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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.
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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.
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27
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Expectancies for smoking cessation among drug-involved smokers: implications for clinical practice. J Subst Abuse Treat 2013; 46:320-4. [PMID: 24314605 DOI: 10.1016/j.jsat.2013.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/22/2022]
Abstract
Drug-involved smokers may be less motivated to quit smoking because they expect smoking cessation to occasion adverse outcomes (e.g., exacerbation of drug use). Non-treatment-seeking adult smokers from the community (N=507) reported drug involvement, expectancies for smoking abstinence via the Smoking Abstinence Questionnaire (SAQ), and motivation to quit smoking (desire to quit and abstinence goal). Mediation analyses evaluated the indirect effects of binge drinking, marijuana, cocaine, other stimulant, opiate, and barbiturate/other sedative involvement on motivation to quit smoking through the SAQ Adverse Outcomes scale. Adverse outcomes expectancies accounted for a reduced desire to quit smoking and a lower likelihood of endorsing a goal of complete smoking abstinence among those involved with binge drinking, marijuana, cocaine, other stimulants, opiates, and barbiturates/other sedatives. Drug-involved smokers' greater expectancies for adverse outcomes upon quitting smoking may deter smoking quit attempts. Interventions are encouraged to counteract the notion that smoking cessation jeopardizes sobriety.
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