Tobacco smoking policies in Australian alcohol and other drug treatment services, agreement between staff awareness and the written policy document

A qualitative study of using nicotine products for smoking cessation after discharge from residential drug and alcohol treatment in Australia

INTRODUCTION

Tobacco smoking is highly prevalent among alcohol and other drugs (AOD) service clients and, despite interest in quitting, abstinence is rarely sustained. Nicotine products may assist after discharge from residential treatment services, but little is known about client receptivity to them. This study examined AOD withdrawal service clients' experiences of two types of nicotine products for smoking cessation post-discharge, combination nicotine replacement therapy (cNRT) and nicotine vaping products (NVP).

METHODS

We held semi-structured telephone interviews with 31 Australian AOD service clients in a clinical trial of a 12-week smoking cessation intervention using Quitline support plus cNRT or NVP delivered post-discharge from a smoke-free residential service. We asked about health and social factors, nicotine cravings, Quitline experience, and barriers and facilitators to cNRT or NVP, then thematically analysed data.

RESULTS

cNRT and NVP were described by participants as feasible and acceptable for smoking cessation. For most participants, cost limited cNRT access post study, as did difficulty navigating NVP prescription access. Quitline support was valued, but not consistently used, with participants noting low assistance with NVP-facilitated cessation. Participants considered both cessation methods acceptable and socially supported, and sought information on decreasing nicotine use via NVP.

DISCUSSION AND CONCLUSIONS

AOD service clients highly valued receiving cNRT or NVP with behavioural support for smoking reduction or abstinence. Both interventions were acceptable to service clients. Findings suggest a potential need to examine both whether NVP use should be permitted in this context, and guidance on the individual suitability of cNRT or NVP.

Awareness of tobacco control policies and anti-tobacco attitudes and behaviors among school personnel

INTRODUCTION

Adolescent smoking is a serious public health concern, and the role of personnel in reducing students’tobacco use has been proven. Anti-tobacco policies are strong factors for tobacco control but most are newly implemented in China. This study aimed to examine the awareness of anti-tobacco policies among school personnel in a southern city of China, and assess its influence on personnel’s anti-tobacco attitudes and behaviors towards students.

METHODS

An online cross-sectional study was conducted between September 2017 and January 2018 in schools of Shanghai, China. A total of 3194 subjects from 33 schools were selected by a two-stage stratified cluster randomized sampling design. Prevalence of anti-tobacco policy awareness is presented. Crude (ORs) and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) were estimated to assess the association between policy awareness and anti-tobacco attitudes or behaviors.

RESULTS

In all, 22.4% of surveyed participants knew four or five polices presented in the survey and 13.0% of personnel knew none of these policies. Most of the participants fully support prohibiting indoor (94.6%) and outdoor (86.3%) smoking in public places, bans on tobacco advertising (90.9%), and printing warning pictures on cigarette boxes (89.5%). Less than half of the personnel had taken action to stop students from smoking (45.7%), encourage students to quit smoking (42.4%) or participated in relevant educational activities held by schools (37.4%) in the previous year. The school personnel’s anti-tobacco attitudes (AOR=1.28; 95% CI: 1.21–1.36) and behaviors (AOR=1.10; 95% CI: 1.03–1.17) were strengthened with increasing level of policy awareness.

CONCLUSIONS

The involvement of school personnel can be an important part of intervention to improve anti-tobacco campaigns on campus. The study calls for the implementation of projects or activities to improve anti-tobacco policy awareness in the school environment as part of school tobacco control strategy.

Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial

AIM

Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8 weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow-up.

DESIGN

Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016.

SETTING

Thirty-two eligible services (provided face-to-face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician.

PARTICIPANTS

Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow-up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%).

INTERVENTION

Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care.

MEASUREMENTS

Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent.

FINDINGS

At 8 weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5-5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8-0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9-1.02, P = 0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use.

CONCLUSIONS

Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.

Addressing tobacco in Australian alcohol and other drug treatment settings: a cross-sectional survey of staff attitudes and perceived barriers

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.