Behavioral health care provider’s beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A’s intervention
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Cited by 3 publications
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Assessing Tobacco Treatment Engagement in Assertive Community Treatment Programs
Objective: Despite high tobacco use prevalence among those with serious mental illnesses, few Assertive Community Treatment (ACT) programs provide tobacco treatment. Understanding the factors associated with the intentions to engage in tobacco treatment from both provider and consumer perspectives is important. The purpose was to examine ACT providers’ intention to provide and consumer intention to engage in tobacco treatment. Method: A cross-sectional survey of ACT program providers ( N = 51) and consumers ( N = 43) from four community mental health centers. Multiple linear regression analyses were used to examine factors associated with the intentions to provide or engage in tobacco treatment from among attitudinal, subjective norms, and perceived behavioral control variables. Results: Providers reported positive attitudes, high degree of perceived behavior control, and high intentions for delivering tobacco treatment, but poor perceptions of subjective norms. These results were like consumers’ intentions to engage in tobacco treatment. In regression analysis, only subjective norms and perceived behavior control were significant predictors for providers’ intentions to provide tobacco treatment, but there were no significant predictors of consumers’ intentions to engage in tobacco treatment. Both providers and consumers endorsed poor implementation of evidence-based tobacco treatment. Conclusion: Poor engagement in tobacco treatment within ACT programs indicates the need for policymakers to support tobacco treatment within the services. This finding calls for training of mental and behavioral health providers while supporting tobacco-free initiatives in ACT treatment service settings.
Assessing Tobacco Treatment Engagement in Assertive Community Treatment Programs
Objective: Despite high tobacco use prevalence among those with serious mental illnesses, few Assertive Community Treatment (ACT) programs provide tobacco treatment. Understanding the factors associated with the intentions to engage in tobacco treatment from both provider and consumer perspectives is important. The purpose was to examine ACT providers’ intention to provide and consumer intention to engage in tobacco treatment. Method: A cross-sectional survey of ACT program providers ( N = 51) and consumers ( N = 43) from four community mental health centers. Multiple linear regression analyses were used to examine factors associated with the intentions to provide or engage in tobacco treatment from among attitudinal, subjective norms, and perceived behavioral control variables. Results: Providers reported positive attitudes, high degree of perceived behavior control, and high intentions for delivering tobacco treatment, but poor perceptions of subjective norms. These results were like consumers’ intentions to engage in tobacco treatment. In regression analysis, only subjective norms and perceived behavior control were significant predictors for providers’ intentions to provide tobacco treatment, but there were no significant predictors of consumers’ intentions to engage in tobacco treatment. Both providers and consumers endorsed poor implementation of evidence-based tobacco treatment. Conclusion: Poor engagement in tobacco treatment within ACT programs indicates the need for policymakers to support tobacco treatment within the services. This finding calls for training of mental and behavioral health providers while supporting tobacco-free initiatives in ACT treatment service settings.
Implementing a tobacco-free workplace program at a substance use treatment center: a case study
Background People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center. Methods This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice. Results Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center. Conclusions Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.
Self-Reported Comfort and Use of Tobacco Cessation Interventions by Healthcare Providers
BackgroundThe effects of tobacco use create a significant burden on the American healthcare system. The U.S. Preventive Services Task Force (USPSTF) recommends a tobacco cessation framework consisting of asking all patients about any tobacco use, advising they quit, assessing their willingness to start a quit attempt, assisting in any attempts, and arranging follow-up. This is known as the "5A's" and is considered a standard of care for tobacco cessation. Physician-provided cessation interventions have been shown to be effective in helping patients stop their tobacco use; however, studies have shown that physicians and other healthcare providers do not consistently offer tobacco cessation interventions. This study aimed to evaluate healthcare providers' comfort with and self-reported use of tobacco cessation interventions. MethodsAn online survey was made available to all Penn State Health Milton S. Hershey Medical Center physicians, physician assistants (PAs), nurse practitioners (NPs), registered nurses (RNs), and respiratory therapists (RTs). The survey assessed respondents' use of the USPSTF "5A's" cessation framework, comfort in counseling patients, use of cessation interventions, and desire for further education. Descriptive statistics were generated, and chi-square tests were used to compare differences in responses across provider groups. ResultsA total of 430 healthcare professionals (mean age of 40.1 years, 76.1% female) responded to the survey, including 55 (12.1%) physicians, 76 (17.7%) resident/fellows, 44 (10.2%) PAs, 57 (13.5%) NPs, 146 (33.9%) RNs, and 54 (12.5%) RTs. The majority (n = 407, 95.5%) of respondents reported a belief that it is "extremely" or "very" important for their patients to stop smoking cigarettes. Although more than 160 (70%) providers reported feeling "very comfortable" or "somewhat comfortable" counseling patients who were "ready to quit" smoking, only half reported the same for patients who were "not ready to quit." There was significant variation in the use of the recommended "5A's," with NPs and attending physicians reporting the most regular use. Self-reported use of the "Ask" and "Advise" components of the "5A's" was higher than the "Assess", "Assist", and "Arrange" components, with low rates of use of pharmacologic cessation methods. Only 13 (3.2%) providers reported regularly billing for cessation counseling. ConclusionsWhile healthcare professionals recognize the importance of tobacco cessation for their patients, gaps persist in the consistent application of the "5A's" model and provider comfort in counseling patients to quit, particularly those perceived as "not ready to quit." This discomfort with counseling, along with hesitancy to offer cessation interventions, results in missed opportunities to help patients with tobacco use disorder. Differences in cessation practices across healthcare roles suggest opportunities for targeted improvement. Enhancing both provider training and health system interventions is essential for expanding patient access to effective ces...
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