Health Care Provider Tobacco Cessation Counseling Among Current African American Tobacco Users

Palmer, R. C.; McKinney, Sheila

doi:10.1016/s0027-9684(15)30405-3

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…14 The 45 – 55% lower risk for recurrent CHD events and all-cause mortality in the current study is similar to two other cohort studies of patients with a history of CHD. 15,16 Considering that 15% of this sample of US adults was smoking despite having a history of CHD, smoking cessation should continue to be a high priority to lower recurrent CHD and mortality risk in individuals with CHD.…”

Section: Discussionsupporting

confidence: 89%

Effect of Sustaining Lifestyle Modifications (Nonsmoking, Weight Reduction, Physical Activity, and Mediterranean Diet) After Healing of Myocardial Infarction, Percutaneous Intervention, or Coronary Bypass (from the REasons for Geographic and Racial Differences in Stroke Study)

Booth¹,

Levitan²,

Brown³

et al. 2014

The American Journal of Cardiology

110

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Guidelines recommend lifestyle modification for individuals with coronary heart disease (CHD). Few data demonstrate which lifestyle modifications, if sustained, reduce recurrent CHD and mortality risk among cardiac patients after the post-acute rehabilitation phase. We determined the association between ideal lifestyle factors and recurrent CHD and all-cause mortality among REasons for Geographic and Racial Differences in Stroke study participants with CHD (n=4,174). Ideal lifestyle factors (physical activity ≥4 times/week, non-smoking, highest quartile of Mediterranean diet score, waist circumference <88/<102 cm for women/men) were assessed through questionnaires and an in-home study visit. There were 447 recurrent CHD events and 745 deaths over a median 4.3 and 4.5 years, respectively. After multivariable adjustment, physical activity ≥4 versus no times/week and non-smoking versus current smoking were associated with reduced hazard ratios (HR) [95% confidence interval] for recurrent CHD (0.69 [0.54–0.89] and 0.50 [0.39–0.64], respectively) and death (0.71 [0.59–0.86] and 0.53 [0.44–0.65], respectively). The multivariable adjusted HR (95% CI) for recurrent CHD and death comparing the highest versus lowest quartile of Mediterranean diet adherence were 0.77 (0.55–1.06) and 0.84 (0.67–1.07), respectively. Neither outcome was associated with waist circumference. Comparing participants with 1, 2, and 3 versus 0 ideal lifestyle factors (non-smoking, physical activity ≥4 times/week, highest quartile of Mediterranean diet score), the HR (95% CI) were 0.60 (0.44–0.81), 0.49 (0.36–0.67) and 0.38 (0.21–0.67), respectively, for recurrent CHD and 0.65 (0.51–0.83), 0.57 (0.43–0.74) and 0.41 (0.26–0.64), respectively, for death. In conclusion, maintaining smoking cessation, physical activity and Mediterranean diet adherence is important for secondary CHD prevention.

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Section: Discussionsupporting

confidence: 89%

Effect of Sustaining Lifestyle Modifications (Nonsmoking, Weight Reduction, Physical Activity, and Mediterranean Diet) After Healing of Myocardial Infarction, Percutaneous Intervention, or Coronary Bypass (from the REasons for Geographic and Racial Differences in Stroke Study)

Booth¹,

Levitan²,

Brown³

et al. 2014

The American Journal of Cardiology

110

View full text Add to dashboard Cite

show abstract

“…There are a few key practices that can help to address perceived barriers to tobacco use disorder care and support providers to provide tobacco use screenings that may increase their consistent use, namely, programming a hard stop in the EHR that requires the input of patients’ tobacco use status, training providers to screen for tobacco use, and making a TUA template available to providers [ 24 , 84 , 86 , 87 , 88 ]. In the present study, mandated tobacco screenings were most common in health care settings where hard stops in EHRs for entry of tobacco use status were used than in settings in which they were not; likewise, screening was marginally more common in centers where provider tobacco training was readily available than in settings where training was not offered.…”

Section: Discussionmentioning

confidence: 99%

Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment

Siddiqi

Britton

Chen

et al. 2022

IJERPH

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Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers’ use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers’ perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients’ interest in quitting and providers’ potential impacts on a successful quit attempt.

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“… 2 , 25 Disparities are due to both the historical and present-day forms of systemic racism in the US, which have contributed to the overrepresentation of poverty and unequal access to work, education, housing, health insurance, and quality health care for Black US residents. 26 , 27 , 28 , 29 , 30 Furthermore, racial bias and discriminatory practices in the US health care system, including exploitation of Black individuals, unequal treatment, and clinician bias contribute to lower likelihood of receiving clinician advice or assistance to quit 31 and overall mistrust of recommended treatments. 23 , 32 The primary hypothesis was that individuals randomized to the ADT group would have significantly higher abstinence at week 12 than participants randomized to UC.…”

Section: Introductionmentioning

confidence: 99%

Multiple Pharmacotherapy Adaptations for Smoking Cessation Based on Treatment Response in Black Adults Who Smoke

et al. 2023

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ImportanceAdapting to different smoking cessation medications when an individual has not stopped smoking has shown promise, but efficacy has not been tested in racial and ethnic minority individuals who smoke and tend to have less success in quitting and bear a disproportionate share of tobacco-related morbidity and mortality.ObjectiveTo evaluate efficacy of multiple smoking cessation pharmacotherapy adaptations based on treatment response in Black adults who smoke daily.Design, Setting, and ParticipantsThis randomized clinical trial of adapted therapy (ADT) or enhanced usual care (UC) included non-Hispanic Black adults who smoke and was conducted from May 2019 to January 2022 at a federally qualified health center in Kansas City, Missouri. Data analysis took place from March 2022 to January 2023.InterventionsBoth groups received 18 weeks of pharmacotherapy with long-term follow-up through week 26. The ADT group consisted of 196 individuals who received a nicotine patch (NP) and up to 2 pharmacotherapy adaptations, with a first switch to varenicline at week 2 and, if needed, a second switch to bupropion plus NP (bupropion + NP) based on carbon monoxide (CO)-verified smoking status (CO ≥6 ppm) at week 6. The UC group consisted of 196 individuals who received NP throughout the duration of treatment.Main Outcomes and MeasuresAnabasine-verified and anatabine-verified point-prevalence abstinence at week 12 (primary end point) and weeks 18 and 26 (secondary end points). The χ2 test was used to compare verified abstinence at week 12 (primary end point) and weeks 18 and 26 (secondary end points) between ADT and UC. A post hoc sensitivity analysis of smoking abstinence at week 12 was performed with multiple imputation using a monotone logistic regression with treatment and gender as covariates to impute the missing data.ResultsAmong 392 participants who were enrolled (mean [SD] age, 53 [11.6] years; 224 [57%] female; 186 [47%] ≤ 100% federal poverty level; mean [SD] 13 [12.4] cigarettes per day), 324 (83%) completed the trial. Overall, 196 individuals were randomized to each study group. Using intent-to-treat and imputing missing data as participants who smoke, verified 7-day abstinence was not significantly different by treatment group at 12 weeks (ADT: 34 of 196 [17.4%]; UC: 23 of 196 [11.7%]; odds ratio [OR], 1.58; 95% CI, 0.89-2.80; P = .12), 18 weeks (ADT: 32 of 196 [16.3%]; UC: 31 of 196 [15.8%]; OR, 1.04; 95% CI, 0.61-1.78; P = .89), and 26 weeks (ADT: 24 of 196 [12.2%]; UC: 26 of 196 [13.3%]; OR, 0.91; 95% CI, 0.50-1.65; P = .76). Of the ADT participants who received pharmacotherapy adaptations (135/188 [71.8%]), 11 of 135 (8.1%) were abstinent at week 12. Controlling for treatment, individuals who responded to treatment and had CO-verified abstinence at week 2 had 4.6 times greater odds of being abstinent at week 12 (37 of 129 [28.7%] abstinence) than those who did not respond to treatment (19 of 245 [7.8%] abstinence; OR; 4.6; 95% CI, 2.5-8.6; P &lt; .001).Conclusions and RelevanceIn this randomized clinical trial of adapted vs standard of care pharmacotherapy, adaptation to varenicline and/or bupropion + NP after failure of NP monotherapy did not significantly improve abstinence rates for Black adults who smoke relative to those who continued treatment with NP. Those who achieved abstinence in the first 2 weeks of the study were significantly more likely to achieve later abstinence, highlighting early treatment response as an important area for preemptive intervention.Trial RegistrationClinicalTrials.gov Identifier: NCT03897439

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Health Care Provider Tobacco Cessation Counseling Among Current African American Tobacco Users

Cited by 6 publications

References 27 publications

Effect of Sustaining Lifestyle Modifications (Nonsmoking, Weight Reduction, Physical Activity, and Mediterranean Diet) After Healing of Myocardial Infarction, Percutaneous Intervention, or Coronary Bypass (from the REasons for Geographic and Racial Differences in Stroke Study)

Effect of Sustaining Lifestyle Modifications (Nonsmoking, Weight Reduction, Physical Activity, and Mediterranean Diet) After Healing of Myocardial Infarction, Percutaneous Intervention, or Coronary Bypass (from the REasons for Geographic and Racial Differences in Stroke Study)

Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment

Multiple Pharmacotherapy Adaptations for Smoking Cessation Based on Treatment Response in Black Adults Who Smoke

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