Providers’ Non-Cigarette Tobacco Use Intervention Practices in Relation to Beliefs about Patients, Prioritization of and Skills for Intervention, and Referral Knowledge in Texas Healthcare Centers Providing Care to Persons with Behavioral Health Needs

Abstract

Rates of non-cigarette (colloquially, other) tobacco use is elevated among adults with behavioral health conditions. Little is known about whether behavioral health providers are using brief interventions, including the evidence-based 5As (Ask, Advise, Assess, Assist, and Arrange) for other tobacco use, or what provider factors may be associated with use of these interventions. The current study redressed this gap. Overall, 86 providers in Texas (9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs) that provide a broad range of mental and behavioral health services, 6 substance use treatment programs in LMHAs, and 55 stand-alone substance use treatment programs) took a survey assessing their beliefs regarding (1) patients’ concerns about other tobacco use; (2) their desire to quit; (3) importance of intervening on other tobacco use with cessation counseling; (4) perceived skills to intervene; (5) knowledge of referral options for treatment. Logistic regression analyses were conducted to determine the association between each factor and use of the 5As. Results showed that 70.9% of providers asked patients about other tobacco use status, 65.1% advised them to quit, 59.3% assessed quit interest, 54.7% assisted with a quit attempt, and 31.4% arranged a follow-up. Providers who believed patients were concerned about other tobacco use, recognized the importance of offering other tobacco use cessation counseling, believed they had the necessary skills to treat other tobacco use, and possessed knowledge of referral options, respectively, were more likely to deliver the 5As (ps < 0.05). Results add to a limited literature on provider intervention practices for other tobacco use in settings where behavioral health care is provided, highlighting the significance of provider beliefs, perceived skills, and referral knowledge to care delivery. Findings reveal opportunities to increase delivery of the 5As for other tobacco use to behavioral health patients and suggest provider factors that could be targeted to build this capacity.

Changes in Substance Use Treatment Providers’ Delivery of the 5A’s for Non-Cigarette Tobacco Use in the Context of a Comprehensive Tobacco-Free Workplace Program Implementation

“…Each variable was analyzed as binary, as described further below. This classification was consistent with prior work examining provider factors [48] and provider delivery of the 5A's for cigarette smoking [39][40][41]54,55] and for non-cigarette tobacco use [48], enhancing comparability with extant publications.…”

“…Although most literature is focused on the effects of provider training on cigarette smoking intervention provision, education may be equally critical to non-cigarette tobacco use intervention. A recent study found that providers who believed patients were concerned about their non-cigarette tobacco use thought it was important to offer non-cigarette tobacco use cessation counseling, felt they were equipped with the skills to do so, and were familiar with referral options, were more likely to deliver the 5A's to patients with behavioral health needs [48]. These results highlight several factors that can be targeted in provider training; however, longitudinal research is needed to support SUTC workplace interventions that can improve these metrics and ultimately impact providers' non-cigarette tobacco intervention practices.…”

Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study

“…Each item was rated using a 5-point Likert scale ranging from never to always. Similar to previous research and in order to facilitate comparison, endorsements were grouped as follows: never/sometimes/about half the time vs. most of the time/always [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study

“…The University of Houston Institutional Review Board (IRB) concluded that this project did not meet the definition of human subjects research under 45 CFR 46.102 (I) (i.e., a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge); therefore, no IRB review/approval was necessary. Detailed recruitment procedures are described elsewhere ( Siddiqi et al, 2022 , Taing et al, 2022 , Jafry et al, 2022 , Britton et al, 2023 , Britton et al, 2023 ).…”