Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities — United States, 2016

Marynak, Kristy; VanFrank, Brenna; Tetlow, Sonia; Mahoney, Margaret; Phillips, Elyse; Mbbs, Ahmed Jamal; Schecter, Anna; Tipperman, Doug; Babb, Stephen

doi:10.15585/mmwr.mm6718a3

“…This differs from prior work that found an increase in tobacco services received by clients after the implementation of a TFG policy (Guydish et al, 2017). However, only 26.2% of SUD treatment programs in the U.S. offered NRT to clients in 2016 (Marynak et al, 2018). Increasing access to tobacco cessation services and access to smoking cessation pharmacotherapies may further promote smoking cessation at these programs as the efficacy of pharmaceutical support for smoking cessation has been found to be higher when combined with a smoke-free policy (Gilpin et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

“…Tobacco-free grounds (TFG) policies, which restrict the use of any tobacco products on program property (indoor or outdoor), may help reduce smoking in SUD programs. Currently, one-third of SUD treatment programs in the U.S. have restricted smoking policies on program grounds and there has been an increase in the prevalence of SUD treatment programs that offer smoking cessation services (Cohn et al, 2017;Marynak et al, 2018;Muilenburg et al, 2016;Shi and Cummins, 2015;SAMHSA, 2017). Tobacco-free grounds in the workplace, behavioral health care setting and college campus are often accompanied by an increase in tobacco cessation services offered to clients and staff (Correa-Fernandez et al, 2017;Hahn et al, 2012;Seidel et al, 2017) with the goal of increasing the use of these services to promote tobacco cessation.…”

Section: Introductionmentioning

confidence: 99%

Smoking related outcomes before and after implementation of tobacco-free grounds in residential substance use disorder treatment programs

Gubner

¹

,

Williams

²

,

Le

³

et al. 2019

Drug and Alcohol Dependence

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Background: This study examined the impact of a tobacco-free grounds (TFG) policy and the California $2.00/pack tobacco tax increase on tobacco use among individuals in residential substance use disorder (SUD) treatment. Methods: We conducted three cross-sectional surveys of clients enrolled in three residential SUD treatment programs. Wave 1 (Pre-TFG) included 190 clients, wave 2 (post-TFG and pre-tax increase) included 200 clients, and wave 3 (post-tax increase) included 201 clients. Demographic and tobacco-use characteristics were first compared between waves using bivariate comparisons. Regression models were used to compare each outcome with survey wave as the predictor, while adjusting for demographic characteristics and nesting of participants within programs. Results: Odds of clients being current smokers was lower (AOR=0.43, 95%CI = 0.30,0.60) after implementation of TFG compared to baseline. Adjusted mean ratio (AMR) for cigarettes per day was lower post-TFG compared to baseline (AMR=0.70, CI=0.59, 0.83). There were no differences, across waves, in tobacco-related knowledge, attitudes, or services received by

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“…These patients account for almost 40% of cigarette consumption in the United States ( 167 ). Yet, fewer than half of mental health and substance-use treatment facilities in the United States offer evidence-based tobacco-dependence treatments ( 168 – 170 ). Implementation research is needed to maximize the provision of evidence-based treatments for tobacco dependence within this context.…”

Section: Questions and Recommendationsmentioning

confidence: 99%

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline

Leone

¹

,

Zhang

²

,

Evers-Casey

³

et al. 2020

Am J Respir Crit Care Med

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Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

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“…These patients account for almost 40% of cigarette consumption in the United States (167). Yet, fewer than half of mental health and substance-use treatment facilities in the United States offer evidencebased tobacco-dependence treatments (168)(169)(170). Implementation research is needed to maximize the provision of evidence-based treatments for tobacco dependence within this context.…”

Section: American Thoracic Society Documents E22mentioning

confidence: 99%

NewsCAP: New guidelines favor varenicline for smoking cessation.

2020

AJN, American Journal of Nursing

0

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Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

show abstract

Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities — United States, 2016

Cited by 72 publications

References 8 publications

Smoking related outcomes before and after implementation of tobacco-free grounds in residential substance use disorder treatment programs

Smoking related outcomes before and after implementation of tobacco-free grounds in residential substance use disorder treatment programs

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline

NewsCAP: New guidelines favor varenicline for smoking cessation.

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