Tobacco Treatment Guideline Use and Predictors Among U.S. Physicians by Specialty

Schaer, Daniel; Singh, Binu; Steinberg, Michael B.; Delnevo, Cristine D.

doi:10.1016/j.amepre.2021.05.014

Cited by 12 publications

(16 citation statements)

References 28 publications

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“…Rates of patient-reported 5As receipt at baseline ranged from 85.17% (Ask) to 32.24% (Arrange). These findings align with a general pattern observed in prior studies of usual care across medical specialties [12], and among oncology clinicians in particular [25–27], with Ask and Advise completed routinely (∼80%) and Assist and Arrange delivered at much lower rates (<50%). A recent cross-sectional study found that oncologists have some of the lowest rates of 5As adherence among various medical specialties, especially for Assess (73.6%) and Assist (18.6%) [12].…”

Section: Discussionsupporting

confidence: 88%

Patient-Reported Receipt of Oncology Clinician-Delivered Brief Tobacco Treatment (5As) Six Months following Cancer Diagnosis

Price¹,

Neil²,

Flores³

et al. 2023

Oncology

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Introduction: Smoking after a cancer diagnosis represents a modifiable health risk. It is recommended that oncology clinicians address tobacco use among their patients using the 5As brief model: Asking about use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts (counseling and medication), and Arranging follow-up. However, cross-sectional studies have found limited adoption of 5As (especially Assist and Arrange) in oncology settings. Further investigation is needed to understand changes in, and factors associated with, 5As delivery over time. Methods: Patients recently diagnosed with cancer and reporting current smoking (N = 303) enrolled in a smoking cessation clinical trial and completed three longitudinal surveys; at pre-intervention baseline and 3- and 6-month follow-up post-enrollment. Patient-level correlates of 5As receipt at baseline, 3 months, and 6 months were identified using multilevel regression models. Results: At baseline, patient-reported rates of 5As receipt from oncology clinicians ranged from 85.17% (Ask) to 32.24% (Arrange). Delivery declined from baseline to 6-month follow-up for all 5As, with the largest declines observed for Ask, Advise, Assess, and Assist-Counseling. Diagnosis of a smoking-related cancer was associated with greater odds of 5As receipt at baseline but lower odds at 6-month follow-up. At each time point, female gender, religiosity, advanced disease, cancer-related stigma, and smoking abstinence were associated with lower odds of 5As receipt, while reporting a recent quit attempt prior to enrollment was associated with higher odds of 5As receipt. Conclusion: Oncology clinicians’ 5As delivery declined over time. Clinician delivery of the 5As varied based on patients’ sociodemographics, clinical and smoking characteristics, and psychosocial factors.

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Section: Discussionsupporting

confidence: 88%

Patient-Reported Receipt of Oncology Clinician-Delivered Brief Tobacco Treatment (5As) Six Months following Cancer Diagnosis

Price¹,

Neil²,

Flores³

et al. 2023

Oncology

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“…Primary care clinics are an ideal setting to reach and engage women in smoking cessation treatment, as more than 70% of smokers visit a provider each year [ 30 ]. Implementing the Clinical Practice Guideline can be challenging, however, for primary care practices and providers, due to lack of training, limited knowledge about the recommendations, lack of patient motivation to quit, and inadequate billing and reimbursement systems [ 31 – 34 ]. In Appalachia, these challenges are compounded by limited access to comprehensive cessation programs that offer sustained assistance, inadequate patient education resources, and practical barriers to follow-up [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the “Break Free” program

Patterson

Borger

Burris

et al. 2022

Addict Sci Clin Pract

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Background The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. Methods The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness. Discussion Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020)

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“…The explanation about PARIs and PA prior to each survey would increase individual awareness of the personal injury risk (i.e., attention effect) to some extent. More importantly, effective intervention is not possible without the 5As (ask, advise, assess, assist and arrange) [ 34 ]. Normally, the control group receives 3As (ask, assess, and arrange) of the 5As, which are considered significant components of effective intervention [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Health-Related Behavior Interventions on Physical Activity-Related Injuries in Junior Middle School Students

Tang

Cai

Yang

et al. 2022

IJERPH

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The objective of this study was to determine the effectiveness of an intervention program based on Health-Related Behavior Theory (HRBT) in reducing physical activity-related injuries (PARIs) occurrence and individual risk-taking behaviors, as well as improving PA-related behaviors. A total of 1044 students from six junior middle schools in Shantou city were included and divided randomly into an intervention group (n = 550) and a control group (n = 494), respectively. The intervention group followed a prescribed PARIs intervention program based on HRBT, and the control group performed a common health education program, consisting of seven sessions and lasting seven months from May to November 2018. After the intervention, both groups showed a significantly lower prevalence of PARIs (intervention group: from 25.45% to 10.91%, control group: from 29.76% to 11.74%, both p < 0.05), but no significant between-group differences could be observed in the post-intervention PARIs prevalence (p > 0.05). Compared with the control group, students in the intervention group had a higher improvement in PA-related behaviors and a lower score of risk-taking behaviors (both p < 0.05). Thus, it could be concluded that the HRBT intervention program had a positive effect on PA-related and risk-taking behaviors in junior middle school students, though its effectiveness in reducing the occurrence of PARIs was not significant.

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Tobacco Treatment Guideline Use and Predictors Among U.S. Physicians by Specialty

Cited by 12 publications

References 28 publications

Patient-Reported Receipt of Oncology Clinician-Delivered Brief Tobacco Treatment (5As) Six Months following Cancer Diagnosis

Patient-Reported Receipt of Oncology Clinician-Delivered Brief Tobacco Treatment (5As) Six Months following Cancer Diagnosis

A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the “Break Free” program

Effectiveness of Health-Related Behavior Interventions on Physical Activity-Related Injuries in Junior Middle School Students

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