Integration of an evidence-based tobacco cessation program into a substance use disorders program to enhance equity of treatment access for northern, rural, and remote communities

2020 ◽  
Vol 10 (3) ◽  
pp. 555-564
Author(s):  
Patricia M Smith ◽  
Lisa D Seamark ◽  
Katie Beck
Keyword(s):  
Substance Use ◽  
Behavior Change ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
Access Point ◽  
Indigenous Communities ◽  
Well Being ◽  
Evidence Based ◽  
Treatment Access ◽  
Cessation Intervention

Abstract Integrating tobacco cessation interventions into substance use disorder (SUD) programs is recommended, yet few are implemented into practice. This translational research implementation study was designed to integrate an evidence-based tobacco cessation intervention into a 2-week hospital outpatient SUD program that served a rural municipality and 33 remote Indigenous communities. Objectives included determining tobacco use prevalence, intervention uptake, and staffing resources required for intervention delivery. A series of 1-hr tobacco and health/well-being interactive education and behavior-change groups were developed for the SUD program to create a central access point to offer an evidence-based, intensive tobacco cessation intervention that included an initial counseling/planning session and nine post-SUD treatment follow-ups (weekly month 1; biweekly month 2; and 3, 6, and 12 months). Group sign-in data included age, gender, community, tobacco use, and interest in receiving tobacco cessation help. Thirty-two groups (April 2018 to February 2019) were attended by 105 people from 22 communities—56% were female, mean age = 30.9 (±7.3; 93% <45 years), 86% smoked, and 38% enrolled in the intensive tobacco cessation intervention. The age-standardized tobacco use ratio was two times higher than would be expected in the general rural population in the region. Average staff time to provide the intervention was 1.5–2.5 hr/week. Results showed that a Healthy Living group integrated into SUD programming provided a forum for tobacco education, behavior-change skills development, and access to an intensive tobacco cessation intervention for which enrollment was high yet the intervention could be delivered with only a few staff hours a week.

scholarly journals Use of the Phase-Based Model of Smoking Treatment to Guide Intervention Development for Persons Living with HIV Who Self-Identify as African American Tobacco Smokers

2019 ◽  
Vol 16 (10) ◽  
pp. 1703 ◽  
Author(s):  
Rebecca Schnall ◽  
Jasmine Carcamo ◽  
Tiffany Porras ◽  
Ming-Chun Huang ◽  
Monica Webb Hooper
Keyword(s):  
Substance Use ◽  
African American ◽  
Focus Group ◽  
Tobacco Use ◽  
Support System ◽  
Tobacco Cessation ◽  
Cessation Intervention ◽  
Persons Living With Hiv ◽  
Group Sessions ◽  
Living With Hiv

Cigarette smoking is highly prevalent among persons living with the human immunodeficiency virus (HIV) (PLWH), with rates as high 50% as compared to 14% in the general U.S. population. Tobacco use causes morbidity and mortality in PLWH, and tobacco-related harm is substantially higher in PLWH than smokers in the general population, providing the scientific premise for developing effective tobacco cessation interventions in this population. To better address this issue, we conducted six focus group sessions with 45 African American smokers who are living with HIV to understand the barriers to smoking cessation and the strategies that would be helpful to overcome these barriers. We organized our findings by the Phase-Based Model of Smoking Treatment to understand the intervention components that are needed at each phase to help PLWH successfully quit smoking. Participants in our focus group sessions articulated key components for incorporation into tobacco cessation intervention for PLWH: a personalized plan for quitting, reminders about that plan, and a support system. Participants thought that their HIV and tobacco use were disassociated. Participants described barriers to the use of pharmacotherapy, including adverse side effects of the gum and patch and concerns about the negative health effects of some oral medications. Substance use was identified as a commonly co-occurring condition as well as a barrier to successfully ceasing to smoke tobacco products. In summary, these findings offer information on the components of a tobacco cessation intervention for PLWH, namely reminders, a support system, substance use treatment, and monitoring to prevent relapse.

scholarly journals Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

2021 ◽  
pp. 104973232199344
Author(s):  
Oladunni Oluwoye ◽  
Elizabeth Fraser
Keyword(s):  
Substance Use ◽  
Behavior Change ◽  
Theoretical Domains Framework ◽  
First Episode Psychosis ◽  
Barriers And Facilitators ◽  
First Episode ◽  
Evidence Based ◽  
Behavior Change Techniques ◽  
Episode Psychosis ◽  
And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

scholarly journals A Collaborative Model for Facilitating the Delivery of Smoking Cessation Treatments to Cancer Patients: Results From Three Oncology Practices in South Carolina

2018 ◽  
Vol 14 (2) ◽  
pp. 112-124
Author(s):  
Daniel J. Kilpatrick ◽  
Kathleen B. Cartmell ◽  
Abdoulaye Diedhiou ◽  
K. Michael Cummings ◽  
Graham W. Warren ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
South Carolina ◽  
Quality Improvement ◽  
Collaborative Learning ◽  
Cancer Patients ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Cancer Centers

Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.

scholarly journals Evidence for the Fidelity and Effectiveness of Living Independent From Tobacco for People with Disabilities and Their Caregivers

2019 ◽  
Vol 12 ◽  
pp. 1179173X1882507 ◽  
Author(s):  
Susan M Havercamp ◽  
Wesley R Barnhart ◽  
David Ellsworth ◽  
Erica Coleman ◽  
Allison Lorenz ◽  
...  
Keyword(s):  
Social Support ◽  
Health Promotion ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
People With Disabilities ◽  
Evidence Based ◽  
The People ◽  
Post Test ◽  
Health Related ◽  
Health Promotion Interventions

People with disabilities (PWD) are more likely to use tobacco and less likely to access tobacco cessation programs compared with people without disabilities. Living Independent From Tobacco (LIFT), an evidence-based intervention designed for PWD, was piloted with dyads of PWD (n = 5) and their caregivers (n = 7). As an important source of practical and social support for PWD, caregivers also impact health-related attitudes, knowledge, and behaviors of PWD. Caregivers who smoke may unwittingly interfere with cessation efforts of the people they support. We found that LIFT could be offered to dyads of PWD and their caregivers with fidelity. The intervention was associated with increased use of coping strategies and self-efficacy to reduce smoking. Tobacco use decreased at post-test (−34.94%), with further reduction 6-months after the intervention (−50.60%). Implications for offering inclusive health promotion interventions to both PWD and their caregivers are discussed.

scholarly journals Factors Influencing Implementation of a Workplace Tobacco Cessation Intervention in India: A Qualitative Exploration

2020 ◽  
pp. 216507992095276
Author(s):  
Himanshu A. Gupte ◽  
Marina D’Costa ◽  
Shoba Ramanadhan ◽  
Kasisomayajula Viswanath
Keyword(s):  
Occupational Health ◽  
Tobacco Use ◽  
Tobacco Cessation ◽  
Face To Face ◽  
Program Coordinators ◽  
Cessation Intervention ◽  
High Prevalence ◽  
Core Components ◽  
Workplace Setting ◽  
Qualitative Exploration

Background: Tobacco use is projected to cause more than 8 million deaths annually worldwide by 2030 and is currently linked to 1 million annual deaths in India. Very few workplaces provide tobacco cessation as a part of occupational health in India. In this study, we examined promoters and barriers to implementing an evidence-based tobacco cessation program in a workplace setting in India. Methods: In-depth interviews were conducted with all facilitators (two program coordinators and four counselors) of a workplace tobacco cessation intervention covering implementation efforts in five organizations, including three manufacturing units and two corporate settings. Findings: The identified promoters for implementation of the program were as follows: (a) workplaces that provided access to many individuals, (b) high prevalence of tobacco use that made the intervention relevant, (c) core components (awareness sessions, face-to-face counseling and 6-months follow-up) that were adaptable, (d) engagement of the management in planning and execution of the intervention, (e) employees’ support to each other to quit tobacco, (f) training the medical unit within the workplace to provide limited advice, and (g) efforts to advocate tobacco-free policies within the setting. Barriers centered around (a) lack of ownership from the workplace management, (b) schedules of counselors not matching with employees, (c) nonavailability of employees because of workload, and (d) lack of privacy for counseling. Conclusion/Implications for Practice: This study provided practical insights into the aspects of planning, engaging, executing and the process of implementation of a tobacco cessation intervention in a workplace setting. It provided guidance for an intervention within occupational health units in similar settings.

scholarly journals The Wisdom of and Science behind Indigenous Cultural Practices

Genealogy ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. 6 ◽  
Author(s):  
Rose Borunda ◽  
Amy Murray
Keyword(s):  
Mental Health ◽  
Indigenous People ◽  
Cultural Practices ◽  
Scientific Research ◽  
Indigenous Communities ◽  
Well Being ◽  
Cultural Knowledge ◽  
Evidence Based ◽  
Health Domains ◽  
Mental Well Being

Conquest and colonization have systematically disrupted the processes by which Indigenous communities of the Americas transmit cultural knowledge and practices from one generation to the next. Even today, the extended arm of conquest and colonization that sustain oppression and culturicide continue to inflict trauma upon Indigenous people. Yet, current scientific research now attests to how Indigenous cultural practices promote healing and well-being within physical as well as mental health domains. This examination addresses Indigenous cultural practices related to storytelling, music, and dance. In drawing from evidence-based research, the case is made for not only restoring these practices where they have been disrupted for Indigenous people but that they have value for all people. The authors recommend reintroducing their use as a means to promote physical, spiritual, and mental well-being while recognizing that these practices originated from and exist for Indigenous people.

scholarly journals Implementation Science to Improve Tobacco Cessation Services in Oncology Care

2021 ◽  
Vol 19 (Suppl_1) ◽  
pp. S12-S15
Author(s):  
_ _
Keyword(s):  
Implementation Science ◽  
Tobacco Use ◽  
Working Group ◽  
Tobacco Cessation ◽  
Common Interest ◽  
Evidence Based ◽  
Cancer Centers ◽  
Tobacco Treatment ◽  
Oncology Care ◽  
Science Working

Every patient with cancer deserves access to evidence-based tobacco cessation interventions as part of their routine oncology care. The NCI Cancer Moonshot funded the Cancer Center Cessation Initiative (C3I) to help establish and/or expand tobacco treatment programs at 52 NCI-designated Cancer Centers. Although this initiative has broadened the availability of tobacco treatment services across US cancer centers, the reach and utilization of these services remains low among patients. To help address the remaining gap between the availability and utilization of evidence-based treatments for tobacco use in the oncologic context, staff and investigators at C3I sites and the C3I Coordinating Center formed the C3I Implementation Science Working Group. The mission of this working group is to bring together clinicians, scientists, and policymakers who share a common interest in implementation science and treating tobacco use in the oncologic context to collaborate on projects aimed at shrinking the practice gap in this area. Through case study examples, we describe how the C3I Implementation Science Working Group is supporting efforts to identify effective ways to increase the utilization of evidence-based tobacco treatments within cancer treatment settings and promote the broader impact and long-term sustainability of C3I.

scholarly journals Factors Associated with the Adoption of Tobacco Cessation Programmes in Schools

2016 ◽  
Vol 12 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Melissa A. Little ◽  
Pallav Pokhrel ◽  
Steve Sussman ◽  
Karen J. Derefinko ◽  
Zoran Bursac ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Tobacco Cessation ◽  
Community Organization ◽  
School Level ◽  
Evidence Based ◽  
Tobacco Prevention ◽  
Tobacco Use Cessation ◽  
Cross Sectional ◽  
Tobacco Use Prevention ◽  
Tobacco Education

Background: Although there are now a number of evidence-based tobacco use cessation programs available for dissemination, almost all adolescent tobacco cessation research comprises efficacy and effectiveness studies. As a result, there is a need for more research to guide the scaling up of these programs.Methods: The current study utilized data from a cross-sectional sample of 205 administrators and tobacco prevention program coordinators in school districts and county offices of education throughout California, to explore factors that affect the adoption of tobacco cessation programs in schools.Results: We found that several characteristics of the community, organization and individual respondent were associated with the adoption of evidence-based tobacco cessation programs in schools, including identifying tobacco use prevention as a community priority, having school-level SUP coordinators, greater coordinator effort devoted to tobacco use prevention, having a program champion, and currently receiving TUPE funds (all ps < .05).Conclusions: Although the availability of dedicated tobacco education funds is an important factor in schools adopting tobacco cessation programs with proven effectiveness, our results suggest that strengthening education agencies' capacity to implement prevention programming, through dedicated resources and personnel, has the potential to lead to increased adoption of tobacco cessation programs.

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