Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers

Tobacco use is exceedingly high among individuals receiving care for opioid addiction, but not commonly addressed by clinicians in treatment settings. Taking Texas Tobacco Free (TTTF) is a comprehensive tobacco-free workplace (TFW) program that builds treatment centers’ capacity to address tobacco use with evidence-based tobacco cessation policies and practices. Here, we examine the process and outcomes of TTTF’s implementation within 7 opioid addiction centers. Program goals were structured according to the RE-AIM framework. Pre- and post-implementation data were collected from client facing and non-client facing employees to assess changes in education, training receipt, knowledge, and intervention behaviors, relative to program goals. Centers reported tobacco screenings conducted and nicotine replacement therapy (NRT) delivered through 6 months post-implementation. Overall, 64.56% of employees participated in TTTF-delivered tobacco education, with a 54.9% gain in tobacco control and treatment knowledge (p < 0.0001), and significant increases in exposure to education about tobacco use and harms among individuals with opioid use disorder (p = 0.0401). There were significant gains in clinicians’ receipt of training in 9/9 tobacco education areas (ps ≤ 0.0118). From pre- to post-implementation, there were mean increases in the use of the 5A’s (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with statistically significant gains seen in NRT provision/referral (p < 0.0001). Several program goals were achieved or exceeded; however, 100% center participation in specialized clinical trainings was among notable exceptions. One program withdrew due to competing pandemic concerns; all others implemented comprehensive TFW policies. Overall, TTTF may have improved participating opioid treatment centers’ capacity to address tobacco use, although study limitations, including lower post-implementation evaluation response rates, suggest that results require replication in other opioid addiction treatment settings.

Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers

Tobacco use is disproportionately elevated among patients with substance use disorders relative to the general U.S. population. Tobacco interventions are lacking within substance use treatment centers (SUTCs) due to lack of knowledge and training. This study examined knowledge gain and the organizational factors that might moderate knowledge gains following tobacco education training provided to employees (N = 580) within 15 SUTCs that were participating in a tobacco-free workplace program. The number of total annual patient visits, unique annual patient visits, number of full-time employees, and organizational readiness for implementing change (ORIC) as assessed prior to implementation were examined as potential moderators. Results demonstrated significant knowledge gain (p < 0.001) after training overall; individually, 13 SUTCs had significant knowledge gain (p’s < 0.014). SUTCs with fewer total annual patient visits and fewer full-time employees showed greater knowledge gains. The ORIC total score and all but one of its subscales (Resource Availability) moderated knowledge gain. SUTCs with greater initial Change Efficacy (p = 0.029), Valence (p = 0.027), and Commitment (p < 0.001) had greater knowledge gain than SUTCs with lower scores on these constructs; SUTCs with greater Task Knowledge (p < 0.001) regarding requirements for change exhibited less knowledge gain. Understanding the organizational-level factors impacting training effectiveness can inform efforts in organizational change and tobacco control program implementation.

Evaluation of an Intensive Education Program on the Treatment of Tobacco-use Disorder for Pharmacists: A Randomized Controlled Trial

Tobacco use is one of the main causes of premature deaths and preventable diseases in Qatar. The aim of this randomized controlled trial (RCT) is to design, implement, and evaluate an intensive education program on tobacco-use treatment for pharmacists in Qatar. The study objectives are to assess the effectiveness of the program on pharmacists’ knowledge, skills, attitudes and perceived self-efficacy toward tobacco cessation. Methods: Community pharmacists practicing in Qatar were eligible for participation in the study. Consenting participants were randomly allocated to intervention or control groups. Participants in the intervention group received an intensive education program on treatment of tobacco-use disorder. A short didactic session on a non-tobacco-related topic was delivered to pharmacists in the control group. Outcomes were assessed using survey instruments. Results: Participants in the intervention group (n=57) achieved significantly higher total tobacco-related knowledge scores (mean=33 points) than those in the control group (n=37) (mean=24.5 points) with a p-value of <0.001. Post-intervention total knowledge scores were significantly higher than the baseline scores for participants who received intensive tobacco education with a mean difference of 6.6 points (p-value <0.001). Overall attitudes toward tobacco cessation and self-efficacy in tobacco cessation interventions were better in the group of pharmacists who received tobacco education compared to those who did not. For instance, 43.4% of pharmacists in the intervention group “strongly agreed” that their counseling will increase a patient’s likelihood of quitting tobacco use compared to 14.7% in the control group (p-value=0.014). Furthermore, 20.4% of pharmacists in the intervention group reported that they are “extremely confident” to use appropriate questions to ask patients when providing tobacco cessation counseling versus 5.9% in the control group (p-value=0.005). Conclusion: The findings of this study suggest that provision of an intensive educational program on the treatment of tobacco use disorders results in improved tobacco-related knowledge and self-efficacy in tobacco cessation interventions.

Social media use by leading US e-cigarette, cigarette, smokeless tobacco, cigar and hookah brands

BackgroundYouth and young adults frequently use social media and are susceptible to tobacco use. This study is the first to provide a systematic overview of how leading tobacco product brands use popular social media platforms.MethodsWe identified 112 leading brands of e-cigarettes, hookah, cigars, cigarettes and smokeless tobacco based on sales and self-report user data. We searched for each brand on six platforms: Instagram, Facebook, Twitter, YouTube, Pinterest and Tumblr. In early 2019, we conducted a content analysis of each page, coding: age restrictions, warning display, page characteristics and post characteristics.ResultsCigarette brands were generally not present. Most e-cigarettes, hookah and cigar brands had pages on at least two platforms. One-third of smokeless brands had pages on at least one platform. Few brands had pages on Pinterest and Tumblr. Most pages had existed for 3–5 years. Overall, brand pages rarely used age gating, did not display health warnings, generally posted images of a product alone and often used hashtags unrelated to tobacco. Brands commonly used special features like ephemeral posts on Instagram and pop-up chat windows on Facebook. Many pages displayed images of young people and mentioned flavour. Median followers per brand ranged from about 1 000–10 000, and total followers summed across brands reached over 5 million on Facebook and Instagram alone.ConclusionsLeading brands of most tobacco product types use social media extensively. Several findings identify issues related to youth exposure to and appeal of tobacco social media marketing. Findings can inform tobacco education efforts and regulation.

High School Youth and E-cigarettes: The Influence of Modified Risk Statements and Flavors on E-cigarette Packaging

Objectives: In this paper, we test variations of e-cigarette warning labels on high school youth, alone, and alongside modified risk statements (MRS) and/or flavors, to determine how perceptions of and intentions toward use of e-cigarettes are influenced by these package elements. Methods: An experiment (N = 715 high school youth) varied the warning label participants viewed (FDA warning label/ MarkTen warning label/ abstract warning label) and whether they viewed the label alone or alongside MRS and/or flavors. Results: Drawing upon the Heuristic Systematic Model, we found that youth who view an MRS with any of the warning labels are more likely to engage in counterarguing (compared to the FDA warning label alone), which increases risk perceptions. Additionally, the greater youth perceive the risks associated with e-cigarettes, the lower their intentions of using them, even if they have tried an e-cigarette in the past. Conclusions: Tobacco education and public health messages should encourage youth to evaluate the tobacco industry messages they receive, as counterarguing is associated with higher risk perceptions. Furthermore, fostering increased awareness of the risks associated with e-cigarette use by youth can reduce intentions to use them.

STUDY BASED ON DIAGNOSIS AND EVALUATION OF PATIENTS AFFECTED BY ORAL SUBMUCOUS FIBROSIS (OSMF) FROM BIHAR REGIONS

OSMF (Oral Submucous Fibrosis) is a widely recognized precancerous condition which is also looked upon as a potentially malignant disorder of and is characterized by a reduction in mouth opening, having palpable circumoral fibrous bands either on one side or bilaterally along with the sensation of “burning mouth”. The condition is defined as “an insidious, chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa causing trismus and inability to eat”. The increased consumption of commercially prepared arecanut preparations (Gutkha, Pan masala) specially in the younger generation has led to such high incidence of this diseasein certain areas of India. Based on above reported findings the present study was planned for Study of Cases of Oral Submucous Fibrosis (OSMF) from Bihar Region. All the patients were informed consents. The aim and the objective of the present study were conveyed to them. Approval of the institutional ethical committee was taken prior to conduct of this study. Total 30 cases of the patients suffering from oral submucous fibrosis were enrolled in the present study. In conclusion, the result of present study provides information on the prevalence of oral mucosal lesion in our population. It is important that preventive efforts be carried out by the concerned authorities and public health professionals in establishing tobacco cessation clinics and tobacco education in such masses (especially the young generation) along with a long standing and a close knit motivation program that enables our future generations to come to avoid the menace of tobacco and its subsequent health effects. Keywords: Oral Submucous Fibrosis, OSMF, Oral Cancer, Bihar region, etc.

Tobacco cessation training in 6-year pharmacy schools in Japan: a cross-sectional survey

ObjectivesThis study aimed to identify the extent of tobacco cessation training content, including the introduction of a comprehensive programme; and the presence of tobacco-related topics, including new tobacco products, school years and course of training, educators, and attitudes and policies relevant to tobacco education in pharmacy schools in Japan.DesignA cross-sectional survey.SettingAll pharmacy schools in Japan with a 6-year course of training were invited to participate.MethodsPharmacy schools in Japan that agreed to participate in a web-based survey asking about tobacco cessation training, and attitudes and policies relevant to tobacco education.Primary and secondary outcome measuresThe primary outcome was the number of pharmacy schools that introduced comprehensive tobacco cessation training in their curriculum. The secondary outcome was to clarify the curriculum coverage of 9 basic knowledge and 10 tobacco cessation-specific topics, including new tobacco products.ResultsOf the 75 pharmacy schools with a 6-year course in Japan, 52 (74%) responded to the survey. While 27 (52%) schools reported that comprehensive tobacco cessation training would be beneficial, only 1 school had introduced it as a one-credit elective course in the fifth year. Basic knowledge topics for tobacco cessation listed in or related to the Model Core Curriculum were covered by 44%–65% of the schools, while practical skills were covered in 10%–19% of the schools. Only seven schools (14%) introduced the topic of new tobacco products in their curriculum.ConclusionsThis study revealed that comprehensive tobacco cessation training is not generally offered in pharmacy schools in Japan. The Model Core Curriculum should revise its standards to implement updated tobacco cessation training programmes to keep up with new tobacco products and to train pharmacy students on counselling users of such products.Trial registration numberTokyo University of Pharmacy and Life Sciences No. 17 – 14.