Delivery Of Smoking Cessation Services Research Articles

Innovations in parental smoking cessation assistance delivered in the child healthcare setting.

Addressing parental smoking in the child healthcare setting improves the health of all family members. Innovative approaches, such as mobilizing technology-based platforms, may streamline screening and motivate acceptance of behavioral health services to treat tobacco use and dependence. The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use. Child healthcare practices in five states (IN, NC, OH, TN, and VA) used an electronic tablet screener to identify tobacco use within families and deliver tobacco cessation assistance to smokers. Motivational/educational videos on cessation were displayed via the screener to enhance its utility. Five CEASE intervention practices screened 50,111 family members for tobacco use and identified 6,885 families with children exposed to tobacco smoke. The mean number of screeners per practice per month was 417; the mean number of households with smokers identified per month was 57. Of 2,764 smokers who were at visits and consented, 57% indicated that they wanted a prescription to reduce or quit smoking; 94% of these were given preprinted prescriptions. Of 41% who requested connection to the quitline, 93% were given enrollment forms. Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke. Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice. CLINICAL TRIALS REGISTRATION: Trial Number NCT01882348.

Examining retail purchases of cigarettes and nicotine replacement therapy in Finland.

INTRODUCTIONFinland’s success in achieving the goal of its tobacco endgame largely depends on rectifying deficiencies in the delivery of smoking cessation services. One such weakness, which has not been documented with empirical data, is misuse of nicotine replacement therapy (NRT). This study’s objective was to examine purchase patterns of NRT for estimating improper use of the medication. The study was based on the assumption that duration of a purchase episode is indicative of either proper use or misuse of NRT.METHODSThe participants (n=728), who purchased at least one NRT product in 2016 (mostly gum/lozenge), were selected through enrollment in a large customer loyalty program in Finland (LoCard). Participants were categorized into one of five groups according to their longest purchase episode of NRT, defined by purchases made in consecutive, 4-week intervals.RESULTSMost participants, who did not adhere to NRT guidelines, either purchased the medication for too short (≤4 weeks, 63.5%) or too long (>24 weeks, 13.2%) of a purchase episode. Median purchases of NRT in the first month of use were one and four in the former and latter, respectively. In contrast to other groups, persistent users (>24 weeks) did not curtail purchases of NRT across several 4-week intervals, suggesting potential for dependence on NRT.CONCLUSIONSThe observation that most purchase episodes were terminated prematurely is consistent with surveys reporting widespread NRT misuse. Given uncertainty of greater regulation of NRT sales through legislation, it would be prudent for Finnish retailers to promote proper use of the therapy.

Strategic Priorities to Improve Effectiveness of Anti-smoking Interventions for the Korean Military: An Application of the Analytic Hierarchy Process.

As South Korea remains technically at war with the North, higher smoking prevalence in the military might adversely affect the South Korea's military power and contribute to lifetime smoking in men with mandatory military service. This study was to identify priorities among the anti-smoking strategies to improve the existing smoking cessation programs for the Korean military. The analytic hierarchy process model with a goal, decision criteria, and sub-criteria as well as candidate strategies, was developed following a literature search and expert group discussion. A survey for pairwise comparison was conducted to determine the priority of the (sub-)criteria and strategies by 14 experts. The Super-Decisions software was used to determine the priorities and to analyze their consistency ratios and sensitivities. The study was approved by the ethics committee of the Korea Ministry of Health and Welfare. Eight candidate strategies were developed to improve the effectiveness of military anti-smoking interventions as follows: (1) development of outcome enhancement plans for smoking cessation programs for the military, (2) development of differentiated smoking cessation programs for specific groups, (3) building of community network for continuity and accessibility of anti-smoking project, (4) building of industry-academia-government networks for anti-smoking project, (5) improvement of the perception of and strengthen the reward for smoking cessation, (6) development of a training system for army clinicians for the delivery of smoking cessation services, (7) creation of a certification system for smoking cessation programs, and (8) development of an evaluation system of project performance for smoking cessation. Through the analytic hierarchy process survey, the military specificity and its sub-criterion of practicality were selected as the top concerns of decision criteria for the anti-smoking strategies among the decision criteria of outcome improvement, military specificity, publicness, and economic efficiency. The most important strategy was to improve the perception of and strengthen the reward for smoking cessation. This strategy was most focused on the creation of an anti-smoking environment and improvement of the effectiveness of the projects. The creation of a training system for army clinicians for the delivery of smoking cessation services ranked second. In conclusion, motivating smoking cessation and utilizing well-trained army clinicians were found to be the most important anti-smoking strategies for the Korean military. This study might provide valuable insights for policy makers to reduce tobacco use in the Korean military.

Wula (Voices) of Aboriginal women on barriers to accepting smoking cessation support during pregnancy: Findings from a qualitative study.

To gather Aboriginal women's stories of smoking and becoming pregnant to identify the barriers in accepting smoking cessation support during pregnancy. Qualitative data were collected through use of yarning methodology between August 2015 and January 2016 by an Aboriginal Researcher with experience in social and community services. A short on-line survey was used to collect quantitative data. Interviews only recorded the therapeutic yarning process, which ranged from 9 to 45min duration, averaging 30min. Audio-recorded interviews were transcribed and independently coded. A general inductive analysis was used to determine emergent themes. Twenty Aboriginal women between 17-38 years of age, who were pregnant or recently given birth, living in the Hunter New England (HNE) area took part. Eleven women were still smoking; nine had quit. Most were highly aware of the implications of smoking for their babies. Major themes identified for accepting support were: ambivalence towards a need for support, health professional advice, reduction in smoking, and attitudes to Nicotine Replacement Therapy (NRT). Women reported being advised to cut down, rather than to quit; reducing consumption may be a barrier to accepting NRT. Women recommended enhanced clinical support and Aboriginal community engagement in cessation care. Aboriginal women in the HNE area reported quitting or reducing their cigarette intake during pregnancy. Health Professionals working with Aboriginal women during pregnancy should give consistent messages to quit smoking completely, and offer increased, ongoing and extensive smoking cessation support to Aboriginal mothers. Clinical practices could partner with Aboriginal communities to support the delivery of smoking cessation services.

Exploring Smoking Cessation Attitudes, Beliefs, and Practices in Occupational Health Nursing.

The purpose of this study was to explore occupational health nurses' attitudes, beliefs, and practices regarding the delivery of smoking cessation services to workers. The study included 707 members of the American Association of Occupational Health Nurses (AAOHN) who completed a one-time survey during the fall of 2012. Results indicated that occupational health nurses believed that evidence-based treatments are at least somewhat effective and that they should provide smoking cessation services to their workers; however, a majority of occupational health nurses reported that they did not have appropriate smoking cessation training or guidelines in their workplaces. Occupational health nurses would benefit from training in the use of smoking cessation guidelines and evidence-based smoking cessation interventions, which could be used in their clinical practice. Employers should ensure that workplace policies, such as providing coverage for cessation services, facilitate smokers' efforts to quit. Employers can benefit from many of these policies through cost savings via reduced health care costs and absenteeism.

Smoking cessation services and smoke-free policies at substance abuse treatment facilities: national survey results.

The high prevalence of cigarette smoking among substance-abusing patients has raised concern. This study assessed the prevalence of and factors related to smoking cessation services and smoke-free policies in substance abuse treatment facilities in the United States. Facility-level data were obtained from the 2012 National Survey of Substance Abuse Treatment Services (N=13,094). Multivariate logistic regressions were used to examine institutional- and state-level factors associated with use of smoking cessation services and smoking bans. Of all facilities, 46.8% offered behavioral counseling or pharmacotherapy services for smoking cessation, and 35.2% banned smoking on the property. Programs were more likely to offer smoking cessation services and to ban smoking if they had the following characteristics: they offered inpatient services, accepted government insurance, were licensed by state mental health departments, or were located in metropolitan areas, states with comprehensive smoke-free laws, or states where >30% of substance abuse treatment facilities were smoke free. Public programs were more likely than private for-profit organizations to offer smoking cessation services and to ban smoking. Providing a greater number of services was positively associated with delivery of smoking cessation services but negatively associated with smoking bans. Larger programs were more likely to provide smoking cessation services but less likely to ban smoking. Institutional characteristics and state environments influenced provision of smoking cessation services and smoke-free policies at substance abuse treatment facilities. These factors could be used to design comprehensive programs for dissemination of smoking cessation treatment and promotion of smoking bans at these facilities.

Promoting Tobacco Cessation in a Community-Based Women's Health Centre.

ObjectiveThis report assesses the impact of a series of education sessions delivered to office staff on the delivery of smoking cessation services among patients seeking care at a community-based women’s health center.MethodsA quasi-experimental design was used to examine the delivery of smoking cessation services to patients in a medical office before and after office staff attended a series of 3 educational sessions intended to increase their knowledge and self-efficacy to address cessation. Delivery of smoking cessation services was documented through a systematic review of medical records using a structured abstraction form.ResultsWhile nearly all smokers (93%) were asked about smoking status at their last office visit, few smokers at baseline or follow-up were assessed for interest in setting a quit date or offered pharmacotherapy. Referrals to the smokers quit line increased from <1% at baseline to 8% at follow-up (p<0.001) and “any assistance” also showed a modest but significant increase (<1% baseline, 9% follow-up, p<0.001).ConclusionThis evaluation failed to identify clinical meaningful changes in the delivery of smoking cessation services in this women’s health office before and after completion of a series of educational interventions for office staff. It is anticipated that the implementation of patient centered medical homes, and EMR systems, will help to enhance the delivery of smoking cessation services to women seeking medical care.

Implementing Best Evidence in Smoking Cessation Treatment for Hospitalized Veterans: Results from the VA-BEST Trial

Although the US Department of Veterans Affairs (VA) has promoted adherence to smoking cessation guidelines since 1997, hospitalized smokers do not consistently receive assistance in quitting. In a pre-post guideline implementation trial on the inpatient medicine units of four VA hospitals, the effectiveness of a multimodal intervention (enhanced academic detailing, modification of the nursing admission template, patient education materials and quitline referral, practice facilitation and staff feedback) changing practice behavior was evaluated. Peridischarge interviews were conducted with 824 patients to assess receipt of nurses' and physicians' delivery of the 5A's (Ask, Advise, Assess, Assist, Arrange) in hospitalized smokers. Subjects were significantly more likely to have received each of the 5A's from a nurse during the postimplementation period (except for "advise to quit"). More patients were assisted in quitting (75% versus 56%, adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.6, 3.1) and had follow-up arranged (23% versus 18%, adjusted OR = 1.5, 95% CI = 1.0, 2.2) by a nurse during the postimplementation period. However, unadjusted results showed no improvement in seven-day point prevalence abstinence at six-month follow-up (13.5% versus 13.9%). Nurses' self-efficacy in cessation counseling, as measured in a survey of 166 unit nurses, improved following guideline implementation. A multifaceted intervention including enhanced academic detailing is an effective strategy for improving the delivery of smoking cessation services in medical inpatients. To promote long-term cessation, more intensive interventions are needed to ensure that motivated smokers receive guideline-recommended treatment (including pharmacotherapy and referral to outpatient cessation counseling).

Assessing the Delivery of Cessation Services to Smokers in Urban, Safety-Net Clinics

Inequities in smoking behaviors continue to exist with higher rates among persons with limited formal education and for those living below the poverty level. This report describes the scope of tobacco cessation services delivered to low socio-economic status (SES) patients in several primary care medical offices, considered as "safety-net" sources of health care. Using a cross-sectional design, a random sample of records were reviewed for 922 smokers from 4 medical offices. The primary outcome variable was the delivery of smoking cessation services as documented in medical records; information on patient demographics and number of visits during the past 12 months was also abstracted. Smoking status was assessed during the last office visit for 65 % of smokers, 59 % were advised to quit, readiness to quit was assessed for 24 %, 2 % indicated a willingness to quit within the next 30 days and a quit date was established for 1 %. Among smokers not yet ready to quit, few were counseled on the "5 R's" (Relevance, Risks, Rewards, Roadblocks, Repetition). These results expand our understanding of the unfortunately limited scope of cessation services delivered to persons seen in safety-net medical offices and call attention to the need to redouble efforts to more effectively address smoking cessation among diverse, low SES patients served by safety-net primary care clinics.

Nurses' delivery of the Tobacco Tactics intervention at a Veterans Affairs Medical Center

To determine (1) factors associated with nurses' perceived confidence in and importance of delivering cessation interventions to patients after receiving the Tobacco Tactics educational module, and (2) whether self-reported delivery of smoking cessation services increased after the Tobacco Tactics educational programme was implemented. Intensive nurse-based inpatient smoking cessation interventions are effective; however, due to a lack of nurse confidence, training and time, nurse-administered cessation interventions are seldom implemented. Two cross-sectional surveys among staff trained in the Tobacco Tactics programme, conducted at two months and 15months post-training. Surveys were conducted to determine whether self-reported delivery of smoking cessation services by nursing staff increased after delivery of the Tobacco Tactics training at a Midwestern Veterans Affairs Medical Center. All staff members who attended the training were eligible to complete the surveys at two and 15months post-training. Having a good understanding of the elements of smoking cessation interventions and satisfaction with training were associated with perceived confidence and importance of delivering smoking cessation interventions. Additionally, 86% of participants reported delivering cessation interventions 15months post-training compared with 57% prior to training (p<0·0001). Training nurses how to deliver tobacco cessation interventions increases delivery of cessation services. Nurse-delivered cessation interventions have the potential to increase quit rates and decrease morbidity and mortality among patient populations.

Evaluation of an Intervention to Enhance the Delivery of Smoking Cessation Services to Patients with Cancer

We describe a brief staff training program to improve the delivery of tobacco cessation services to patients with head and neck cancers. This study utilized a quasi-experimental design to compare the delivery of smoking cessation components and outcomes among patients exposed to either usual care (UC) or an enhanced cessation (EC) program implemented following a 1-h staff education program. Of the 179 subjects enrolled, 112 were recontacted by phone 1 month after their clinic visit. More patients in EC compared to UC reported that they were asked about their smoking status (94.2% vs. 76.6%, p = 0.01), advised to quit (92.3% vs. 72.3%, p = 0.01), prescribed cessation medications (30.8% vs. 3.3%, p < 0.001), and received a support call (53.8% vs. 11.7%, p < 0.001) at the 1-month follow-up. Quit attempts and quit rates between groups were similar. The EC intervention improved the delivery of cessation services in a busy clinical setting, but this failed to increase cessation rates after 1 month.

Cost-effectiveness of varenicline and three different behavioral treatment formats for smoking cessation

There is a lack of evidence of the relative cost-effectiveness of proactive telephone counseling (PTC) and Web-based delivery of smoking cessation services in conjunction with pharmacotherapy. We calculated the differential cost-effectiveness of three behavioral smoking cessation modalities with varenicline treatment in a randomized trial of current smokers from a large health system. Eligible participants were randomized to one of three smoking cessation interventions: Web-based counseling (n=401), PTC (n=402), or combined PTC-Web counseling (n=399). All participants received a standard 12-week course of varenicline. The primary outcome was a 7-day point prevalent nonsmoking at the 6month follow-up. The Web intervention was the least expensive followed by the PTC and PTC-Web groups. Costs per additional 6-month nonsmoker and per additional lifetime quitter were $1,278 and $2,601 for Web, $1,472 and $2,995 for PTC, and $1,617 and $3,291 for PTC-Web. Cost per life-year (LY) and quality-adjusted life-year (QALY) saved were $1,148 and $1,136 for Web, $1,320 and $1,308 for PTC, and $1,450 and $1,437 for PTC-Web. Based on the cost per LY and QALY saved, these interventions are among the most cost-effective life-saving medical treatments. Web, PTC, and combined PTC-Web treatments were all highly cost-effective, with the Web treatment being marginally more cost-effective than the PTC or combined PTC-Web treatments.

Substance Abuse Treatment Counselors and Tobacco Use: A Comparison of Comprehensive and Indoor-Only Workplace Smoking Bans

While indoor smoking bans reduce employee tobacco use, less is known about whether comprehensive bans, which prohibit smoking in both indoor and outdoor areas, are associated with lower rates of tobacco use than indoor-only bans. This study integrated data collected via mailed surveys from 1,910 substance abuse treatment counselors and telephone interviews with 417 administrators of substance abuse treatment organizations. Multinomial logistic regression was used to estimate the associations between counselors' self-reported tobacco use and administrators' reports about organizational smoking bans while controlling for counselors' professional and demographic characteristics. In this sample, 20.3% of counselors were current tobacco users, 47.7% identified as former users, and 32.0% reported never using tobacco products. Only 19.5% of counselors worked in a treatment organization that had a comprehensive smoking ban. The likelihood of being a current tobacco user, compared with being a former user or nonuser, was significantly lower for counselors in organizations with comprehensive bans even after controlling for professional and demographic characteristics. Although relatively few substance abuse counselors worked in treatment organizations with comprehensive bans, such bans may represent a promising direction for tobacco control. Given recent research documenting how tobacco use is negatively associated with the delivery of smoking cessation services by health care workers, additional research on the impact of comprehensive environmental tobacco policies is needed.

Cigarette smoking cessation services in outpatient substance abuse treatment programs in the United States

Objective The objective of this study was to estimate the prevalence and determinants of cigarette smoking cessation treatment in U.S. outpatient substance abuse treatment (OSAT) units. Methods Program directors and clinical supervisors from a national sample of 550 OSAT units in the United States were surveyed in 2004–2005. Supervisors reported the availability of cigarette smoking assessment, and individual or group counseling and pharmacotherapy for smoking cessation. This analysis examines whether institutional and resource factors influence the delivery of these services. Results Of OSAT programs in the United States, 41% offer smoking cessation counseling or pharmacotherapy, 38% offer individual/group counseling, and 17% provide quit-smoking medication. In multivariate models, hospital affiliation, service breadth, the priority given to physical health, the availability of medication to treat addictive problems, assessment of cigarette smoking, and a greater perception of the proportion of patients who smoke were associated with the delivery of smoking cessation services. Program size and medical staffing also influenced the availability of quit-smoking medication. Conclusions Of U.S. OSAT programs, two in five offer behavioral treatment for smoking cessation, but fewer than one in five provide access to pharmacotherapy. Substance abuse treatment programs that are medically oriented, provide more comprehensive services, and recognize the burden of tobacco smoking among their patients are more likely to deliver evidence-based smoking cessation services.

Dentists’ and dental hygienists’ role in smoking cessation: an examination and comparison of current practice and barriers to service provision

Dentists and dental hygienists are important but under-used professionals in the delivery of smoking cessation services. This study compared confidence and barriers among dentists and dental hygienists and analysed the impact of barriers on smoking cessation activities. Participants were surveyed on their confidence, perceived barriers, level of smoking cessation activity and practice and demographic factors. Fifty-eight dental hygienists (83% response rate) and 334 dentists (54% response rate) practising in South Australia responded to the survey. Participants indicated high rates of advising patients to quit smoking, but low rates of assisting and referring patients. Hygienists reported greater levels of activity and confidence, fewer barriers and longer consultation times. Confidence, system barriers, and practitioner barriers emerged as the most important predictors of service provision for both dentists and hygienists. Reported levels of smoking-specific education and training were very low (dentists 4%, hygienists 6%). There is potential to increase dentists' and dental hygienists' rates of smoking cessation activity, particularly for the more proactive strategies such as assisting patients to quit and arranging referrals.

Relationship Between Tobacco Control Policies and the Delivery of Smoking Cessation Services in Nonprofit HMOs

This project examined tobacco policies and delivery of cessation services in nonprofit HMOs that collectively provide comprehensive medical care to more than 8 million members. Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study. We also surveyed a random sample of 4207 current smokers who had attended a primary care visit in the past year (399-528 at each of nine health plans). Of these smokers, 71% reported advice to quit, 56% were asked about their willingness to quit, 49% were provided some assistance in quitting (mostly self-help material or information about classes or counseling), and 9% were offered some kind of follow-up. Smokers receiving assistance in quitting reported higher satisfaction with their care. In general, health plans with the most comprehensive policies also showed higher rates of implementing tobacco treatment programs in primary care. Compared with tobacco control efforts of a decade or more ago, considerable progress has been made. However, there is still room for improvement in the proportion of smokers who receive the most effective forms of assistance in quitting.

The delivery of smoking cessation services: current status and future needs

What I will try to do is to present a base of information on the extent to which various smoking cessation services and messages are delivered. I will cover the major channels through which such services and messages are delivered, and I will talk about the benefits of each channel. I will also address what I perceive to be the need to enhance the effectiveness or volume of messages and programmes through those channels. ### Benefits If we start with the mass media, the benefits include the wide reach and cost-effectiveness – and I use that latter term advisedly. What I refer to here is the likelihood that mass media messages on stopping smoking are more likely to get more people to stop smoking per dollar spent than other smoking cessation programmes and strategies. Ken Warner cited the best example: the anti-smoking public service announcements on television and radio in the late 1960s under the Federal Communications Commission’s Fairness Doctrine.1 Also, the mass media allow us to reach high- risk groups that are difficult to reach through other channels, such as unemployed people. Messages through the mass media augment, reinforce, and tie into other services and programmes, such as telephone hotlines and quit-smoking classes. ### Current status What’s the current status of messages being delivered through mass media? Mostly the messages are in the form of public service announcements produced by federal agencies (eg, the Office on Smoking and Health of the Centers for Disease Control and Prevention; the National Cancer Institute; and the National Heart, Lung, and Blood Institute), the voluntary health agencies, and State health departments.2,3 We have, to my knowledge, paid TV or radio messages or paid space on billboards in only three states. California spends about $16 million a year on a paid media campaign funded through their tobacco …