Tobacco Treatment Specialist Research Articles

Smoking Intervention Practices in Texas Healthcare Centers with Sexual and Gender Minority Patients.

This study evaluated the use of evidence-based practices (EBPs) for smoking cessation in centers providing behavioral healthcare for patient populations that included some proportion of sexual and gender minorities (SGMs). Healthcare providers from 75 healthcare centers across Texas serving SGMs with behavioral health needs participated in a survey assessing their center's tobacco control policies and practices. Nearly half (N = 36) of participating centers had a comprehensive tobacco-free workplace policy, 30.67% employed ≥1 tobacco treatment specialist, 73.91% employed ≥1 prescriber, 80.82% mandated screening for patient tobacco use at intake, and 57.53% provided a template for tobacco use assessments. Overall, 70.67% of providers asked patients about smoking status, 69.33% advised patients to quit, 64.00% assessed patients' interest in quitting, 58.67% assisted patients with quit attempts, and 36.00% arranged follow-up. Providers' ability to tailor interventions for special populations like SGMs ranged from very low/0 to very high/10 (M = 4.63 ± 2.59). There are opportunities to improve policy implementation, standardization and usage of evidence-based interventions, and intervention tailoring within settings providing care to SGM patients in Texas to better address their tobacco use inequities.

Study protocol for a hybrid type 1 effectiveness-implementation trial testing virtual tobacco treatment in oncology practices [Smokefree Support Study 2.0

BackgroundPersistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings.Methods/designThis two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes.DiscussionThis trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery.Trial registrationClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.

Policy Proposal for Integration of Tobacco Cessation Interventions into Oral Health Care in Dental Settings

Background: Due to the health consequences and economic losses associated with tobacco, the WHO Framework Convention on Tobacco Control, a worldwide effort to control the effects of tobacco smoking on human health enacted a set of policies to curb tobacco use. Smoking cessation services aim to ensure that every patient is screened for tobacco use, their tobacco use status is documented, and patients who use tobacco are advised to quit. Dental health professionals are strategically positioned to reach many tobacco users and this proposal provides a simple framework whereby dentistry could play a major role in smoking cessation efforts.
 Interventions: Strategies for incorporating Cessation Services into Oral Health Care Delivery include the School Oral Health programs through Public Health Dentistry, updating the Dental School Curriculum through dental education regarding tobacco use prevention and cessation; including Tobacco Treatment Specialists certification in Postgraduate Curriculum for Dental Public Health; Continuing Medical Education (CME) focused on cessation services for dental personnel; Clinical Smoking Cessation Interventions in Dental settings; Compensation of Dental personnel for tobacco use prevention and cessation services; and ongoing research, evaluation and monitoring.
 Conclusion: Incorporation of these evidence-based treatments into dental practice would result in more individuals achieving long-term abstinence and thus reduce tobacco-related death, disease, and economic loss worldwide.
 Author
 A Oyapero 1, O Erinoso 2, O Olatosi 3

A Comparison of Recommendations from a Computer-Based Decision System and Tobacco Treatment Specialists: Insights and Lessons Learned.

This pilot study examines the similarities and differences between treatment recommendations offered by a decision system and trained tobacco treatment specialists. Using a sample of ten de-identified patient cases who used tobacco, we compared recommendations from the manual and preliminary review of cases by four tobacco specialists with the automated analysis of patient cases using both the first version of the rule-based system and the second version with improved and additional rules.

Evaluation of a Tobacco Treatment Training Program.

There is a need for program evaluations associated with educating healthcare professionals about the treatment of patients who use tobacco. The purpose of this study was to evaluate a Tobacco Treatment Specialist Training program with a pre-test and post-test (provided six months after the program) to determine if participants-maintained knowledge and practices to help patients with tobacco cessation in a mixed-model analysis. A pre-test survey was administered to attendees of a three-day tobacco treatment training continuing education certification program. After 6 months, the attendees were provided a post-test survey with open-ended and Likert-style questions. There were 98 participants who completed the pre-test and 16 who completed the post-test. Responses to the knowledge, confidence, and skills post-test indicated that there was significant improvement and maintenance at the six-month post-test. For example, knowledge improved from a mean of 61.1% (SD: 25.6%) to a mean of 87.9% (SD: 14.4%); medians of 66.7% and 77.7%, respectively, p < 0.001. The in-depth, intensive, three-day TTS training program had a lasting impact. Providers reported greater commitment to helping their patients quit and maintain tobacco cessation habits.

Training Tobacco Treatment Specialists through Virtual Asynchronous Learning

Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years.

Integration of a Tobacco Treatment Specialist into Primary Care: Perception from Multidisciplinary Team

Background Tobacco continues to be on the leading cause of avoidable death. Primary care practices are ideal locations to provide tobacco cessation visits. Tobacco treatment specialists are trained individuals with expertise in providing medication and counseling management to patients to help with tobacco cessation. Purpose The purpose of this study was to examine the integration of a tobacco treatment specialist into the primary care setting and the perception of this role from the multidisciplinary team. Method We conducted an electronic cross-sectional survey to evaluate awareness and perception of the integration of a tobacco treatment specialist into a primary care facility that is part of a large Midwestern tertiary healthcare center. The sample for this study included all the primary clinic staff that directly work with patients and included licensed practical nurses, registered nurses, physician assistants, certified nurse practitioners, and medical doctors. Results 55% (n = 22) of staff had utilized the tobacco treatment specialist with direct patient care. Reasons for using the specialist was for referral for follow-up tobacco cessation visit (54%), curbside consultations (21%), medication management (21%), and other reasons (5%). The majority of staff strongly agreed that utilizing the TTS was valuable. Conclusion This study reinforced the positive impact a tobacco treatment specialist can have being integrated into the primary care practice from the perception of the multidisciplinary team.

Delivery of smoking cessation treatment via live chat: An analysis of client-centered coaching skills and behavior change techniques

ObjectiveThis qualitative study explored whether evidence-based tobacco cessation treatment components can be deployed via web-based live chat coaching. MethodsN = 100 randomly selected chats were coded. Researchers used a structured coding guide to note the presence of 3 Motivational Interviewing (MI) skills and 61 behavior change techniques (BCTs). ResultsMI skills were observed in 86% of chats: 31 chats incorporated one skill, 31 incorporated two, and 24 incorporated all three. Open-ended questions were most common (76%), followed by affirmations (47%) and reflective listening statements (38%). BCTs were observed in 100% of chats: 21% involved one-five BCTs, 69% involved six-10 BCTs, and 10% involved 11 or more BCTs. Mean number of BCTs per chat was 7.25 (SD=2.5; range 2–17). The most common BCTs were Social Support (99%), Reward/Threat (95%), Natural Consequences (82%), Regulation (82%), Goals/Planning (64%), and Self Belief (42%). ConclusionsTobacco cessation coaching using MI skills and evidence-based BCTs can be delivered via live chat. This synchronous modality allows the delivery of an intervention tailored to the user’s motivations and goals. Practice implicationsWeb-based live chat can broaden the reach of tobacco treatment specialists to deploy evidence-based counseling skills and behavior change techniques in personalized, accessible coaching.

Tobacco Treatment Specialist Training for Lung Cancer Screening Providers

On the basis of the results of the National Lung Screening Trial,1 the U.S. Preventive Services Task Force (USPSTF) recommends lung cancer screening with a low-dose computed tomography (LDCT) scan as a screening tool for early detection of lung cancer.2 More specifically, this LDCT scan is recommended for high-risk individuals who have at least a 20-pack-year smoking history, who are currently smoking or have quit in the last 15 years, and who are aged 50–80 years.2 At the time of writing this paper, the Centers for Medicare and Medicaid Services (CMS) approved annual lung cancer screening as a covered benefit for those patients who meet the criteria outlined in the 2013 USPSTF recommendation (i.e., have 30-pack-year history and aged 55–77 years).

835-P: Characteristics, Comorbidities, and Tobacco Cessation Outcomes in an Underserved Community with and without Diabetes and Health Disparities

Background: Current smoking in the U.S. disproportionately affects low-income populations with healthcare disparities. Diabetes independently confers substantial atherosclerotic cardiovascular disease risk, and those who smoke have worse health outcomes. Purpose: To increase screening and cessation services in a priority population through a systems level change. Methods: A cross-cultural cohort of staff in large safety net health system were trained as tobacco treatment specialists. A bi-lingual (Spanish-English) program coordinator provided outreach to increase awareness and referrals to the tobacco treatment program. Optimization of an electronic medical record enabled an ambulatory smoking cessation framework. Baseline characteristics and abstinence rates at 7-months were compared between the intervention and usual care cohorts. Dichotomous or categorical variables are presented as percentages and compared between groups using Chi-square. Continuous variables are presented as means with standard deviations and compared using independent t-tests using R software version 3.6.1. Results: From 2018 through 2020, there were 400 referrals. Two-hundred opted into the tobacco cessation program (intervention cohort) and 200 opted out to usual care (control cohort). The average age was 54 years with a mean use of 17 cigarettes per day. Most participants were female (53%), predominantly Hispanic (61%), and received public insurance (88%). In subgroup analyses, 34% and 27% of patients had diabetes in the intervention and usual care cohorts, respectively. The 7-month abstinence rate was 30% versus 5% (p value 0.000) in the intervention versus usual care cohorts, respectively. Conclusion: Creating a sustainable tobacco cessation pathway within a large health-system improves population health access and quit rates in underserved communities with health disparities. Disclosure F. Wang: None. P. A. Allotey: None. M. Vestergaard: None. C. M. D. Vergara: None. J. L. Wilken: None. O. Harel: None. Funding Connecticut Department of Public Health Tobacco and Health Trust Fund (DPH2017-0097)

The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019.

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

Abstract A003: Group tobacco education at short- and long-term substance use disorder programs

Abstract Background: The use of tobacco remains the main cause of preventable disease and death in the United States, with 37.8 million American adults still smoking in 2016. Dana-Farber Cancer Institute's Cancer Care Equity Program (CCEP) hired a Community Health Educator (CHE) to implement a tobacco education program in conjunction with CCEP's lung cancer screenings and smoking cessation counseling. This entailed completing Tobacco Treatment Specialist Training and developing an education curriculum in English and Spanish. In May 2016, CCEP met with a Federally Qualified Health Center (FQHC) in Roxbury, MA, to begin integrating tobacco education for some of their behavioral health programs focused on Substance Use Disorder (SUD). Despite a 5% reduction in the number of smokers since 2005, the rate of active smokers among SUD patients remains higher than that of the general adult population. From 2009 to 2011, adults with SUD represented 8.7% of the population yet used 18.2% of all cigarettes smoked by adults. Methods: Information on the health impacts of tobacco when combined with alcohol and other substances, as well as the impact of tobacco on long-term abstinence, was added to the curriculum to reflect the needs of SUD patients. Two additional local cessation counseling programs were added to reflect where the patients received medical treatment. A bilingual flyer for the FQHC's smoking cessation program was distributed to staff and during the group to facilitate referrals. The weekly groups began at the two-week Acute Treatment Services (ATS) program and expanded monthly to four long-term residential recovery programs. Results: A total of 67 groups were conducted reaching 1,074 individuals. The majority (50) of the groups were conducted at ATS, which serves a patient population not limited to Boston, limiting the ability of the CHE to provide referrals to local cessation counseling programs. However, nicotine replacement therapy medications were available for interested patients. In the residential programs, the patients had established providers, allowing for more referrals to cessation counseling. Preliminary results indicate that although most individuals were familiar with and had used pharmacotherapy in the past, few had considered cognitive and behavioral treatment strategies to quit smoking. These include precessation treatment options, self-monitoring of smoking behaviors, self-management skills, urge coping strategies, maximizing support for nonsmoking, relapse prevention strategies, dealing with slips, and lifestyle balance. Conclusion: Despite the high number of patients with knowledge of the health effects of smoking and pharmacotherapy options, the groups illustrated a need for cognitive and behavioral treatment strategies among SUD treatment patients. Additionally, further evaluation in the form of a post-survey is needed to assess attitudes about the curriculum content and its effectiveness, given the challenges in documenting referrals to cessation counseling services. Citation Format: Christopher S. Lathan, Rebecca K. Jackson. Group tobacco education at short- and long-term substance use disorder programs [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A003.

Long-Term Outcomes of a Preoperative Lung Resection Smoking Cessation Program

BackgroundSmoking cessation programs for patients with cancer suggest 6-mo quit rates between 22% and 40%, and 1-y rates of 33%. We sought to investigate the long-term outcomes of an intensive, preoperative smoking cessation program in patients undergoing lung resection. Material and methodsA retrospective analysis of an IRB-approved, prospective database was performed. Elective lung resections between January 1, 2015 and June 30, 2017 were identified. Demographics, smoking status, pack years, occurrence of smoking cessation counseling, complications, and quit date were obtained. Smoking cessation included face-to-face motivational interviewing, choice of nicotine replacement therapy, discussion that surgery may be canceled or delayed without cessation, and follow-up as needed. ResultsA total of 340 patients underwent lung resection. Of these, 82 patients were classified as current smokers. All were advised to quit and encouraged to meet with a certified tobacco treatment specialist. Sixty-three patients met with a tobacco treatment specialist and 19 did not. Overall, 60 patients (73%) were able to quit before surgery. At 2 y postoperatively, 15 (18%) were lost to follow-up and 9 (11%) had died. Excluding deaths and censoring those lost to follow-up, cessation rates at 6, 12, and 24 mo postoperatively were 55.3%, 55.6%, and 51.7%, respectively. ConclusionsImplementation of an intensive smoking cessation program in the preoperative period demonstrated high initial, mid-term, and long-term success rates. The preoperative period, particularly one centered around lung cancer, is an effective time for smoking cessation intervention and can lead to a high rate of cessation up to 2 y after surgery.

Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks.

BackgroundWithin a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation.ObjectiveThis study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation.MethodsWe conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline.ResultsOf the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers’ messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3).ConclusionsOur study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation.

Enhancing nicotine replacement therapy usage and adherence through a mobile intervention: Secondary data analysis of a single-arm feasibility study in Mexico.

INsTRODUCTIONNicotine Replacement Therapy (NRT) is an effective treatment for smoking cessation. However, medication usage and adherence remain a challenge that contributes to low smoking cessation rates. In Mexico, 8 in 10 smokers are interested in quitting. However, only 6% of Mexican smokers use medication for smoking cessation. The objective of this study is to assess the feasibility and acceptability of a mobile health (mHealth) intervention to increase usage and adherence of NRT in Mexico.METHODSThe study involves a secondary data analysis. Forty smokers were recruited to participate in a single-arm pilot study. Participants received an mHealth intervention that uses tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. The intervention allows two-way interactivity text messaging between participants and a tobacco treatment specialist. NRT was offered to participants in accordance with practice guidelines in Mexico. Outcome measures included utilization of NRT, text messaging interactivity with the program, and biochemically verified abstinence at 12 weeks.RESULTSThirty smokers met the criteria for use of NRT. Average age of participants was 38.1 years (SD=10.7), and they were primarily male (56.7%) with at least an undergraduate degree (60%). All participants requested NRT at baseline, and 60% requested a refill at week 4. During the 12-week intervention period, participants sent 620 messages to the program (mean=20.6, SD=18.34) of which 79 messages (12.7%) were related to NRT. Three themes were identified in the messages related to NRT: enthusiasm, instructions, and side effects. At 12 weeks, 40% of participants reported using NRT <75% of the days. Finally, 30% of participants (9/30) were biochemically verified abstinent using intention-to-treat analysis at 12 weeks.CONCLUSIONSAn mHealth intervention appears to offer a promising strategy to increase usage and adherence of NRT in Mexico. Additional testing as a formal randomized clinical trial appears warranted.

The ‘Take a Break’ game: Randomized trial protocol for a technology-assisted brief abstinence experience designed to engage lower-motivated smokers

BackgroundWhile smoking continues to be the most preventable cause of mortality in the United States, most current smokers remain not ready to quit at any given time. Engaging these ‘motivation phase’ smokers with brief experiences to build confidence and practice skills related to cessation could lead to sooner and more successful quit attempts. Increasingly available mobile technology and gamification can be used to provide smokers with accessible and engaging support. MethodsWe describe our protocol for conducting a randomized controlled trial evaluating Take a Break, an mHealth-based smoking pre-cessation challenge designed for smokers not ready to quit. Participants in the intervention receive 1) Motivational Messages, 2) text message Challenge Quizzes, 3) Goal-setting with tobacco treatment specialist, 4) Coping Mini-Games apps, and 5) Recognition and Rewards for participation during a 3-week challenge. Access to coping mini-games and motivational messaging continues for 6-months. Both intervention and comparison group participants receive brief Nicotine Replacement Therapy (NRT) sampling and daily smoking assessment text messages for three weeks. Primary outcomes include number of days abstinent during the challenge, change in patient-reported self-efficacy after the challenge, time to first quit attempt following the challenge, and 7-day point prevalent smoking cessation at six months. ConclusionTake a Break is an innovative approach to engage those not prepared for a quit attempt. Take a Break provides motivation phase smokers with tools and a brief experience to prepare them for a quit attempt, filling a gap in tobacco cessation support and current research.

Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping HAND 4 randomized controlled trial

BackgroundTobacco smoking remains the leading preventable cause of death in the US. A hospital admission provides smokers with a unique opportunity to stop smoking because it requires temporary tobacco abstinence while illness may enhance motivation to quit. Hospital interventions must continue post-discharge to increase tobacco abstinence long-term, but how best to accomplish this remains unclear. Building on two previous randomized controlled trials, each of which tested smoking cessation interventions that began in hospital and continued after discharge, this trial compares two interventions that provide sustained smoking cessation treatment after hospital discharge with the goal of improving long-term smoking cessation rates among hospitalized smokers.Methods/designHelping HAND 4 is a three-site randomized controlled trial that compares the effectiveness of two active interventions for producing validated past 7-day tobacco abstinence 6 months after hospital discharge. Smokers who are admitted to three hospitals receive a standard in-hospital smoking intervention, and those who plan to quit smoking after discharge are recruited and randomly assigned to two interventions that begin at discharge, Personalized Tobacco Care Management (PTCM) or Quitline eReferral. Each lasts 3 months. At discharge, PTCM provides 8 weeks of free nicotine replacement (NRT; a participant’s choice of patch, gum, lozenge, or a combination) and then proactive smoking cessation support using an automated communication platform and live contact with a tobacco treatment specialist who is based in the health care system. In the eReferral condition, a direct referral is made from the hospital electronic health record to a community-based resource, the state’s telephone quitline. The quitline provides up to 8 weeks of free NRT and offers behavioral support via a series of phone calls from a trained coach. Outcomes are assessed at 1, 3, and 6 months after discharge. The study hypothesis is that PTCM will produce higher quit rates than eReferral.DiscussionHelping HAND 4 is a pragmatic trial that aims to evaluate interventions in real-world conditions. This project will give hospital systems critical evidence-based tools for meeting National Hospital Quality Measures for tobacco treatment and maximizing their ability to improve cessation rates and overall health for the millions of smokers hospitalized annually in the US.Trial registrationProspectively registered prior to start of enrollment at Clinicaltrials.gov, NCT03603496 (July 27, 2018). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00084MJ&selectaction=Edit&uid=U00002G7&ts=2&cx=ff0oxn

Success of a Tobacco Cessation Program for Parents at a Children's Hospital

Children are most affected by passive smoke and least able to avoid it. The Tobacco Dependence Program was developed to help reduce first-, second-, and thirdhand smoke exposure to our patients while they are in the hospital. The Tobacco Dependence Program consists of a director, 3 coordinators, and 15 team members certified as tobacco treatment specialists. The program is offered to any admitted patient or his or her caregiver(s). We support participants whether their goal is to quit smoking or to abstain during the hospitalization. We provide weekly counseling and free over-the-counter nicotine replacement therapy for the entire duration of the hospitalization. The inclusion criterion for caregivers is a 7-d minimum stay. In-patients are automatically eligible. Before discharge, we provide a referral to an out-patient program. As of March 2019, we enrolled 138 participants, 5% were in-patients. Fifty-five percent had children who were critically ill and in the ICU: pediatric ICU/progressive care unit (PCU) 28%, neonatal ICU 19%, cardiac ICU (CICU) 9%. The ethnicity of the participants was predominately white (56%), followed by African American (33%), Hispanic (12%), and Asian (<1%). Fifty-six percent of the participants were female. Fifty-nine percent of the participants began smoking between the ages of 12 and 18 y, 21% began between the ages of 18 and 25 y, 9% began before the age of 12 y, and 7% between the ages of 25 and 35 y. Fifty percent of the survey respondents stated that they were able to quit before discharge. The Tobacco Dependence Program offers support to families as they begin the cessation process and provide the tools to continue a smoke-free lifestyle after discharge. The program is feasible and welcomed to assist patients and families in this process.

Pharmacists help lead on vaping, tobacco cessation.

When the Duquesne University School of Pharmacy in Pittsburgh launched its Certified Tobacco Treatment Specialist (CTTS) training program in 2014, information about electronic cigarettes wasn’t part of the curriculum, says Associate Professor of Pharmacy Jamie McConaha. CTTS programs are accredited by the Council for Tobacco Treatment Training Programs, which doesn’t mandate that the curriculum include information about electronic nicotine delivery systems or vaping, explained McConaha, who is course coordinator for Duquesne’s accredited program. “However, we were finding, years on, that [vaping] was getting more prevalent. And we were getting a ton of questions about it,” she said. When it became clear that tobacco cessation specialists needed to be able to talk to their patients about vaping, McConaha incorporated a 1-hour lecture on the topic to the curriculum. “Now, it’s close to 2 hours,” she said. “I feel like that lecture changes every time we give it. We’re constantly updating it.”

Feasibility, Acceptability, and Adoption of an Inpatient Tobacco Treatment Service at a Safety-Net Hospital: A Mixed-Methods Study.

Rationale: Hospitalization is an opportunity to engage smokers who may not seek tobacco treatment. Our safety-net hospital developed and implemented an inpatient intervention consisting of an "opt-out" electronic health record-based Best Practice Alert (BPA)+order-set, designed to trigger referral to the Tobacco Treatment Consult (TTC) service (a team staffed by tobacco treatment specialists) for all hospitalized smokers, regardless of motivation to quit.Objectives: We performed a sequential explanatory mixed-methods study to evaluate the feasibility, acceptability, and adoption of the TTC service.Methods: Among all admissions of adult "current smokers" between July 2016 and June 2017, we calculated the percentage of patients whose clinicians accepted the order-set (through a simple "order" click), thus generating the TTC referral. We then determined the extent of clinician follow-through of TTC recommendations for prescribing nicotine replacement therapy among 1,651 consecutive smokers seen by the TTC service. Finally, we conducted qualitative interviews with inpatient clinicians (n = 25) to understand their rationale for adoption or nonuse of the TTC intervention, including perceived usefulness, barriers to adoption, and strategies to improve the utility of the service.Results: Clinicians accepted the TTC order-set for 4,100 out of 6,598 "current smokers" (62.1%) for whom the BPA fired, typically after initially deferring the BPA. Rates of acceptance significantly differed across clinical services (range: 8% [obstetrics-gynecology] to 82.2% [cardiology]; P < 0.00001). A chart review showed that 43.5% (719/1,651) of the patients seen by the TTC service desired outpatient nicotine replacement therapy, but only half of these patients (48.8%; 351/719) received a discharge prescription from the inpatient team. Clinicians expressed that they valued the TTC service, but that BPA fatigue, time constraints, competing priorities, and poor communication with the TTC service were barriers to using the service and following recommendations. Clinicians suggested strategies to address barriers to the use of tobacco treatment interventions during hospitalization and after discharge.Conclusions: Implementing a large-scale "opt-out" tobacco treatment service for hospitalized smokers at a safety-net hospital is feasible and acceptable, but suffers from inconsistent adoption due to a variety of clinician barriers. System-level changes are needed to increase uptake and sustain inpatient tobacco treatment interventions to promote smoking cessation.