Tobacco-related knowledge following a comprehensive tobacco-free workplace program within behavioral health facilities: Identifying organizational moderators

Garey, Lorra; Neighbors, Clayton; Leal, Isabel; Lam, Cho Y.; Wilson, William T.; Kyburz, Bryce; Stacey, Tim; Correa-Fernández, Virmarie; Williams, Teresa; Zvolensky, Michael J.; Reitzel, Lorraine R.

doi:10.1016/j.pec.2019.04.013

Cited by 15 publications

(37 citation statements)

References 39 publications

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“…Given that the 5As are synonymous with best practices in smoking cessation treatment, these improvements are promising. 20–22 Although this study did not assess the mechanisms by which training affected clinician behaviors, prior studies have suggested that training may increase knowledge, 7 , 12 , 17 improve clinician confidence in delivering screenings and interventions, 17 , 18 and affect positive attitudes about intervention. 17 , 27 …”

Section: Discussionmentioning

confidence: 99%

“…These data were assessed within pre-established ranges and later collapsed based on within-sample distribution, commensurate with cut-points used in prior work. 12 Data were collected via Survey Monkey prior to TTTF implementation.…”

Section: Methodsmentioning

confidence: 99%

“… 9 , 11 Other possible explanations include the lack of training to address nicotine dependence, competing clinical priorities, and the prevalence of tobacco use among clinicians in behavioral health treatment clinics. 8 , 12 , 13 Ultimately, these misbeliefs and challenges to treatment implementation contribute to substandard care for nicotine dependence in BHC patients in behavioral health facilities. Moreover, they stand in stark contrast to research showing that behavioral health patients and the clinicians who treat them report a pressing need for proper tobacco cessation services and training.…”

Section: Introductionmentioning

confidence: 99%

“… 9 TTTF has been implemented in hundreds of behavioral health treatment clinics across the state of Texas and has significantly increased their capacity to deliver evidence-based tobacco cessation care to their patients. 12 , 13 , 15 , 16 It is important to note that the implementation of programs with elements similar to those in TTTF have also shown promise in improving clinician efforts to deliver tobacco cessation treatment. 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

“… 15 , 16 Emerging research within this area has also found, for example, that knowledge of the requirements for change, perceived availability of resources, and the number of annual clinic patient contacts moderated gains in staff knowledge following training, whereas perceived value in the change and number of patient contacts moderated knowledge gain among clinicians. 12 Although this study added to the literature on knowledge gained through education, an outcome potentially more tied to the patient experience is changes in clinician behaviors to address tobacco use with patients. Such research is critical to understanding organizational factors that may influence clinician behaviors and support or hinder program delivery to achieve maximal penetration and impact.…”

Section: Introductionmentioning

confidence: 99%

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Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician’s Delivery of Smoking Interventions within Behavioral Health Treatment Clinics

Nitturi

Chen

Kyburz

et al. 2020

Nicotine &Amp; Tobacco Research

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Background Smoking is elevated amongst individuals with behavioral health disorders, but not commonly addressed. Taking Texas Tobacco Free is an evidence-based, tobacco-free workplace program that addresses this, in-part, by providing clinician training to treat tobacco use in local mental health authorities (LMHAs). This study examined organizational moderators of change in intervention delivery from pre- to post-program implementation. Methods LMHA leaders completed the Organizational Readiness for Implementing Change (ORIC) and provided organization demographics pre-implementation. Clinicians (N=1,237) were anonymously surveyed about their consistent use of the 5As (Asking about smoking; Advising clientele to quit; Assessing willingness to quit; Assisting them to quit; Arranging follow-up) pre- and post-program implementation. Adjusted generalized linear mixed models were used for analyses (responses nested within LMHAs), with interaction terms used to assess moderation effects. Results Clinician delivery of 5As increased pre- to post-implementation (p<0.001). LMHAs with fewer employees (ref=<300) demonstrated greater increases in Asking, Assessing, and Assisting over time. LMHAs with fewer patients (ref=<10,000) evinced greater changes in Asking over time. Less initial ORIC Change Efficacy, Change Commitment, and Task Knowledge were each associated with greater pre- to post-implementation changes in Asking. Less initial Task Knowledge was associated with greater increases in Advising, Assessing, and Assisting. Finally, less initial Resource Availability was associated with greater increases in Assisting (all moderation term ps<0.025). Conclusion The smallest and least ready LMHAs showed the largest gains in tobacco cessation intervention delivery; thus, low initial readiness was not a barrier for program implementation, particularly when efficacy-building trainings and resources are provided. Implications This study examined organizational moderators of increases in tobacco cessation treatment delivery over time following the implementation of a comprehensive tobacco-free workplace program within 20 of 39 local mental health authorities (LMHAs) across Texas (hundreds of clinics; servicing >50% of the state) from 2013-2018. Overall, LMHAs with fewer employees and patients, and that demonstrated the least initial readiness for change, evinced greater gains in intervention delivery. Findings add to dissemination and implementation science by supporting that low initial readiness was not a barrier for this aspect of tobacco-free workplace program implementation when resources and clinician training sessions were provided.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician’s Delivery of Smoking Interventions within Behavioral Health Treatment Clinics

Nitturi

Chen

Kyburz

et al. 2020

Nicotine &Amp; Tobacco Research

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Behavioral health care provider’s beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A’s intervention

Jafry

Martinez

Chen

et al. 2023

Addictive Behaviors Reports

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A cluster-randomized trial of a brief multi-component intervention to improve tobacco outcomes in substance use treatment

Guydish

McCuistian

Hosakote

et al. 2023

Subst Abuse Treat Prev Policy

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Background Smoking prevalence is high among people in substance use disorder (SUD) treatment, and program interventions to address smoking are often complex and lengthy. This cluster-randomized trial tested whether a brief multi-component intervention impacted tobacco outcomes among staff and clients. Methods Seven SUD treatment programs were randomly assigned to the multi-component intervention or to waitlist control. The 6-month intervention included a leadership motivation assessment, program incentives, 4 staff training sessions and a leadership learning community session. Survey data were collected from staff and clients at pre- and post-intervention. Outcomes were first compared across condition (intervention vs waitlist control), and then examined pre- to post-intervention with condition collapsed. Results Staff in the intervention (n = 48) and control conditions (n = 26) did not differ at post-intervention on smoking prevalence, self-efficacy to help clients quit, or practices used to help clients quit smoking. Intervention clients (n = 113) did not differ from controls (n = 61) in smoking prevalence or receipt of tobacco services. Pre-post comparisons collapsed across condition showed a decrease in client and staff smoking prevalence, which could not be attributed to the intervention, and a decrease in client receipt of cessation medication. Conclusion The brief multi-component intervention did not support changes in smoking prevalence or in tobacco-related services received by clients. Other intervention features are needed to reduce smoking among SUD clients. Trial registration Randomization occurred at the program level and outcomes measured are program-level measures. Accordingly, the trial is not registered.

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Tobacco-related knowledge following a comprehensive tobacco-free workplace program within behavioral health facilities: Identifying organizational moderators

Cited by 15 publications

References 39 publications

Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician’s Delivery of Smoking Interventions within Behavioral Health Treatment Clinics

Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician’s Delivery of Smoking Interventions within Behavioral Health Treatment Clinics

Behavioral health care provider’s beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A’s intervention

A cluster-randomized trial of a brief multi-component intervention to improve tobacco outcomes in substance use treatment

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