Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment

Abstract

Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers’ use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers’ perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients’ interest in quitting and providers’ potential impacts on a successful quit attempt.

Changes in Substance Use Treatment Providers’ Delivery of the 5A’s for Non-Cigarette Tobacco Use in the Context of a Comprehensive Tobacco-Free Workplace Program Implementation

“…In our sample of SUTCs, only about 39% of providers had received tobacco training in the year prior to program implementation; this number almost doubled by post-implementation. Low pre-implementation training receipt rates are consistent with those reported within prior studies in healthcare settings [63] and in SUTCs in particular [29]. However, consistent with expectations of the outcomes of increased training receipt, there were significant increases in provider beliefs that it was as critical to treat tobacco use as it was to treat other substance use throughout treatment and in provider self-efficacy to deliver TUAs effectively.…”

“…However, tobacco use screenings, a natural first step prior to the delivery of evidence-based interventions, are not pervasive within SUTCs. A recent Texas-based study published in 2022 indicated that 80% of participating SUTCs mandated tobacco use screenings, an increase from 70.2% recorded in a 2016 study, though samples may have differed between studies [29,30]. While these statistics potentially indicate an improvement in SUTC tobacco screening delivery over time, sizeable gaps in screening practice still exist with the growing spectrum of tobacco products.…”

“…Despite the efficacy of these guidelines for treating tobacco dependence, provider barriers exist that prevent their application in clinical practice. Providers have frequently reported difficulty in providing tobacco cessation care as a result of a lack of knowledge, time, and available resources; perceived irrelevance to the chief complaint; and low confidence in patient compliance [29]. The array of barriers experienced and the wide-reaching influence that providers have on patient behavior highlight missed opportunities to reduce tobacco use among their patients.…”

Organization-Level Factors Associated with Changes in the Delivery of the Five A’s for Smoking Cessation following the Implementation of a Comprehensive Tobacco-Free Workplace Program within Substance Use Treatment Centers

“…Providers in substance use treatment centers commonly report several barriers to screening and intervention in patients' smoking, including, but not limited to, a lack of time and training [22][23][24][25][26][27][28][29][30]. The current study found that substance use treatment centers with more provider-reported barriers to routine smoking cessation intervention delivery at preimplementation experienced greater gains in assessing patients' interest in quitting smoking.…”

“…For example, providers may be concerned that addressing their patients' smoking may interfere with their nonnicotine substance use recovery [21]. Additionally, a variety of other barriers exist, including a lack of knowledge and training in treating tobacco dependence (i.e., low self-efficacy), inadequate time and resources, and the high rates of smoking among the providers themselves [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”