Browsing by Subject "Smoking cessation"
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Item A selective review of smoking cessation interventions in the emergency department(Springer Nature, 2022) Pettit, Nicholas; Pope, Ian; Neuner, Bruno; Lash, Rebecca; Bernstein, Steven L.; Emergency Medicine, School of MedicineBackground: Emergency department (ED) patients disproportionally smoke compared to the general population and frequently utilize the ED for routine, urgent, and emergent care. Thus, the ED is a target-rich environment for interventions aimed at increasing smoking cessation, especially among vulnerable populations. Promotion of smoking cessation in the ED has the potential to address health inequalities and reach patients that experience significant barriers to accessing preventive care and lifestyle modifications. Topics of review: This narrative review presents a concise summary of the major smoking cessation strategies studied in the ED setting for adults, children, and pregnant ED patients. Additionally, this review presents the strategies to increase the uptake of smoking cessation in the ED, as well as an international perspective of smoking cessation efforts in the ED. Past and ongoing efforts to improve smoking cessation among ED patients are discussed, and critical knowledge gaps and research opportunities are highlighted. Conclusion: Smoking cessation is both efficacious and feasible during an ED visit, with multiple options available to both adults, children, parents, and pregnant patients. Little standardization among cessation strategies among EDs has been demonstrated, despite the ED being uniquely positioned to address disparities in smoking cessation and contribute towards national smoking cessation goals. During most ED visits, any health care team member can address ongoing tobacco use, and smoking cessation can easily be related to the context of the patient’s presenting complaint. To be effective, health care systems and teams must recognize the ED as a suitable location to engage with patients regarding their knowledge and awareness of ongoing smoking use, and are well suited to provide and initiate effective smoking cessation treatments.Item Bridging the Gap in Tobacco Cessation Services: Utilizing Community Pharmacists to Facilitate Transitions of Care in the USA(Springer, 2022) Newlon, Jenny; Ellis Hilts, Katy; Champion, Victoria; Suchanek Hudmon, Karen; School of NursingInterprofessional strategies for promoting tobacco cessation lead to enhanced quit rates among patients; however, current approaches might not effectively support patients with their quit attempts after they are discharged from the hospital. This paper explores opportunities for interprofessional collaboration between health system-based providers and community pharmacists, as one proposed approach to bridging tobacco cessation services during transitions of care. Suggested strategies include (1) increasing other healthcare professionals' awareness of legislative advances that permit pharmacists to prescribe cessation medications in some states, and (2) encouraging bi-directional communication between health system-based and community-based providers, especially via integrated electronic health records. Community pharmacists can offer a convenient solution to obtain the post-discharge medication and counseling support that patients need to increase their chances of quitting for good. Additional steps are discussed to improve broadscale capacity of this service being provided in community pharmacies.Item Clinical Perspective: Treatment of adolescent e-cigarette use – limitations of existing nicotine use disorder treatment and future directions for e-cigarette use cessation(Elsevier, 2021) Adams, Zachary W.; Kwon, Elizabeth; Aalsma, Matthew C.; Zapolski, Tamika C.B.; Dir, Allyson; Hulvershorn, Leslie A.; Psychiatry, School of MedicineElectronic cigarette use ("vaping") has surged in the United States since the mid-2010s. From 2011 to 2018, current e-cigarette use among high school students escalated from 1.5% to 20.8% (∼3.05 million youths),1 countering downward trends in combustible nicotine product use (21.8% in 2011 to 13.9% in 2018).1 Although preventing the initial uptake of vaping is crucial, for the millions of adolescents who have taken up this behavior-many of whom express interest in quitting (eg, 44.5% of current, adolescent non-light e-cigarette users in one US national representative sample)2-it is critically important to help them quit vaping so as to curtail future substance use disorders and other health consequences. Here, we discuss several challenges around adolescent vaping treatment, and highlight research areas in urgent need of attention.Item Closing the Tobacco Treatment Gap: A Qualitative Study of Tobacco Cessation Service Implementation in Community Pharmacies(MDPI, 2024-03-28) Ellis Hilts, Katy; Elkhadragy, Nervana; Corelli, Robin L.; Hata, Micah; Tong, Elisa K.; Vitale, Francis M.; Suchanek Hudmon, Karen; Health Policy and Management, Richard M. Fairbanks School of Public HealthTobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers' Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.Item Development and acceptability of an educational video about a smoking cessation quitline for use in adult outpatient mental healthcare(Oxford University Press, 2021) Kazan, Adina S.; Perry, Laura M.; Atiya, Wasef F.; Voss, Hallie M.; Kim, Seowoo; Easwar, Sanjana; Mercorella, Hannah N.; Lewson, Ashley; Rogers, James L.; Arnold, Dodie; Raines, Amanda M.; Brown, Lisanne; Moore, Tonia; Hoerger, Michael; Psychology, School of ScienceTobacco use is a leading preventable cause of early mortality and is prevalent among adults with mental health diagnoses, especially in the southern USA. Increasing cessation resources in outpatient mental health care and targeting individuals most receptive to changing their behavior may improve cessation. Drawing on the transtheoretical model, our goals were to develop an educational video about the Louisiana Tobacco Quitline and evaluate its acceptability. We designed the video with knowledge derived from Louisiana-specific data (2016 Louisiana Adult Tobacco Survey, N = 6,469) and stakeholder feedback. Bivariate associations between demographic/tobacco-use characteristics and participants’ stage of quitting (preparation phase vs. nonpreparation phase) were conducted, which informed design elements of the video. Four stakeholder advisory board meetings involving current smokers, mental health clinicians, and public health advocates convened to provide iterative feedback on the intervention. Our stakeholder advisory board (n = 10) and external stakeholders (n = 20) evaluated intervention acceptability. We found that 17.9% of Louisiana adults were current smokers, with 46.9% of them in the preparation phase of quitting. Using insights from data and stakeholders, we succeeded in producing a 2-min video about the Louisiana Tobacco Quitline which incorporated three themes identified as important by stakeholders: positivity, relatability, and approachability. Supporting acceptability, 96.7% of stakeholders rated the video as helpful and engaging. This study demonstrates the acceptability of combining theory, existing data, and iterative stakeholder feedback to develop a quitline educational video. Future research should examine whether the video can be used to reduce tobacco use.Item Electronic Cigarette Awareness, Use, and Perceptions among Cancer Patients(SAGE Publications, 2018-05-09) Buczek, Erin J.; Harrington, Kathleen F.; Hendricks, Peter S.; Schmalbach, Cecelia E.; Otolaryngology -- Head and Neck Surgery, School of MedicineObjective: Electronic cigarettes (e-cigs) are an emerging trend, yet little is known about their use in the cancer population. The objectives of this study were (1) to describe characteristics of e-cig use among cancer patients, (2) to define e-cig advertising exposure, and (3) to characterize perceptions of traditional cigarettes versus e-cigs. Study Design: Cross-sectional study. Setting: Comprehensive cancer center. Subjects and Methods: Inpatient, current smokers with a cancer diagnosis. E-cig exposure and use were defined using descriptive statistics. Wilcoxon rank test was used to compare perceptions between e-cigs and traditional cigarettes. Results: A total of 979 patients were enrolled in the study; 39 cancer patients were identified. Most cancer patients were women (59%), with an average age of 53.3 years. Of the patients, 46.2% reported e-cig use, most of which (88.9%) was "experimental or occasional." The primary reason for e-cig use was to aid smoking cessation (66.7%), alternative use in nonsmoking areas (22.2%), and "less risky" cigarette replacement (5.6%). The most common sources for e-cig information were TV (76.9%), stores (48.7%), friends (35.9%), family (30.8%), and newspapers or magazines (12.8%). Compared with cigarettes, e-cigs were viewed as posing a reduced health risk (P < .001) and conferring a less negative social impression (P < .001). They were also viewed as less likely to satisfy nicotine cravings (P = .002), to relieve boredom (P = .0005), to have a calming effect (P < .001), and as tasting pleasant (P = .006). Conclusions: E-cig use and advertising exposure are common among cancer patients. E-cig use is perceived as healthier and more socially acceptable but less likely to produce a number of desired consequences of cigarette use.Item Findings and Future Directions from a Smoking Cessation Trial Utilizing a Clinical Decision Support Tool(Elsevier, 2022-09) Rindal, Donald Brad; Kottke, Thomas E.; Jurkovich, Mark W.; Asche, Stephen E.; Enstad , Chris J.; Truitt, Anjali R.; Ziegenfuss, Jeanette Y.; Romito, Laura M.; Thyvalikakath, Thankam P.; O'Donnell, Jean; Spallek, Heiko; Dental Public Health and Dental Informatics, School of DentistryBackground Tobacco smoking is the leading cause of disease, death, and disability in the United States. Dental practitioners are advised to provide evidence-based smoking cessation interventions to their patients, yet dental practitioners frequently fail to deliver brief smoking cessation advice. Objectives To test whether giving dental practitioners a clinical decisions support (CDS) system embedded in their electronic dental record would increase the rate at which patients who smoke (1) report receiving a brief intervention or referral to treatment during a recent dental visit, (2) taking action related to smoking cessation within 7 days of visit, and (3) stop smoking for 1 day or more or reduce the amount smoked by 50% within 6 months. Methods Two-group, parallel arm, cluster-randomized trial. From March through December 2019, 15 nonacademic primary care dental clinics were randomized via covariate adaptive randomization to either a usual care arm or the CDS arm. Adult smokers completed an initial telephone survey within 7 days of their visit and another survey after 6 months. Results Forty-three patients from 5 CDS and 13 patients from 2 usual care clinics completed the 7-day survey. While the proportion of patients who reported receipt of a brief intervention or referral to treatment was significantly greater in the CDS arm than the usual care arm (84.3% vs 58.6%; P = .005), the differences in percentage of patients who took any action related to smoking cessation within 7 days (44.4% vs 22.3%; P = .077), or stopped smoking for one day or more and/or reduced amount smoked by 50% within 6 months (63.1% vs 46.2%; P = .405) were large but not statistically significant. Conclusions Despite interruption by COVID-19, these results demonstrate a promising approach to assist dental practitioners in providing their patients with smoking cessation screening, brief intervention and referral to treatment.Item Implementing Brief Tobacco Cessation Interventions in Community Pharmacies: An Application of Rogers’ Diffusion of Innovations Theory(MDPI, 2022-05-30) Hilts, Katy Ellis; Corelli, Robin L.; Prokhorov, Alexander V.; Zbikowski, Susan M.; Zillich, Alan J.; Hudmon, Karen Suchanek; Health Policy and Management, School of Public HealthPharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists' perceptions of factors associated with the implementation of "Ask-Advise-Refer", a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers' Diffusion of Innovations Theory, assessed pharmacists' perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.Item Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context(Annals of Family Medicine, 2021) Cohen, Deborah J.; Sweeney, Shannon M.; Miller, William L.; Hall, Jennifer D.; Miech, Edward J.; Springer, Rachel J.; Balasubramanian, Bijal A.; Damschroder, Laura; Marino, Miguel; Emergency Medicine, School of MedicinePurpose: We undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care. Methods: We purposively sampled and interviewed practice staff (eg, office managers, clinicians) from a subset of 104 practices participating in EvidenceNOW-a multisite cardiovascular disease prevention initiative. We calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening and, if relevant, counseling and in the proportion of hypertensive patients with adequately controlled BP. We analyzed interview data to identify operational changes, transforming these into numeric data. We used Configurational Comparative Methods to assess the joint effects of multiple factors on outcomes. Results: In clinician-owned practices, implementing a workflow to routinely screen, counsel, and connect patients to smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome with a moderate level of facilitation support. These patterns did not manifest in health- or hospital system-owned practices or in Federally Qualified Health Centers, however. The BP outcome improved by at least 10 points among solo practices after medical assistants were trained to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improved when practices implemented a second BP measurement when the first was elevated, and when staff learned where to document this information in the electronic health record. With 50 hours or more of facilitation, BP outcomes improved among larger and health- and hospital system-owned practices that implemented these operational changes. Conclusions: There was no magic bullet for improving smoking or BP outcomes. Multiple combinations of operational changes led to improvements, but only in specific contexts of practice size and ownership, or dose of external facilitation.Item Long-term evaluation of a train-the-trainer workshop for pharmacy faculty using the RE-AIM framework(Elsevier, 2021-09) Elkhadragy, Nervana; Corelli, Robin L.; Zillich, Alan J.; Campbell, Noll L.; Suchanek Hudmon, Karen; Medicine, School of MedicineBackground: Although two thirds of tobacco users express interest in quitting, few pharmacists address tobacco use as part of routine practice. Historically, pharmacy schools provided inadequate tobacco cessation training for students. To address this educational gap, train-the-trainer workshops were conducted between 2003 and 2005 to train pharmacy faculty (n = 191) to teach a shared, national tobacco cessation curriculum at their academic institutions. Objective: To characterize faculty perceptions of the train-the-trainer workshops and estimate the long-term reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of the shared curriculum at pharmacy schools. Methods: This study is the second phase of a sequential mixed methods study. Results from Phase 1, a qualitative study, informed the development of survey items for Phase 2. Applying the RE-AIM framework, a web-based survey was developed and administered to train-the-trainer participants. Results: Of 191 trainees, 137 were locatable; of these, 111 completed a survey (81.0%). Most (n = 87; 78.4%) reported current employment in academia. The most highly rated reason for attending a workshop was to improve teaching of tobacco cessation content, and 98.1% reported moderate or high confidence for teaching tobacco cessation. Among those who practice in a clinical setting, 70.6% reported asking their patients about tobacco use all or almost all the time. Just over three fourths of faculty respondents who work in academia believe that shared curricula should be more broadly considered for use in pharmacy schools, and 79.0% agreed that shared curricula are a cost-effective approach to teaching. Conclusion: Evidence is provided for long-term reach, effectiveness, adoption, implementation, and maintenance of the Rx for Change shared tobacco cessation training program. Participants perceived that the workshop resulted in long-term, positive effects on their careers as well as their teaching and clinical practice.