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Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study

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  • Maggie Britton

    (Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
    Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
    Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
    These authors contributed equally to this work.)

  • Isabel Martinez Leal

    (Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
    Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
    Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
    These authors contributed equally to this work.)

  • Midhat Z. Jafry

    (Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA)

  • Tzuan A. Chen

    (Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
    Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA)

  • Anastasia Rogova

    (Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
    Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA)

  • Bryce Kyburz

    (Integral Care, 1430 Collier Street, Austin, TX 78704, USA)

  • Teresa Williams

    (Integral Care, 1430 Collier Street, Austin, TX 78704, USA)

  • Lorraine R. Reitzel

    (Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
    Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA)

Abstract

People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers’ misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients’ substance-use recovery, although research indicates that it enhances support for recovery and relapse prevention. A total of 86 treatment providers employed in SUTS (i.e., 9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs), 6 substance-use treatment programs in LMHAs, and 55 stand-alone substance-use treatment centers) in Texas, USA, answered survey questions about their (1) thoughts about treating tobacco during substance-use treatment, and (2) delivery of the 5A’s tobacco-use intervention (Ask, Advise, Assess, Assist, Arrange). Twenty-six providers and leaders were interviewed about attitudes toward tobacco-free workplace policies and tobacco dependence and the relative importance of treating tobacco (vs. other substance-use disorders) at their center. Providers who did not believe tobacco use should be addressed as soon as clients begin treatment (i.e., endorsed responses of after 1 year, it depends on the client, or never) had lower odds of Asking clients about their tobacco use (OR = 0.195), Advising clients to quit smoking (OR = 0.176), and Assessing interest in quitting smoking (OR = 0.322). Qualitative results revealed barriers including beliefs that clients need to smoke to relieve the stress of substance-use recovery, are disinterested in quitting, fears that concurrent treatment would jeopardize substance use, and limited resources; additional training and education resources was the key facilitator theme. The results demonstrate a critical need to eliminate barriers to tobacco-treatment provision for clients in SUTS through education to correct misperceptions, specialized training to equip providers with knowledge and skills, and resources to build center capacity. Integrating evidence-based smoking interventions into routine care is key to support the recovery efforts of clients in SUTS.

Suggested Citation

  • Maggie Britton & Isabel Martinez Leal & Midhat Z. Jafry & Tzuan A. Chen & Anastasia Rogova & Bryce Kyburz & Teresa Williams & Lorraine R. Reitzel, 2023. "Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study," IJERPH, MDPI, vol. 20(7), pages 1-21, March.
  • Handle: RePEc:gam:jijerp:v:20:y:2023:i:7:p:5260-:d:1106919
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    References listed on IDEAS

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    1. Richter, K.P. & Gibson, C.A. & Ahluwalia, J.S. & Schmelzle, K.H., 2001. "Tobacco use and quit attempts among methadone maintenance clients," American Journal of Public Health, American Public Health Association, vol. 91(2), pages 296-299.
    2. Ajzen, Icek, 1991. "The theory of planned behavior," Organizational Behavior and Human Decision Processes, Elsevier, vol. 50(2), pages 179-211, December.
    3. Cassidy R. LoParco & Tzuan A. Chen & Isabel Martinez Leal & Maggie Britton & Brian J. Carter & Virmarie Correa-Fernández & Bryce Kyburz & Teresa Williams & Kathleen Casey & Anastasia Rogova & Hsien-Ch, 2022. "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," IJERPH, MDPI, vol. 19(19), pages 1-13, September.
    4. Midhat Z. Jafry & Sean M. Reuven & Maggie Britton & Tzuan A. Chen & Isabel Martinez Leal & Anastasia Rogova & Bryce Kyburz & Teresa Williams & Mayuri Patel & Lorraine R. Reitzel, 2022. "Providers’ Non-Cigarette Tobacco Use Intervention Practices in Relation to Beliefs about Patients, Prioritization of and Skills for Intervention, and Referral Knowledge in Texas Healthcare Centers Pro," IJERPH, MDPI, vol. 19(21), pages 1-12, November.
    5. Matthew Taing & Bryce Kyburz & Isabel Martinez Leal & Kathy Le & Tzu-An Chen & Virmarie Correa-Fernandez & Teresa Williams & Daniel P. O’Connor & Ezemenari M. Obasi & Kathleen Casey & Litty Koshy & Lo, 2020. "Clinician Training in the Adaptation of a Comprehensive Tobacco-Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed," IJERPH, MDPI, vol. 17(17), pages 1-15, August.
    6. Williams, J.M. & Steinberg, M.L. & Griffiths, K.G. & Cooperman, N., 2013. "Smokers with behavioral health comorbidity should be designated a tobacco use disparity group," American Journal of Public Health, American Public Health Association, vol. 103(9), pages 1549-1555.
    7. Kathy Le & Tzuan A. Chen & Isabel Martinez Leal & Virmarie Correa-Fernández & Ezemenari M. Obasi & Bryce Kyburz & Teresa Williams & Kathleen Casey & Matthew Taing & Daniel P. O’Connor & Lorraine R. Re, 2021. "Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers," IJERPH, MDPI, vol. 18(19), pages 1-16, October.
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