Non-Implementation of Tobacco Cessation Services

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Laschober, T. C., Muilenburg, J. L., & Eby, L. T. (in press). Factors linked to substance use disorder counselors’ (non)implementation likelihood of tobacco cessation 5 A’s, counseling, and pharmacotherapy. Journal of Addictive Behaviors Therapy & Rehabilitation.

Study Background: Despite efforts to promote the use of tobacco cessation services (TCS), implementation extensiveness remains limited. This study investigated three factors (cognitive, behavioral, environmental) identified by social cognitive theory as predictors of substance use disorder counselors’ likelihood of use versus non-use of tobacco cessation (TC) 5 A’s (ask patients about tobacco use, advise to quit, assess willingness to quit, assist in quitting, arrange for follow-up contact), counseling, and pharmacotherapy with their patients who smoke cigarettes.

Methods: Data were collected in 2010 from 942 counselors working in 257 treatment programs that offered TCS. Cognitive factors included perceived job competence and TC attitudes. Behavioral factors encompassed TC-related skills and general training. External factors consisted of TC financial resource availability and coworker TC attitudes. Data were analyzed using logistic regression models with nested data.

Results: Approximately 86% of counselors used the 5 A’s, 76% used counseling, and 53% used pharmacotherapy. When counselors had greater TC-related skills and greater general training they were more likely to implement the 5 A’s. Implementation of counseling was more likely when counselors had more positive attitudes toward TC treatment, greater general training, greater financial resource availability, and when coworkers had more positive attitudes toward TC treatment. Implementation of pharmacotherapy was more likely when counselors had more positive attitudes toward TC treatment, greater general training, and greater financial resource availability.

Conclusion: Findings indicate that interventions to promote TCS implementation should consider all three factors simultaneously as suggested by social cognitive theory.

Tobacco Ban Implementation in Substance Use Disorder Treatment Programs

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Muilenburg, J. L., Laschober, T. C., & Eby, L. T. (in press). Prevalence of and factors related to tobacco ban implementation in substance use disorder treatment programs. Administration and Policy in Mental Health and Mental Health Services Research.

This study examined the prevalence of and factors (psychological climate for change and staff attributes) related to indoor and outdoor tobacco bans for patients, employees, and visitors in U.S. substance use disorder treatment programs. Data were collected from a random sample of 1,026 program administrators. Almost all programs banned tobacco use indoors and around one third banned tobacco use outdoors. When there was no tobacco ban, the majority of programs restricted smoking to designated indoor and/or outdoor areas. Further, all psychological climate for change factors (perceived program support, perceived tobacco culture, and tobacco ban beliefs) but none of the staff attributes (percentage licensed/certified clinicians, percentage clinicians with master’s degrees, total staff with education in health-related field) were significantly related to the implementation of comprehensive tobacco bans (both indoors and outdoors).

New Publication on Mentoring

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Eby, L. T., Butts, M. M., Hoffman, B. J., & Sauer, J. B. (in press). Cross-lagged relations between mentoring received from supervisors and employee OCBs: disentangling causal direction and identifying boundary conditions. Journal of Applied Psychology.

Forthcoming: Sustained, new, never, and discontinued tobacco cessation services adopters

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Eby, L. T., Laschober, T. C., & Muilenburg, J. L. (in press). Sustained, new, never, and discontinued tobacco cessation services adopters. Journal of Substance Abuse Treatment.

This study examined longitudinal adoption patterns of tobacco cessation (TC) counseling and TC pharmacotherapy in substance use disorder treatment programs and baseline predictors (program characteristics and program culture) of these patterns 12-months later. Telephone survey data were collected in 2010 from 685 randomly sampled program administrators working in geographically representative treatment programs across the U.S. Regarding TC counseling, about 41% of programs never adopt, 33% sustain, and 27% change adoption patterns. Concerning TC pharmacotherapy, about 62% of programs never adopt, 19% sustain, and 18% change adoption patterns. The three most consistent predictors of counseling adoption patterns are TC reimbursement, TC financial resource availability, and smoking culture. For TC pharmacotherapy adoption patterns, the most consistent predictors include profit status, TC reimbursement, level of care, TC financial resource availability, and smoking culture. Findings provide insights into program characteristics and program culture as both potential barriers and facilitators of longitudinal TCS adoption.

Forthcoming publication: Relationship between low-income patient census and substance use disorder treatment programs’ availability of tobacco cessation services

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Muilenburg, J. L., Laschober, T. C., & Eby, L. T. (in press). Relationship between low-income patient census and substance use disorder treatment programs’ availability of tobacco cessation services. Journal of Drug Issues.

Low income adults with substance use disorders (SUDs) have a high prevalence of tobacco use and often limited access to tobacco cessation treatment. This study examines the relationship between low-income SUD patient census (i.e., percentage of patients whose treatment costs are covered by Medicaid and Federal block grants) and SUD programs’ availability of three evidence-based tobacco cessation services: behavioral treatments, system-level support, and pharmacotherapy. Data were collected from a random sample of 1,006 program administrators in 2010. Mixed-effects models results show that the percentage of low-income patients is significantly positively associated with the availability of behavioral treatments and system-level support but not pharmacotherapy. Thus, low-income patients may have similar access to tobacco cessation pharmacotherapy but greater access to behavioral treatments and system-level support. However, the availability of tobacco cessation services is not widespread overall, which may hamper access to extensive services to address low-income SUD patients’ high smoking rates.

New publication: “Understanding why counselors implement tobacco cessation services with patients”

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Eby, L. T., Laschober, T. C., & Muilenburg, J. L. (in press). Understanding why counselors implement tobacco cessation services with patients. Journal of Substance Abuse Treatment.

This study aimed to understand substance use disorder counselors’ implementation of evidence-based tobacco cessation services (TCS) with their patients who smoke. Drawing from an established adoption of innovations framework, we investigated the association between counselors’ perceptions of the availability of TCS (both pharmacotherapies and behavioral treatments) in their treatment program and the implementation of TCS (both pharmacotherapies and behavioral treatments) with their patients who smoke and whether this association is moderated by the strength of an organization’s climate for implementation and the fit of the innovation with users’ values. Data were collected in 2010 from 682 counselors working in 239 treatment programs across the U.S. that offer evidence-based TCS. Mixed-effect models showed that perceived availability of TCS was related with greater TCS implementation. This relationship was moderated by several indicators of climate for implementation but not by the fit of the innovation with users’ values.