Evaluation of Community-Based Cessation Programs: How Do Smokers with Behavioral Health Conditions Fare?

Though persons with behavioral health conditions experience large disparities in tobacco use, questions about the efficacy of evidence-based tobacco use treatment remain understudied in community health settings. This evaluation examined outcomes from eight community-based tobacco cessation programs for participants with and without behavioral health conditions (n = 974 participants). The majority (64.8%) of participants reported one or more current behavioral health conditions, including mental illness and/or substance abuse. Participants who used cessation medication during the program and who attended more counseling sessions had an increased likelihood of being quit at 4-month follow-up. Quit rates were between 9.8% (intent-to-treat rate) and 30.6% (responder rate); behavioral health status did not negatively affect reported quit rates. Findings add to the growing literature evaluating community-based interventions within the behavioral health population.

Perceptions of Tobacco Control Media Campaigns Among Smokers With Lower Socioeconomic Status.

People with low socioeconomic status (SES) in the United States have disparately high rates of smoking and experience disproportionately high burdens of smoking-related disease. Tobacco control media campaigns are a critical strategy for reducing tobacco use prevalence, but evidence is mixed about the optimal use of mass media to reach and promote tobacco use cessation among people with low SES. Improved understanding of the factors influencing how low-SES tobacco users evaluate tobacco control media campaigns may inform development of more effective messages and strategies. Focus groups with primarily low-SES smokers in Connecticut were conducted, finding that participants had seen many tobacco control television ads that used graphic imagery and testimonials, but participants voiced two main themes that limited ad effectiveness: (1) skepticism about the content of ads, the role of the tobacco industry and the government in sponsoring the ads, and the safety and efficacy of cessation supports; and (2) barriers to quitting such as stress, social contexts, and addiction that participants perceived as being underappreciated in the context of the ads. Tobacco control media campaigns targeting low-SES tobacco users may need additional messages, tools, or refinements to more optimally motivate this group to make quit attempts.

"The Job Has Become Advocating for the Job": Threats to Funding Dramatically Influence Program Outcomes.

As public health funding is increasingly threatened, a better understanding is needed about how periods of funding uncertainty impact program staff, activities, and outcomes. In North Carolina, 2 years of uncertainty and threats of funding cuts for a statewide youth tobacco prevention initiative contributed to reduced grantee morale and confidence about achieving program goals, displaced focus from core program activities, and caused premature loss of personnel, resulting in substantially reduced program activities and outcomes. The range of negative impacts of funding uncertainty and threats highlights the need for programs to create an infrastructure to support ongoing sustainability planning and activities.

Assessment Following Distal Radius Fractures: A Comparison of 4 Scoring Systems, Visual Numerical Scales, and Objective Measurements.

PURPOSE: To compare 4 recognized upper-limb scoring systems that are regularly used to assess wrist function after injury. METHODS: We reviewed 116 patients 6 months after volar locking plate fixation for distal radius fractures. Two purely subjective and 2 composite scoring systems composed of both subjective and objective components were compared along with visual numerical scores for pain and function and objective measures of function. Each score was standardized into a scale from 0 to 100. RESULTS: The distribution of the standardized total scores was statistically significantly different and indicated marked variability between scoring systems and therefore the information provided. Overall, the subjective scoring systems correlated well with each other and with both visual numerical scores for pain and function. However, the composite scores and objective measures of function correlated poorly with the subjective scores including the visual numerical scores. CONCLUSIONS: Results from wrist scoring systems should be interpreted with caution. It is important to ensure that the component parts of each score are taken into consideration separately because total scores may be misleading. CLINICAL RELEVANCE: Composite scores may be outdated and should be avoided.

North Carolina health professionals' communication with adolescents about smoking.

BACKGROUND: The middle school and high school years are a time when adolescents are at high risk for initiation of smoking and progression to nicotine addiction. This research examines the prevalence with which North Carolina students receive smoking-related communication from health professionals and how such communication relates to smoking behaviors. METHODS: Data are from the 2009 North Carolina Youth Tobacco Survey (NCYTS), a biennial public and charter school-based survey of students in grades 6-12. The overall response rate was 78.2% (n = 3,301) for high school students and 79.2% (n = 3,805) for middle school students. Weighted multivariable logistic regression models were used to identify variables that are significantly related to health professionals' communication about smoking and/or advice against smoking. RESULTS: A majority of respondents reported that they had not been asked about or advised against smoking. Middle school and high school students who had tried to quit smoking in the past 12 months were significantly more likely to report having been asked about smoking (OR = 2.00 [95% CI, 1.23-3.28], OR = 1.96 [95% CI,1.44-2.661, respectively) or advised against smoking (OR = 2.25 [95% CI,1.13-4.50], OR = 2.02 [95% CI, 1.31-3.14], respectively) than were students who had not tried to quit. LIMITATIONS: This research is based on a cross-sectional survey and is subject to the honesty of the participants. Results may not generalize beyond public and charter school students in North Carolina. CONCLUSIONS: North Carolina health professionals need to increase communication with adolescents in order to sustain the historically low rates of smoking in this age group.

Support among middle school and high school students for smoke-free policies, North Carolina, 2009.

INTRODUCTION: In the United States, little is known about youth attitudes toward smoke-free policies. Our research measures North Carolina middle school and high school students' opinions about smoke-free policies in indoor and outdoor public places as well as private places such as vehicles, homes, and work environments. METHODS: Data come from the 2009 North Carolina Youth Tobacco Survey. The overall middle school response rate was 79.2% (n = 3,805 students); the overall high school response rate was 78.2% (n = 3,301 students). To account for the complex survey design and sampling weights, data were analyzed by using SAS survey procedures. RESULTS: Most middle school and high school students support smoke-free policies across all venues. Support for smoke-free policies for several venues is also strong among high school students who are current smokers and those who want to stop smoking. CONCLUSION: Until smoke-free legislation becomes universal, youth are at risk for exposure in many venues. The North Carolina legislature can protect the health and well-being of North Carolina youth by passing new legislation that is concordant with youth preferences regarding smoke-free policies.

Successful implementation of a wellness and tobacco cessation curriculum in psychosocial rehabilitation clubhouses.

BACKGROUND: Tobacco remains a seemingly intractable problem for individuals living with severe and persistent mental illness. This study evaluated the implementation, technical assistance, and perceived impact of a model curriculum ("Learning About Healthy Living") to promote wellness and motivation to quit tobacco use in psychosocial rehabilitation clubhouses. METHODS: We used semi-structured interviews (n = 9) with clubhouse staff (n = 12) and a survey of participating clubhouse members (n = 271) in nine clubhouses. RESULTS: Fifty-eight percent of clubhouse participants completed surveys. Results showed tobacco users open to tobacco-free policies (62%) and perceiving more discussions about quitting tobacco with healthcare providers (69%). Analyses of staff interviews and member surveys revealed four key themes: (1) the curriculum was successfully implemented and appreciated; (2) technical assistance kept implementation on track; (3) adding wellness content and interactive components should enhance the curriculum; and, (4) the curriculum advanced other healthful policies and practices. CONCLUSIONS: Mental health settings are important locations for implementing programs to address tobacco use. In this real-world implementation of a model curriculum in psychosocial rehabilitation clubhouses, the curriculum tested well, was feasible and well-received, and suggests potential impact on tobacco use outcomes. Revision, dissemination, and a randomized controlled trial evaluation of the model curriculum should now occur.

High tobacco use among lesbian, gay, and bisexual populations in West Virginian bars and community festivals.

With no information on tobacco use for lesbian, gay, or bisexual (LGB) populations in West Virginia (WV), it is unclear if nationally-identified LGB tobacco disparities also exist in this State. To address this data gap, we conducted a community tobacco survey in bars and events associated with the WV Pride Parade and Festival. Trained community surveyors used electronic and paper survey instruments in bars (n = 6) in three WV cities and community events associated with the WV Pride Parade and Festival. We analyzed results from 386 completed surveys from self-identified LGB individuals. Tobacco use among LGB bar patrons and LGB attendees at Pride-affiliated events was elevated (45%), as was current cigarette use (41%). Users of cigars and chewing tobacco were frequently dual users of cigarettes, with 80% and 60% reporting dual use, respectively. A substantial disparity likely exists in tobacco use among LGB West Virginians. Targeted interventions addressing tobacco use among LGB West Virginians are warranted in these venues, and the addition of a demographic question on sexual orientation would improve data collection and monitoring of this disparity.

Achieving fire-safe cigarette legislation through coalition-based legislative advocacy.

Advocates who work for tobacco control legislation through coalition-based policy advocacy have access to a broad base of support and resources that are critical to overcoming the tobacco industry lobby. This article provides an example of how a coalition-based advocacy strategy that engaged a diverse group of stakeholders and was supported by a national coordinating movement achieved state level fire-safe cigarette legislation in a tobacco-producing and manufacturing state.

Smoking as a vital sign: prompts to ask and assess increase cessation counseling.

BACKGROUND: Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers' attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: "Current smoker?" and "Plan to quit?" METHODS: Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics. RESULTS: From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P<.001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P<.005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P=.41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P<.001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095-0.456). CONCLUSIONS: Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.

State adoption of 100% smoke-free acute non federal hospital campus policies.

To assess the number and percentage of acute care hospitals in the U.S. that have adopted smoke-free hospital campus (SFHC) policies, researchers conducted an assessment from January 2008 to May 2008 of available data on SFHC policy adoption in each state. Slightly more than one third (34.4%) of acute care, non-Federal hospitals had adopted such policies, with wide variation of policy adoption between states.