Academic journal article Journal of Drug Issues

Does the Presence of a Smoking Cessation Clinical Trial Affect Staff Practices Related to Smoking?

Academic journal article Journal of Drug Issues

Does the Presence of a Smoking Cessation Clinical Trial Affect Staff Practices Related to Smoking?

Article excerpt

This study investigated whether organizational changes occurred when nicotine treatments were tested in specialty care clinics. Two intervention clinics (one drug treatment and one HIV-care) participated in clinical trials for nicotine treatment. Three clinics (two drug and one HIV-care) were control clinics. Staff in the intervention clinics (n=57) and in the control clinics (n=62) were surveyed at baseline and 18 months later. Staff surveys concerned nicotine-related knowledge, beliefs about treating smoking, self-efficacy in delivering such treatment, nicotine related practices, and barriers to providing nicotine treatment. Mean scale scores at 18 months were no different in clinics participating in the clinical trials from the control group for any of the five scales (knowledge, practices, barriers, efficacy, and beliefs). The presence of a smoking cessation clinical trial did not influence staff knowledge, attitudes, or practices related to smoking in these clinics. More specific organizational intervention may influence staff practices related to addressing smoking among clients in drug treatment and HIV-care clinics.

INTRODUCTION

Research has shown elevated smoking rates among special populations with existing healthcare needs, including substance abuse and HIV infection (Kaiman, 1998; Mamary, Bahrs, & Martinez, 2002). Studies of persons with substance abuse problems report that 60% to 100% of those in treatment smoke (Burling, Ramsey, Seidner, & Kondo, 1997; Kaiman, 1998), that substance abusing persons who smoke are more heavily addicted to nicotine than other smokers (Hughes, 2002; Sobell, 2002), and that alcohol-dependent individuals die from smoking-related causes more frequently than from alcohol-related causes (Hurt et al., 1996). Smoking prevalence among persons living with HIV is also higher than that in the general population (Sobell, Sobell, & Agrawal, 2002), and higher than that among HIV negative persons (Burns et al., 1991; Craib et al., 1992). Smoking predicts HIVrelated medical complications for those living with HIV (Diaz et al., 2000), and psychosocial factors associated with smoking cessation failure (e.g., negative affect, stress) may be more prevalent among persons with HIV (Demás, Schoenbaum, Wills, Doll, & Klein, 1995). There are benefits to quitting smoking for persons with these co-occurring conditions. Smoking cessation has been associated with recovery from alcohol abuse (Sullivan & Covey, 2002), and reduced alcohol consumption has been associated with successful smoking cessation (West, 200 1 ). Smoking cessation is a recommended medical priority for persons living with HIV (Hirschtick et al., 1 995).

Despite the benefits of smoking cessation, smoking behavior is frequently overlooked in healthcare settings (Frazier et al., 2001). Studies of healthcare professionals in a range of clinical settings have investigated factors that facilitate or impede the provision of nicotine dependence treatment. Attitudinal barriers include low outcome expectations and low self-efficacy (Borrelli et al., 2001; Tremblay et al., 2001 ), perceived lack of patient interest (Krupski et al., 2002; Simoyan, Badner, & Freeman, 2002), and low priority given to smoking cessation among competing healthcare needs (Pollak et al., 2001). Structural or organizational barriers include time constraints and the failure of insurance companies to reimburse smoking cessation counseling (Krupski et al., 2002; Simoyan, Badner, & Freeman, 2002). These difficulties may be part of the larger problem of translating scientific advances into improved clinical practice and can be conceptualized in terms of organizational change. In this paper, we explore the questions of whether clinics participating in clinical trials of smoking cessation experienced organizational change regarding smoking practices.

There are reasons that participation in clinical trials may influence organizational practices. …

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