Measuring Smoking Knowledge, Attitudes and Services (S-KAS) Among Clients in Addiction Treatment

Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 11/2010; 114(2-3):237-41. DOI: 10.1016/j.drugalcdep.2010.09.017
Source: PubMed


Addiction treatment programs are increasingly working to address prevalent and comorbid tobacco dependence in their service populations. However at present there are few published measurement tools, with known psychometric properties, that can be used to assess client-level constructs related to tobacco dependence in addiction treatment settings. Following on previous work that developed a staff-level survey instrument, this report describes the development and measurement characteristics of the smoking knowledge, attitudes and services (S-KAS) for use with clients in addiction treatment settings.
250 clients enrolled in residential drug abuse treatment programs were surveyed. Summary statistics were used to characterize both the participants and their responses, and exploratory factor analysis (EFA) was used to examine the underlying factor structure.
Examination of the rotated factor pattern indicated that the latent structure was formed by one knowledge factor, one attitude factor, and two "service" factors reflecting program services and clinician services related to tobacco dependence. Standardized Cronbach's alpha coefficients for the four scales were, respectively, .57, .75, .82 and .82.
The proposed scales have reasonably good psychometric characteristics, although the knowledge scale leaves room for improvement, and will allow researchers to quantify client knowledge, attitudes and services regarding tobacco dependence treatment. Researchers, program administrators, and clinicians may find the S-KAS useful in changing organizational culture and clinical practices related to tobacco addiction, help in program evaluation studies, and in tracking and improving client motivation.

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    • "The results from this study demonstrated that the majority of patients who participated in the survey were current smokers and that they have substantial ETS exposure across several environments. This is consistent with previous literature demonstrating high rates of smoking (75–97%) among individuals with SUDs (see Guydish et al., 2011; Kalman, 1998; Nahvi et al., 2006; Pajusco et al., 2012). However, these findings are discouraging as high ETS exposure rates were found among study participants. "
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    ABSTRACT: Introduction: Environmental Tobacco Smoke (ETS) has been linked to numerous health problems. While research has demonstrated high prevalence of tobacco use among individuals receiving treatment for substance use disorders (SUDs), no studies have examined ETS among individuals receiving treatment for SUDs, paying specific attention to non-smokers who may be at risk for high exposure to ETS. Methods: Participants (N=261) enrolled in outpatient substance abuse treatment completed a survey, in which 14 items were used to quantify ETS exposure and smoking policies across several environments. Results: Among smokers, 85% reported that their significant others also smoked as compared to 15% among non-smokers (χ(2)=6.624, p<.05). A logistic regression examined the characteristics that predicted smoking in the home. The overall model was significant, (χ(2)=36.046, p<.0005) with variables that independently predicted smoking in the home included having less than a high school diploma, being female, and living with a smoker. Income, age, and living with children were not found to be significant. Overall, 42% white collar workers 26% of service workers and 30% of blue collar workers reported no exposure to ETS. Sixty-seven percent of smokers strongly agreed or agreed that the hazards of secondhand smoke have been clearly demonstrated versus 58% of non-smokers. Conclusions: Smokers and non-smokers enrolled in outpatient substance abuse treatment are frequently exposed to ETS at home, work, and in social settings. The dangers of ETS should be addressed among this population through education, smoke-free policies, and cessation resources, with help from their treatment facility.
    Addictive Behaviors 07/2014; 39(12):1718-1722. DOI:10.1016/j.addbeh.2014.07.016 · 2.76 Impact Factor
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    • "Although smoking cessation programs are rarely available, cross-sectional studies have shown that they are more likely to be offered when organizational cultures value smoking cessation (Fuller et al., 2007) and provide training to staff (Knudsen et al., 2010; Richter, Choi, McCool, Harris, & Ahluwalia, 2004). Most previous research on the availability of smoking cessation services in SUD treatment has used cross-sectional designs (Delucchi et al., 2009; Fuller et al., 2007; Guydish et al., 2011; Hahn, Warnick, & Plemmons, 1999; Knudsen et al., 2010; McCool et al., 2005; Richter et al., 2004), with one recent study on the effectiveness of organizational change interventions to promote adoption (Guydish et al., 2012). Guydish and colleagues found that residential treatment programs were able to increase their delivery of nicotine replacement therapy (NRT) and tobacco-related practices after the programs completed a structured change process. "
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    ABSTRACT: Introduction: The majority of individuals who enter substance use disorder (SUD) treatment also use tobacco. Integrating smoking cessation services into SUD treatment may have substantial public health benefits, but few studies have examined whether organizations offering counseling-based smoking cessation programs sustain them over time. Methods: This study examines sustainment of smoking cessation programs using 2 waves of data collected from 150 SUD treatment organizations. Data were collected in 2006-2008 and 2009-2010 using face-to-face interviews, telephone interviews, and mailed surveys. Logistic regression models of sustainment were estimated with administrators' attitudes toward smoking cessation and organizational barriers as covariates. Results: About 60.2% of these SUD treatment organizations sustained their counseling-based smoking cessation programs at follow-up. Sustainment was significantly more likely when administrators' baseline attitudes about the impact of smoking cessation on recovery were more supportive (odds ratio, OR = 1.84; 95% confidence interval, CI = 1.13-3.01; p =.015) and when programs were accredited (OR = 3.95, 95% CI = 1.65-9.50, p =.002). Worsening over time of barriers encompassing staff interest, staff skills, and competing treatment demands were negatively associated with sustainment (OR = 0.58, 95% CI = 0.42-0.81, p =.001). Conclusions: These findings provided empirical support for theoretical perspectives regarding the importance of leadership and staff expertise in promoting sustainment of innovations over time. Although the majority of SUD treatment organizations sustained their smoking cessation programs, the 40% rate of discontinuation is concerning and highlights the ongoing challenges faced by tobacco control efforts in substance abuse treatment.
    Nicotine & Tobacco Research 11/2012; 15(6). DOI:10.1093/ntr/nts242 · 3.30 Impact Factor
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    • ", similar to the staff survey, also asked about tobacco-related services the client received while in treatment (Guydish et al., 2010). The four S-KAS scales, each scored from 1 to 5, reflect Knowledge (α = 0.57), Attitudes (α = 0.75) and tobacco-related Clinician Services (α = 0.82) and Program Services (α = 0.82). "
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    ABSTRACT: Smoking prevalence among persons in addiction treatment is 3-4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence. The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked. From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163)=7.15, p=0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123)=3.66, p=0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235)=10.58, p=0.0013) and clients received more tobacco-related services from their program (F(1, 235)=92.86, p<0.0001) and from their counselors (F(1, 235)=61.59, p<0.0001). Most changes remained at follow-up. The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.
    Drug and alcohol dependence 09/2011; 121(1-2):30-7. DOI:10.1016/j.drugalcdep.2011.08.003 · 3.42 Impact Factor
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