https://openworks.mdanderson.org/sumexp23/1051/thumbnail.jp

Azad, Briana

Britton, Maggie

Casey, Kathleen

Chen, Tzuan A.

Kyburz, Bryce

Leal, Isabel Martinez

Reitzel, Lorraine R.

Rogova, Anastasia

Siddiqi, Ammar D.

Williams, Teresa

English

OpenWorks @ MD Anderson

Introduction• Cigarette smoking, a known cause of cancers, is elevated among people experiencing homelessness, with a prevalence of ~78%. • People experiencing homelessness have considerable interest in quitting smoking; however, agencies that serve them rarely provide evidence-based tobacco screening and intervention. • Barriers to care provision include inaccurate provider beliefs about their clients’ concerns about smoking, and a lack of knowledge on how to address tobacco dependence. • Consequently, comprehensive tobacco-free workplace programs (TFWPs) that include provider training are critical to implement in settings where people experiencing homelessness receive services. • One such TFWP, called Taking Texas Tobacco Free (TTTF) has been implemented in homeless-serving agencies pre-COVID-19, yielding significant increases in providers’ capacity to address tobacco use. • Here, we extend the TFWP to new agencies and examine its effects on providers’ beliefs about their guests’/clients’ smoking and knowledge about evidence-based cessation interventions during COVID-19.MethodsParticipants and Procedures• TTTF enrolled 3 homeless-serving agencies to participate in the TFWP implementation. • Together, the agencies served 1,355 guests/clients annually through 13,090 visits. • Agencies employed 17 and 11 providers at pre- and post- implementation, respectively. • Providers completed anonymous surveys pre- (N=9) and post- (N=6) implementation.Key Variables of Interest• Providers rated their agreement with 5 statements using a 5-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree: o My guests/clients are concerned about smokingo My guests/clients who smoke want to quit smokingo I have the required skills to help my guests/clients quit smokingo My guests/clients follow my advice about behavior changeo I know where to refer guests/clients for help with smoking cessationEvaluating the Effects of a Tobacco-Free Workplace Program on Provider Beliefs about Guest/Client Tobacco Use and Self-Efficacy to Intervene at Texas Homeless-Serving Agencies during COVID-19Briana Azad (bazad@mdanderson.org)1,2, Tzuan A. Chen3,4, Ammar D. Siddiqi2,5, Maggie Britton2,3 Isabel Martinez Leal2,3, Anastasia Rogova2,3, Bryce Kyburz6, Kathleen Casey6, Teresa Williams6, & Lorraine R. Reitzel2,31Department of Psychology, University of Houston; 2Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center; 3Department of Psychological, Health & Learning Sciences, University of Houston; 4HEALTH Research Institute, University of Houston; 5Department of Biosciences, Rice University; 6Integral CareConclusions• Findings show an increase in provider beliefs that guests/clients are concerned about their smoking and want to quit, reflecting a correction of inaccurate beliefs prominent in this setting; additionally, more providers at post-implementation felt they had the required skills to help clients quit.• Although past work implementing the TTTF program in homeless-serving agencies yielded significant increases in providers’ capacity to address tobacco use, increases in this implementation were not statistically significant. This may be due to: o inadequate statistical power from a low number of responding providers (N=9 at pre-, N=6 at post-implementation), and o COVID-19 challenges to agency capacity-building.• Over time, fewer providers felt that their guests/clients followed their advice about behavior change. This may be due to:o the reality of quitting (e.g., it typically takes many attempts to quit).• Over time, fewer providers endorsed knowing where to refer guests/clients for cessation assistance. Education and dissemination materials provided by TTTF included information about the Texas Tobacco Quitline and other external resources. Thus, results may reflect: o employee turnover (and workforce reduction in 1 case) during implementation, o failure to implement the recommended train-the-trainer program to educate new staff, and o low uptake of specialized provider trainings offered to bolster provider self-efficacy and teach skills to motivate quit attempts.• Future work should enroll more agencies with a larger provider base and ensure participation in all training opportunities. Funding DisclosureThis work was possible through funding from the Cancer Prevention and Research Institute of Texas (CPRIT): PP210026 to Reitzel (2021-2023). Presentation of these results was supported by MD Anderson Partnership for Careers in Cancer Science and Medicine Summer Experience. Conclusions drawn in this work are solely the responsibility of the authors and do not necessarily represent the official views of the sponsoring organizations. The authors declare no conflict of interest. This study was approved by the IRB at the University of Houston and the QIAB at the University of Texas MD Anderson Cancer Center; all appropriate ethical codes were adhered to in the conduct of the work. Employees provided consent for data collection. Analysis• Changes in each key variable of interest over time were assessed using separate logistic regression analyses. • Agency was included as a covariate to control for between-agency variance in key variables of interest. • Given the anonymity of survey data, pre- and post-implementation provider responses could not be matched at the individual level and were thus treated independently.ResultsVariables of InterestPre-implementation Post-implementationp-valueN % N %My guests/clients are concerned about smoking 1 11.11 3 50.00 0.9084My guests/clients who smoke want to quit smoking 0 0.00 3 50.00 0.9480I have the required skills to help my guests/clients quit smoking 3 33.33 4 66.67 0.9472My guests/clients follow my advice about behavior change 5 55.56 2 33.33 0.4203I know where to refer guests/clients for help with smoking cessation 5 55.56 3 50.00 0.9914Table 2: Changes in provider beliefs from pre- (N=9) to post- (N=6) implementation of a comprehensive tobacco-free workplace program in three Texas homeless-serving agenciesNote: MI = Motivational Interviewing; TTS = Tobacco Treatment SpecialistFigure 1: Table of contents from the Taking Texas Tobacco Free step-by-step implementation guide illustrative of program components Scan the QR code to download a copyTable 1: Characteristics of homeless-serving agencies (N=3) in Texas participating in a comprehensive tobacco-free workplace programNote: % = Percentage of providers that agreed or strongly agreed with the variable of interestAgenciesAnnual Guests/ Clients ServedAnnual Guest/ Client Visits# Providers Employed Counties Served# of Providers Trained in MI# of Providers Trained as TTSPre PostAgency #1 1,000 3,000 2 2 Zavala 0 0Agency #2 180 90 3 3 Cameron 2 1Agency #3 175 10,000 12 6 Travis 0 0

Evaluating the Effects of a Tobacco-Free Workplace Program on Provider Beliefs about Guest/Client Tobacco Use and Self-Efficacy to Intervene at Texas Homeless-Serving Agencies during COVID-19

https://openworks.mdanderson.org/cgi/viewcontent.cgi?article=1051&context=sumexp23

Evaluating the Effects of a Tobacco-Free Workplace Program on Provider Beliefs about Guest/Client Tobacco Use and Self-Efficacy to Intervene at Texas Homeless-Serving Agencies during COVID-19

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