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JAPNA Article: Assessing Tobacco Treatment Engagement in Assertive Community Treatment Programs - Sep-Oct 2024 (30.5)

With over five decades of promoting tobacco control efforts in the U.S., best practices focus on preventing initiation, promoting cessation, eliminating secondhand tobacco smoke (SHS) exposure, and de-normalizing tobacco use as a behavior (Centers for Disease Control and Prevention, 2014; US Department of Health and Human Services, 2014, 2020). Tobacco control efforts are largely lacking within mental healthcare systems in the U.S. (Huddlestone et al., 2018; Marynak et al., 2018). An estimated 60% of those with serious mental illnesses (SMI) use tobacco with high rates of tobacco-related morbidity and mortality, yet there is poor adoption of evidence-based tobacco treatment in mental and behavioral health settings (Chesney et al., 2021; Dickerson et al., 2018; Dregan et al., 2020; Jamal et al., 2016; Marynak et al., 2018; Prochaska et al., 2017). To support tobacco treatment these settings, there is the need to address existing gaps in poor consumer engagement, inadequate healthcare provider tobacco treatment delivery, and passive or permissive organizational policies related to tobacco use (Gfroerer et al., 2013; Huddlestone et al., 2022; Jamal et al., 2016). 

The Assertive Community Treatment (ACT) services are important mental healthcare settings to provide ‘wrap around’ services for individuals with SMI (Thorning & Dixon, 2020). However, there is a dearth of tobacco treatment services in ACT programs, although tobacco is one of the most frequently used substances in these settings (Abufarsakh et al., 2023; Garcia et al., 2021; Spivak et al., 2019). Studies show that the poor attitudes, subjective norms, and perceived behavioral control surrounding tobacco treatment among both providers and consumers influences the adoption of evidence-based tobacco treatment in mental and behavioral health settings (Brunette et al., 2019; Okoli et al., 2017; Okoli et al., 2018; Otachi et al., 2023). These issues have not been studied within ACT services. Thus, the purpose of this study was to understand attitudinal factors associated with tobacco treatment delivery by providers and engagement by consumers within ACT services in Kentucky, a state with one of the highest adult tobacco-use rates in the U.S (Kentucky Cabinet for Health and Family Services, 2013; Odani et al., 2018). Specifically, among a sample of ACT services consumers and providers we examined factors associated with 1) Engaging in tobacco treatment by ACT service consumers and 2) Delivery of tobacco treatment by ACT service providers. 

Authors:  Chizimuzo T.C. Okoli, PhD, MPH, APRN, FAAN; Bassema Abufarsakh, PhD, RN; Sarret Seng, BS, BSN, RN; Heather Robertson, MA; Zainab Almogheer, MSN

Disclosures: The APNA planner and authors have no relevant financial relationships with ineligible companies or off-label uses to disclose.

Target Audience:  RN, APRN

Learning Outcomes:
Upon completion of this article, the participant will be able to:

1. Describe attitudes, subjective norms, perceived behavioral control and intentions to deliver tobacco treatment among ACT service providers.
2. Describe attitudes, subjective norms, perceived behavioral control and intentions to engage in tobacco treatment among ACT service consumers.
3. Discuss opportunities to engage in education and training about evidence-based tobacco treatment for people living with serious mental and behavioral health challenges.

Keywords:  Assertive Community Treatment, Tobacco Treatment, Serious Mental Illness, Community Setting

Nursing Continuing Professional Development:
1.0 contact hours.  * In order to receive contact hours, you must: read the entire article, complete an evaluation, honor statement, and earn a passing score on the post-test before the expiration date. You will have 5 tries to correctly answer the questions on the posttest and a score of 80% is required to pass. Once you have passed and completed the evaluation and honor statement, your nursing continuing professional development certificate will be generated online and available for immediate printing. Credit cannot be earned unless all components of the program are completed.  

Access to this course will end:  October 31, 2026

The American Psychiatric Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

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