Browsing by Author "Casey, Kathleen"
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Item Enablers and Inhibitors to Implementing Tobacco Cessation Interventions within Homeless-Serving Agencies: A Qualitative Analysis of Program Partners’ Experiences(2024-06-06) Martinez Leal, Isabel; Siddiqi, Ammar D.; Rogova, Anastasia; Britton, Maggie; Chen, Tzuan A.; Williams, Teresa; Casey, Kathleen; Sanchez, Hector; Reitzel, Lorraine R.Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n = 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers’ attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study’s findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation.Item Implementation of a Comprehensive Tobacco Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed(2020-09-29) Taing, MatthewAlthough there have been substantial decreases in the prevalence of cigarette smoking in the last two decades, these overall population estimates often fail to account for subpopulations, such as individuals who are homeless or vulnerably housed, that have disproportionately high smoking rates. Despite this, clinicians do not commonly address tobacco use among individuals who are homeless. Tobacco-free workplace programs, like TTTF, are evidence-based, tobacco control initiatives that may be effective in increasing capacity to address tobacco use within homeless-serving community agencies by addressing known clinician barriers to intervention by providing education, specialized training, and resources to promote and assist quit attempts. Here, we examine the outcomes of TTTF’s implementation within 4 agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N=68) to assess changes in training receipt, knowledge, and intervention behaviors. Results indicated significant gains in clinicians’ receipt of training in 9 (of 9) target areas (ps≤0.0042) and a 53% knowledge gain (ps<0.0001). From pre- to post-implementation, there were mean increases in the use of the 5A’s (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen over time in assisting residents/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (ps≤0.0491). Overall, TTTF improved clinicians’ capacity to address tobacco use among homeless and vulnerably housed individuals and may serve as a model for tobacco control efforts in similar agencies. This project was completed with contributions from Bryce Kyburz, Teresa Williams, and Kathleen Casey from Integral Care at Austin.