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Purpose. To assess the relationship between household smoking restrictions and smoking patterns among Chinese American adults. Design. This is a cross-sectional analysis based on a National Institutes of Health-funded population-based household and telephone survey of 2537 Chinese American adults. Setting. Two communities in New York City. Subjects. The analyses focused on male current smokers (N = 600). Measures. Demographic characteristics, smoking status, household smoking restrictions, cigarettes smoked per day, and past quit attempts were based on self-reported data. Results. Among current smokers, 37% reported living in a home with a complete smoking ban. Smokers with a full household smoking ban smoked fewer cigarettes on weekdays and weekends than smokers with no household smoking ban (p ≤ .05) and were 3.4 times (p ≤ .01) more likely to report having at least one quit attempt in the past 12 months. Smokers with knowledge of the dangers of environmental tobacco smoke (ETS) exposure were 2.8 times (p ≤ .01) more likely to have at least one quit attempt in the last 12 months compared with those who were unaware of the danger of ETS and more likely to live in a smoke-free household. Conclusions. Smoke-free home policies and interventions to raise awareness among smokers of the dangers of ETS have the potential to significantly reduce tobacco use and exposure to household ETS among this immigrant population.

No population-based data are available on the degree to which Chinese Americans have adopted smoke-free household policies and whether these policies are effective in reducing environmental tobacco smoke (ETS) exposure. The present study examines the prevalence of smoke-free home rules among Chinese Americans living in New York City, describes predictors of adopting full smoking bans in the home, and explores the association between household smoking restrictions and ETS exposure at home. In-person interviews using a comprehensive household-based survey were conducted with 2,537 adults aged 18–74 years. Interviews were conducted in Mandarin, Cantonese, and other Chinese dialects. A total of 66% of respondents reported that smoking was not allowed inside the home, 22% reported a partial ban on smoking in the home, and 12% reported no smoking ban. Among current smokers, 38% reported a full household smoking ban. Current smoking status was the strongest predictor of less restrictive household smoking policies. Knowledge of the dangers of ETS, support of smoke-free air legislation, years in the United States, gender, income, and marital status also were associated with household smoking bans. Those living with a total household smoking ban were significantly less likely to report 30-day exposure to ETS than were those living in homes with a partial ban or no ban (7% vs. 68% and 73%, respectively). In homes of smokers and nonsmokers alike, exposure to ETS remains high. Smoke-free home rules and interventions among smokers and nonsmokers to raise awareness of the dangers of ETS have the potential to significantly reduce exposure to household ETS among this immigrant population.

Synchronous home-based telemedicine for primary care experienced growth during the coronavirus disease 2019 pandemic. A review was conducted on the evidence reporting on the feasibility of synchronous telemedicine implementation within primary care, barriers and facilitators to implementation and use, patient characteristics associated with use or nonuse, and quality and cost/revenue-related outcomes. Initial database searches yielded 1,527 articles, of which 22 studies fulfilled the inclusion criteria. Synchronous telemedicine was considered appropriate for visits not requiring a physical examination. Benefits included decreased travel and wait times, and improved access to care. For certain services, visit quality was comparable to in-person care, and patient and provider satisfaction was high. Facilitators included proper technology, training, and reimbursement policies that created payment parity between telemedicine and in-person care. Barriers included technological issues, such as low technical literacy and poor internet connectivity among certain patient populations, and communication barriers for patients requiring translators or additional resources to communicate.

BACKGROUND: Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability. METHODS: We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis. RESULTS: Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains. CONCLUSION: Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and ...

© 2019 Society for the Study of Addiction Aim: To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). Design: Cross-sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. Setting and participants: Survey respondents (n=127 countries) who completed an open-ended question on the 26-item survey. Measurements: The open-ended question asked the following: 'In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country?'. We conducted thematic analysis of the responses. Findings: The most frequently reported barriers included a lack of health-care system infrastructure (n=86) (e.g. treatment not integrated into primary care, lack of health-care worker training), low political priority (n=66) and lack of funding (n=51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n=11), policymakers' lack of awareness about the effectiveness and affordability of TDT (n=5), public norms supporting tobacco use (n=11), a lack of health-care leadership and expertise in the area of TDT (n=6) and a lack of grassroots and multi-sector networks supporting policy implementation (n=8). The analysis captured patterns of co-occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health-care infrastructure and capacity to implement Article 14. Conclusion: Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a health-care system infrastructure, low political priority and lack of funding.

Aim To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). Design Cross‐sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. Setting and participants Survey respondents (n=127 countries) who completed an open‐ended question on the 26‐item survey. Measurements The open‐ended question asked the following: In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country? We conducted thematic analysis of the responses. Findings The most frequently reported barriers included a lack of health care system infrastructure (n=86) (e.g., treatment not integrated into primary care, lack of health care worker training), low political priority (n=66) and lack of funding (n=51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n=11), policymakers' lack of awareness about the effectiveness and affordability of TDT (n=5), public norms supporting tobacco use (n=11), a lack of health care leadership and expertise in the area of TDT (n=6) and a lack of grassroots and multisector networks supporting policy implementation (n=8). The analysis captured patterns of co‐occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health care infrastructure and capacity to implement Article 14. Conclusion Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a healthcare system infrastructure, low political priority and lack of funding.

The study aimed to estimate the cost for developing and implementing 2 smoking cessation service delivery models that were evaluated in a 2-arm cluster randomized trial in Commune Health Centers (CHCs) in Vietnam. In the first model (4As) CHC providers were trained to ask about tobacco use, advise smokers to quit, assess readiness to quit, and assist with brief counseling. The second model included the 4As plus a referral to Village Health Workers (VHWs) who were trained to provide multisession home-based counseling (4As + R). An activity-based ingredients (ABC-I) costing approach with a healthcare provider perspective was applied to collect the costs for each intervention model. Opportunity costs were excluded. Costs during preparation and implementation phase were estimated. Sensitivity analysis of the cost per smoker with the included intervention' activities were conducted. The cost per facility-based counseling session ranged from USD 9 to USD 11. Cost per home-based counseling session at 4As + R model was USD 4. The non-delivery cost attributed to supportive activities (eg, Monitoring, Logistic, Research, General training) was USD 107 per counseling session. Cost per smoker ranged from USD 6 to USD 451. The study analyzed and compared cost of implementing and scaling community-based smoking cessation service models in Vietnam.