Date of Graduation

2008

Document Type

Dissertation/Thesis

Abstract

Tobacco use remains one of the leading preventable causes of death in the United States (U.S.), contributing to nearly 440,000 deaths each year and resulting in an annual cost of more than {dollar}75 billion in direct medical costs. The objectives of this study were: (1) to assess the knowledge, attitudes and beliefs of pharmacists in high tobacco use and low tobacco use states toward tobacco cessation counseling, as well as the barriers and motivators associated with tobacco cessation counseling in the pharmacy practice setting and (2) to determine the feasibility of implementing a tobacco cessation program in the pharmacy practice setting and assess counseling behavior after training pharmacists in the Rx for Change program. In phase I, a cross-sectional survey was conducted to assess the current tobacco cessation counseling behaviors of pharmacists in both high and low tobacco use states, attitudes and beliefs towards pharmacy’s role in tobacco control and cessation counseling, behavioral control (barriers) to providing counseling and prior training in tobacco cessation counseling. The Theory of Planned Behavior was employed in the survey development process in order to assess pharmacists’ intention to provide tobacco cessation counseling. It was hypothesized that attitudes, subjective norms and behavioral control would be related to behavioral intentions to provide tobacco cessation counseling. Surveys were mailed to a random sample of pharmacists in three low and three high tobacco use states. There were 288 respondents, for a response rate of 14.49%. It was found that all three variables were each independently associated with cessation counseling intentions. In multivariate analysis, only attitudes were significantly associated with intention to provide cessation counseling, controlling for subjective norms and behavioral control. The addition of demographic and pharmacy characteristics showed age, years licensed and prior training in tobacco cessation counseling were also significantly associated with intention to provide counseling. Attitudes and prior training in tobacco cessation counseling remained significant for pharmacists in both high and low tobacco use states. No significant differences were found between these two groups. Attitudes and prior training were also significant for pharmacist who provide and pharmacists who do provide tobacco cessation counseling. Phase II was a qualitative analysis of the feasibility of implementing tobacco cessation counseling in the pharmacy after pharmacists have received tobacco cessation counseling training using the Rx for Change training program. In Phase II, pharmacists reported a higher level of knowledge and skills, as well as confidence to provide tobacco cessation counseling after receiving tobacco cessation training as compared with before training. The pharmacists initially reported a high level of intention to provide tobacco cessation counseling to patients once they received training. As a result, they did counsel more patients on cessation in the four week follow-up period. The findings of this study suggest that pharmacists’ attitudes are the main determinant of intentions to provide tobacco cessation counseling. Although training in tobacco cessation counseling enables pharmacists to provide quality counseling to patients, training alone does not activate pharmacists’ intentions to provide. Although the Theory of Planned Behavior asserts that the direct determinants of an individual’s behavioral intention are their attitudes, subjective norms and behavioral control, this study’s findings were that pharmacists’ attitudes were the most important factor determining their intention to provide tobacco cessation counseling to patients. Also, it was not determined whether providing pharmacists with tobacco cessation training has an impact on the effectiveness of counseling. Although it may increase the number of patients that pharmacists counsel, an additional study assessing patient outcomes to tobacco cessation counseling is needed to assess behavior change and determine effectiveness.

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