Abstract P025: Tobacco screening practices and perceived barriers in offering tobacco cessation services in the primary prevention of lung cancer among Texas healthcare centers providing behavioral health treatment
Authors: Siddiqi Ammar D. , Britton Maggie , Chen Tzuan A. , Carter Brian J. , Wang Carol , Leal Isabel Martinez , Rogova Anastasia , Kyburz Bryce , Williams Teresa , Patel Mayuri , Reitzel Lorraine R. 
Published: January 2023

Abstract
Cigarette smoking is the leading cause of preventable death and illness globally and accounts for over 80% of all lung cancer diagnoses in the U.S. Patients with behavioral health (e.g., mental health and/or substance use) needs have elevated levels of smoking relative to the general population and are thus disparately impacted by tobacco-related cancers. Tobacco screenings, a precursor to providing evidence-based interventions for smoking cessation, play a critical role in the primary prevention of lung cancer. However, their use in behavioral health treatment centers has historically been inconsistent. The aim of this study was to analyze barriers and facilitators to tobacco screening in settings where Texans receive behavioral health care to contextualize current screening trends and, in turn, provide recommendations for improvement. This study assessed the prevalence of mandated tobacco screenings in 80 centers providing healthcare to Texans with behavioral health needs. We examined key factors that could enhance screening conduct (i.e., provision of a tobacco use assessment template, hard stop in the electronic health record [EHR] for patient tobacco use status, and the availability of tobacco screening training), assessed associations between center practices and mandated tobacco screenings, and delineated providers’ perceived barriers to tobacco use intervention provision. Results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in the EHR (p&lt;0.008) and to make training on tobacco screening available to providers (p=0.016). The most widespread barriers to tobacco use disorder care provision, endorsed by at least 50% of all respondents at &gt;1 type of healthcare center (e.g. federally qualified health centers, global local mental health authorities, substance use treatment centers in local mental health authorities, and stand-alone substance use treatment centers), were relative perceived importance of competing diagnoses, lack of community resources for referral, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to prevent cancer-related disparities in this group. Healthcare centers can support their providers to intervene upon tobacco use by mandating screenings, streamlining clinical workflow with hard stops in patient records, and by educating providers about patient’s interest in quitting along with the importance of treating tobacco with brief evidence-based intervention strategies. Future work should focus on how these healthcare centers can facilitate providers’ ability to link tobacco screenings with smoking cessation services and lung cancer eligibility screening to increase the early detection of lung cancers and prevent tobacco-related cancer disparities.
Citation Format: Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Brian J. Carter, Carol Wang, Isabel Martinez Leal, Anastasia Rogova, Bryce Kyburz, Teresa Williams, Mayuri Patel, Lorraine R. Reitzel. Tobacco screening practices and perceived barriers in offering tobacco cessation services in the primary prevention of lung cancer among Texas healthcare centers providing behavioral health treatment. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P025.