Factors influencing implementation of smoking cessation treatment within community mental health centers

Clayton H. Brown, Deborah Medoff, Faith B. Dickerson, Li Juan Fang, Alicia Lucksted, Richard W. Goldberg, Julie Kreyenbuhl, Seth Himelhoch, Lisa B. Dixon

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Objective: Consumers with serious mental illness smoke more and are at higher risk for smoking-related illness. We examined provider and consumer factors influencing the implementation of the evidence-based "5 A's" (ask, advise, assess, assist, arrange) in six community mental health centers in greater Baltimore. Methods: Data collected as part of a larger study examining the effectiveness of delivery of the 5 A's at patient visits. First, we examined responses to a survey administered to 49 clinicians on barriers and attitudes toward delivering the 5 A's. Second, we used multilevel models to examine variance between patients (n = 228), patient factors, and variance between their psychiatrists (n = 28) in the delivery of the 5 A's (and first 3 A's). Results: The most strongly endorsed barrier was perceived lack of patient interest in smoking cessation. Psychiatrists and patients both accounted for significant variance in the delivery of the 5 A's and 3 A's. Patient "readiness to change" predicted delivery of the full 5 A's, while smoking severity predicted delivery of the first 3 A's. Conclusions: There is a critical need for creative and collaborative solutions, policies, and clinician training to address actual and perceived obstacles to the delivery of evidence-based smoking cessation treatment in the mental health care setting.

Original languageEnglish
Pages (from-to)145-150
Number of pages6
JournalJournal of Dual Diagnosis
Issue number2
StatePublished - Apr 3 2015

Bibliographical note

Publisher Copyright:
© 2015 Copyright Taylor & Francis Group, LLC.


  • Barriers to treatment
  • Implementation research
  • Serious mental illness
  • Smoking cessation

ASJC Scopus subject areas

  • Psychiatry and Mental health


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