title: Factors influencing implementation of smoking cessation treatment within community mental health centers.
abstract: 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.
authors.forename: Clayton H
authors.initials: CH
authors.lastname: Brown
authors.forename: Deborah
authors.initials: D
authors.lastname: Medoff
authors.forename: Faith B
authors.initials: FB
authors.lastname: Dickerson
authors.forename: Li Juan
authors.initials: LJ
authors.lastname: Fang
authors.forename: Alicia
authors.initials: A
authors.lastname: Lucksted
authors.forename: Richard W
authors.initials: RW
authors.lastname: Goldberg
authors.forename: Julie
authors.initials: J
authors.lastname: Kreyenbuhl
authors.forename: Seth
authors.initials: S
authors.lastname: Himelhoch
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Dixon
mesh_terms: D000328:Adult; D003155:Community Mental Health Centers; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D010349:Patient Compliance; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D014029:Tobacco Use Disorder / Q000150:complications / Q000628:therapy*
keywords: barriers to treatment; implementation research; serious mental illness; smoking cessation