Abstract A012: Changes in providers' pro-cessation beliefs moderate improvement in cigarette screening and 5As delivery in rural healthcare centers following a tobacco free workplace program participation
Abstract
Cigarette smoking remains disproportionately high amongst individuals living in rural and medically underserved areas, contributing to cancer inequities. Despite this, tobacco use is not commonly addressed in healthcare visits. Training providers on smoking cessation interventions may improve treatment delivery by strengthening pro-cessation beliefs. Whether changes in these beliefs affect improvements in intervention delivery remains unclear. Here, we explore these associations in the context of the implementation of a comprehensive tobacco-free workplace program (TFWP). This study evaluates whether center-level changes in provider pro-cessation beliefs following a TFWP implementation would improve Tobacco Use Assessment (TUA) screening and 5As (Ask, Advise, Assess, Assist, Arrange) clinical care for cigarette use across 17 healthcare centers (9 medical and 8 substance use) serving rural Texas. Surveys were completed by providers before (N=391) and after (N=329) implementation; data were analyzed using linear mixed models with an interaction term and post hoc pairwise analyses. Centers were categorized as high or low change groups based on median split in providers’ beliefs that: 1) quitting supports recovery from other co-morbid substance dependencies, 2) they can confidently provide care (self-efficacy), and 3) patients want to quit smoking. Six outcomes were assessed: the proportion of new patients receiving a TUA and each of the 5As for all patients who smoke. Changes in providers’ belief that quitting supports recovery significantly moderated delivery of TUAs, as well as Advise, Assess, and Assist (all P<0.010), with significant differences for high-change centers (all P<0.002). Additional pairwise comparisons showed only high-change centers saw significant increases in Ask (P=0.038), though both high- and low-change centers saw significant increases in Arrange (both P<0.007). Moreover, provider self-efficacy significantly moderated delivery of TUAs, Ask, Advise, Assess, and Assist (all P<0.001), with significant differences for high-change centers (all P<0.002); again pairwise, both high- and low-change centers saw significant increases in Arrange (both P<0.032). Providers’ change in beliefs about their patients wanting to quit smoking did not significantly moderate outcomes; however, high-change centers demonstrated significant increases in Advise, Assist, and Arrange (all P<0.030) over time. Findings suggest that centers experiencing larger shifts in providers’ beliefs about how quitting smoking can help co-morbid dependence recovery and their confidence in providing care may yield the most dramatic change in cigarette use care delivery. This has implications for training content and, potentially, the selection of healthcare centers with the largest capacity for change from a TFWP implementation. Findings can help address clinical practice gaps by strengthening smoking treatment delivery and, ultimately, preventing associated cancers in rural and medically underserved communities. Simbiat Eji-lasisi, Julie Neisler, Nikhil K. Patel, Ammar D. Siddiqi, Emmanuel Eziakor, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Teresa Williams, Kathleen Casey, Lorraine R. Reitzel. Changes in providers' pro-cessation beliefs moderate improvement in cigarette screening and 5As delivery in rural healthcare centers following a tobacco free workplace program participation [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A012.