The aim of this study was to apply factor analytic techniques to staff survey questions frequently used in the study of smoking in drug abuse treatment settings, and to identify scales that may measure relevant constructs more robustly than individual survey items. The results identified five scales having reasonably good basic psychometric properties. These scales reflect knowledge of smoking risks, attitudes toward treating nicotine dependence in the context of drug abuse treatment, counselor self-efficacy in providing such services, barriers to providing such services, and practices used to address smoking among clinic clients. These scales may be useful, for example, for assessing whether staff training regarding nicotine dependence results in increased smoking-related knowledge, more favorable attitudes towards treating smoking in drug abuse treatment settings, or increased self-efficacy when addressing smoking with clients. Interventions designed to change clinical practice, like the Addressing Tobacco Through Organizational Change Intervention (Ziedonis et al., 2007
), or large scale policy interventions designed to increase smoking cessation intervention in statewide treatment systems, like those in New Jersey (Williams et al., 2005
) or New York (Tobacco-Free Services Title 14, 2008
), could use the practice scale to assess whether counselors are delivering more smoking-related services to clients over time.
Limitations to the current study include the process of scale development used and the need for large and diverse samples in factor analysis. The process of scale development is usually an iterative process, beginning with the collection of a set of items selected with the goal of forming those items into a scale as the organizing force. The items used in this analysis were not preselected with scale development in mind but, as in a number of staff survey studies related to smoking, used individual items to measure knowledge, attitudes, and practices. Because of this, there was variation in response choices across items. Even with this variation, however, the items formed scales with face validity and internal consistency, offering a strong first step towards the development of more refined items and scales. Future work focused on these scales should first consider confirming these findings, preferably in a larger sample to confirm that these scales replicate. It may also be appropriate to use some form of control group to examine change in these measures over time. Finally, the psychometric properties may be improved by refining the responses so that they use a common format.
The four “orphaned” items, those not fitting in with the others, are interesting to consider. The two factual questions, one related to light cigarettes and one to the benefits of quitting for someone with 20 years of smoking, apparently address facts not well-known among clinical providers. Compared to other bits of knowledge about smoking cessation, these are more recent findings, but point to the need to assure that providers have the most up-to-date information available. Answers to the question as to whether nicotine dependence treatment should be offered to clients who smoke may reflect a complex issue regarding the various factors that go into treatment selection as well as the issues stemming from traditions as discussed in the introduction of this article. The final question has a fairly complex format which may have confused some respondents, and the clinicians’ answers may reflect the same range of treatment selection factors influencing the answers given to the third of these four questions.
Persons enrolled in drug abuse treatment smoke at a rate 3-4 times that of the general population and. because of this, bear a disproportionate burden of illness related to smoking. Individual treatment programs have initiated efforts to better address smoking among both clients and staff (Bernstein & Stoduto, 1999
; Hurt, Croghan, Offord, Eberman, & Morse, 1995
; McDonald, Roberts, & Descheemaeker, 2000
), the VA system has made broad and enduring efforts to better address smoking across all specialties of medical/psychiatric/addiction care (Isaacs, Schroeder, & Simon, 2004
), and at least three states have launched policy initiatives to better address smoking among persons in publicly-funded drug abuse treatment systems (Williams et al., 2005
; Tobacco-Free Services Title 14 NYCRR, 2008
; Toussaint, VanDeMark, Silverstein, & Stone, in press
). As drug treatment programs and systems implement innovative smoking cessation interventions and policy approaches to better address nicotine dependence, there is an increasing need for improved strategies to measure outcomes of these interventions and approaches. The measurement scales reported here offer tools to measure program change in response to these interventions.