The Smoking Cessation Counseling Scale SCC Psychometrics and

The Smoking Cessation Counseling Scale (SCC): Psychometrics and Application to Research and Practice Robin Newhouse, Ph. D, RN, NEA-BC, FAAN University of Maryland School of Nursing This study was funded by a grant from the Robert Wood Johnson Foundation

Study Team *Robin Newhouse, Ph. D, RN Laura Morlock, Ph. D *Cheryl Dennison, Ph. D, RN Kevin Frick, Ph. D Peter Pronovost, MD, Ph. D *Yulan Liang, Ph. D RAs: Janine Michaelson, RN, BSN & Julie Twigg RN, BSN * Co-presenters 2

Aims of Study Parent study A phased randomized cluster trial to evaluate the effect of a rural hospital collaborative on HF patient care Sub-study Test the psychometric properties of the Smoking Cessation Counseling Scale (SCC) which measures evidence-based smoking cessation practices 3

Helping Smokers Quit: A Guide for Nurses. March 2005. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http: //www. nurses 4 tobaccocontrol. org/files/AHRQnurses. Guide. pdf

Design and Sample Design: Cross-sectional Sample: 23 rural hospitals from the eastern U. S. 591 Registered Nurses Data source: Written survey (SCC) at baseline 5 5

Nurse Demographics Characteristic N Percentage Full Time 499 84. 4% Age 36 -50 243 41. 1% 18 -35 209 35. 4% 51 -65 126 21. 3% Race White 522 88. 3% Gender Female 554 93. 7% Degree Associates Bachelors Degree 338 57. 2% 189 32. 0% 6

Hospital Demographics Characteristic Mean(SD) Range Hospital Beds 131 (95) 20 -390 Average Daily Census 80 (70) 7 -323 7

SCC Description 24 items with response format: 1= not at all 2= less than ½ of the time, 3= more than ½ of the time and 4= all of the time 2 items with response format: 10 point (1 -not at all to 10 - very) 8

Advanced Counseling Means(SD) FL* I advise smokers to set a quit date 2. 44(1. 06) . 59 I advise smokers to get support from family, friends and coworkers 2. 95(0. 94) . 69 I review past quit attempts-what helped, what led to relapse 2. 45 (0. 98) . 71 I help the patient anticipate challenges, particularly during the critical first few weeks 2. 54 (0. 96) . 77 I help patients anticipate nicotine withdraw 2. 77(0. 97) . 78 I identify reasons for quitting and benefits of quitting 3. 19(0. 85) . 66 I advise patients that total abstinence is essential-not even a single puff 2. 65(1. 07) . 74 I advise patients that drinking alcohol is strongly associated with relapse 2. 35 (1. 06) . 69 I advise patients that having other smokers in household hinders successful quitting 2. 87(1. 02) . 78 I recommend use of over-the-counter nicotine patch, gum or lozenge; or get a 2. 97(0. 96) prescription for nasal spray, inhaler, or buproprion SR unless contraindicated I use cessation materials that are appropriate by age, culture, language, education and 2. 64(1. 04) pregnancy status I provide information for follow-up visits with the patient's doctor 2. 46(1. 10) . 62 I advise patients if relapse occurs, they should repeat the quit attempt-it is part of the quitting process I advise patients if relapse occurs, they should review the circumstances and learn from the experience I advise patients that if relapse occurs, they should reassess the pharmacotherapy use and problems 2. 58(1. 04) . 80 2. 54(1. 05) . 82 2. 36(1. 04) . 77 . 48. 45 9

Referral to Services Means(SD) FL* I provide the number for the toll-free National Quitline 2. 19(1. 09) . 72 I refer the patient to web resources for AHRQ 1. 95(1. 00) . 86 I refer the patient to web resources for Tobacco Free Nurses Initiative 1. 77(0. 93) . 86 Means(SD) FL* I advise tobacco users to quit 3. 46(0. 79) . 71 I ask tobacco users if they are willing to quit 3. 30(0. 86) . 69 If tobacco users are willing to quit, I provide resources and assistance 3. 60(0. 64) . 67 If tobacco users are not willing to quit, I provide resources and help patient identify barriers to quitting 3. 05(0. 93) . 62 Means(SD) FL* Basic Counseling Standard Care I assess my patient tobacco use 3. 6(0. 61) . 86 I document my patient tobacco use 3. 5(0. 67) . 85 FL*= Factor Loadings 10

Convergent Validity Total SCC was positively associated with comfort in smoking cessation counseling (r=. 604, p<. 000) and comfort in referral to resources (r=. 630, p<. 000). When controlling for age, gender, work status, education and ethnicity, comfort with smoking cessation counseling independently predicted higher total SCC scores, explaining 36% of variance in SCC (adjusted R 2 =0. 36). 11

Psychometrics Reliability: Cronbach’s alpha = 0. 955 Validity: Exploratory Factor Analysis: All items loaded on four factors (explained 68. 3% of SCC variation) Convergent validity: Controlling for nurse characteristics, comfort in smoking cessation counseling predict higher SCC scores (R 2 = 0. 36) 12

References Newhouse, R. , Dennison, C. , Liang, Y. Psychometric Testing of the Smoking Cessation Counseling (SCC) Scale. (2011). Journal of Nursing Scholarship, 43(4), 405 -11 doi 10. 1111/j. 15475069. 2011. 01420. x. Newhouse, R. P. , Dennison, C, Liang, Y. , Morlock, L. , Frick, K. , Pronovost, P. (2011). Smoking Cessation Counseling by Registered Nurses: Description and Predictors in Rural Hospitals. American Nurse Today Online, 6(6). Available at: http: //www. americannursetoday. com/Article. aspx? id=7902&fid=7870. 13

Robin P. Newhouse, Ph. D, RN newhouse@son. umaryland. edu 410 -706 -7654 14