Healthcare Provider Beliefs on Knowledge, Attitudes, and Clinic-based Practices Regarding Traditional and Emerging Diverse Tobacco Products and Marijuana: A Qualitative Study of Primary Care Healthcare Providers in Georgia Open Access

Abstract

This qualitative study explored beliefs on knowledge, attitudes, and clinic-based practices regarding traditional and emerging diverse tobacco products and marijuana among rural and urban Georgia healthcare providers in the primary care setting. These tobacco products included cigars and cigar-like products, smokeless tobacco, hookah, and electronic cigarettes. Cigarette smoking contributes to thousands of deaths every year in the United States, but their use has been steadily declining over that few decades. However, there has been a significant rise in the purchasing and using of emerging tobacco products and marijuana. There have been very few studies done on the knowledge and attitudes of healthcare providers regarding alternative tobacco products, marijuana, and their use. Examining knowledge and perceptions about these emerging tobacco products from healthcare providers is the first step in addressing the impact of these newly integrated products socially, economically, and medically. This study was composed of 20 semi-structured interviews with healthcare providers in primary care settings located in urban and suburban Atlanta and southern Georgia. The Health Belief Model and Clinician-Patient Communication Framework provided basis for developing questions, thematic analysis, and the public health implications of emerging tobacco products and assessing their use and effects in the primary care setting. Results showed that there is not only a lack of knowledge about these products, but some believe that some of these products can be used in cessation efforts towards cigarette smoking. In addition, providers do not ask specific questions about tobacco products used and many times are not addressing their use during clinic visits; however, there is a definite need for additional research on emerging tobacco products to give the providers the tools to give sound advice for their patients. Overall, this study and its findings will inform future research into emerging tobacco products and marijuana, their health effects, and the implications for the healthcare community.

Table of Contents

Acknowledgements vi

Chapter I: Introduction 1

Problem Definition & Justification 1

Theoretical Framework 4

Purpose and Research Questions 7

Chapter II: Review of the Literature 8

Introduction 8

Effects of Various Tobacco Products 8

Tobacco Users and Non-Users' Attitudes Toward Tobacco Products 11

Healthcare providers' attitudes toward tobacco products 12

Conclusion 13

Chapter III: Methodology 15

Introduction and Research Design 15

Participants and Sampling 15

Data Collection and Measures 16

Data Analysis 18

Chapter IV: Results 19

Study Participants 19

Knowledge and Attitudes 19

Cigars and Cigarillos 19

Smokeless Tobacco 21

Hookah 23

Electronic Cigarettes 24

Marijuana 26

Clinic Based Practices 28

Perceived Areas for Needed Research and Information 30

Chapter V: Discussion 32

Knowledge and Attitudes 32

Clinic-based Practices 33

Perceived Needed Research 34

Strengths and Limitations 35

Public Health Implications and Recommendations 36

Conclusions 37

References 38

Appendix A: Semi-Structured Interview Guide 41

Appendix B: Informed Consent 43

Appendix C: Recruitment Email Template 44

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral
Keyword	knowledge cigars Georgia smokeless tobacco cigarettes marijuana healthcare providers beliefs tobacco tobacco products clinic based practices primary care Health Belief Model attitudes electronic cigarettes hookah
Committee Chair / Thesis Advisor	Berg, Carla, Emory University
Committee Members	Thompson, Winifred, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Community-based non-profit organization (e.g., AID Atlanta)

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