Nursing Staff Attitude, Subjective Norms, Perceived Behavior Control, and Intention to Provide Tobacco Treatment in a Psychiatric Hospital


Although the nursing staff is fundamental in assisting individuals with mental illnesses (MI) to stop tobacco use, they often have mixed feelings about providing tobacco treatment (TT) services to people with MI in inpatient psychiatric settings.


Therefore, this study aimed to understand factors associated with nursing staff’s intentions to provide TT interventions for individuals diagnosed with MI in a psychiatric facility using the constructs of the theory of planned behavior (TPB).


Secondary data analysis was performed using cross-sectional data collected from 98 nursing staff who worked in a state inpatient psychiatric facility. A 15-item questionnaire was used to assess nursing staff intentions to provide TT services based on TPB constructs, including attitudes (four items), subjective norms (four items), perceived behavioral controls (four items), and intentions (three items) toward providing TT. The mean scores of each subscale ranged from 1 to 7. A logistic regression analysis was used to examine the relationship between TBP constructs and nursing staff intentions to provide TT for people with MI.


Nursing staff had an acceptable mean score in the intentions subscale (4.34 ± 2.01). Only two constructs of TPB explained nursing staff intentions to provide TT: subjective norms (OR = 2.14, 95% CI [1.46, 3.13]) and perceived behavioral control (OR = 2.33, 95% CI [1.32, 4.12]).


The constructs of the TPB, the subjective norms, and the perceived behavior control were able to predict nurses’ intentions to provide TT for inpatients in a psychiatric setting. Accordingly, we suggest implementing policies that make TT a normative practice while supporting the confidence and competence of nurses to deliver TT in psychiatric facilities.

Seminars for Collaborative Opportunities for Research

Recording Photos 2021 Schedule

Dr. Zim Okoli presents "Enhancing Evidence-Based Practice Adoption: Tobacco Treatment in Mental and Behavioral Health Settings" at SCORE, February 24th, 2021 at 12:00 PM EST.

Engaging clients with mental illnesses and behavioral health challenges in tobacco treatment


People living with mental illness have higher tobacco use rates and are disproportionately affected by tobacco-related illness and death. In fact, smoking is the leading cause of death in individuals with mental illness and substance use disorders. Yet smokers with mental illness have low success with traditional tobacco treatment programs. Behavioral health care providers need to be more aggressive in offering tobacco use treatment in these populations. The following video gives more background on this population and discusses how to adapt tobacco treatment programs to help those with mental disorders (about 18% of the US population). Many in this population use tobacco to affect their mood often when bored, needing to concentrate, or wanting momentary stress relief. In fact, some mental health facilities actually encourage nicotine use. But early tobacco use may actually cause psychosis or other mental illness and the tar from cigarettes can counteract the effectiveness of mental illness medication (I.e. antipsychotics, antidepressants, mood stabilizers, etc.). Smoking cessation could help the medications treating mental illness to be more effective. For these reasons and many more, the BH WELL team is passionate about changing the norm of nicotine addiction within mental health settings.


Video Citations

Educational Materials


Tailored tobacco treatment educational materials are available to health professionals. These materials will serve as aids to health professionals working with anyone who wants to stop smoking and stop using other nicotine products. These resources were specifically designed to support individuals living with mental and behavioral health challenges who want to stop smoking and who want to stop using other nicotine products.

This policy brief summarizes tobacco treatment policies and practices for Community Mental Health Centers (CMHCs) in Kentucky. CMHC's provide services to people living with mental illness. Based on CDC estimates, adults with mental illness consume about 41% of all tobacco products. 

Here you will find training materials related to the effects of tobacco use. This includes presentations by Dr. Okoli and a testimonial of a teenage Juul user from North Carolina.

These additional resources include the Stanford Tobacco Prevention toolkit, BREATHE's online tobacco treatment specialist training, and a link to the Truth Initiative project.

View tools for health care providers to help patients using tobacco begin tobacco dependence treatment and the tools for those using tobacco who want to quit.

Here you will find media resources including a PSA series about teenage Juul use and a brief KET segment about tobacco dependence treatment being essential to mental health recovery.

Psychiatric Nursing Care Across the Life Span

The American Psychiatric Nurses Association and APNA Kentucky Chapter 2017 Annual Conference presented PSYCHIATRIC NURSING CARE ACROSS THE LIFE SPACE on March 24 at Embassy Suites in Lexington, Kentucky. 

BH WELL team members presented on a number of topics: 
“Understanding Dual Diagnosis: Intellectual Disability and Mental Health” Dr. Dianna Inman 

RN to BSN Work Learning Program Orientation

The RN to BSN Work Learning Program Orientation was held at Eastern State Hospital in October 2017. Work Learning cohort members learned of library and writing support and spent time getting to know one another and their Peer Tutor. In addition, the cohort were experienced a Speed Meet and Greet where they had one-on-one time to get to know RN to BSN online faculty.