{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:23:44Z","timestamp":1777051424659,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA 129312"],"award-info":[{"award-number":["R01 CA 129312"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R25 CA 236637"],"award-info":[{"award-number":["R25 CA 236637"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["T32 CA117865"],"award-info":[{"award-number":["T32 CA117865"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Cancer Institute of the National Institutes of Health","award":["R01 CA 129312"],"award-info":[{"award-number":["R01 CA 129312"]}]},{"name":"National Cancer Institute of the National Institutes of Health","award":["R25 CA 236637"],"award-info":[{"award-number":["R25 CA 236637"]}]},{"name":"National Cancer Institute of the National Institutes of Health","award":["T32 CA117865"],"award-info":[{"award-number":["T32 CA117865"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Pharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists\u2019 perceptions of factors associated with the implementation of \u201cAsk-Advise-Refer\u201d, a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers\u2019 Diffusion of Innovations Theory, assessed pharmacists\u2019 perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.<\/jats:p>","DOI":"10.3390\/pharmacy10030056","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:25:12Z","timestamp":1653956712000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Implementing Brief Tobacco Cessation Interventions in Community Pharmacies: An Application of Rogers\u2019 Diffusion of Innovations Theory"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6676-2767","authenticated-orcid":false,"given":"Katy Ellis","family":"Hilts","sequence":"first","affiliation":[{"name":"Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5357-138X","authenticated-orcid":false,"given":"Robin L.","family":"Corelli","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA 94117, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander V.","family":"Prokhorov","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan M.","family":"Zbikowski","sequence":"additional","affiliation":[{"name":"inZights Consulting, LLC, Seattle, WA 98115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7495-3678","authenticated-orcid":false,"given":"Alan J.","family":"Zillich","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3713-5510","authenticated-orcid":false,"given":"Karen Suchanek","family":"Hudmon","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA 94117, USA"},{"name":"Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.15585\/mmwr.mm6552a1","article-title":"Quitting Smoking among Adults\u2014United States, 2000\u20132015","volume":"65","author":"Babb","year":"2017","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta19950","article-title":"Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): A prospective cohort study","volume":"19","author":"Dobbie","year":"2015","journal-title":"Health Technol. Assess."},{"key":"ref_3","unstructured":"Merritt Hawkins (2022, May 24). 2017 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. Available online: https:\/\/www.merritthawkins.com\/news-and-insights\/thought-leadership\/survey\/survey-of-physician-appointment-wait-times\/."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1177\/1062860614521278","article-title":"Primary care access barriers as reported by nonurgent emergency department users: Implications for the US primary care infrastructure","volume":"30","author":"Hefner","year":"2015","journal-title":"Am. J. Med. Qual."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Qato, D.M., Zenk, S., Wilder, J., Harrington, R., Gaskin, D., and Alexander, G.C. (2017). The availability of pharmacies in the United States: 2007\u20132015. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0183172"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.pec.2005.03.009","article-title":"Tobacco cessation counseling: Pharmacists\u2019 opinions and practices","volume":"61","author":"Hudmon","year":"2006","journal-title":"Patient Educ. Couns."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1592\/phco.23.5.666.32192","article-title":"Smoking-cessation services in Iowa community pharmacies","volume":"23","author":"Aquilino","year":"2003","journal-title":"Pharmacotherapy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/jcpt.12131","article-title":"Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy","volume":"39","author":"Saba","year":"2014","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Carson-Chahhoud, K.V., Livingstone-Banks, J., Sharrad, K.J., Kopsaftis, Z., Brinn, M.P., To-A-Nan, R., and Bond, C.M. (2019). Community pharmacy personnel interventions for smoking cessation. Cochrane Database Syst. Rev., CD003698.","DOI":"10.1002\/14651858.CD003698.pub3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1093\/ntr\/ntq222","article-title":"One-year outcomes and a cost-effectiveness analysis for smokers accessing group-based and pharmacy-led cessation services","volume":"13","author":"Bauld","year":"2011","journal-title":"Nicotine Tob. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1592\/phco.27.7.1040","article-title":"Tobacco interventions delivered by pharmacists: A summary and systematic review","volume":"27","author":"Dent","year":"2007","journal-title":"Pharmacotherapy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1211\/ijpp.17.04.0005","article-title":"Ask, advise and refer: Hypothesis generation to promote a brief tobacco\u2014Cessation intervention in community pharmacies","volume":"17","author":"Patwardhan","year":"2009","journal-title":"Int. J. Pharm. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"93","DOI":"10.5688\/ajpe77593","article-title":"The role of academic pharmacy in tobacco cessation and control","volume":"77","author":"McBane","year":"2013","journal-title":"Am. J. Pharm. Educ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1093\/ntr\/ntx212","article-title":"A Meta-Analysis of Brief Tobacco Interventions for Use in Integrated Primary Care","volume":"20","author":"Wray","year":"2018","journal-title":"Nicotine Tob. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jsat.2019.01.024","article-title":"A pilot study of Counsel to Quit\u00ae: Evaluating an Ask Advise Refer (AAR)-based tobacco cessation training for medical and mental healthcare providers","volume":"99","author":"Chavarria","year":"2019","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jen.2017.08.004","article-title":"Emergency Nurse Implementation of the Brief Smoking-Cessation Intervention: Ask, Advise, and Refer","volume":"44","author":"Simerson","year":"2018","journal-title":"J. Emerg. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1345\/aph.1P226","article-title":"Implementing a referral to telephone tobacco cessation services in Louisiana community pharmacies: A pilot study","volume":"44","author":"Baggarly","year":"2010","journal-title":"Ann. Pharmacother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1331\/JAPhA.2012.10117","article-title":"Effectiveness of intervention to implement tobacco cessation counseling in community chain pharmacies","volume":"52","author":"Patwardhan","year":"2012","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.japh.2018.04.016","article-title":"Outcomes of a randomized trial evaluating two approaches for promoting pharmacy-based referrals to the tobacco quitline","volume":"58","author":"Hudmon","year":"2018","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Greenhalgh, T., Macfarlane, F., Steed, L., and Walton, R. (2016). What works for whom in pharmacist-led smoking cessation support: Realist review. BMC Med., 14.","DOI":"10.1186\/s12916-016-0749-5"},{"key":"ref_21","unstructured":"Rogers, E.M. (2003). Diffusion of Innovations, The Free Press. [5th ed.]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.sapharm.2012.06.001","article-title":"Recruitment of community pharmacies in a randomized trial to generate patient referrals to the tobacco quitline","volume":"9","author":"Corelli","year":"2013","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.sapharm.2012.03.001","article-title":"A randomized trial evaluating 2 approaches for promoting pharmacy-based referrals to the tobacco quitline: Methods and baseline findings","volume":"9","author":"Zillich","year":"2013","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_24","unstructured":"Centers for Disease Control and Prevention (2019). Celebrating the 15th Anniversary of the National Network of Tobacco Cessation Quitlines, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0002-9459(24)03799-9","article-title":"Evaluation of a train-the-trainer program for tobacco cessation","volume":"71","author":"Corelli","year":"2007","journal-title":"Am. J. Pharm. Educ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.ypmed.2004.10.003","article-title":"Statewide evaluation of a tobacco cessation curriculum for pharmacy students","volume":"40","author":"Corelli","year":"2005","journal-title":"Prev. Med."},{"key":"ref_27","first-page":"12","article-title":"Not blowing smoke: Academic pharmacy aims to reduce tobacco use to ashes","volume":"9","author":"Lang","year":"2016","journal-title":"Acad. Pharm. Now"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.japh.2017.12.015","article-title":"Pharmacist prescriptive authority for smoking cessation medications in the United States","volume":"58","author":"Adams","year":"2018","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1331\/JAPhA.2014.13001","article-title":"Tobacco cessation education for pharmacists: Face-to-face presentations versus live webinars","volume":"54","author":"Hudmon","year":"2014","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S60","DOI":"10.1002\/chp.20149","article-title":"Advancing public health through continuing education of health care professionals","volume":"31","author":"Hudmon","year":"2011","journal-title":"J. Contin. Educ. Health Prof."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1001\/archinternmed.2010.344","article-title":"Engaging physicians and pharmacists in providing smoking cessation counseling","volume":"170","author":"Prokhorov","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1331\/JAPhA.2010.09034","article-title":"Effect of a tobacco cessation continuing professional education program on pharmacists\u2019 confidence, skills, and practice-change behaviors","volume":"50","author":"Martin","year":"2010","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1001\/archinternmed.2010.343","article-title":"A prescription for improved chronic disease management: Have community pharmacists function at the top of their training: Comment on \u201cEngaging physicians and pharmacists in providing smoking cessation counseling\u201d","volume":"170","author":"Guglielmo","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3158","DOI":"10.1016\/j.sapharm.2021.09.001","article-title":"Community pharmacy technicians\u2019 engagement in the delivery of brief tobacco cessation interventions: Results of a randomized trial","volume":"18","author":"Corelli","year":"2021","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.sapharm.2017.05.018","article-title":"Advancing pharmacy practice through implementation science","volume":"13","author":"Curran","year":"2017","journal-title":"Res. Soc. Adm. Pharm."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/10\/3\/56\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:21:09Z","timestamp":1760138469000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/10\/3\/56"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,30]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["pharmacy10030056"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy10030056","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,30]]}}}