Mental Health Provider Attitudes Toward Tobacco Treatment for Veterans with Serious Mental Illness: A Qualitative Analysis.

Veterans with serious mental illness (SMI) smoke at disproportionately high rates but receive smoking cessation treatment at disproportionately low rates. Mental health providers have strong relationships with veterans with SMI but often do not treat smoking. Knowledge, attitudes, and self-efficacy are related to smoking treatment delivery, but their interactions have yet to be explored in qualitative data for providers working with veterans with SMI. Guided by the theory of planned behavior, this project explored how knowledge, attitudes, self-efficacy, and emerging themes impeded or facilitated smoking cessation treatment delivery in SMI clinics at a Veterans Affairs medical center. Semistructured interviews were conducted with 20 multidisciplinary providers. Data were analyzed qualitatively using an inductive-deductive approach, and the number of providers endorsing themes was quantified. Many providers had knowledge of high smoking rates among veterans with SMI and smoking harms. Though most (60%) providers asked about smoking, only 20% followed up about smoking. Medical record prompts to ask about smoking facilitated smoking treatment delivery. Providers held various attitudes toward smoking, such as viewing smoking as enjoyable for veterans and smoking discussions as a potential threat to rapport, that were related to feelings of guilt and frustration. Low self-efficacy due to limited training in smoking cessation exacerbated discomfort. Half of providers expressed motivation to increase smoking discussions. Knowledge, attitudes, emotions, and self-efficacy may interact with one another as providers decide how to treat smoking. Intensive implementation strategies designed to improve provider delivery of tobacco treatment should make sure to address all these barriers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).