Tobacco-free Workplace Program at a Substance Use Treatment Center

Abstract

Objectives: About 65%-87% of substance use disorder patients smoke cigarettes, compared to 14% of the general adult population. Few substance use treatment centers (SUTCs) have comprehensive tobacco-free workplace (TFW) policies or offer tobacco interventions. Taking Texas Tobacco Free (TTTF) implements an evidence-based TFW program in SUTCs, including at the Billy T. Cattan Recovery Outreach Center (BTC). We present a mixed methods case study of BTC's TTTF implementation, success factors, and challenges. Methods: TTTF provided policy development assistance, training, treatment resources, and technical assistance over ∼9 months. Implementation was tailored using mixed methods. Quantitative data included surveys to stakeholders (Nmax = 7), a pre- and post-training questionnaire assessing knowledge gain, and reported quantities of tobacco use assessments (TUAs) administered and nicotine replacement therapy (NRT) provided. Qualitative data included stakeholder focus groups and interviews (18 participants). Results: All employees reported TFW policy compliance. Employees exhibited a 20% knowledge gain. Clinicians increased self-report of NRT provision and tobacco cessation counseling. During implementation, BTC administered TUAs to 171 patients and dispensed NRT to 70 of 110 tobacco-using patients. Conclusion: Qualitative findings contextualized quantitative outcomes. TTTF implementation changed clinician attitudes, knowledge, and practices regarding tobacco treatment, facilitating patient quit attempts.

Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician’s Delivery of Smoking Interventions within Behavioral Health Treatment Clinics

“…However, these results may also reflect other factors, including that smaller organizations—namely, those with fewer employees and a more consistently visiting/enduring patient base—may have been better able to adopt the TTTF program and its recommendations for practice possibly through greater leadership support or lower staff resistance. 29 …”

“…This might be due to a reduced ability to detect training session non-attendees in a bustling treatment facility and thus a greater likelihood of clinician “no shows” to the education/training session. Prior research has also indicated that coworkers influence each other in their attitudes toward tobacco cessation which ultimately results in the implementation of the 5As 29 ; therefore, it follows that there would be an easier diffusion of tobacco cessation knowledge in a center with lower numbers of full-time employees where contact between fellow clinicians would likely be higher than in a large center. In addition, bureaucratic holdups could have also limited clinics with larger staff numbers from a swift implementation of best practices.…”

Addressing Smoking Cessation among Women in Substance Use Treatment: A Qualitative Approach to Guiding Tailored Interventions

“…However, participants’ experiences and recommendations on what they need to quit smoking are supported by the TTTF program and have been successfully implemented by our program partners [ 32 , 36 , 37 ], which is aligned with the recommended components of a women-centered approach to tobacco cessation [ 13 , 60 ]. Researchers advocate that smoking cessation interventions for women experiencing disadvantages should: (1) be tailored to women’s needs; (2) focus on building confidence and motivation; (3) incorporate social justice issues; and (4) adopt a holistic and comprehensive approach [ 13 ].…”

“…Our comprehensive program focuses on treating tobacco dependence among groups experiencing disadvantage with the highest smoking rates and need for assistance in quitting. To date, TTTF has been successfully implemented in 300 mental health centers [ 30 , 31 , 32 , 33 , 34 , 35 ] and has recently expanded into 30 standalone SUTCs/community centers [ 36 , 37 , 38 ], four of which serve women only and are the subject of this report.…”

Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers

“…Recently, organizational tobacco control programs have been successful in addressing tobacco use in SUTCs, such as in Texas, New Jersey, New York, Oregon, and Utah [14][15][16][17][18][19].…”