Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers’ use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers’ perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients’ interest in quitting and providers’ potential impacts on a successful quit attempt.

Tobacco use treatment is not prioritized in substance use treatment centers (SUTCs), leading to tobacco-related health inequities for patients with substance use disorders (SUDs) and necessitating efforts to enhance providers’ care provision. Training providers on how to treat tobacco use increases their intervention on patients’ smoking, but limited work addresses its effects on their non-cigarette tobacco use intervention provision. This study redressed this gap using data from 15 unaffiliated SUTCs in Texas (serving 82,927 patients/year) participating in a tobacco-free workplace program (TFWP) that included provider education on treating tobacco use, including non-cigarette tobacco use. SUTC providers completed surveys before (n = 259) and after (n = 194) TFWP implementation. Past-month screening/intervention provision for non-cigarette tobacco use (the 5A’s; ask, advise, assess, assist, arrange) and provider factors theoretically and practically presumed to underlie change [i.e., beliefs about concurrently treating tobacco use disorder (TUD) and other SUDs, self-efficacy for tobacco use assessment (TUA) delivery, barriers to treating tobacco dependence, receipt of tobacco intervention training] were assessed. Generalized linear or linear mixed models assessed changes over time from before to after TFWP implementation; low vs. high SUTC-level changes in provider factors were examined as moderators of changes in 5A’s delivery. Results indicated significant improvement in each provider factor and increases in providers’ asking, assisting, and arranging for non-cigarette tobacco use over time (ps < 0.04). Relative to their counterparts, SUTCs with high changes in providers’ beliefs in favor of treating patients’ tobacco use had greater odds of advising, assessing, assisting, and arranging patients, and SUTCs with greater barrier reductions had greater odds of advising and assisting patients. Results suggest that TFWPs can address training deficits and alter providers’ beliefs about treating non-tobacco TUD during SUD care, improve their TUA delivery self-efficacy, and reduce intervention barriers, ultimately increasing intervention provision for patients’ non-cigarette tobacco use. SUTCs with the greatest room for improvement in provider beliefs and barriers to care provision seem excellent candidates for TFWP implementation aimed at increasing non-cigarette tobacco use care delivery.

Cigarette smoking is the leading cause of preventable death and illness globally and accounts for over 80% of all lung cancer diagnoses in the U.S. Patients with behavioral health (e.g., mental health and/or substance use) needs have elevated levels of smoking relative to the general population and are thus disparately impacted by tobacco-related cancers. Tobacco screenings, a precursor to providing evidence-based interventions for smoking cessation, play a critical role in the primary prevention of lung cancer. However, their use in behavioral health treatment centers has historically been inconsistent. The aim of this study was to analyze barriers and facilitators to tobacco screening in settings where Texans receive behavioral health care to contextualize current screening trends and, in turn, provide recommendations for improvement. This study assessed the prevalence of mandated tobacco screenings in 80 centers providing healthcare to Texans with behavioral health needs. We examined key factors that could enhance screening conduct (i.e., provision of a tobacco use assessment template, hard stop in the electronic health record [EHR] for patient tobacco use status, and the availability of tobacco screening training), assessed associations between center practices and mandated tobacco screenings, and delineated providers’ perceived barriers to tobacco use intervention provision. Results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in the EHR (p&lt;0.008) and to make training on tobacco screening available to providers (p=0.016). The most widespread barriers to tobacco use disorder care provision, endorsed by at least 50% of all respondents at &gt;1 type of healthcare center (e.g. federally qualified health centers, global local mental health authorities, substance use treatment centers in local mental health authorities, and stand-alone substance use treatment centers), were relative perceived importance of competing diagnoses, lack of community resources for referral, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to prevent cancer-related disparities in this group. Healthcare centers can support their providers to intervene upon tobacco use by mandating screenings, streamlining clinical workflow with hard stops in patient records, and by educating providers about patient’s interest in quitting along with the importance of treating tobacco with brief evidence-based intervention strategies. Future work should focus on how these healthcare centers can facilitate providers’ ability to link tobacco screenings with smoking cessation services and lung cancer eligibility screening to increase the early detection of lung cancers and prevent tobacco-related cancer disparities. Citation Format: Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Brian J. Carter, Carol Wang, Isabel Martinez Leal, Anastasia Rogova, Bryce Kyburz, Teresa Williams, Mayuri Patel, Lorraine R. Reitzel. Tobacco screening practices and perceived barriers in offering tobacco cessation services in the primary prevention of lung cancer among Texas healthcare centers providing behavioral health treatment. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P025.