Addressing Tobacco Use Among Consumers and Staff at Behavioral Health Treatment Facilities Through Comprehensive Workplace Programming

Abstract

Tobacco use is the leading cause of death and disability in the United States; cigarette smoking is the most common form of tobacco use. Smoking has become increasingly concentrated among individuals with behavioral health needs (e.g., persistent mental illness) and has led to increased morbidity and mortality in this group relative to the general population. Comprehensive tobacco-free workplace programs are effective in reducing tobacco use and cigarette smoke exposure among behavioral health consumers and the individuals who serve them. Taking Texas Tobacco-Free (TTTF) represents an academic-community partnership formed to address tobacco use among consumers and employees at behavioral health clinics across Texas via the dissemination of an evidence-based, multicomponent tobacco-free workplace program. Program components of TTTF include tobacco-free campus policy implementation and enforcement, staff education about tobacco use hazards, provider training to regularly screen for and address tobacco dependence via intervention, and community outreach. These components, the nature of the academic-community partnership, the process of behavioral health facility involvement and engagement, and the benefits and challenges of implementation from the perspectives of the project team and participating clinic leaders are described. This information can guide similar academic and community partnerships and inform the implementation of other statewide tobacco-free workplace programming.

Implementation of a tobacco-free workplace program at a local mental health authority

“…Academic-community partnerships are an ideal means to facilitate the translation of scientific findings and evidence-based practices for tobacco dependence treatment into real-world scenarios. Spindletop, an LMHA in Texas, capitalized on a multi-component TFW program [28] to adopt and implement a TFW policy on all its premises. Spindletop exceeded program expectations by also adopting a tobacco-free hiring policy.…”

“…Taking Texas Tobacco Free (TTTF) is an academiccommunity partnership aimed at assisting selected Local Mental Health Authorities (LMHAs) across Texas to adopt comprehensive, evidence-based, and multi-component TFW programs that are sustainable beyond the funding period [28]. LMHAs are administrative entities that oversee and provide behavioral health services to specific geographic areas of the state [29].…”

“…To evaluate the goals' achievement, TTTF administered surveys pre-and post-program implementation and requested reports from LMHAs. Aiming to provide a model for similar settings [30], the purpose of this paper is to describe the implementation of the TFW program at Spindletop Center, one of the LMHAs participating in TTTF [28].…”

Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

“…Following the successful implementation of TTTF within 18 LMHAs [31,33], we were funded to enable its statewide dissemination through active and passive means and to implement a more cost-effective TTTF within additional LMHAs, this time using a mixed methods approach not included in the prior implementation. Researchers recommend the use of qualitative and mixed methods approaches to address the complexities involved in implementing interventions across diverse contexts [44] and for developing strategies that facilitate the implementation of EBPs [34,36].…”

“…Authorities (LMHAs) throughout Texas to implement comprehensive and sustainable tobacco cessation [31], designed to target known implementation barriers across diverse levels of influenceorganizational, community, clinician, and client. LMHAs are state agencies that administer and provide behavioral health services across Texas according to geographic region through non-profit community mental health centers [32].…”