Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers

Abstract

Tobacco use is exceedingly high among individuals receiving care for opioid addiction, but not commonly addressed by clinicians in treatment settings. Taking Texas Tobacco Free (TTTF) is a comprehensive tobacco-free workplace (TFW) program that builds treatment centers’ capacity to address tobacco use with evidence-based tobacco cessation policies and practices. Here, we examine the process and outcomes of TTTF’s implementation within 7 opioid addiction centers. Program goals were structured according to the RE-AIM framework. Pre- and post-implementation data were collected from client facing and non-client facing employees to assess changes in education, training receipt, knowledge, and intervention behaviors, relative to program goals. Centers reported tobacco screenings conducted and nicotine replacement therapy (NRT) delivered through 6 months post-implementation. Overall, 64.56% of employees participated in TTTF-delivered tobacco education, with a 54.9% gain in tobacco control and treatment knowledge (p < 0.0001), and significant increases in exposure to education about tobacco use and harms among individuals with opioid use disorder (p = 0.0401). There were significant gains in clinicians’ receipt of training in 9/9 tobacco education areas (ps ≤ 0.0118). From pre- to post-implementation, there were mean increases in the use of the 5A’s (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with statistically significant gains seen in NRT provision/referral (p < 0.0001). Several program goals were achieved or exceeded; however, 100% center participation in specialized clinical trainings was among notable exceptions. One program withdrew due to competing pandemic concerns; all others implemented comprehensive TFW policies. Overall, TTTF may have improved participating opioid treatment centers’ capacity to address tobacco use, although study limitations, including lower post-implementation evaluation response rates, suggest that results require replication in other opioid addiction treatment settings.

Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment

“…However, although it is highly likely that these studies had different survey respondents, the results indicate that rates of tobacco screening in Texas’ mental health and substance abuse treatment centers have increased over time (i.e., from 58.4% and 70.2%, respectively, in 2016 [ 24 ] to 81.25% and 80%, respectively, in the current 2021 data collection). This could be the result of several known public health efforts in Texas geared toward improving tobacco use disorder care in behavioral health treatment settings (e.g., [ 50 , 51 , 52 , 53 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]). Regardless, tobacco screening should be occurring with 100% of adult patients in these settings, as well as in other health care settings where patients with behavioral health care needs are seen (like FQHCs), indicating the need for more progress in this area.…”

“…Texas, the second-largest state in the US, is known for its rapid growth and diverse demographics, has six of the twenty-five largest US urban cities, and has the greatest number of residents living in rural areas (where tobacco use rates are higher than in urban areas), making it an important setting in which to explore tobacco use screening practices [ 48 , 49 ]. Additionally, given known statewide efforts to enhance tobacco use disorder care delivery in Texas since 2016 [ 24 , 50 , 51 , 52 , 53 ], more recent data are needed to understand any changes in tobacco use screening practices within behavioral health care settings since the prior report. Finally, the exploration of tobacco screening practices and associated limiting factors for behavioral health patients should expand beyond traditional treatment settings (e.g., mental health centers).…”

Lung Cancer Screening Eligibility and Referral Practices in Texas Organizations Serving People with Substance Use Disorders

“…State-level policies and community-academic partnerships have pioneered tobacco control efforts prioritizing people with SUDs, including within Texas where over half of global LMHAs and a handful of SUTCs have implemented comprehensive tobacco-free workplace programs [ 16 , 17 , 18 , 31 , 32 , 33 , 34 , 35 ]. Accordingly, most respondents indicated that their organization mandated that every adult patient be screened for tobacco use; therefore, a natural next step for these organizations would be to assess eligibility for lung cancer screening (using patient tobacco use history) and make referrals (when appropriate and if feasible).…”

Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study

“…Each item was rated using a 5-point Likert scale ranging from never to always. Similar to previous research and in order to facilitate comparison, endorsements were grouped as follows: never/sometimes/about half the time vs. most of the time/always [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”