Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers

Abstract

Although tobacco use is the leading preventable cause of death and is elevated among patients with substance use disorders, many substance use treatment centers (SUTCs) do not offer tobacco use interventions (i.e., screening and treatment). This study examined a key outcome of the implementation of a tobacco-free workplace program that provided education and specialized training to employees; namely, changes in clinician provision of the five As (Asking about tobacco use; Advising to quit; Assessing willingness to quit; Assisting with quitting; Arranging follow-up) from before to after the larger program implementation. The five As are a brief tobacco screening and treatment protocol that was taught as part of the program and that formed the basis for further intervention (e.g., provision of nicotine replacement therapies, Motivational Interviewing to enhance desire and willingness to make a quit attempt). Moreover, we also examined organizational moderators that may have impacted changes in the delivery of the five As over time among clinicians from 15 participating SUTCs. The number of the centers’ total and unique annual patient visits; full-time employees; and organizational readiness for implementing change were assessed as potential moderators of change in clinicians’ behaviors over time. Clinicians completed pre- and post-program implementation surveys assessing their provision of the five As. Results demonstrated significant increases in Asking (p = 0.0036), Advising (p = 0.0176), Assisting (p < 0.0001), and Arranging (p < 0.0001). SUTCs with higher Change Efficacy (p = 0.025) and lower Resource Availability (p = 0.019) had greater increases in Asking. SUTCs with lower Resource Availability had greater increases in Assessing (p = 0.010). These results help guide tobacco control program implementation to increase the provision of tobacco use interventions (i.e., the five As) to SUTC patients and elucidate Change Efficacy and Resource Availability as organizational factors promoting this clinician behavior change.

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.…”

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

“…Tobacco use is exceedingly high among individuals receiving care for OUD, but rarely addressed by clinicians in these treatment settings [ 9 , 10 , 11 ]. Although prior studies implemented a similar program in addiction/substance use treatment centers [ 25 , 31 , 35 , 43 , 44 , 45 , 46 ], to our knowledge, no prior studies have reported details of the implementation of multi-component, multi-level treatment programs designed to build capacity for addressing tobacco use within OUD treatment centers. The current study addressed this gap by describing outcomes of the implementation of TTTF, a comprehensive tobacco-free workplace program [ 24 , 25 , 26 , 27 , 28 , 30 , 32 ], within 7 OUD treatment centers in Texas.…”

Collaborative Learning: A Qualitative Study Exploring Factors Contributing to a Successful Tobacco Cessation Train-the-Trainer Program as a Community of Practice

“…The TTTF program includes adoption of a 100% tobacco-free workplace policy that covers all tobacco products, including electronic nicotine delivery systems, as well as implementing tobacco use screenings that assess clients for use of these products. To date, TTTF has partnered with 23 local mental health authorities (LMHAs) in the implementation of this comprehensive tobacco-free workplace program [22,47,54,[56][57][58]. LMHAs are non-profit, state-funded agencies throughout Texas responsible for providing behavioral health services through community mental health centers within a safety-net healthcare system that serves underserved, lower-income individuals [59].…”

“…LMHAs are non-profit, state-funded agencies throughout Texas responsible for providing behavioral health services through community mental health centers within a safety-net healthcare system that serves underserved, lower-income individuals [59]. While provision of general employee and specialized provider tobacco education has been a cornerstone of the TTTF program that has successfully increased provider delivery of tobacco cessation services to clients [58], the effects of the education were continuously being lost due to high employee turnover [60,61]. The TTTF Train-the-Trainer program was developed to embed sustainable, local expertise within LMHAs on the general harms of tobacco use and how to treat tobacco dependence using evidence-based tobacco cessation interventions [18].…”