Implementing tobacco-free policy in residential substance use disorders treatment: Practice changes among staff

Barbara K Campbell; Thao Le; Caravella McCuistian; Sindhushree Hosakote; Kwinoja Kapiteni; Joseph Guydish

doi:10.1016/j.dadr.2022.100033

Implementing tobacco-free policy in residential substance use disorders treatment: Practice changes among staff

Drug Alcohol Depend Rep. 2022 Feb 22:2:100033. doi: 10.1016/j.dadr.2022.100033. eCollection 2022 Mar.

Authors

Barbara K Campbell¹, Thao Le², Caravella McCuistian², Sindhushree Hosakote², Kwinoja Kapiteni², Joseph Guydish²

Affiliations

¹ Division of General & Internal Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
² Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA.

Abstract

Introduction: Implementing tobacco-free policies in substance use disorders (SUD) treatment may reduce tobacco-related, health disparities. This study examined adoption of tobacco-related policy and practices in six residential programs participating in a California-sponsored, 18-month, tobacco-free policy intervention.

Methods: Directors (N=6) completed surveys of tobacco-related policies before and after the intervention. Staff completed cross-sectional surveys assessing tobacco-related training, beliefs, practices, workplace smoking policy, tobacco cessation program services, and smoking status pre- (n=135) and post-intervention (n=144).

Results: Director surveys indicated no programs had tobacco-free grounds, one provided tobacco-related staff training, and two provided nicotine replacement therapy (NRT) pre-intervention. At post-intervention, 5 programs had implemented tobacco-free grounds, 6 provided tobacco cessation training, and 3 provided NRT. Across all programs, staff were more likely to report smoke-free workplaces (AOR = 5.76, 95% CI1.14,29.18) post- versus pre-intervention. Staff positive beliefs towards addressing tobacco use were higher post-intervention (p<0.001). Odds of clinical staff reporting tobacco-related training participation (AOR = 19.63, 95% CI14.21,27.13) and program-level provision of NRT (AOR = 4.01, 95% CI 1.54, 10.43) increased post- versus pre-intervention. Clinical staff reporting they provided tobacco cessation services were also higher post-intervention (p= 0.045). There were no changes in smoking prevalence or quit intention among smoking staff.

Conclusion: A tobacco-free policy intervention in SUD treatment was associated with implementation of tobacco-free grounds, tobacco-related training among staff, more positive staff beliefs towards and delivery of tobacco cessation services to clients. The model may be improved with greater emphasis on staff policy awareness, facilitating availability of NRT, and reducing staff smoking.

Keywords: substance use treatment; tobacco cessation; tobacco-free policy.