Smoking, the most common form of tobacco use, is the leading preventable cause of death and disability in the US. Smoking causes 17 different types of cancers and is responsible for 30% of cancer deaths.

In recent decades, population-level tobacco control (TC) initiatives have been successful at reducing smoking rates overall; however, equivalent reductions are not being experienced among all population subgroups. One priority group in this regard is those with (non-nicotine) substance use disorders (SUDs), who are estimated to smoke at rates as high as 87%. Consequently, cancer incidence is also elevated in this group. Evidence-based practices (EBPs) known to be efficacious in reducin...

Read More

Smoking, the most common form of tobacco use, is the leading preventable cause of death and disability in the US. Smoking causes 17 different types of cancers and is responsible for 30% of cancer deaths.

In recent decades, population-level tobacco control (TC) initiatives have been successful at reducing smoking rates overall; however, equivalent reductions are not being experienced among all population subgroups. One priority group in this regard is those with (non-nicotine) substance use disorders (SUDs), who are estimated to smoke at rates as high as 87%. Consequently, cancer incidence is also elevated in this group.

Evidence-based practices (EBPs) known to be efficacious in reducing tobacco use include organizational-level policy initiatives that create and enforce tobacco-free work environments; education initiatives to address staff’s potential negative attitudes towards tobacco cessation and clinician reluctance to tackle tobacco use during SUD treatment; 3) specialized training on individual-level interventions for tobacco cessation (psychopharmacology and behavioral counseling); and 4) community-level interventions to facilitate broader support for tobacco-free norms.

Unfortunately there is a known research-to-practice gap in the adoption of EBPs for tobacco cessation in SUD treatment settings, including widespread existence of a smoking culture, high rates of smoking among staff, and misconceptions about how quitting tobacco might interfere with SUD treatment. As a result, few SUD treatment facilities include screening or tobacco-cessation services, and fewer than 1 in 10 SUD treatment facilities have banned the use of tobacco on their grounds. Therefore, building capacity to address tobacco use and dependence in SUD treatment centers via EBP implementation can contribute significantly to the prevention of tobacco-related cancers in Texas.

The overall goals are to increase the reach, adoption, implementation, and maintenance of a comprehensive tobacco-free workplace program, Taking Texas Tobacco Free (TTTF), in 18 dedicated substance abuse centers across Texas. TTTF implementation will include: 1) the initiation and enforcement of completely tobacco-free workplace policies; 2) education to all staff and specialized training to clinicians; 3) the integration of tobacco use screenings into routine practice; 4) the provision of evidence-based tobacco use cessation services to employees and consumers; and 5) extension of outreach into local communities.

TTTF includes best practices for addressing tobacco use in healthcare settings and is an empirically-supported intervention that has been successfully implemented within behavioral healthcare facilities across Texas in the past. Iterative stakeholder feedback will guide program adaptation and implementation in a dedicated SUD treatment center setting with an emphasis on capacity building for sustainability beyond the project period.

Goals include 100% implementation of tobacco-free campus policies, training/education of clinicians/staff, regular screening and comprehensive treatment of tobacco-using consumers; and decreasing employee tobacco use over time in 18 SUD treatment centers. Conservative estimates based on preliminary data indicate 38,019 people/professionals will be reached & 35,599 people/professionals served.

PP170070 uses a community-academic partnership to develop and strengthen the infrastructure supporting the ongoing delivery of the most appropriate tobacco prevention and cessation services to an underserved group with very high tobacco use rates. Through this program, SUD treatment centers will adopt and implement strong tobacco-free workplace policies with a sustainable plan for enforcement, integrate regular TUAs into clinical practice, regularly treat tobacco dependence among consumers, incorporate tobacco education into new employee orientations and annual training endeavors to maintain and supplement gains acquired via active training efforts, and de-normalize tobacco use through increases in knowledge and competence regarding how to clinically address tobacco use among SUD constituents.

The impact of this program will be directly assessed through reach of education/training among employees, increases in the delivery of EBPs by providers to SUD consumers, and reduced tobacco use rates among employees from pre to post-implementation. Ultimately, the sustained implementation of EBPs in SUD treatment centers will lead to cumulative decreases in tobacco smoke exposure and increased tobacco quit rates, which will reduce the incidence of tobacco-related cancers among Texans. Therefore, the TTTF program implementation in SUD treatment settings will have a tremendous impact on cancer prevention in Texas through its statewide reach, focus on an underserved population, and concentration in areas with higher tobacco use rates.

Read Less