Need. Smoking, the most common form of tobacco use, is the leading preventable cause of death and disability in the US. Smoking is causally related to 17 different types of cancers and is responsible for 30% of cancer deaths. Smoking has become increasingly concentrated among individuals with behavioral health needs (e.g., mental illness). This subpopulation smokes at high rates (<64% prevalence vs 15% in US overall), quits at low rates, and consequently suffers from greater cancer incidence and mortality relative to the general population.

Permissive attitudes toward tobacco use within behavioral health clinics contribute toward a missed opportunity to proactively address tobacco depende...

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Smoking, the most common form of tobacco use, is the leading preventable cause of death and disability in the US. Smoking is causally related to 17 different types of cancers and is responsible for 30% of cancer deaths. Smoking has become increasingly concentrated among individuals with behavioral health needs (e.g., mental illness). This subpopulation smokes at high rates (<64% prevalence vs 15% in US overall), quits at low rates, and consequently suffers from greater cancer incidence and mortality relative to the general population.

Permissive attitudes toward tobacco use within behavioral health clinics contribute toward a missed opportunity to proactively address tobacco dependence. Multi-component tobacco-free workplace programs that include tobacco-free campus policies, staff education, tobacco use assessment (TUA) implementation, and tobacco dependence intervention training are effective in reducing cancer incidence by increasing quit rates and preventing exposure to cancer-causing environmental tobacco smoke (ETS).

Community mental health clinics in Texas, governed by regional administrative entities referred to as Local Mental Health Authorities (LMHAs), provide behavioral healthcare services to consumers in 39 geographic service areas across the state. Taking Texas Tobacco Free (TTTF) is a CPRIT-funded tobacco-free workplace program intervention that provides education, staff training, practical advice, technical assistance, consultation, and treatment resources to 18 Texas LMHAs (serving over 200 behavioral health clinics and half Texas’ counties).

TTTF has achieved its contractual evaluation goals and has been shown effective in increasing organizational capacity for the provision of evidence-based interventions for tobacco use. We propose to disseminate and implement TTTF to the remaining Texas LMHAs, creating a truly statewide prevention initiative. Responsiveness to CPRIT priorities include the targeting of underserved, vulnerable, and high-risk populations, in areas where significant disparities in smoking rates and tobacco-related cancer incidence exist, via an established community-academic partnership with an Austin-based LMHA.

The overall goal is to increase the reach, adoption, implementation, and maintenance of a comprehensive tobacco-free workplace program to remaining LMHAs in Texas with the aim of reducing tobacco-related cancers among individuals with behavioral health needs. The previously implemented program, TTTF, will be scaled up to remaining agencies utilizing active dissemination strategies that include a step-by-step replication guide and toolkit with training materials and sample policies delivered via a user-friendly web-based platform, face-to-face consultation with stakeholders, trainings with clinical champions to facilitate capacity, and the promulgation of narratives of best practices.

TTTF implementation will occur in stages that include exploration through translational formative evaluation, organizational preparation, active program implementation, systems integration, and sustainability/maintenance. Iterative stakeholder feedback and project staff consultation, technical assistance, and training will guide all stages of implementation.

Specific Goals: Goal 1: Identify via mixed methods the unique organizational and contextual factors that would affect the planned dissemination and implementation of TTTF among the remaining Texas LMHAs and incorporate this information into the scale-up vision and plan; Goal 2: Compile a toolkit of materials and a step-by-step implementation/replication guide and package it for web-based dissemination to the target audience; Goal 3: Use both active and passive strategies to deliver TTTF to, and implement it within, LMHAs; and Goal 4: Evaluate the effectiveness of the disseminated TTTF program with regard to effectiveness, as well as reach, adoption, implementation, and maintenance objectives.

Through this program, LMHAs 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 LMHA constituents.

Ultimately, this program will lead to a cumulative decrease in exposure to ETS and increased tobacco quit rates, which will reduce the incidence of tobacco-related cancers among Texans with behavioral health needs. Consequently, the dissemination and implementation of the TTTF program will have a tremendous impact on cancer prevention in Texas through its extended and comprehensive reach statewide.

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