Tobacco use is causally linked to ~17 different cancers and remains the leading cause of death, disability, and disease. Although tobacco use has steadily declined in the general population, tobacco use rates among individuals with opioid use disorders (OUDs) has remained remarkably high (75%-95%). As such, individuals with OUDs are recognized as a priority population for tobacco control and intervention. Despite the heightened detrimental health effects of concurrent use of tobacco and opioids, as well as positive effects of tobacco cessation on OUD treatment outcomes, many OUD treatment programs (OTPs; i.e., one or more OUD treatment centers within the same organization) fail to prov...

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Tobacco use is causally linked to ~17 different cancers and remains the leading cause of death, disability, and disease. Although tobacco use has steadily declined in the general population, tobacco use rates among individuals with opioid use disorders (OUDs) has remained remarkably high (75%-95%). As such, individuals with OUDs are recognized as a priority population for tobacco control and intervention. Despite the heightened detrimental health effects of concurrent use of tobacco and opioids, as well as positive effects of tobacco cessation on OUD treatment outcomes, many OUD treatment programs (OTPs; i.e., one or more OUD treatment centers within the same organization) fail to provide sustained tobacco use disorder care to their patients. In PP230078, we propose to disseminate and implement Taking Texas Tobacco Free (TTTF), a successful, evidence-based tobacco control intervention for cancer prevention that will provide policy and workflow guidance, specialized training, and resources to OTPs to bolster their ability to provide tobacco cessation and relapse prevention interventions to their patients. TTTF has been previously implemented in substance use disorder treatment centers (SUTCs) through PP170070, including OTPs. However, OTPs are unique relative to other SUTCs due to the complicated relationship between pain and tobacco use for many OTP patients. Additionally, OTPs differ from other SUTCs due to particularly high patient tobacco use rates, low staff numbers, and early business hours. Finally, OTPs with medication-assisted treatment are distinct from other SUTCs in that they employ a provider with prescription capabilities, permitting a greater focus on pharmacotherapy provision in PP230078 than in past work. Together, these differences warrant TTTF program adaptations to "scale up" for dissemination to OUD treatment centers across Texas. Responsiveness to CPRIT priorities include that it prioritizes: 1) populations disproportionately affected by cancer risk prevalence; 2) geographic areas of the state disproportionately affected by cancer risk prevalence due to high tobacco use prevalence (e.g., El Paso); 3) program assessment to identify best practices, use as a quality improvement tool, and guide future program direction; and 4) populations with obstacles to cancer prevention services. Overall Project Strategy. TTTF implementation in >/= 2 OTPs (targeted # will be dependent on program interest and team capacity [i.e., funds/time] based on already-enrolled program size) will include the: 1) initiation (or refreshing) of tobacco-free workplace policies; 2) provision of tailored education and specialized training on tobacco use cessation and relapse prevention care with OTP patients while enabling capacity for a sustainable center-led training program; 3) provision of setting-tailored resources to motivate patients and providers for tobacco use disorder care provision; and 4) engagement and education of the community around these topics. A mixed methods process, with stakeholder feedback, will guide program adaptation and implementation, with an emphasis on capacity building for sustainment beyond the project period. Implementation will inform a step-by-step implementation and sustainment guide for OTPs and tailored training and health promotion materials. TTTF will be actively and passively disseminated to OTPs across Texas via direct email contact and promotion via the web, social media, and community outreach. Hands-on technical assistance will be provided to OTPs interested in self-led implementation during this phase. The project team has an extensive record of collaboration, is firmly grounded in implementation science, community partnerships, and health equity interventions for tobacco use, and has generated participation commitment from OTPs. Specific Goals. PP230078 has 3 primary goals: 1) adapt TTTF for dissemination and implementation in OUD treatment centers; 2) execute and evaluate an active implementation within >/=2 OTPs to fully inform the dissemination products (e.g., step-by-step implementation and sustainment guide) to reflect setting-specific considerations, barriers, and solutions; and 3) passively and actively disseminate the adapted TTTF program to OTPs across the state (providing technical assistance for center-led implementation), the community-at-large, and academic audiences. Significance and Impact. PP230078 will increase the capacity for, and the provision of, evidence-based practices for tobacco use disorder intervention in OTPs and thereby help to reduce tobacco use rates and prevent tobacco-related cancers for this group. Moreover, our dissemination materials and technical assistance will facilitate center-led program adoption and sustainment statewide. Consequently, this program will significantly impact tobacco-related cancer prevention among a group of Texans who disproportionately use tobacco products.

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