Going tobacco-free: Predictors of clinician reactions and outcomes of the NY State Office of Alcoholism and Substance Abuse Services tobacco-free legislation.

In an effort to reduce patient tobacco dependence and create healthier work environments, New York State (NYS) mandated 100% tobacco-free addiction treatment programs for state funded or certified facilities in 2008. This article presents the results of a longitudinal study examining how local implementation features shape clinician reactions to the regulation and influence post-regulation clinician behavior and strain (Managing Effective Relationships in Treatment Services, MERITS II). The project was funded by the National Institute on Drug Abuse (NIDA), in response to a program announcement focusing on health services research on practice improvement utilizing community treatment programs within NIDA’s Clinical Trials Network (CTN). A cohort of 147 clinicians associated with 13 treatment organizations throughout NYS (including several programs affiliated with the CTN’s Greater New York Node) completed a survey prior to the passage of the regulation and again approximately 1 year post-regulation.

Findings reveal that local implementation features of clinician participation in the planning for change, the provision of change-related information, and perceived organizational support predicted perceptions of change management fairness, which in turn predicted clinical practice behaviors to support smoking cessation, as well as psychological and behavioral strain. In contrast, self-efficacy for change was neither related to local implementation nor clinician outcomes. Understanding the important role that local implementation features have in efforts to create a work environment that facilitates the use of clinical practice behaviors to support smoking cessation in clients and reduce strain in response to organizational change has important implications for managing the change process.