Perceived implementation of the Office of Alcoholism and Substance Abuse Services (OASAS) tobacco-free regulation in NY State and clinical practice behaviors to support tobacco cessation: A repeated cross-sectional study.

This study, based on data from the Managing Effective Relationships in Treatment Services (MERITS II) project, an ancillary study of the National Drug Abuse Treatment Clinical Trials Network (CTN), measured substance use disorder clinicians’ perceptions regarding the implementation extensiveness of the Office of Alcohol and Substance Abuse Services (OASAS) tobacco-free regulation, passed in New York State in July of 2008, at three time-points and across organizations with varying characteristics. Repeated cross-sectional data were collected from clinicians approximately 4 months pre-regulation (time 0, n=362), 10-12 months post-regulation (time 1, n=462), and 20-24 months post-regulation (time 2, n=509). Clinician perceptions of implementation extensiveness (number of required policies in effect), use of tobacco cessation-related intake procedures, and use of guideline recommended counseling for treating tobacco dependence are significantly greater at time 1 and time 2 compared to time 0. Additionally, differences are found in perceived implementation extensiveness based on hospital-based status, profit status, and level of care offered, although the pattern of effects differed some over the three time-points under investigation.

Conclusions: In conclusion, New York State offers a unique context for studying the implementation extensiveness of a mandatory tobacco-free regulation. These findings suggest that the OASAS tobacco-free regulation is associated with changes in tobacco policies in SUD treatment organizations over time and greater reported use of clinical practice behaviors to support tobacco cessation. In addition, it appears as if the regulation lessens differences in treatment provision between clinicians who work in hospital- versus non-hospital-based settings, for-profit versus non-profit organizations, and settings offering inpatient only, outpatient only, and both outpatient and inpatient care. These are important findings given the difficult challenges associated with sustaining organizational change over time and barriers to treating tobacco dependence in SUD treatment, though there is additional work to be done to bring about regulatory change and align clinical practice behaviors to support tobacco cessation in New York.