Smoking-related outcomes and associations with tobacco-free policy in addiction treatment, 2015-2016.

This study assessed changes in smoking-related outcomes in two cross-sectional samples of clients enrolled in addiction treatment and whether tobacco-free grounds policies were associated with smoking-related outcomes. Clients in 25 NIDA Clinical Trials Network-affiliated treatment programs were surveyed in 2015 (N=1,176) and 2016 (N=1,055). The samples were compared on smoking prevalence, cigarettes per day (CPD), thinking of quitting, past year quit attempts, staff and clients smoking together, attitudes towards quitting, and tobacco-related services. Second, programs with (n=6) and without (n=17) tobacco-free grounds at both time points were compared on smoking-related outcomes. Last, we examined changes in these measures for two programs that adopted tobacco-free grounds between 2015 and 2016.

Results found one difference across such years, such that the mean score for the tobacco Program Service scale increased from 2.37 to 2.48 (p=0.043, effect size=0.02). In programs with tobacco-free grounds policies, compared to those without, both CPD and the rate of staff and clients smoking together were significantly lower. In the two programs where tobacco-free grounds were implemented during study years, client smoking prevalence decreased (92.5% v. 67.6%, p=.005), the rate of staff and clients smoking together decreased (35.6% v. 4.2%, p=.031), mean CPD decreased (10.62 v. 8.24, p<.001) and mean tobacco services received by clients increased (2.08 v. 3.05, p<.001).

Conclusions: Findings indicate first, little change over time in smoking prevalence or other smoking-related measures in this population, and second, support the use of tobacco-free grounds policies as a strategy to address smoking in these settings. The authors recommend that the Center for Substance Abuse Treatment require tobacco-free grounds policies as a condition for block grant and capacity expansion funding to addiction treatment programs, that state agencies concerned with regulation and licensing of addiction treatment programs require adoption of tobacco-free grounds and that, even in the absence of a future mandate, addiction treatment programs implement tobacco-free grounds as a way to reduce health risks for both program staff and clients.