A quasi-experimental study examining New York State’s tobacco-free regulation: Effects on clinical practice behaviors.

On July 24, 2008, New York State (NYS) became the first state to require all state-funded or state-certified substance use disorder (SUD) treatment organizations to be 100% tobacco-free and offer tobacco cessation (TC) treatment. This study used a quasi-experimental, non-equivalent control group design with a pretest and posttest to examine the effect of the NYS tobacco-free regulation on three clinical practice behaviors (use of TC-related intake procedures, use of guideline recommended counseling for TC, and pharmacotherapy availability) in a diverse sample of SUD treatment programs, all participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) platform study, “Managing Effective Relationships in Treatment Services (MERITS). Repeated cross-sectional data were collected from NYS counselors (experimental group, from the MERITS II study) and non-NYS counselors (control group, from MERITS I) approximately 4 months pre-regulation and 10-12 months post-regulation. Using mixed-effects models, results at pre-regulation indicate no group differences in the three clinical practice behaviors. However, significant post-regulation effects were found such that the experimental group reports greater use of TC-related intake procedures, guideline recommended counseling, and availability of pharmacotherapy than the control group. Additionally, the experimental but not the control group shows increases in all three clinical practice behaviors from pre-regulation to post-regulation.

Conclusions: Two main conclusions can be reached from these findings. First, the New York State tobacco-free regulation had a positive effect on important clinical practice behaviors related to treating tobacco dependence. And second, although the passage of the regulation is associated with increased use of tobacco cessation clinical practice behaviors, there is much opportunity for improving the use of these practices. With increasing numbers of states considering tobacco-free regulations in SUD treatment, the lessons learned from the New York State experience should prove valuable in efforts to effectively implement regulatory change in other programs.