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Smoking in California drug treatment: A policy intervention

Institution: University of California, San Francisco
Investigator(s): Joseph Guydish, Ph.D.
Award Cycle: 2018 (Cycle 27) Grant #: 27IR-0040 Award: $931,110
Subject Area: State and Local Tobacco Control Policy Research
Award Type: High Impact Research Project Award

Initial Award Abstract

Adult smoking prevalence in California was 11.6% in 2014, the lowest smoking rate among states after Utah.  Smoking nevertheless remains high in behavioral health populations, including those with mental health and substance abuse problems, and the California Tobacco Control Program (CTCP) has conducted a series of county-level trainings for behavioral health staff in recent years. Persons with substance use disorders (SUDs) account for 15% of all US smokers. In California, this translates into 660,000 of the total 4.4 million adult smokers.  Smoking prevalence among those in publicly-funded drug abuse treatment is about 73%, an epidemic rate unyielding to public health tobacco control strategies.  However, recent research shows that implementing tobacco-free grounds policies in SUD programs results in decreased smoking prevalence, decreased cigarettes per day among continuing smokers, and greatly reduces the rate of staff members smoking together with clients. The California Department of Healthcare Services (DHCS) includes an SUD Programs Division, which licenses and regulates 1200 drug treatment programs, serving over 100,000 admissions annually and, year over year, reaching an increasing proportion of California smokers.  Persons treated in these programs experience excessive tobacco-related morbidity and mortality. Reaching this smoking saturated, health disparity population with effective tobacco control policies will reduce smoking in one of California’s most tobacco-vulnerable populations. With the long term goal of implementing tobacco-free grounds in all California SUD programs, this application will focus on residential treatment programs where clients live, and where policy change will achieve the greatest gains in the shortest time. In collaboration with CTCP and DHCS this project will: (1) Survey 441 California residential treatment programs to identify those that do and no not have tobacco-free grounds policies in place, (2) recruit 21 large residential treatment programs for intervention to implement tobacco-free grounds, (3) implement tobacco free grounds in 7 programs each year over 3 years, with measurement in all programs annually to control for effects of time or external factors, and (4) use results to promote tobacco-free grounds policies throughout the California SUD treatment system.