Background: Research suggests that cigarette smoking is strongly associated with opioid use disorder (OUD). People with OUD who smoke are less likely to sustain recovery from opioid use than those who do not smoke. Drug treatment courts (DTCs) operate within the criminal justice system and are an alternative to incarceration that links people to substance use treatment and behavioral health services. While multiple studies have documented the association between smoking and OUD in behavioral health settings, it is unknown if this association extends to individuals receiving OUD treatment in drug treatment courts.

Method: We used preliminary data from the baseline survey of the HEROIC (Health Evaluation on the Results of Opioid Intervention Court) study, a longitudinal study of DTC (n =129). Logistic regression models were used to examine the effect of current smoking status on past 3-month opioid use (i.e., illicit and prescription) while controlling for sex, anxiety, depression, and annual household income.

Results: The prevalence of smoking, illicit, and prescription opioid use was 63%, 29%, and 29% respectively. Compared to nonsmokers, DTC clients who smoked had greater odds of past 3-month non-medical prescription opioid use (AOR = 3.25, 95% CI: 1.25, 8.41, p < 0.05). Similarly, DTC clients who smoked had greater odds of past 3-month illicit opioid use relative to nonsmokers (AOR = 5.65, 95% CI: 1.97, 16.25, p < 0.01).

Conclusion: These findings are consistent with previous research about the relationship between smoking and OUD but extend the literature by noting that it persists in DTC populations. DTC clients may benefit from the integration of smoking cessation programs in the court system since they are at a greater risk of experiencing tobacco-related illnesses than the general population. Future studies are needed to examine this relationship longitudinally to understand if it predicts DTC success rates.

Background: Tobacco use is higher among adults with any mental illness (AMI) compared to no mental illness. The Bureau of Tobacco Free Florida (BTFF) aims to reduce tobacco-related disparities in Florida by supporting health systems change (HSC) interventions that promote provider-driven tobacco dependence treatment (TDT). Since 2018, BTFF’s HSC interventions focus on behavioral healthcare settings to support TDT for people with AMI who use tobacco. The objectives of this mixed methods study are to analyze and describe behavioral healthcare provider (BHCP) knowledge, behaviors, and beliefs related to systems, policies, and behaviors promoted in these HSC interventions.

Methods: We conducted a secondary analysis using data from a statewide healthcare provider survey to examine organizational systems and policies at behavioral healthcare organizations. We also examined BHCP beliefs and behaviors regarding TDT. We conducted BHCP focus groups to help contextualize quantitative findings and describe BHCP perspectives, beliefs, and behaviors related to addressing tobacco use among patients.

Results: We found that BHCPs are less likely than other provider types to engage with patients about tobacco use and provide TDT. They were also largely unaware of tobacco cessation resources for patients and lacked training on TDT. However, data indicate that having organizational systems and policies in place that support TDT was associated with higher rates of provider-reported cessation intervention behaviors. Further, we found that while the majority of BHCPs believe TDT is a part of their role and are confident in their ability to assist patients, they tend to view their role as supportive to primary healthcare providers and prioritized provider-patient relationships and mental health priorities over tobacco cessation intervention.

Conclusions: HSC interventions in behavioral healthcare settings are a promising avenue to increase tobacco cessation interventions among people with AMI; tailored trainings, systems, and resources for BHCPs could improve tobacco cessation intervention behavior.

Background

The Tobacco Prevention and Cessation (TPC) Health Systems Change (HSC) initiative is an ongoing partnership between the Indiana Department of Health (IDOH) and hospitals, mental health facilities, and primary care practices in the state.

Methods

Through a collaborative approach, an online survey and monthly metric tool were created for use by partners. In year 6 of this initiation, a tool to collect patient stories about their experiences working with the tobacco health systems change programs was introduced. Additionally, a case study was employed to document the processes and steps of a particularly innovative partner organization.

Findings

We will demonstrate the Tableau-developed data dashboard used to share progress and evaluation findings with partners. Across all TPCHSC partner sites, to date, 3673 or 21% of all identified tobacco users have been referred to a tobacco treatment specialist and 279 individuals have accepted services from a tobacco treatment specialist. A total of 989 Hoosiers have been referred to the Indiana Tobacco Quitline as a result of the HSC partnership. This presentation will also include findings from the case study including a process map, examples of achievements, and patient stories.

Discussion

This case study is being used to prepare additional partners and support those partners in their health systems change processes. This proposed presentation shows the benefit of the development of data dashboards for sharing timely insights with partners. Evaluation is often perceived as time-consuming and distracting to partners leading the day-to-day work of public health initiatives; however, when partners are engaged in evaluation planning and when insights are shared routinely, evaluation findings can be used to inform changes and process improvement throughout the initiative. This presentation also showcases on the power of collecting and sharing patient stories and feedback and highlights the importance of qualitative methodologies in public health evaluation efforts.

Background: The New York Tobacco Control Program funds Health Systems for a Tobacco-Free New York (HSTFNY) grantees to partner with various healthcare organizations in New York State, including Federally Qualified Health Centers (FQHCs), to encourage the adoption and implementation of tobacco-related systems and policies that facilitate the treatment of tobacco dependence. We conducted a case study to explore how grantee technical assistance (TA) work facilitates changes in adoption, implementation, and maintenance of tobacco related systems and policies within FQHCs.

Methods: From February to August 2022, we conducted key informant interviews with 9 HSTFNY grantee organizations and 13 staff from 4 FQHCs in New York State. We used the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM Evaluation Framework to guide study development and analysis.

Results: There was substantial agreement between HSTFNY grantees and FQHCs for the types of strategies used to promote adoption, implementation, and maintenance of tobacco-related systems and policies. Both agreed identifying dedicated champions, developing/distributing educational materials, attending meetings, providing support for updating/developing policies and workflow, and providing education/training were facilitators to adopting and implementing systems and policies. Staff turnover due to the COVID-19 pandemic and prioritizing other health issues were barriers to implementing tobacco-related systems and policies. FQHCs and grantees had similar perspectives related to intervention and setting characteristics that affected implementation, including embedding the components into the electronic health record and FQHC staff identifying a need to change/update the tobacco-related systems and policies within their healthcare organizations.

Conclusion: This study identified several factors related to grantee TA efforts that supported adoption, implementation, and maintenance of tobacco related health system interventions in FQHCs. Findings from this study could inform future selection and development of strategies and tools that leverage facilitators and address barriers to support FQHCs’ uptake and sustainability of systems and policies.

According to a 2017 Morbidity and Mortality Weekly Report (MMWR) report, 68% of adult smokers wanted to stop smoking, 55.4% made a quit attempt in the past year, 7.4% recently quit smoking, and 57.2% had been advised by health professional to quit. However, only 31.2% of smokers used cessation counseling and/or medication when trying to quit. Expected cessation rate for any single unassisted quit attempt is about 7% (Zhu et al , 2000). In 2018, 22.7% of adults in Arkansas smoked, when the national rate was 16.1%. In 2023, the adult smoking rate in Arkansas has decreased to 20.2%, while the national rate is 12.5%. Program leaders will describe the collaboration between MD Anderson Cancer Center’s Certified Tobacco Treatment Training Program and the Arkansas Department of Health’s Be Well Arkansas Quitline (the first Quitline in the nation operated independently by a state department of health). The translation of essential elements of the MD Anderson Tobacco Treatment Program (TTP) into a scalable curriculum and intensive training for other providers will be discussed. Through the collaboration, 422 healthcare providers in Arkansas (covering every county) were trained by MD Anderson to treat nicotine addiction using evidence-based practices. Be Well Arkansas Call Center has demonstrated a significant positive impact in reducing tobacco use rates in Arkansas with a quit rate 21.0%. Not only do Arkansas residents benefit from tobacco cessation services through their state quitline, but providers have fewer complications when implementing various treatment methods, saving valuable time and resources and improving outcomes of quit attempts. Key components will be shared about training program, its effectiveness in improving quit rates and lessons learned in implementing this program. The program serves as a model for other state departments of health seeking to improve effective tobacco treatment services and reduce burden of tobacco-related diseases in their communities.