Abstract 4184: Congruent views among substance use treatment center leadership on organizational readiness to implement a tobacco-free workplace program is linked to provider uptake of non-cigarette tobacco use treatment
Authors: Carter Brian J. , Chen Tzuan A. , Britton Maggie , Leal Isabel Martinez , Correa-Fernández Virmarie , Rogova Anastasia , Kyburz Bryce , Williams Teresa , Casey Kathleen , Reitzel Lorraine R. 
Published: April 2023

Purpose: Tobacco use, linked to 17 cancers, is the leading cause of preventable death in the US. Despite elevated tobacco use among patients, substance use treatment centers (SUTCs) do not routinely address tobacco use. A tobacco-free workplace program (TFWP) implemented in SUTCs included tobacco-free policy guidance, provision of resources, and education for providers on evidence-based tobacco use treatment, which emphasized use of the 5As: Asking about tobacco use, Advising to quit, Assessing willingness to quit, Assisting with quitting, and Arranging follow-up. Congruent SUTC leadership views on readiness for TFWP implementation may forecast greater organizational support for implementation and thus enhanced provider uptake. Given the increasing use of non-cigarette tobacco products, this study examined associations between congruent views among SUTC leadership on readiness to implement the TFWP and changes in providers’ delivery of the 5As for non-cigarette tobacco-using patients (i.e., uptake) from pre- to post- program implementation.

Methods: Post-enrollment but before TFWP implementation, CEOs and Directors from each of 15 participating SUTCs (n=84) completed the Organizational Readiness for Implementing Change (ORIC), which has an overall readiness score and 5 subscale scores (resource availability, change efficacy, change valence, change commitment, and task knowledge). Center-level ORIC congruence was measured by calculating the difference between CEO-reported ORIC and mean Director-reported ORIC scores. Providers from each SUTC completed pre- and post-implementation surveys (pre n=259, post n=194) on their delivery of the 5As to non-cigarette tobacco-using patients during the prior month. Generalized linear regression analyses explored the effect of ORIC congruence on changes in the use of each of the 5As over time.

Results: Use of each of the 5As increased over time. Providers from SUTCs with more leadership congruence on (a) task knowledge and overall readiness had greater increases in Assisting with quitting and (b) resource availability, change efficacy, task knowledge, and overall readiness had larger increases in Arranging follow-up.

Conclusion: Reducing the research-to-practice translation gap in tobacco control through TFWP implementation in settings where users receive care is a critical cancer prevention strategy. TFWPs may facilitate greater provider uptake of evidence-based treatment and more effectively address patients’ non-cigarette tobacco use in SUTCs by purposefully aligning leadership support for change. Strategies to align leadership support may include convening CEOs and Directors to identify multi-level organizational barriers and facilitators and engage in group problem-solving with respect to any barriers.

Citation Format: Brian J. Carter, Tzuan A. Chen, Maggie Britton, Isabel Martinez Leal, Virmarie Correa-Fernández, Anastasia Rogova, Bryce Kyburz, Teresa Williams, Kathleen Casey, Lorraine R. Reitzel. Congruent views among substance use treatment center leadership on organizational readiness to implement a tobacco-free workplace program is linked to provider uptake of non-cigarette tobacco use treatment. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4184.