Munck Machado Nathalia, Cagan Rick, Faseru Babalola, Choi Won S, Brown Andrew, Chadwick Ginny, Jackson Ja'net, Everett Kevin D, Bond Tristi, Richter Kimber
Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
Behavioral Health Tobacco Project, National Alliance on Mental Illness - NAMI Kansas, Topeka, KS, USA.
Subst Abus. 2023 Jul;44(3):235-240. doi: 10.1177/08897077231188239. Epub 2023 Sep 7.
People with mental health (MH) and substance use disorders (SUD) have high rates of tobacco use and tobacco-related mortality. They want to stop smoking and studies have shown they can quit, but few behavioral health facilities provide tobacco treatment. The purpose of this paper is to describe how a midwestern statewide behavioral health collaboration used regional data to pinpoint strengths and weaknesses in tobacco treatment trends, identified policies in neighboring states that were associated with high rates of tobacco treatment, and worked with state leaders to implement these policies to enhance treatment.
We used publicly available data from 2 SAMHSA annual national surveys of MH/SUD facilities to describe services and policies in behavioral health facilities in Kansas and 3 neighboring states (Missouri, Nebraska and Oklahoma). We interviewed neighboring state leaders to identify policies they had implemented to boost tobacco recovery services in behavioral health. We collaborated with our state behavioral health agency to encourage adoption of similar policies.
Using 7 years of survey data (2014-2020), rates for screening, counseling, and medications for tobacco dependence were highest in Oklahoma and Missouri facilities. Oklahoma had the highest percentages of facilities reporting smoke-free campuses. In all states, rates of tobacco service provision and smoke-free campuses were lower among SUD facilities than in MH facilities. State leaders associated several policies with high performance, including (a) requiring programs contracting with the state to conduct screening, provide counseling, and adopt smoke-free campuses (Oklahoma and Missouri); (b) state-based collection of tobacco treatment service provision data (Oklahoma); (c) providing facilities with free NRT for clients (Oklahoma); (d) setting benchmarks for service provision (Oklahoma); (e) comprehensive Medicaid coverage of cessation medications (Missouri). Upon review of these findings, Kansas behavioral health officials adopted a 2-year process to implement similar policies and are integrating tobacco treatment requirements into the state Certified Community Behavioral Health Clinic program.
Summarizing and sharing freely-available data across states laid the groundwork for cross-border networking and policy change. State and federal agencies should integrate these policies into contracts and block grants to reduce tobacco-related disparities among individuals with behavioral health conditions.
患有精神健康（MH）和物质使用障碍（SUD）的人群吸烟率和烟草相关死亡率很高。他们想要戒烟，研究表明他们能够戒烟，但很少有行为健康机构提供烟草治疗服务。本文的目的是描述一个中西部全州范围的行为健康合作组织如何利用区域数据来查明烟草治疗趋势中的优势和不足，确定与高烟草治疗率相关的邻州政策，并与州领导合作实施这些政策以加强治疗。
我们使用了美国药物滥用和精神健康服务管理局（SAMHSA）对MH/SUD机构进行的两次年度全国性调查中的公开数据，来描述堪萨斯州及3个邻州（密苏里州、内布拉斯加州和俄克拉荷马州）行为健康机构的服务和政策。我们采访了邻州的领导，以确定他们为促进行为健康方面的烟草康复服务而实施的政策。我们与本州的行为健康机构合作，鼓励采用类似政策。
利用7年的调查数据（2014 - 2020年），俄克拉荷马州和密苏里州机构在烟草依赖筛查、咨询和药物治疗方面的比率最高。俄克拉荷马州报告无烟校园的机构比例最高。在所有州，SUD机构的烟草服务提供率和无烟校园率都低于MH机构。州领导将几项政策与高绩效联系起来，包括：（a）要求与州签约的项目进行筛查、提供咨询并采用无烟校园政策（俄克拉荷马州和密苏里州）；（b）基于州的烟草治疗服务提供数据收集（俄克拉荷马州）；（c）为客户向机构提供免费的尼古丁替代疗法（NRT）（俄克拉荷马州）；（d）设定服务提供基准（俄克拉荷马州）；（e）医疗补助全面覆盖戒烟药物（密苏里州）。在审查这些结果后，堪萨斯州的行为健康官员采用了一个为期两年的过程来实施类似政策，并将烟草治疗要求纳入该州的认证社区行为健康诊所项目。
总结并共享各州的公开数据为跨境网络建设和政策变革奠定了基础。州和联邦机构应将这些政策纳入合同和整笔拨款中，以减少患有行为健康疾病的个体之间的烟草相关差异。
