The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America.
University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America.
BMC Health Serv Res. 2024 Feb 14;24(1):201. doi: 10.1186/s12913-024-10629-5.
People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center.
This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice.
Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center.
Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.
在美国，患有物质使用障碍的人群吸烟率远高于普通人群，并且受到与烟草相关疾病的影响不成比例。许多物质使用治疗中心不提供基于证据的戒烟治疗，也不维持全面的无烟工作场所政策。当前工作的目标是确定在物质使用治疗中心成功实施全面无烟工作场所计划的障碍和促进因素，该计划包括全面的无烟政策和基于证据的戒烟治疗服务。
本研究基于民族志方法，并采用定性案例研究设计。数据通过对物质使用治疗中心的员工（n=6）和患者（n=16）的访谈以及现场访问（n=8）收集。使用主题分析进行数据分析，主题分析受扩展的规范化进程理论指导，旨在为医疗保健实践中的创新实施提供信息。
物质使用治疗中心的员工支持该计划的实施，并对干预的目的及其潜在益处有很好的理解。然而，该研究确定了中心在实施过程中面临的重大挑战，包括患者中普遍存在的吸烟行为，导致员工认为戒烟是一个低优先级问题，因为他们的客户缺乏戒烟的兴趣和能力。我们确定了一些促成这种态度转变的因素，包括为员工提供烟草培训、积极的领导支持、吸烟员工人数少，以及获得尼古丁替代产品等物质资源。全面无烟工作场所计划的实施和积极执行有助于逐渐改变态度，并改善物质使用治疗中心提供基于证据的戒烟护理的情况。
尽管物质使用治疗中心面临着复杂的行为健康和社会经济需求的客户所带来的多重挑战，但可以将戒烟实践纳入其日常运营中。在适当的支持下，物质使用治疗中心可以为他们的客户提供急需的戒烟护理，这些客户不成比例地受到与烟草相关的健康状况和系统性健康不平等的影响。
