The New York Policy on Smoking in Addiction Treatment

http://www.ncbi.nlm.nih.gov/pubmed/22420814

Am J Public Health. 2012 Mar 15. [Epub ahead of print]

The New York Policy on Smoking in Addiction Treatment: Findings After 1 Year.

Guydish J, Tajima B, Kulaga A, Zavala R, Brown LS, Bostrom A, Ziedonis D, Chan M.

Source

Joseph Guydish, Barbara Tajima, and Mable Chan are with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Agatha Kulaga is with the New York University Langone Medical Center, New York, NY. Roberto Zavala and Lawrence S. Brown are with the Addiction Research and Treatment Corporation, Brooklyn, NY. Alan Bostrom is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Douglas Ziedonis is with the Department of Psychiatry, University of Massachusetts Medical School, Worcester.

Abstract

Objectives. 

We assessed changes in smoking prevalence and other measures associated with the July 2008 New York Office of Alcohol and Substance Abuse Services tobacco policy, which required that all publicly funded addiction treatment programs implement smoke-free grounds, have "no evidence" of smoking among staff, and make tobacco dependence treatment available for all clients. 

Methods. 

In a random sample of 10 programs, staff and clients were surveyed before thepolicy and 1 year later. Measures included tobacco-related knowledge, attitudes, and practices used by counselors and received by clients. 

Results. 

Client smoking decreased from 69.4% to 62.8% (P = .044). However, response to the policydiffered by program type. Outpatient programs showed no significant changes on any of the staff and client survey measures. In methadone programs, staff use of tobacco-related practices increased (P < .01), client attitudes toward tobacco treatment grew more positive (P < .05), and clients received more tobacco-related services (P < .05). Residential clients were more likely to report having quit smoking after policy implementation (odds ratio = 4.7; 95% confidence interval = 1.53, 14.19), but they reported less favorable attitudes toward tobacco treatment (P < .001) and received fewer tobacco-related services from their program (P < .001) or their counselor (P < .001). 

Conclusions. 

If supported by additional research, the New York policymay offer a model that addiction treatment systems can use to address smoking in a population where it has been prevalent and intractable. Additional intervention or policy supports may be needed in residential programs, which face greater challenges to implementing tobacco-free grounds.