Reducing Cancer Risk in a Vulnerable Population: Tobacco Policies in Substance Use Disorder Treatment Facilities

Smoking increases the risk of cancer in almost every organ in the body, and leads to one in every three cancer deaths in the United States.1 Smoking rates have fallen dramatically in the general population since the 1960s,2 yet they remain high among vulnerable populations. Individuals with substance abuse disorders (SUDs) are disproportionately burdened by the tobacco epidemic, with smoking rates ranging from 71-92%.3-5 Each year, 435,000 deaths are attributed to smoking; approximately 200,000 occur among individuals with a mental illness or SUD. Patients with alcohol dependence are more likely to die from tobacco-related than alcohol-related causes.3 In addition, patients with SUDs are less likely to obtain cancer screenings,6 and have higher rates of cancer incidence 6,7 and mortality than the general population.8 Tobacco-free policies and tobacco treatment services are effective in reducing smoking,1 yet SUD treatment facilities are slow to adopt these policies.9 Little is known about how to effectively accelerate adoption of tobacco-related policies in SUD treatment facilities. The purpose of this community engaged research project is to assess community readiness and develop tailored strategies to promote tobacco-free policies and tobacco treatment services in SUD treatment facilities. The community is defined as individuals who receive SUD treatment at the Chrysalis House, Kentucky’s oldest SUD treatment facility for women. The Chrysalis House has three residential facilities, a 40 unit apartment complex, and 18 scattered site apartments (22 total facilities). The research team will consist of academic researchers and a Community Research Team, nominated by the Chrysalis House Executive Director and Treatment Director (10 individuals who seek care at the Chrysalis House). Currently, the Chrysalis House allows smoking and other tobacco product use on their campuses, and does not offer comprehensive tobacco treatment. This study will be guided by the Community Readiness Model (CRM), which has been applied to program development and policy change in healthcare facilities.10,11 The CRM guides assessment of six readiness dimensions and then each facility is placed in a readiness stage.12 Our research team has adapted and tested this model to promote smoke-free community policy in rural Kentucky using a stage-specific, tailored policy development intervention.13 The long-term objective is to develop and test a stage-specific, tailored policy development intervention to promote facility adoption of tobacco-free policies and tobacco treatment services to reduce premature death and chronic disease among individuals with SUDs. This project will leverage and build on existing salary support for the PI and the Community Research Team members granted by the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) program, a career development grant. Aim 1: Explore facilitators and barriers to the adoption of comprehensive tobacco-free policies (tobacco-free on all campus grounds) and comprehensive tobacco treatment services (based on the U.S. Public Health Service Clinical Guidelines) at Chrysalis House’s 22 residential facilities. This is an exploratory, descriptive design using qualitative methods. Facilitators will be assessed using Community Asset Mapping. Community Asset Mapping is an assessment process to identify persons, facilities, local coalitions, advocacy groups, and existing tobacco policies that can form the base of positive social change.14 Community assets, as well as barriers will be assessed through six focus groups of five members each (N=30); two groups of patients (n=10), two of treatment providers (n=10), and two of administration (n=10). Aim 2: Assess facility readiness to adopt comprehensive tobacco-free policy and provide evidence based tobacco treatment services among key stakeholders at Chrysalis House’s 22 residential facilities.15 Aim 2a: Adapt and test an online readiness survey to assess readiness to adopt tobacco-related policies in SUD treatment facilities. To validate the readiness survey, focus groups will be conducted with five members each (N=20); two groups of decision makers (n=10) and two groups of patients (n=10). Then, an online readiness survey will be distributed to 3-5 key informants in each of the 22 Chrysalis House facilities (N=66-110) Aim 3: Develop stage-specific, tailored strategies to promote the adoption of comprehensive tobacco-free policies and tobacco treatment services in SUD treatment facilities. Focus groups will be conducted with five members each (N=20); two groups of decision makers (n=10) and two groups of patients (n=10) to tailor the existing smoke-free community policy development strategies for promotion of tobacco policies in SUD treatment facilities. Anticipated Outcomes: This project will support the development of competitive external grants to test a stage-specific, tailored intervention to accelerate the dissemination of comprehensive tobacco-free policies and tobacco treatment services in SUD treatment facilities. The ultimate goal of this program of research is to reduce cancer morbidity and mortality attributable to tobacco use among individuals with SUDs.