Secondhand Smoke and Behavioral Health (C6059)

Fallin-Bennett Project Overview The proposed Kentucky Tobacco Control Policy Center will strengthen Kentucky’s capacity to understand, implement, and promote effective tobacco prevention, tobacco treatment, and lung cancer screening. Over two years, the Center will first build a comprehensive picture of the current tobacco control policy landscape across K-12 schools, tobacco retailers, and federally qualified health centers (FQHCs). In the second year, findings will be shared with key stakeholders, best practices will be highlighted, and technical assistance will be provided to promote evidence-based policy change and collaboration. Okoli Enhancing Tobacco Treatment in Integrated Behavioral Health Programs Tobacco use remains not only the top cause of preventable disease in the U.S. but also the top cause of disability and death. Further, adults living with mental and behavioral health challenges are using tobacco at rates much higher (40-80%) than people not living with mental and behavioral health challenges (18%). Evidence suggests that individuals living with mental and behavioral health challenges want to quit (70%). Further, stopping tobacco is shown to aid recovery from mental illnesses. These issues are substantive needs within the behavioral health community coupled with the current challenges in providing tobacco treatment at the community level: lack of behavioral health tobacco dependence treatment expertise, current barriers to some behavioral health organizations being able to bill for allowable tobacco treatment services, and health professional staffing challenges. This proposal intends to address these challenges by building upon key foundations started in our previous contract period. This is a huge system shift and any change requires ‘change agents’ to optimize the success of an endeavor. Current clinical practice guidelines for tobacco dependence treatment recommend the adoption of brief interventions within health care systems, to enhance engagement of consumers. Significance has been established for tobacco treatment interventions with a tailored approach considering determinants related to both the system and individual (Sultana, Inungu & Jahanfar, 2025). Yet, in the mental health care system, few clinicians routinely adopt such strategies (Ratschen, Britton, Doody, Leonardi-Bee, & McNeill, 2009; Rogers & Sherman, 2014). In previous research, a key factor for poor tobacco treatment provision is the perception that tobacco treatment is a non-normative behavior with mental health care providers (Okoli, Otachi, Kaewbua, Woods, & Robertson, 2017). An important way to enhance practice is through directed training which can assist providers in understanding the principles and skills to provide tobacco treatment (Sheffer et al., 2016). Enhancement of such tobacco treatment skills among healthcare providers can increase capacity and produce the ‘change agents’ needed to address the poor tobacco treatment outcomes among mental health service consumers. With over 50 years of tobacco control efforts in the U.S., the science in this area is equivocal. Healthcare delivery systems must adopt evidence-based tobacco treatment practices by providing tobacco cessation pharmacotherapy, engaging consumers in behavioral counseling, and integrating systemic interventions that promote environmental change (i.e., tobacco-free policies) (Fiore et al, 2008; Hitsman, Moss, Montoya, & George, 2009). Moreover, lung cancer screening has become a recommended standard practice for tobacco control efforts (Prochaska, 2025). In fact, lung cancer screening for adults at high risk due to their smoking history is shown to decrease smoking rates and increase cessation attempts (Heiden et al, 2022). Although at very high risk, people with mental and behavioral health challenges have low lung cancer screening rates (Hernandez et al., 2025; Rogova et al., 2025). Given this situation, it has been recommended that behavioral health professionals should be trained in assessment of lung cancer screening eligibility and offer patients education, as well as behavioral health organizations have the integration of lung cancer screening counseling, provide practical support, and collaborate with community organizations to improve lung cancer screening for people with mental and behavioral health challenges (Rogova et al., 2025). In fact, when people with mental and behavioral health challenges enroll in lung cancer screening, they are likely to complete the course and express satisfaction (Flores et al., 2021). Hence, opportunities to improve behavioral health care provider education about lung cancer risk assessments and strategies to increase the screening of people with mental and behavioral health challenges at high risk, are needed. A major step in initiating any tobacco control effort is to first adopt comprehensive tobacco-free environments; but in the U.S, many behavioral health settings still do not adequately have such policies in place (Huddlestone, Sohal, Paul, & Ratschen, 2018; Marynak et al., 2018). The adoption of such tobacco-free policies involves a systematic approach of understanding the unique context of an organization, as well as the principles that underlie successful integration of change within a setting. Thus, integrating tobacco-free policies within community-based integrated behavioral health organizations and supporting lung cancer screening for those at risk requires careful analysis of their specific setting and tailoring current evidence-based approaches with their context in mind. We propose to tackle these challenges by the following objectives: 1. Provide tailored behavioral health technical assistance and training to behavioral health organizations and health departments upon request regarding tobacco use, treatment, policy, and messaging. 2. Evaluate tobacco treatment and lung cancer screening capacity of providers in Certified Community Behavioral Health Clinics. 3. Create, evaluate, and disseminate tobacco treatment resources tailored to the behavioral health population.