Examining the Sustained Impact of California’s Tobacco Free for Recovery Initiative: Qualitative Perspectives from Program Directors

Abstract

Background: Smoking prevalence among people in substance use treatment is substantially higher than the national average. Residential substance use treatment represents an opportune time to address this disparity. California launched the Tobacco Free for Recovery Initiative to help residential substance use treatment programs implement tobacco-free grounds policies and increase smoking and other tobacco cessation services. Eleven programs that participated in the initiative were revisited over two years later to examine the sustainability of changes made during the initiative. Methods: Directors in each of the treatment programs participated in semi-structured interviews. Thematic analysis methods and an implementation science framework were applied to investigate research questions. Results: Over half of the programs (n = 6; 54.5%) remained tobacco free after two years. The other five programs (45.5%) reverted their policies or had never implemented tobacco free grounds. All programs reported offering smoking cessation services at the time of interview, irrespective of tobacco free policies. Directors identified barriers and supports for sustainability and described ongoing needs. Conclusions: Guided by an implementation framework, results from this study offer recommendations for how to support residential substance use treatment programs in addressing smoking prevalence among clients.