Alcohol dependent and HIV-positive individuals smoke at higher rates than the general population, and incur associated increases in smoking-related morbidity, mortality and healthcare costs. Substance abuse treatment and HIV care settings may be optimal venues for delivering nicotine dependence treatment, but structural and attitudinal barriers impede implementation. This Center component will investigate organizational changes that occur in clinics hosting each of the two TRC clinical trials of nicotine dependence treatment, compare observed changes with those in similar clinics not involved in the clinical trials, and assess maintenance of organizational change after the clinical trials are completed. Three clinics that host a TRC clinical trial of nicotine dependence treatment (intervention group) will be compared with two clinics that do not host a TRC clinical trial (control group) on staff knowledge, attitudes, and practices (KAP) related to nicotine dependence treatment. Data will be collected through a workforce survey conducted at each clinic at 4 time points: baseline, 18-months, 36-months and 45-months. The study will compare the KAP of individual service providers in the intervention clinics (n=77) with the KAP of those in the control clinics (n=43), with the hypotheses that clinical trial participation will produce increased knowledge of nicotine dependence and its treatment, more favorable attitudes towards nicotine dependence treatment, and improved clinical practices. This component extends the TRC clinical trials by assessing how the implementation of innovative client-level interventions may impact organizational-level attitudes and practices, and extends the scientific reach of the TRC into translational research. The long term goal is to improve the treatment of patients in complex settings by including organizational change to drive adoption of innovative interventions.
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