? ? The delivery of health services to promote smoking cessation may substantially reduce cancer-related morbidity and mortality. However, there has been little research conducted within healthcare settings to measure the delivery of these services, particularly within those organizations that serve client populations with high rates of tobacco use. There is little national-level data on the delivery of smoking cessation (and other tobacco use) services in substance abuse treatment settings. Furthermore, there is no data regarding the adoption and implementation of the Public Health Service clinical practice guideline, Treating Tobacco Use and Dependence in these facilities. Additional gains in cancer prevention may be achieved if smoking cessation services are also available to the counseling staff within these healthcare organizations. Environmental policies may also prevent cancer for clients as well as center staff. The proposed research would gather organizational-level and counselor-level data by building upon three existing nationally representative samples of facilities: 362 publicly funded specialty substance abuse treatment centers, 401 privately funded centers, and 400 therapeutic communities. Telephone interviews with program directors will determine whether centers have: 1) adopted and implemented the guideline, including the 5 A's, pharmacotherapies, and psycho-social interventions; 2) adopted environmental tobacco-related policies; and 3) provide insurance coverage for employee smoking cessation. Mail questionnaires will be distributed to counselors to assess their attitudes toward smoking cessation and the extent to which they deliver these services. Integration of these data with information collected from these facilities in 2002- 2003 will allow for multivariate modeling of the organizational characteristics associated with guideline adoption and implementation as well as a longitudinal analysis of pharmacotherapy adoption. The information collected in this research would represent valuable information about the services delivered to a population at high-risk of tobacco-related cancers and identify barriers to such service delivery. ? ?
