Most people in treatment for drug abuse smoke cigarettes and many will die from tobacco-related illnesses. Some facilities are beginning to offer tobacco treatment, but little is known about the prevalence or quality of these services. The purpose of this project is to better understand how drug treatment facilities currently address tobacco and to develop a validated measure of tobacco treatment that is sensitive to change. This is the second revision to this application. In response to first-round reviewers, the application added an expert in scale development, provided more details on qualitative methods, and expanded qualitative and quantitative analyses. In response to second-round reviewers, this revision expands the study beyond methadone to include all types of outpatient substance abuse treatment facilities, restricts Phase I qualitative site visits to Kansas City substance abuse facilities, enlists the support/expertise of an organizational management researcher, and expands the array of organizational measures used. These changes enhance study generalizability, reduce year 1 costs and effort, and bring the study into line with the resources available through the R21 mechanism. There are three Specific Aims: 1. Identify why and how nicotine dependence services are offered, from the perspectives of staff and patients. Data will be collected using systems checklists and qualitative interviews at 8-12 Kansas City area drug treatment facilities representing a range of treatment types and levels of tobacco services. 2. Develop a Tobacco Treatment Survey (TTS), adapt for tobacco a measure of organizational readiness for change (ORC), and identify other organizational measures potentially related to tobacco treatment service provision. These measures will be based on site visit findings, a conceptual framework, and existing measures. 3. Test and refine the TTS and compare to organizational measures. The TTS, ORC, and other organizational measures will be phone-administered to a sample of 120 substance abuse treatment sites. The TTS will be refined through validity analyses and compared to the ORC and other organizational measures to identify potential aspects of facility climate and structure related to high and low rates of service provision. The project is innovative in that it adapts methods from health services and intervention research from multiple health care settings. This application will yield detailed descriptions of how services are offered in facilities and a validated measure of nicotine dependence services. These descriptions and measures will provide tools for identifying high- and low-service facilities, determine potential organizational factors related to service delivery, and support future research on tobacco treatment services in substance abuse treatment. People with mental illnesses, including alcohol and other drug problems, smoke 70% of the cigarettes consumed in the United States. The purpose of this project is to better understand how substance abuse treatment facilities currently address tobacco among their patients and to develop a validated measure of the types and quality of services provided. Project findings will support future policy and research to strengthen tobacco treatment services in substance abuse treatment. ? ? ?
