title: Sustainment of smoking cessation programs in substance use disorder treatment organizations.
abstract: BACKGROUND
  The majority of individuals who enter substance use disorder (SUD) treatment also use tobacco. Integrating smoking cessation services into SUD treatment may have substantial public health benefits, but few studies have examined whether organizations offering counseling-based smoking cessation programs sustain them over time.
  
  
  METHODS
  This study examines sustainment of smoking cessation programs using 2 waves of data collected from 150 SUD treatment organizations. Data were collected in 2006-2008 and 2009-2010 using face-to-face interviews, telephone interviews, and mailed surveys. Logistic regression models of sustainment were estimated with administrators' attitudes toward smoking cessation and organizational barriers as covariates.
  
  
  RESULTS
  About 60.2% of these SUD treatment organizations sustained their counseling-based smoking cessation programs at follow-up. Sustainment was significantly more likely when administrators' baseline attitudes about the impact of smoking cessation on recovery were more supportive (odds ratio, OR = 1.84; 95% confidence interval, CI = 1.13-3.01; p =.015) and when programs were accredited (OR = 3.95, 95% CI = 1.65-9.50, p =.002). Worsening over time of barriers encompassing staff interest, staff skills, and competing treatment demands were negatively associated with sustainment (OR = 0.58, 95% CI = 0.42-0.81, p =.001).
  
  
  CONCLUSIONS
  These findings provided empirical support for theoretical perspectives regarding the importance of leadership and staff expertise in promoting sustainment of innovations over time. Although the majority of SUD treatment organizations sustained their smoking cessation programs, the 40% rate of discontinuation is concerning and highlights the ongoing challenges faced by tobacco control efforts in substance abuse treatment.
authors.affiliation: Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-0086, USA. hannah.knudsen@uky.edu
authors.forename: Hannah K
authors.initials: HK
authors.lastname: Knudsen
authors.forename: Jessica
authors.initials: J
authors.lastname: Muilenburg
authors.forename: Lillian T
authors.initials: LT
authors.lastname: Eby
mesh_terms: D003376:Counseling / Q000379:methods*; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D015397:Program Evaluation; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D014481:United States