title: Smoking Behaviors and Attitudes Among Clients and Staff at New York Addiction Treatment Programs Following a Smoking Ban: Findings After 5 Years.
abstract: BACKGROUND
  Addiction treatment clients are more likely to die of tobacco-related diseases than of alcohol or illicit drug-related causes. We aimed to assess smoking behavior, and smoking-related attitudes and services, in New York addiction treatment programs before a statewide smoking ban in treatment facilities was implemented (2008), 1 year (2009) and 5 years after implementation (2013).
  
  
  METHODS
  We conducted surveys at each time point with clients (N = 329, 341, and 353, respectively) and staff (N = 202, 203, and 166, respectively) from five residential and two methadone maintenance programs in New York State. At each data collection wave, questionnaires measured smoking behavior as well as smoking-related knowledge, attitudes, and experiences with tobacco cessation services as part of addiction treatment.
  
  
  RESULTS
  Staff smoking prevalence decreased from 35.2% in 2008 to 21.8% in 2013 (P = .005) while client smoking prevalence over the same period was unchanged (68.1% vs. 66.0%, P = .564). Among clients who smoked, mean cigarettes per day decreased from 13.7 (SD = 8.38) to 10.2 (SD = 4.44; P < .001). There were significant time-by-treatment-type interactions for client tobacco-related attitudes and cessation services received; and for staff self-efficacy and cessation services provided. In residential programs, scores for most items decreased (became less positive) in 2009 followed by a partial rebound in 2013. Methadone program scores tended to rise (become more positive) throughout the study period.
  
  
  CONCLUSIONS
  Staff and clients may respond differentially to tobacco-free policies depending on type of treatment program, and this finding may help to inform the implementation of tobacco-free policies in other statewide addiction treatment systems.
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA; apagano@prev.org.
authors.forename: Anna
authors.initials: A
authors.lastname: Pagano
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA;
authors.forename: Joseph
authors.initials: J
authors.lastname: Guydish
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA;
authors.forename: Thao
authors.initials: T
authors.lastname: Le
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA;
authors.forename: Barbara
authors.initials: B
authors.lastname: Tajima
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA;
authors.forename: Emma
authors.initials: E
authors.lastname: Passalacqua
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA;
authors.forename: Arturo
authors.initials: A
authors.lastname: Soto-Nevarez
authors.affiliation: START Treatment and Recovery Centers, Brooklyn, NY; Division of Community and Public Health Programs, Department of Public Health, Weil Medical College, Cornell University, New York, NY;
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Brown
authors.affiliation: Langley Porter Psychiatric Institute, University of California, San Francisco, San Francisco, CA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010361:Patients / Q000523:psychology*; D012907:Smoking / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology; D016320:Substance Abuse Treatment Centers / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors