BRIEF

Promoting Smoke-free Environments and Tobacco Cessation in Residential Treatment Facilities for Mental Health and Substance Addictions, Oregon, 2010

Linda L. Drach, MPH; Daniel Morris, PhD, MS; Cathryn Cushing; Cinzia Romoli, MS; Richard L. Harris, MSW

Suggested citation for this article: Drach LL, Morris D, Cushing C, Romoli C, Harris RL. Promoting smoke-free environments and tobacco cessation in residential treatment facilities for mental health and addictions, Oregon, 2010. Prev Chronic Dis 2011;9:110080. DOI: http://dx.doi.org/10.5888/pcd9.110080 .

PEER REVIEWED

Abstract

We assessed tobacco-related policies and procedures at all state-funded, community-based residential mental health and substance addiction treatment facilities before implementation of new state policy requirements. We conducted telephone interviews with 162 of 166 (98%) facility administrators. Only 15% had voluntarily implemented 100% smoke-free campus policies, and 47% offered cessation resources at patient discharge; however, less than 10% expressed opposition to these future requirements. Smoking bans and cessation support in residential treatment facilities can reduce tobacco-related disparities among people with mental illness and addictions, but states may need to be the catalyst for policy implementation.

Bryan J. Weiner, PhD; Lindsey Haynes-Maslow, MHA; Leila C. Kahwati, MD, MPH; Linda S. Kinsinger, MD, MPH; Marci K. Campbell, PhD

Suggested citation for this article: Weiner BJ, Haynes-Maslow L, Kahwati LC, Kinsinger LS, Campbell MK. Implementing the MOVE! weight-management program in the Veterans Health Administration, 2007-2010: a qualitative study. Prev Chronic Dis 2012;9:110127. DOI: http://dx.doi.org/10.5888/pcd9.110127.

PEER REVIEWED

Abstract

Introduction

One-third of US veterans receiving care at Veterans Health
Administration (VHA) medical facilities are obese and, therefore, at higher risk
for developing multiple chronic diseases. To address this problem, the VHA
designed and nationally disseminated an evidence-based weight-management program
(MOVE!). The objective of this study was to examine the organizational factors
that aided or inhibited the implementation of MOVE! in 10 VHA medical
facilities.

Methods

Using a multiple, holistic case study design, we conducted 68 interviews with
medical center program coordinators, physicians formally appointed as program
champions, managers directly responsible for overseeing the program, clinicians
from the program’s multidisciplinary team, and primary care physicians
identified by program coordinators as local opinion leaders. Qualitative data
analysis involved coding, memorandum writing, and construction of data displays.

Results

Organizational readiness for change and having an innovation champion were most consistently
the 2 factors associated with MOVE! implementation. Other organizational factors,
such as management support and resource availability, were barriers to
implementation or exerted mixed effects on implementation. Barriers did not
prevent facilities from implementing MOVE! However, they were obstacles that had
to be overcome, worked around, or accepted as limits on the program’s scope or
scale.

Conclusion

Policy-directed implementation of clinical weight-management
programs in health care facilities is challenging, especially when no new
resources are available. Instituting powerful, mutually reinforcing
organizational policies and practices may be necessary for consistent, high-quality
implementation.