Provider Perspectives on a Tobacco-Free Workplace Program in Healthcare Settings Serving Rural and Medically...

People with substance use disorders (SUDs) smoke at elevated rates compared to the general population, experience significant health disparities, and are overrepresented in rural and medically underserved areas with limited substance use treatment centers (SUTCs), leading individuals to seek care at medical healthcare centers (MHCs) (i.e., organizations providing comprehensive primary and preventive care). Thus, understanding MHCs' and SUTCs' capacity for adoption of tobacco-free workplace programs (TFWPs) that involve tobacco-free workplace policies and tobacco use treatment delivery is vital. Centers were continuously enrolled from August 2021 to January 2024, spanning the official duration and ending of the COVID-19 pandemic. As part of a mixed methods study, healthcare providers (N = 347) from 9 MHCs (n = 173) and 10 SUTCs (n = 174) in Texas were surveyed; 85 providers and clinical managers from a subset of this sample, drawn from 5 MHCs and 7 SUTCs, completed interviews about their perception of resource availability for, and value of, TFWPs. The organizational readiness for change theory guided the development of investigator-generated surveys and interviews focused on assessing the constructs of resource availability for and valuing of TFWPs. Quantitative findings generally revealed similar perceptions on value and resource availability. However, more MHC than SUTC providers endorsed lack of time as a barrier to delivering cessation care (p = 0.006). Qualitative themes included lack of training and resources to build capacity; limited institutional frameworks, policies, and practices; underprioritizing of tobacco cessation treatment; and erroneous assumptions that tobacco use sustains SUD sobriety. Results emphasize that MHCs need shorter intervention strategies, while SUTCs may be poised for longer interventions as supported through greater endorsement by MHC compared to SUTC providers of time as a barrier to deliver cessation care alongside similar perceptions on value and resource availability across both settings (MHCs, SUTCs). Overall, findings reinforce the need to build greater capacity across healthcare settings for patients' tobacco use treatment.