Tobacco treatment and policies in mental health and substance use treatment facilities in the US

Abstract

Background

The prevalence of tobacco use among people with mental health and substance use disorders in the US is high. State- and facility-level factors could be associated with the provision of tobacco treatment and tobacco-free grounds policy in mental health and substance use treatment facilities. We estimated the latest prevalence of, and factors associated with tobacco treatment provision and tobacco-free grounds policies in these facilities.

Methods

This cross-sectional study used data from the 2021–2022 National Substance Use and Mental Health Services Survey. Two multivariate Poisson regression models with robust standard errors were employed to estimate state- and facility-level factors associated with two outcomes: 1) provision of any tobacco treatment (screening, behavior counseling, or pharmacotherapy), and 2) having a tobacco-free grounds policy.

Results

Among over 17,300 facilities, 87.2 % provided tobacco treatment, and 38.6 % implemented tobacco-free grounds policies. Private for-profit facilities were less likely to provide tobacco treatment (Adjusted Risk Ratio [ARR] 0.87, 95 % CI 0.86–0.89). Private for-profit and nonprofit facilities, those licensed by state or tribal health agencies, and those in tobacco nation states were less likely to implement tobacco-free grounds policies. In contrast, facilities with opioid treatment programs were more likely to achieve both outcomes.

Conclusions

Disparities exist in providing tobacco treatment and tobacco-free ground policies, particularly in privately owned facilities. Payers should incentivize the adoption of tobacco treatment and tobacco-free campus policies, and states should incorporate these requirements into licensure and/or accreditation standards for mental health and substance use treatment facilities.