Assessing client and staff beliefs and attitudes to inform tobacco-free campus policy implementation at substance use disorder treatment centers.

Introduction: US patients with behavioral health conditions have smoking rates two to three times higher than the general population. Tobacco-free environments at substance use disorder (SUD) facilities can positively impact patient's outcomes as well as the health of staff, but client perceptions to the contrary can slow adoption. This study assessed client and staff beliefs, attitudes, and knowledge regarding the implementation of a tobacco-free campus policy at McLeod Addictive Disease Center, a full-service SUD treatment facility based in Charlotte, North Carolina.

Methods: During the height of the 2020 COVID-19 pandemic, the research team conducted a mixed-methods study at the McLeod Center lasting from May to November 2020. Using convenience sampling, the team conducted two staff surveys that were administered online (n=134; n=28) and virtual interviews of clients (n=38) to assess beliefs, attitudes and knowledge of tobacco use and the tobacco-free campus planned for 2021.

Results: Many staff identified as current or former smokers (n=57); some expressed the belief that the policy will positively impact clients' SUD recovery (n=12). Encouragingly, clients expressed positive feelings associated with the policy (n=16) and reported interest in receiving tobacco cessation treatment (n=25).

Conclusions: Staff are interested in helping clients quit tobacco use. Most of the interviewed clients, however, believed that utilizing tobacco products while receiving treatment for their dependence on another substance, would improve their success. The McLeod Center was one of the first community-based SUD treatment facilities in North Carolina to transition to a 100% tobacco-free campus in 2021. This research and results serve as a blueprint for other facilities making similar policy changes.