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Tobacco-Free Grounds Policies in Treatment Programs Reduce Smoking for Clients and Staff

  • The Centers for Disease Control and Prevention (CDC) recently reported that cigarette smoking among adults in the U.S. has decreased from 20.9% in 2005 to 15.1% in 2015.
  • As smoking prevalence declines overall, smoking in subgroups becomes increasingly important in terms of tobacco control, health disparities, and social justice. For example, rates of smoking are significantly higher for persons with mental or behavioral health disorders, and a review of smoking prevalence in U.S. addiction treatment programs from 1987 to 2009 found a median annual smoking prevalence of 76.3%.

    Previous studies have found that tobacco-free grounds policies in addiction treatment programs have resulted in lower smoking prevalence among staff, but were less clear on the impact on client smoking.

    This study asked two questions: first, whether any changes in smoking behavior were observed among clients enrolled in addiction treatment programs from 2015-2016, and, second, whether tobacco-free grounds policies were associated with differences in smoking-related measures.

    Using a sample of clients from 25 treatment programs affiliated with the NIDA Clinical Trials Network, surveys were collected in 2015 and 2016. The samples were compared on smoking prevalence, cigarettes per day (CPD), thinking of quitting, past year quit attempts, staff and clients smoking together, attitudes towards quitting, and tobacco-related services.

    Programs with (n=6) and without (n=17) tobacco-free grounds at both time points were compared on smoking-related outcomes. And changes in these measures were examined for two programs that adopted tobacco-free grounds between 2015 and 2016.

    Results found one difference across such years, such that the mean score for the tobacco Program Service scale increased from 2.37 to 2.48. In programs with tobacco-free grounds policies, compared to those without, both CPD and the rate of staff and clients smoking together were significantly lower.

    In the two programs where tobacco-free grounds were implemented during the study years:

  • client smoking prevalence decreased from 92.5% to 67.6%,
  • rate of staff and clients smoking together decreased (35.6% to 4.2%),
  • mean CPD decreased (10.62 to 8.24), and
  • mean tobacco services received by clients increased (2.08 to 3.05).


  • Conclusions: Findings indicate first, little change over time in smoking prevalence or other smoking-related measures in this population, and second, support the use of tobacco-free grounds policies as a strategy to address smoking in these settings. The authors recommend that the Center for Substance Abuse Treatment require tobacco-free grounds policies as a condition for block grant and capacity expansion funding to addiction treatment programs, that state agencies concerned with regulation and licensing of addiction treatment programs require adoption of tobacco-free grounds and that, even in the absence of a future mandate, addiction treatment programs implement tobacco-free grounds as a way to reduce health risks for both program staff and clients.

    Find it in the CTN Library

    Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

    Articles were written based on the following published research:

    Guydish JR, et al. Smoking-Related Outcomes and Associations with Tobacco-Free Policy in Addiction Treatment, 2015-2016. Drug and Alcohol Dependence 2017 (in press).
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