Total versus Partial Workplace Tobacco Use Bans in Texas Behavioral Health Centers and their Associations with Employees' Report of Clear Signage, Policy Enforcement, Policy Awareness, and Their Beliefs, Training, and Practices Conducive to Addressing Clients' Tobacco Use

Sriya N Kakarla; Noor Shabaneh; Midhat Z Jafry; Maggie Britton; Anastasia Rogova; Brian J Carter; Tzuan A Chen; Isabel Martinez Leal; Bryce Kyburz; Teresa Williams; Lorraine R Reitzel

doi:10.14485/hbpr.11.1.4

Total versus Partial Workplace Tobacco Use Bans in Texas Behavioral Health Centers and their Associations with Employees' Report of Clear Signage, Policy Enforcement, Policy Awareness, and Their Beliefs, Training, and Practices Conducive to Addressing Clients' Tobacco Use

Health Behav Policy Rev. 2024 Feb;11(1):1471-1482. doi: 10.14485/hbpr.11.1.4.

Affiliations

¹ Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, USA.
² Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL 60611, USA.
³ Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA.
⁴ Integral Care, 1430 Collier St., Austin, TX 78704, USA.

Abstract

Objectives: Adults with behavioral health needs exhibit elevated tobacco use rates. Tobacco-free workplace policies (TFWPs) at behavioral health treatment centers can effectively curb clients' tobacco use and secondhand smoke/vape exposure. However, there is little extant observational research about how total versus partial workplace tobacco use bans are associated with employee's perceptions of signage clarity, consistency of enforcement, and stakeholders' policy awareness in behavioral health centers. Additionally, little is understood about the relations of total or partial TFWPs with other factors that may affect evidence-based client care provision including employees' beliefs and their tobacco treatment practices. This study examined these associations within Local Mental Health Authorities (LMHAs) providing behavioral healthcare throughout Texas.

Methods: Employees from 30 of 39 LMHAs (covering >75% of Texas' statewide service area) responded to a 2021 survey on their TFWP characteristics, communication, awareness, enforcement, and other tobacco-related factors. Associations between the TFWP (total vs partial) and variables of interest were explored using independent proportions tests (p<0.10).

Results: Relative to their counterparts, LMHAs with total TFWPs reported clearer signage; more consistent enforcement; and greater client, contractor, and visitor awareness (ps=.013-.078). They were also more likely to offer tobacco screening training, promote the Quitline, and believe in the benefits of concurrent treatment of behavioral health needs and tobacco use (ps=.024-.079).

Conclusions: LMHAs with partial TFWPs had weaknesses in communication, enforcement, awareness, and greater barriers to tobacco use care provision. There are opportunities for collaboration between LMHAs to share policies and care-facilitation practices to reduce the research-to-practice gap and resultant tobacco use inequities statewide.

Keywords: Tobacco-free workplace policies; behavioral health; health policy evaluation; tobacco use and control.