Intervention description
The multi-component intervention was based on the Addressing Tobacco Through Organizational Change (ATTOC) model, which targets barriers at multiple levels and supports program leaders through an organizational change process [Leadership commitment to address smoking is a common feature in program-level tobacco interventions (e.g., [Each program received a $15,000 incentive, with no restriction on use. Program incentives were disbursed on the same schedule for all programs, so that each program received $5,000 after baseline, $5,000 after 6 months, and the final $5,000 after the 12-month data collection. Financial disincentives create a barrier to organizational change [Each program participated in a sequence of four, one-hour, staff training sessions scheduled approximately once per month. A fifth session, held after the training sequence and near the end of the intervention period, was used as a learning community for program leaderships. Lack of training is commonly cited by staff as a barrier to providing tobacco services to clients ([In the current study, the first training session included the prevalence of smoking in SUD treatment and associated mortality, and summarized data drawn from baseline surveys collected in that program. The first training session was conducted in-person for intervention programs but, due to COVID restrictions, was conducted by webinar for waitlist programs. Following the first training session, program staff were invited by email to 3 additional webinar trainings. In four programs all staff were invited to all trainings, while in 3 programs the Director selected staff to attend. The second training discussed how to talk with clients about their tobacco use, use of the 5As (Ask, Advise, Assess, Assist, and Arrange; AHRQ, [Learning communities, with roots in educational systems, are used to promote capacity building and sustainability [