Introduction
ABUSE
The prevalence of combustible cigarette smoking among adults in the United States (US) is 12.5% [The Substance Abuse and Mental Health Services Administration (SAMHSA, 2021) [Differences in smoking rates reflect health disparities [Several states have implemented tobacco free policies to address smoking in SUD treatment. New Jersey mandated tobacco free grounds in residential SUD programs in 2001 [These interventions are often complex and time-consuming. They are also likely to be costly, however there are no published reports estimating costs of tobacco-free policy interventions. The New York State policy, with support of the state regulatory authority for SUD treatment, followed a multi-year planning process and provided staff training and NRT to programs [Apart from a statewide mandate, like that in New York, little is known about how to bring these interventions to scale in SUD treatment systems. The California Department of Healthcare Services (CalHHS, 2023) [While randomized trials have been used to test patient-level smoking cessation interventions in SUD treatment [The current study recruited residential SUD programs into a cluster-randomized trial of a brief multi-component tobacco intervention. The objective was to assess whether the intervention, modified to increase scalability, may affect staff or client smoking rates, or tobacco-related services received by clients.