Initial leadership concerns and availability of tobacco cessation services moderate changes in employee-reported concerns about tobacco-free workplace policy implementation over time

Author:

Siddiqi Ammar D12ORCID,Carter Brian J234,Chen Tzuan A35,Martinez Leal Isabel23,Britton Maggie23,Correa-Fernández Virmarie3,Rogova Anastasia236,Kyburz Bryce7,Williams Teresa7,Reitzel Lorraine R23ORCID

Affiliation:

1. Department of Biosciences, Rice University , 6100 Main Street, Houston, TX 77005 , USA

2. Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center , Houston, TX 77230 , USA

3. Department of Psychological, Health, and Learning Sciences, University of Houston , 491 Farish Hall, Houston, TX 77204 , USA

4. Feinberg School of Medicine, Northwestern University , 420 E Superior Street, Chicago, IL 60611 , USA

5. Division of Research, HEALTH Research Institute, University of Houston , 4349 Martin Luther King Boulevard, Houston, TX 77204 , USA

6. Department of Health Services Research, The University of Texas MD Anderson Cancer Center , Houston, TX 77230 , USA

7. Integral Care , 1430 Collier Street, Austin, TX 78704 , USA

Abstract

Abstract Tobacco-free workplace policies (TFWPs) are underused evidence-based interventions that reduce the elevated use of tobacco among substance use treatment center (SUTC) employees and patients. SUTC employees’ anticipated concerns about stakeholder pushback are barriers to TFWP adoption. Examination of discrepancies between anticipated and actualized employee-reported TFWP concerns arising from coworkers, patients, and community members in the context of leadership concerns and tobacco cessation care availability for employees may inform strategies to increase TFWP uptake. This study analyzed changes in employee-reported TFWP concerns from before to after a comprehensive tobacco-free workplace intervention that included TFWP implementation, using Chi-square/Fisher’s exact tests. Preimplementation leadership policy concerns and tobacco cessation care availability were examined as moderators in generalized linear mixed models. Overall, 452 employees and 13 leaders provided data from 13 SUTCs collectively serving >82 000 patients annually. Results revealed significant decreases over time in employee-reported concerns about TFWP resistance from coworkers. Moderation analyses indicated that employee-anticipated concerns from coworkers and patients, respectively, were less likely to be actualized in SUTCs where leadership endorsed preimplementation TFWP concerns, whereas employee-reported patient concerns rose over time in SUTCs where leadership had no initial implementation concerns. Additionally, employee-anticipated concerns from coworkers were overestimated in SUTCs that did not offer tobacco cessation care to employees. Results supporting the nonactualization of anticipated employee concerns following TFWP implementation can be used to engage other SUTCs for TFWP adoption. Furthermore, moderation effects may suggest that center characteristics translate to greater attention to rollout, ultimately enhancing TFWP stakeholder acceptance.

Funder

Cancer Prevention and Research Institute of Texas

National Institute on Drug Abuse

National Cancer Institute

National Institutes of Health

University of Texas MD Anderson’s Cancer Center Support

Research Education Grant

Publisher

Oxford University Press (OUP)

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