Understanding the Adoption and Implementation of Tobacco-Free Regulation in Subst

描述（由申请人提供）：2008年7月24日，纽约州（NYS）成为全国第一个要求由纽约州酒精中毒和药物滥用服务办公室（OASAS）监督的所有1419个国家资助或国家认证的成瘾治疗项目100%无烟的州（www.oasas.state.ny.us/pio/press/pr-7-23-07.cmf）。为雇员创造更健康的工作场所和促进客户不依赖烟草的目标值得称赞，并可能随着时间的推移产生积极影响（例如，吸烟率降低、治疗效果改善）。然而，法规的实施将是纽约州药物滥用治疗中心的一个重大变化，与实施创新相关的失败率很高（Rogers, 2002），特别是当它们是外部强加的时候（Bolman & Deal, 2006; Rogers, 2002）。此外，OASAS的规定是高度限制性的，范围广泛，并挑战了如何最好地对待使用物质的客户的根深蒂固的信念。因此，随着时间的推移，该法规可能会对临床医生的工作反应和工作经验产生广泛的影响。建议项目的具体目标是：(1)提供一段时间以来在纽约州治疗环境中实施OASAS无烟法规的分析描述；(2)纵向检验临床医生对OASAS法规在其治疗中心实施的广泛程度的看法与他们的心理需求满足、应变反应之间的关系；(3)纵向考察临床医生参与实施过程与近端实施结果（程序公正感知、变革自我效能）和远端实施结果（应变反应、临床实践行为）的关系。随着法规在纽约州治疗中心实施，该项目还将提供随时间变化的细粒度分析。公共卫生相关性：临床医生对实施OASAS无烟法规的看法预计与心理和认知反应有关，而心理和认知反应又与心理、行为和身体紧张有关。在药物滥用治疗机构工作的临床医生已经处于高压力、高倦怠的职业中。因此，了解实施这种自上而下驱动的、限制性的、国家强制规定对临床医生的附加效应，对个人健康和健康政策具有重大影响。

DESCRIPTION (provided by applicant): On July 24, 2008 New York State (NYS) became the first in the nation to require all 1,419 state- funded or state-certified addiction treatment programs overseen by the NYS Office of Alcoholism and Substance Abuse Services (OASAS) to be 100% tobacco-free (www.oasas.state.ny.us/pio/press/pr-7-23-07.cmf). The goal of creating healthier workplaces for employees and fostering tobacco independence in clients is laudable and may yield positive effects over time (e.g., lower rates of smoking, better treatment outcomes). However, the implementation of the regulation will be a major change for substance abuse treatment centers in NYS and the failure rate associated with implementing innovations is high (Rogers, 2002), particularly when they are externally imposed (Bolman & Deal, 2006; Rogers, 2002). Moreover, the OASAS regulation is highly restrictive, broad in scope, and challenges deeply-held beliefs about how to best treat substance using clients. As such, as the regulation is implemented over time it may have wide-ranging effects on clinicians' work reactions and work experiences. Specific Aims of the proposed project are to: (1) provide an analytic description of the implementation of the OASAS Tobacco-Free Regulation in NYS treatment settings over time, (2) examine longitudinally the relationship between clinician perceptions of how extensively the OASAS regulation has been implemented at their treatment center and their psychological need fulfillment, strain reactions, and (3) examine longitudinally how clinician involvement in the implementation process relates to both proximal implementation outcomes (procedural justice perceptions, self-efficacy for change) and distal (strain reactions, clinical practice behaviors) implementation outcomes. The project also will provide a fine-grained analysis of change over time as the regulation becomes implemented in NYS treatment centers. PUBLIC HEALTH RELEVANCE: Clinicians' perceptions of the implementation of the OASAS tobacco-free regulation are expected to relate to psychological and cognitive reactions, which in turn are proposed to relate to psychological, behavioral, and physical strain. Clinicians working in substance abuse treatment facilities are already working in a high stress, high burnout occupation. Thus, understanding the additive effects of the implementation of this top-down driven, restrictive, state-mandated regulation on clinicians has substantial individual health and health policy implications.