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所有1,419个由纽约州酗酒和药物滥用服务办公室（OASAS）监督的州资助或州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）。为员工创造更健康的工作场所和促进客户烟草独立的目标是值得称赞的，随着时间的推移可能会产生积极的影响（例如，吸烟率较低，治疗效果较好）。然而，该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（Bolman & Deal，2006; Rogers，2002）。此外，OASAS法规具有高度限制性，范围广泛，并挑战了关于如何最好地对待物质使用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。拟议项目的具体目标是：（1）提供纽约州治疗环境中OASAS无烟法规随时间推移的实施情况的分析描述，（2）纵向检查临床医生对OASAS法规在其治疗中心实施程度的看法与其心理需求满足、紧张反应、以及（3）纵向检查临床医生参与实施过程如何与近端实施结果（程序正义感知、改变的自我效能）和远端实施结果（紧张反应、临床实践行为）相关。该项目还将提供一个随着时间的推移变化的细粒度分析，因为该法规成为纽约州治疗中心实施。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，而这些反应又与心理、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在一个高压力、高倦怠的职业中工作。因此，理解这种自上而下驱动的，限制性的，国家强制性的法规对临床医生的实施的附加效应具有重大的个人健康和健康政策的影响。

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.