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

了解物质领域无烟法规的采用和实施

• 批准号: 8013341
• 负责人: Lillian T Eby
• 金额: $ 26.91万
• 依托单位: UNIVERSITY OF GEORGIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-15 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8013341
• 关键词: Administrator; Adoption; Alcoholism; Behavior; Behavioral; Belief; Cereals; Characteristics; Client; Clinical Trials Network; Cognitive; Competence; Data; Distal; Employee; Failure; Focus Groups; Fostering; Funding; Goals; Health; Health Policy; Individual; Justice; Link; Mediating; National Institute of Drug Abuse; New York; Nicotine Dependence; Occupations; Organizational Change; Outcome; Patients; Perception; Process; Reaction; Regulation; Research; Sampling; Self Efficacy; Services; Smoker; Smoking; Smoking Status; Stress; Substance Abuse Treatment Centers; Substance abuse problem; Textiles; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Treatment outcome; Uncertainty; Work; Workplace; addiction; burnout; clinical practice; experience; implementation science; innovation; meetings; policy implication; programs; psychologic; social; substance abuse treatment; theories; treatment center; treatment program; volunteer

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.

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酗酒和药物滥用服务办公室 (OASAS) 监督的所有 1,419 个国家资助或国家认证的成瘾治疗项目必须 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培养客户的烟草独立性的目标值得称赞，并且随着时间的推移可能会产生积极的影响（例如，降低吸烟率、更好的治疗结果）。然而，该法规的实施将是纽约州药物滥用治疗中心的重大变化，与实施创新相关的失败率很高（Rogers，2002），特别是在外部强加的情况下（Bolman＆Deal，2006；Rogers，2002）。此外，OASAS 法规限制性强、范围广泛，对如何最好地对待吸毒客户的根深蒂固的信念提出了挑战。因此，随着该法规的实施，它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) 分析描述 OASAS 无烟法规在纽约州治疗环境中随时间推移的实施情况，(2) 纵向研究临床医生对其治疗中心实施 OASAS 法规的广泛程度的看法与他们的心理需求满足、紧张反应之间的关系，以及 (3) 纵向研究临床医生如何参与实施过程 涉及近端实施结果（程序正义认知、变革的自我效能）和远端实施结果（紧张反应、临床实践行为）。随着该法规在纽约州治疗中心的实施，该项目还将提供对随时间变化的细粒度分析。公共卫生相关性：临床医生对 OASAS 无烟监管实施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、行为和身体压力有关。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、国家强制监管对临床医生的附加影响对个人健康和健康政策具有重大影响。