{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:27:55Z","timestamp":1792114075867,"version":"4.4.0"},"reference-count":54,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T00:00:00Z","timestamp":1598313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004917","name":"Cancer Prevention and Research Institute of Texas","doi-asserted-by":"publisher","award":["PP170070"],"award-info":[{"award-number":["PP170070"]}],"id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P20CA221697"],"award-info":[{"award-number":["P20CA221697"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Tobacco use is exceedingly high among those who are homeless or at risk of homelessness but not commonly addressed by clinicians. Taking Texas Tobacco Free (TTTF) is a tobacco control program that addresses known clinician barriers to intervention (e.g., low training receipt, limited resources). Here, we examine the process and outcomes of TTTF\u2019s adaptation within four agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N = 68) to assess changes in training receipt, knowledge, and intervention behaviors, relative to program goals. Results indicated significant gains in clinicians\u2019 receipt of training in 9 (of 9) target areas (p\u2019s \u2264 0.0042) and a 53% knowledge gain (p &lt; 0.0001). From pre- to post-implementation, there were mean increases in the use of the 5As (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen in assisting residents\/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (p\u2019s \u2264 0.0491). All program goals, except gains related to advising smokers to quit and the use of specific interventions (behavioral counseling), were met. Overall, TTTF improved clinicians\u2019 capacity to address tobacco use among homeless and vulnerably housed individuals and can serve as a model for tobacco control efforts in similar agencies.<\/jats:p>","DOI":"10.3390\/ijerph17176154","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T09:30:07Z","timestamp":1598347807000},"page":"6154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Clinician Training in the Adaptation of a Comprehensive Tobacco-Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed"],"prefix":"10.3390","volume":"17","author":[{"given":"Matthew","family":"Taing","sequence":"first","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"},{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce","family":"Kyburz","sequence":"additional","affiliation":[{"name":"Integral Care, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel Martinez","family":"Leal","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"},{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"},{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"},{"name":"Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu-An","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"},{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virmarie","family":"Correa-Fernandez","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"},{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Williams","sequence":"additional","affiliation":[{"name":"Integral Care, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"},{"name":"Department of Health &amp; Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezemenari M.","family":"Obasi","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"},{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Casey","sequence":"additional","affiliation":[{"name":"Integral Care, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Litty","family":"Koshy","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7165-5720","authenticated-orcid":false,"given":"Lorraine R.","family":"Reitzel","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health &amp; Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA"},{"name":"HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.childyouth.2015.09.017","article-title":"Tobacco use among foster youth: Evidence of health disparities","volume":"58","author":"Braciszewski","year":"2015","journal-title":"Child. 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