{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:12:06Z","timestamp":1792195926715,"version":"4.4.0"},"reference-count":81,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T00:00:00Z","timestamp":1679616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of State Health Services","award":["NU58DP006805"],"award-info":[{"award-number":["NU58DP006805"]}]},{"name":"Department of State Health Services","award":["R25DA054015"],"award-info":[{"award-number":["R25DA054015"]}]},{"name":"Department of State Health Services","award":["3U54MD015946-03S1"],"award-info":[{"award-number":["3U54MD015946-03S1"]}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH)","doi-asserted-by":"publisher","award":["NU58DP006805"],"award-info":[{"award-number":["NU58DP006805"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH)","doi-asserted-by":"publisher","award":["R25DA054015"],"award-info":[{"award-number":["R25DA054015"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH)","doi-asserted-by":"publisher","award":["3U54MD015946-03S1"],"award-info":[{"award-number":["3U54MD015946-03S1"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"NIDA through the National Institute on Minority Health and Health Disparities of the NIH","doi-asserted-by":"publisher","award":["NU58DP006805"],"award-info":[{"award-number":["NU58DP006805"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"NIDA through the National Institute on Minority Health and Health Disparities of the NIH","doi-asserted-by":"publisher","award":["R25DA054015"],"award-info":[{"award-number":["R25DA054015"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"NIDA through the National Institute on Minority Health and Health Disparities of the NIH","doi-asserted-by":"publisher","award":["3U54MD015946-03S1"],"award-info":[{"award-number":["3U54MD015946-03S1"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers\u2019 misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients\u2019 substance-use recovery, although research indicates that it enhances support for recovery and relapse prevention. A total of 86 treatment providers employed in SUTS (i.e., 9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs), 6 substance-use treatment programs in LMHAs, and 55 stand-alone substance-use treatment centers) in Texas, USA, answered survey questions about their (1) thoughts about treating tobacco during substance-use treatment, and (2) delivery of the 5A\u2019s tobacco-use intervention (Ask, Advise, Assess, Assist, Arrange). Twenty-six providers and leaders were interviewed about attitudes toward tobacco-free workplace policies and tobacco dependence and the relative importance of treating tobacco (vs. other substance-use disorders) at their center. Providers who did not believe tobacco use should be addressed as soon as clients begin treatment (i.e., endorsed responses of after 1 year, it depends on the client, or never) had lower odds of Asking clients about their tobacco use (OR = 0.195), Advising clients to quit smoking (OR = 0.176), and Assessing interest in quitting smoking (OR = 0.322). Qualitative results revealed barriers including beliefs that clients need to smoke to relieve the stress of substance-use recovery, are disinterested in quitting, fears that concurrent treatment would jeopardize substance use, and limited resources; additional training and education resources was the key facilitator theme. The results demonstrate a critical need to eliminate barriers to tobacco-treatment provision for clients in SUTS through education to correct misperceptions, specialized training to equip providers with knowledge and skills, and resources to build center capacity. Integrating evidence-based smoking interventions into routine care is key to support the recovery efforts of clients in SUTS.<\/jats:p>","DOI":"10.3390\/ijerph20075260","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T03:31:48Z","timestamp":1679887908000},"page":"5260","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3561-1832","authenticated-orcid":false,"given":"Maggie","family":"Britton","sequence":"first","affiliation":[{"name":"Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA"},{"name":"Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA"},{"name":"Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0073-339X","authenticated-orcid":false,"given":"Isabel","family":"Martinez Leal","sequence":"additional","affiliation":[{"name":"Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA"},{"name":"Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA"},{"name":"Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Midhat Z.","family":"Jafry","sequence":"additional","affiliation":[{"name":"Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4312-7258","authenticated-orcid":false,"given":"Tzuan A.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA"},{"name":"Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5701-7083","authenticated-orcid":false,"given":"Anastasia","family":"Rogova","sequence":"additional","affiliation":[{"name":"Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA"},{"name":"Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce","family":"Kyburz","sequence":"additional","affiliation":[{"name":"Integral Care, 1430 Collier Street, Austin, TX 78704, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Williams","sequence":"additional","affiliation":[{"name":"Integral Care, 1430 Collier Street, Austin, TX 78704, 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 Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA"},{"name":"Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"106","DOI":"10.3322\/caac.21444","article-title":"Who\u2019s still smoking? 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