{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T13:02:47Z","timestamp":1784034167917,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004917","name":"Cancer Prevention & Research Institute of Texas","doi-asserted-by":"crossref","award":["PP210003"],"award-info":[{"award-number":["PP210003"]}],"id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute at the National Institutes of Health","doi-asserted-by":"crossref","award":["P30CA016672"],"award-info":[{"award-number":["P30CA016672"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Institute on Drug Abuse at the National Institutes of Health","award":["R25DA059907"],"award-info":[{"award-number":["R25DA059907"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Tobacco use, and particularly cigarette smoking, is elevated among patients with substance use disorders (SUDs), resulting in health inequities. In rural and medically underserved areas (MUAs), healthcare access is limited; thus, patients with SUDs may receive care in substance use treatment centers (SUTCs) and\/or medical healthcare centers (MHCs). Healthcare providers in these settings should know the importance and benefits of quitting tobacco use for patients with SUDs, as this is essential for effective cessation care. This study examined baseline provider knowledge\/training receipt and knowledge gains following training in SUTCs and MHCs serving rural and MUAs of Texas, USA. Methods: From 2021 to 2024, 428 providers from 8 SUTCs and 8 MHCs completed an e-survey on tobacco knowledge and past-year training. They then completed 1 to 1.5 h of training. Knowledge gain was assessed via a 10-item test delivered pre- and post-training. Results: Pre-training knowledge and past-year training rates were low across settings; providers at SUTCs were more likely than those at MHCs to know that persons with behavioral disorders like substance misuse are 2 times more likely to smoke than the general USA population. Both groups demonstrated significant knowledge gains from training (SUTCs: 37.41% and MHCs: 45.92% increases; ps &lt; 0.0001). Conclusions: Findings support the need for routine tobacco training in healthcare centers serving rural and MUAs of Texas. Brief educational sessions may help address provider knowledge gaps and, ultimately, strengthen cessation care and reduce tobacco-related disparities in these settings.<\/jats:p>","DOI":"10.3390\/ijerph22111701","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T10:56:27Z","timestamp":1762858587000},"page":"1701","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tobacco-Related Knowledge Among Employees at Substance Use Treatment and Medical Healthcare Centers Serving Rural and Medically Underserved Patients with Substance Use Disorders in Texas, USA"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2947-4858","authenticated-orcid":false,"given":"Jedidiah A.","family":"Feyisetan","sequence":"first","affiliation":[{"name":"Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA"},{"name":"School of Medicine, Texas Tech University Health Sciences Center, 3601 4th St STOP 6238, Lubbock, TX 79430, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3561-1832","authenticated-orcid":false,"given":"Maggie","family":"Britton","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, 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, and Learning Sciences, University of Houston, McElhinney Hall, 3623 Cullen Blvd., Houston, TX 77204, USA"},{"name":"HEALTH Research Institute, University of Houston, 4349 Martin Luther King Blvd., 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 Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhyank S.","family":"Sekhar","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, 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"}]},{"given":"Kathleen","family":"Casey","sequence":"additional","affiliation":[{"name":"Integral Care, 1430 Collier Street, Austin, TX 78704, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5639-2646","authenticated-orcid":false,"given":"Ammar D.","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA"},{"name":"School of Medicine, University of California, San Francisco, 533 Parnassus Ave., San Francisco, CA 94143, 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 Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2025, July 22). Cigarette Smoking, Available online: https:\/\/www.cdc.gov\/tobacco\/about\/index.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1377\/hlthaff.2022.00901","article-title":"A Widening Divide: Cigarette Smoking Trends Among People With Substance Use Disorder And Criminal Legal Involvement","volume":"42","author":"Saloner","year":"2023","journal-title":"Health Aff."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jsat.2014.12.007","article-title":"Cigarette Smoking During Substance Use Disorder Treatment: Secondary Outcomes from a National Drug Abuse Treatment Clinical Trials Network study","volume":"53","author":"McClure","year":"2015","journal-title":"J. Subst. Abus. Treat."},{"key":"ref_4","unstructured":"National Cancer Institute (2022). Addressing Smoking in Medically Underserved and Vulnerable Populations, Tobacco Contol Monograph Series 23: Treating Smoking in Cancer Patients: An Essential Component of Cancer Care."},{"key":"ref_5","unstructured":"Brannen, J. (2025, July 22). After Census Redefines Urban and Rural, Texas Remains Steadfastly Both. Available online: https:\/\/kinder.rice.edu\/urbanedge\/census-redefines-urban-rural."},{"key":"ref_6","unstructured":"Texas Hospital Association (2025, July 25). Rural Hospital Financing. Available online: https:\/\/www.tha.org\/wp-content\/uploads\/2022\/04\/Rural_Hospital_Financing_FINAL.pdf."},{"key":"ref_7","unstructured":"Mulverhill, L. (2025, July 25). Health IT in Texas, Available online: https:\/\/comptroller.texas.gov\/economy\/fiscal-notes\/archive\/2017\/november\/health-it.php."},{"key":"ref_8","unstructured":"Health Resources and Services Administration (2024, October 31). How We Define Rural, Available online: https:\/\/www.hrsa.gov\/rural-health\/about-us\/what-is-rural."},{"key":"ref_9","unstructured":"Health Resources and Services Administration (2024, November 01). Rural Health Grants Eligibility Analyzer, Available online: https:\/\/data.hrsa.gov\/topics\/rural-health\/rural-health-eligibility."},{"key":"ref_10","unstructured":"Health Resources and Services Administration (2024, October 31). Glossary, Available online: https:\/\/data.hrsa.gov\/glossary."},{"key":"ref_11","unstructured":"Health Resources and Services Administration (2024, October 31). What Is Shortage Designation?, Available online: https:\/\/bhw.hrsa.gov\/workforce-shortage-areas\/shortage-designation."},{"key":"ref_12","unstructured":"Health Resources and Services Administration (2024, November 01). Find MUA\/P, Available online: https:\/\/data.hrsa.gov\/topics\/health-workforce\/shortage-areas\/mua-find."},{"key":"ref_13","unstructured":"Texas Health and Human Services (2025, October 13). Adult Substance Use Services, Available online: https:\/\/www.hhs.texas.gov\/services\/mental-health-substance-use\/adult-substance-use-services."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kakarla, S.N., Carter, B.J., Siddiqi, A.D., Britton, M., Chen, T.A., Martinez Leal, I., Williams, T., Casey, K., Sanchez, H., and Reitzel, L.R. (2024). Abstract A090: Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and\/or medically underserved areas of Texas. Cancer Epidemiol. Biomark. Prev., 33.","DOI":"10.1158\/1538-7755.DISP24-A090"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/s13643-022-02030-2","article-title":"Barriers and facilitators to clinical behaviour change by primary care practitioners: A theory-informed systematic review of reviews using the Theoretical Domains Framework and Behaviour Change Wheel","volume":"11","author":"Mather","year":"2022","journal-title":"Syst. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"357","DOI":"10.5964\/ejop.v16i3.1900","article-title":"The Theory of Planned Behavior and the Social Identity Approach: A New Look at Group Processes and Social Norms in the Context of Student Binge Drinking","volume":"16","author":"Willis","year":"2020","journal-title":"Eur. J. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1016\/S0735-1097(17)35918-1","article-title":"Tobacco Cessation: A Knowledge, Attitude and Practice (Kap) Survey among Residents","volume":"69","author":"Kattoor","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"132","DOI":"10.11114\/ijsss.v8i4.4870","article-title":"Social Cognitive Theory and Health Care: Analysis and Evaluation","volume":"8","year":"2020","journal-title":"Int. J. Soc. Sci. Stud."},{"key":"ref_19","first-page":"100493","article-title":"Behavioral health care provider\u2019s beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A\u2019s intervention","volume":"17","author":"Jafry","year":"2023","journal-title":"Addict. Behav. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Carter, B.J., Siddiqi, A.D., Chen, T.A., Britton, M., Martinez Leal, I., Correa-Fernandez, V., Rogova, A., Kyburz, B., Williams, T., and Casey, K. (2023). Educating Substance Use Treatment Center Providers on Tobacco Use Treatments Is Associated with Increased Provision of Counseling and Medication to Patients Who Use Tobacco. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054013"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Le, K., Chen, T.A., Martinez Leal, I., Correa-Fernandez, V., Obasi, E.M., Kyburz, B., Williams, T., Casey, K., Brown, H.A., and O\u2019Connor, D.P. (2021). Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18147597"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Taing, M., Nitturi, V., Chen, T.A., Kyburz, B., Martinez Leal, I., Correa-Fernandez, V., Obasi, E.M., Williams, T., Casey, K., and O\u2019Connor, D.P. (2021). Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010239"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s10597-016-0065-8","article-title":"Smoking Cessation and Electronic Cigarettes in Community Mental Health Centers: Patient and Provider Perspectives","volume":"53","author":"Chen","year":"2017","journal-title":"Community Ment. Health J."},{"key":"ref_24","unstructured":"Agency for Healthcare Research and Quality (2025, July 25). Treating Tobacco Use and Dependence: 2008 Update, Available online: https:\/\/www.ahrq.gov\/prevention\/guidelines\/tobacco\/index.html."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.addbeh.2016.10.012","article-title":"Impact of quitting smoking and smoking cessation treatment on substance use outcomes: An updated and narrative review","volume":"65","author":"McKelvey","year":"2017","journal-title":"Addict. Behav."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"519","DOI":"10.15585\/mmwr.mm6718a3","article-title":"Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities\u2014United States, 2016","volume":"67","author":"Marynak","year":"2018","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.15585\/mmwr.mm7414a3","article-title":"Tobacco-Related Clinical Services and Tobacco-Free Policies in Behavioral Health Treatment Facilities\u2014United States, 2023","volume":"74","author":"VanFrank","year":"2025","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jsat.2016.04.004","article-title":"Barriers and Facilitators to Tobacco Cessation in a Nationwide Sample of Addiction Treatment Programs","volume":"67","author":"Pagano","year":"2016","journal-title":"J. Subst. Abus. Treat."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Siddiqi, A.D., Britton, M., Chen, T.A., Carter, B.J., Wang, C., Martinez Leal, I., Rogova, A., Kyburz, B., Williams, T., and Patel, M. (2022). Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19159647"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Rogova, A., Leal, I.M., Britton, M., Chen, T.A., Lowenstein, L.M., Kyburz, B., Casey, K., Skeene, K., Williams, T., and Reitzel, L.R. (2024). Implementing a tobacco-free workplace program at a substance use treatment center: A case study. BMC Health Serv. Res., 24.","DOI":"10.1186\/s12913-024-10629-5"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"652","DOI":"10.5993\/AJHB.44.5.9","article-title":"Tobacco-free Workplace Program at a Substance Use Treatment Center","volume":"44","author":"Le","year":"2020","journal-title":"Am. J. Health Behav."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel (2008). A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service Report. Am. J. Prev. Med., 35, 158\u2013176.","DOI":"10.1016\/j.amepre.2008.04.009"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"186","DOI":"10.2105\/AJPH.94.2.186","article-title":"Reversal of misfortune: Viewing tobacco as a social justice issue","volume":"94","author":"Healton","year":"2004","journal-title":"Am. J. Public Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/phe\/phq006","article-title":"Smoking and Social Justice","volume":"3","author":"Voigt","year":"2010","journal-title":"Public Health Ethics"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Voigt, K. (2013). Denormalisation strategies for the improvement of health-related behaviours: The case of tobacco. Ethics in Public Health and Health Policy, Springer.","DOI":"10.1007\/978-94-007-6374-6_4"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100208","DOI":"10.1016\/j.dadr.2023.100208","article-title":"Predictors of improved clinician screening, assessment, and treatment for tobacco use for clients in community mental healthcare following training","volume":"9","author":"Foster","year":"2023","journal-title":"Drug Alcohol. Depend. Rep."},{"key":"ref_37","unstructured":"American Lung Association (2025, July 31). Behavioral Health & Tobacco Use. Available online: https:\/\/www.lung.org\/quit-smoking\/smoking-facts\/impact-of-tobacco-use\/behavioral-health-tobacco-use."},{"key":"ref_38","unstructured":"Agency for Healthcare Research and Quality (2025, July 31). Patients Not Ready to Make a Quit Attempt Now (The \u201c5 R\u2019s\u201d), Available online: https:\/\/www.ahrq.gov\/prevention\/guidelines\/tobacco\/5rs.html."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"46","DOI":"10.18332\/tpc\/125354","article-title":"Barriers and facilitators to cessation among tobacco users with concomitant mental illness attending group behavioral tobacco cessation: A qualitative study","volume":"6","author":"Olando","year":"2020","journal-title":"Tob. Prev. Cessat."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s11414-015-9475-6","article-title":"Methods to Improve the Selection and Tailoring of Implementation Strategies","volume":"44","author":"Powell","year":"2017","journal-title":"J. Behav. Health Serv. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/11\/1701\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T05:23:03Z","timestamp":1763011383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/11\/1701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["ijerph22111701"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22111701","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}