The rate of sustainment may be unique to these early adopting programs, and it is unknown whether these findings would generalize to later adopters. An additional limitation is sample attrition, which was examined through a series of bivariate multinomial logistic regression models. Associations between participation Trichostatin A chemical structure status at the follow-up (i.e., closure, hard refusal, or unable to be contacted, with participation as the reference category) and structural characteristics, smoking cessation medications, organizational barriers, and staff tobacco use were estimated for the 153 organizations with smoking cessation programs at baseline. There were no significant differences, but this may reflect the small cell sizes for the three types of nonparticipation.
Response bias was also examined for the full baseline sample of 897 organizations. At the bivariate level, participation status did vary by availability of a counseling-based smoking cessation program, profit status, sample type, organizational size, and administrator attitudes. These variables were entered into a multivariate model, which yielded only three significant differences. Publicly funded programs were less likely than privately funded programs to directly refuse to participate. Similar to prior research (Knudsen et al., 2005), larger programs were significantly less likely to close. Finally, having a counseling-based smoking cessation program was protective against closure. These differences suggest that some caution may still be warranted in interpreting the findings.
However, the finding that offering a counseling-based smoking cessation program protected against organizational closure suggests an additional benefit of offering this service. This study also provides the opportunity to consider the intersection of public policy and sustainment of clinical interventions. In 2008, New York was the first in the United States to institute a statewide policy requiring tobacco-free campuses and delivery of smoking cessation services by all licensed SUD treatment programs (Brown, Nonnemaker, Federman, Farrelly, & Kipnis, 2012; Eby, Sparks, Evans, & Selzer, 2012). Of the 10 New York SUD organizations that participated at follow-up, none discontinued their counseling-based smoking cessation programs, suggesting that state policy may play an important role in sustaining evidence-based practices. The majority of individuals who enter SUD treatment also use tobacco, placing them at heightened risk of SUD relapse, morbidity, and mortality. Nearly 40% of treatment organizations that Dacomitinib had adopted counseling-based smoking cessation programs discontinued this service over time.