An Open Access article published in the Health Behavior and Policy Review Journal.


Sriya N. Kakarla & Noor Shabaneh (Authors contributed equally)
Midhat Z. Jafry, BS
Maggie Britton, PhD
Anastasia Rogova, PhD
Brian J. Carter, JD
Tzuan A. Chen, PhD
Isabel Martinez Leal, PhD
Bryce Kyburz, MA
Teresa Williams, MS
Lorraine R. Reitzel, PhD


Tobacco-free workplace policies (TFWPs) at behavioral health treatment centers can curb clients’ tobacco use and secondhand smoke/vape exposure. However, there is little extant observational research about how total versus partial workplace tobacco use bans are associated with employees’ perceptions of best tobacco-related practices in behavioral health centers. Little is understood about the relationship between total or partial TFWPs and other factors that influence evidence-based client care including employees’ beliefs and their tobacco treatment practices. In this study, we examined these associations within Local Mental Health Authorities (LMHAs) providing behavioral healthcare throughout Texas.


Employees from 30 of 39 LMHAs (> 75% of Texas’ statewide service area) responded to a 2021 survey on their TFWP characteristics. We explored associations between the TFWP (total vs partial) and variables of interest using independent proportions tests (p < .10).

LMHAs with total TFWPs reported clearer signage, more consistent enforcement, and greater client, contractor, and visitor awareness (ps = .013 to .078). They were also more likely to offer tobacco screening training, promote the Quitline, and believe in the benefits of concurrent treatment of behavioral health needs and tobacco use (ps = .024 to .079).


LMHAs with partial TFWPs had weaknesses in communication, enforcement, awareness, and greater barriers to tobacco use care. There are opportunities for collaboration between LMHAs to share policies and care-facilitation practices to reduce the research-to-practice gap and resultant tobacco use inequities statewide.

Source: Health Behavior and Policy Review, Volume 11, Number 1, February 2024
Publisher: Paris Scholar Publishing Ltd.
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