The recent tobacco settlements in 48 states will challenge state Departments of Public Health and other agencies to develop and implement public and organizational policies intended to prevent, control and treat tobacco use. The nationally-recognized Massachusetts Tobacco Control Program (MTCP), the largest, single purpose public health initiative in the nation, includes tobacco treatment services provided primarily through tobacco treatment specialists (TTSs) housed within community health settings (CHSs). The goal of this study is to evaluate present Massachusetts state policy designed to make effective tobacco treatment services available to a wide group of adult tobacco users, especially those at greatest risk (e.g., underserved, low income, industry-targeted minority groups), and to inform future policy. The proposed study is divided into two phases. Phase I is a descriptive case study of the longitudinal development of allocative policies and program standards developed by the MTCP for funding tobacco treatment services. Phase II is a prospective comparative case study of CHSs participating in MTCP initiatives to determine the relationship of the policy and standards to implementation of tobacco treatment services. Data will be obtained via two types of methods: (1) qualitative methods, including content analysis of public documents, and key informant interviews at the state, community and organizational level; and (2) quantitative methods including: structured surveys of CHS administrator and clinicians, TTSs and community informants; CHS monitoring data; and treatment checklists completed by standardized patients and by observers to evaluate quality of treatment services provided. These data will be used to investigate factors associated with program implementation, as measured by quantity of tobacco treatment services provided by CHSs, quality of services provided (i.e., the degree to which standards of practice are applied), reach of services (i.e., the degree of penetration into the CHS and surrounding community), and implementation of tobacco treatment-related systems to support the services within the CHS. The historical and prospective information gathered will be summarized into two reports. The first report will describe the funding policy and program standards development from 1994 to 2000; the process by which CHSs received, or did not receive, funding; and then, if funded, the process used to implement the tobacco treatment program. This report will provide recommendations for other states considering similar policies. The second report will summarize the continuing policy development and factors related to successful implementation of the program in CHSs. Recommendations will be made about what standards should be included in a funding policy in order to assure successful implementation of a tobacco treatment program and services in different types of settings.
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