Addressing tobacco smoking in a medically supervised injecting center with an organizational change intervention: An acceptability study

Background: Among people who inject drugs (PWIDs), the rate of smoking exceeds 90% making this population particularly susceptible to tobacco-related illnesses and in need of smoking cessation care (SCC). The Medically Supervised Injecting Centre (MSIC) may be a potential setting to address tobacco smoking among PWIDs. Aims: This study aimed to assess the acceptability of an organizational change intervention to integrate SCC into usual care practice at a MSIC. In addition, provision of SCC as reported by staff and clients was also explored. Methods: Online cross-sectional surveys with staff and clients were conducted pre- and post-implementation of an organizational change intervention. The intervention consisted of six core components: engaging organizational support, identifying a SCC support champion, promoting the center's tobacco smoking policy, implementing a smoker identification system, providing education and evidence-based SCC treatments. Results: Over 85% of staff agreed that it was acceptable to address client smoking as part of usual care. From pre- to post-intervention staff self-reported delivery of SCC strategies significantly increased for the provision of verbal advice (P = 0.001), offer of free nicotine replacement therapy (P = 0.000), referral to a GP (P = 0.008) and follow-up to check on quit smoking progress (P = 0.005). Nearly all (94%) clients agreed that it was acceptable to be asked by staff about their tobacco smoking and the majority held positive attitudes toward receiving SCC, agreeing that it was helpful to talk to staff about their smoking (89%). In the post-intervention period, more clients reported receiving SCC (P < 0.05). Conclusions: The organizational intervention was well-received, with high acceptability from both clients and staff. Translational research aspect: This research will provide novel information to shape program development for smoking cessation care in MSICs. This is T3 research.