Abstract People with opioid use disorder (OUD) have very high tobacco use rates (75-95%) that are rarely addressed in opioid treatment programs (OTPs) where they receive care. This is a missed opportunity to leverage the benefits of concurrent tobacco cessation to facilitate OUD recovery and prevent tobacco-related cancer disparities. Based on Social Cognitive Theory, OUTPACE (Opioid Use Treatment Programs Advancing Cessation Efforts) Tobacco is a comprehensive tobacco-free workplace program that provides policy and workflow guidance, specialized training, and resources to bolster OTPs’ capacity to screen for tobacco use and briefly intervene with referral to a Quitline for care. Here, we describe its implementation. Methods: We partnered with an OTP with 40 staff working in 3 clinic locations serving 295 patients yearly across 4 Texas counties (1 rural and 2 partially rural, collectively serving 4 medically underserved areas). Data on staff’s pre-implementation tobacco-related policies and practices were collected via e-surveys and interviews to guide implementation, using EPIS (episframework.com). Implementation strategy bundles aided uptake of OUTPACE Tobacco’s core components. Program implementation spanned 2024-2025 and was evaluated quantitively and qualitatively; sustainment is ongoing. Results: At pre-implementation, OTP tobacco screening and intervention capacity was poor with 50% of 33 responding staff asking patients about tobacco use and only 4.2-29% advising them to quit, assessing quit interest, assisting quitting, and following up. Staff rated their tobacco intervention knowledge at 5.4 (SD=2.7) on a 1 to 10 scale. About 42% received past year training on tobacco use care and only 12% favored concurrent opioid and tobacco treatment. Barriers included lack of training (50%), patient education materials (50%), and referral resources (36%). However, 88% of staff wanted training and, overall, agreed that OUTPACE Tobacco was acceptable, appropriate, and feasible for implementation. Qualitative findings contextualize and support survey responses. During implementation, all staff were trained on the harms of tobacco use and how to help patients quit, exhibiting a 47% knowledge gain (p0.001). The OTP director completed tobacco treatment specialist training and a train-the-trainer program. A tobacco-free workplace policy was implemented and 4,000 patient education and 2,000 provider nudge materials were provided. Staff were trained on HIPAA-secure Quitline referral methods, which are ongoing; engaged callers may receive up to 12 counseling calls and 16 weeks of dual NRT across 2 quit attempts a year. Mixed methods implementation findings and lessons learned will be shared. Conclusions: Implementation of OUTPACE Tobacco in a high-need OTP provides proof-of-concept for the uptake of a multi-component tobacco-free workplace intervention despite initial barriers. These findings suggest the usefulness of OUTPACE Tobacco implementation in OTPs to address critical gaps in tobacco-related care that put patients with OUD at risk for cancer disparities. Citation Format: Asfand B. Moosa, Maggie Britton, Isabel Martinez Leal, Hannah Wani, Tzuan A. Chen, Diane M. Beneventi, Jennifer A. Minnix, Maher A. Karam-Hage, Paul M. Cinciripini, Mikal Zere, Marcy Zere, Douglas Thornton, Lorraine R. Reitzel. Preventing tobacco-related cancer disparities among opioid use treatment program stakeholders: A case study of a tailored tobacco-free workplace program implementation with reach to rural/medically underserved areas of Texas abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B014.
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