State Leadership Academies to Reduce Tobacco Use Prevalence in the United States: Four Case Studies of Early State Adopters of Tobacco Treatment and Policy.

From 2010 to 2023, the Smoking Cessation Leadership Center partnered with the Substance Abuse and Mental Health Services Administration to launch the State Leadership Academies (hereinafter, Leadership Academies) to address tobacco use in populations with behavioral health conditions in the United States. The Leadership Academies were a facilitated convening of leaders in tobacco control, behavioral health, and public health who were tasked with creating action plans to reduce the high rates of tobacco use in populations with behavioral health conditions in their states. State partners convened for a 2-day summit between 2010 and 2023, created an action plan, and, in the subsequent 3 to 5 years, implemented and evaluated the action plan in the areas of data, systems, education, or policy. Using a multimethods evaluation approach, we describe short-term outcomes (collaborations), intermediate outcomes (examples of integration of tobacco treatment and policy), and long-term outcomes (decline in tobacco use prevalence) of the Leadership Academies, focusing on 4 state case studies. The case studies highlighted unique partnerships, impactful strategies, the harnessing of state-level infrastructure, and the importance of political will to achieve state-level reductions in tobacco use in populations with behavioral health conditions. The 4 states showed a mean decline of 5.2% in smoking prevalence among people with frequent poor mental health and 6.2% among people with heavy drinking during their Leadership Academy tenure. The case demonstrated the importance of cross-sector collaboration, leadership buy-in, and the creation of sustainable funding structures to support the scaling up of promising projects. Leadership Academies were an effective engagement model to reduce the prevalence of tobacco use in populations with behavioral health conditions.