Abstract B043: Staff perceptions and value of concurrent tobacco use and behavioral health treatment and tobacco-free programs: A qualitative study of health centers in rural and medically underserved areas of Texas

Abstract Background: Tobacco use in rural/medically underserved areas (MUAs) is high, especially for patients with behavioral health (BH, i.e., substance use and mental health disorder) needs. Lack of access to healthcare–specifically, evidence-based tobacco cessation care–partly drives these disparities and results in greater tobacco-related cancer incidence and mortality. Despite clinical guidelines and research supporting concurrent treatment of tobacco dependence and BH needs, cessation treatment in health centers (HCs) is often underutilized. Tobacco-free workplace programs (TFWPs) effectively address tobacco use in HCs, but the beliefs and values of HC staff shape their implementation success. Few studies have examined factors associated with the perceived value of TFWPs in HCs in rural/MUAs. This qualitative study explored staff attitudes toward concurrent treatment of tobacco use and BH needs, and valuation of TFWPs prior to program adoption to inform HCs’ ability for successful program implementation in rural/MUAs of Texas. Methods: Prior to HCs adopting a comprehensive TFWP, we conducted and analyzed 16 semi-structured group interviews with staff–providers (N=70) and managers (N=15)–in 12 HCs in rural/MUAs serving 93 counties and 91,045 total unique patients annually. Interviews lasting ∼50 minutes focused on staff attitudes towards TFWP adoption. Rapid qualitative analysis (RQA) was used to facilitate timely data analysis. Using RQA templates of key domains drawn from interview guides, transcripts were independently summarized by two analysts to organize data into matrices and facilitate systematic comparison. During final data analysis, analysts used thematic analysis to synthesize data into themes. Results: Data analysis produced 3 themes, highlighting minimal organizational support and practices for addressing tobacco dependence among patients and attitudinal barriers: 1) consistent prioritization of “harm reduction” techniques, often rooted in misconceptions about patients’ willingness to quit and about perceived threats to other BH treatment; 2) limited support for providing tobacco use screenings and tobacco cessation services, largely due to insufficient training, resources, and awareness, and thus, poor utilization of the state Quitline; and 3) hesitance regarding TFWP integration, with staff expressing concerns that TFWPs may stigmatize patient behaviors and infringe on their bodily autonomy. Conclusion: Findings highlight critical attitudinal and structural barriers influencing concurrent treatment of tobacco use and BH needs and TFWP implementation in HCs serving rural/MUAs. Applied findings included provision of tailored staff education and training, evidence-based cessation tools (i.e., patient educational materials, varied nicotine replacement therapies), and clear communication about TFWP goals to improve staff buy-in and facilitate implementation. These insights can inform future intervention efforts aimed at reducing tobacco-related cancer disparities among individuals with BH needs. Citation Format: Tarik Goulbourne, Isabel Martinez Leal, Maggie Britton, Hannah Wani, Asfand B. Moosa, Tzuan A. Chen, Abigail E. Bergey, Ammar D. Siddiqi, Teresa Williams, Kathleen Casey, Lorraine R. Reitzel. Staff perceptions and value of concurrent tobacco use and behavioral health treatment and tobacco-free programs: A qualitative study of health centers in rural and 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 B043.