While 14% of the adult U.S. population smokes, these rates are 2-4 times higher for patients with psychiatric or substance use disorders (Kalman 2005). Patients with substance use disorders want to quit, and they can successfully quit if they receive evidence-based interventions tailored to their needs (Kalman 2010). Contrary to the belief that tobacco cessation will hinder treatment, it actually enhances mental health and non-nicotine substance use treatment outcomes (Lemon 2003, McKelvey 2017). Consequently, efforts should be made to integrate nicotine dependence treatment into substance use treatment through multilevel (clinical, program, and system) changes (Baca and Yahne 2009, Prochaska 2004). Taking Texas Tobacco Free (TTTF) is a multicomponent, tobacco free workplace program that expanded in 2017 to work with substance use treatment centers and community agencies serving clients enrolled in substance use treatment. TTTF helps centers build their capacity to treat tobacco dependence among clients with substance use disorders.

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Starting in 2021, TTTF was further expanded to serve priority groups from rural and/or medically underserved areas (MUA), who often experience elevated rates of tobacco use and limited access to smoking cessation services (Lasser 2000). To fully address rural and MUA tobacco use, TTTF has a planned expansion into systems and places that already provide healthcare to these priority populations - namely, Federally Qualified Health Centers (where treatment of substance use disorders typically occurs in these areas) and surrounding substance use treatment centers (Rosen 2010, Fiore 2008, MACPAC 2017). In doing so, TTTF aspires to further our mission of preventing cancers among Texans by providing targeted reach and interventions for reducing tobacco use.