State Leadership Academies to reduce cigarette smoking among people with behavioral health conditions in the United States.

Objective: Smoking is concentrated in behavioral health populations in the United States, calling for efforts to increase access to cessation services. Methods: Between 2010 and 2023, the Smoking Cessation Leadership Center (SCLC) implemented state Leadership Academies-a facilitated summit of public health leaders and community champions charged with developing an action plan to address smoking in their state. Using a multi-methods approach, we evaluated state Leadership Academies using the RE-AIM framework. States completed progress surveys and set targets for reductions in smoking prevalence within 5 years of participating in the summit. We measured the average yearly decline in smoking prevalence for adults with frequent poor mental health and heavy drinking from the Behavioral Risk Factors Surveillance System. Results: SCLC reached 24 state Leadership Academies. The mean annual smoking prevalence decline for frequent poor mental health was 1.2 % (95 % CI 0.9 %-1.4 %) and heavy drinking was 1.1 % (95 % CI 0.8 %-1.3 %) during their time in the Leadership Academy. Since 2010, SCLC trained 57,312 individuals, conducted 127 webinars, and facilitated collaborations among 2773 organizations. State action plans focused on large-scale education initiatives to train behavioral health providers. Action plans also focused on improving policy and systems-level initiatives that increased implementation of tobacco-free grounds policy in behavioral health facilities and eliminated barriers to access to cessation pharmacotherapy. Conclusions: Leadership Academies are a multi-layered engagement and action framework to initiate and sustain incremental change in the provision of smoking cessation services in behavioral health facilities, with the potential to reduce smoking prevalence among impacted behavioral health populations.