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Abstract Background Many primary care clinicians (PCCs) hold stigma toward people with opioid use disorder (OUD), which may be a barrier to care. Few interventions exist to address PCC stigma toward people with OUD. This study examined whether an online training incorporating patient narratives reduced PCCs’ stigma toward people with OUD (primary) and increased intentions to treat people with OUD compared to an attention-control training (secondary). Methods PCCs from 15 primary care clinics were invited to complete a 30 min online training for an electronic health record-embedded clinical decision support (CDS) tool that alerts PCCs to screen, diagnose, and treat people with OUD. PCCs were randomized to receive a stigma-reduction version of the training with patient narrative videos or a control training without patient narratives and were blinded to group assignment. Immediately after the training, PCCs completed surveys of stigma towards people with OUD and intentions and willingness to treat OUD. CDS tool use was monitored for 6 months. Analyses included independent samples t-tests, Pearson correlations, and logistic regression. Results A total of 162 PCCs were randomized; 88 PCCs (58% female; 68% white) completed the training (Stigma = 48; Control = 40) and were included in analyses. There was no significant difference between intervention and control groups for stigma (t = − 0.48, p = .64, Cohen’s d = − 0.11), intention to get waivered (t = 1.11, p = .27, d = 0.26), or intention to prescribe buprenorphine if a waiver were no longer required (t = 0.90, p = 0.37, d = 0.21). PCCs who reported greater stigma reported lower intentions both to get waivered (r = − 0.25, p = 0.03) and to prescribe buprenorphine with no waiver (r = − 0.25, p = 0.03). Intervention group and self-reported stigma were not significantly related to CDS tool use. Conclusions Stigma toward people with OUD may require more robust intervention than this brief training was able to accomplish. However, stigma was related to lower intentions to treat people with OUD, suggesting stigma acts as a barrier to care. Future work should identify effective interventions to reduce stigma among PCCs. Trial Registration: ClinicalTrials.gov NCT04867382. Registered 30 April 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04867382

Introduction This study quantifies the impacts of strengthening 2 tobacco control policies in “Tobacco Nation,” a region of the United States (U.S.) with persistently higher smoking rates and weaker tobacco control policies than the rest of the US, despite high levels of support for tobacco control policies. Methods We used a microsimulation model, ModelHealth TM :Tobacco, to project smoking-attributable (SA) outcomes in Tobacco Nation states and the U.S. from 2022 to 2041 under 2 scenarios: (1) no policy change and (2) a simultaneous increase in cigarette taxes by $1.50 and in tobacco control expenditures to the CDC-recommended level for each state. The simulation uses state-specific data to simulate changes in cigarette smoking as individuals age and the health and economic consequences of current or former smoking. We simulated 500 000 individuals for each Tobacco Nation state and the U.S. overall, representative of each population. Results Over the next 20 years, without policy changes, disparities in cigarette smoking will persist between Tobacco Nation and other U.S. states. However, compared to a scenario with no policy change, the simulated policies would lead to a 3.5% greater reduction in adult smoking prevalence, 2361 fewer SA deaths per million persons, and $334M saved in healthcare expenditures per million persons in Tobacco Nation. State-level findings demonstrate similar impacts. Conclusions The simulations indicate that the simulated policies could substantially reduce cigarette smoking disparities between Tobacco Nation and other U.S. states. These findings can inform tobacco control advocacy and policy efforts to advance policies that align with evidence and Tobacco Nation residents’ wishes.