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Melzer AC, Reese ZA, Mascarhenas L, Clancy CB, Deepak J, Gogineni H, Gesthalter Y, Hart JL. Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs. ATS Sch 2023; 4:546-566. [PMID: 38196686 PMCID: PMC10773493 DOI: 10.34197/ats-scholar.2022-0131re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/20/2023] [Indexed: 01/11/2024] Open
Abstract
Background Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients. Objective We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams. Methods We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT. Results Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams. Conclusion TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.
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Affiliation(s)
- Anne C. Melzer
- Center for Care Delivery and Outcomes
Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Pulmonary, Allergy, Critical
Care, and Sleep, and
| | - Zachary A. Reese
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
| | - Lorraine Mascarhenas
- Department of Internal Medicine,
University of Minnesota Medical School, Minneapolis, Minnesota
| | - Caitlin B. Clancy
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
| | - Janaki Deepak
- Division of Pulmonary and Critical Care,
Department of Medicine, University of Maryland School of Medicine, Baltimore,
Maryland
| | - Hyma Gogineni
- Department of Pharmacy, Western University
of Health Sciences, Pomona, California
| | - Yaron Gesthalter
- Department of Pulmonary and Critical Care,
University of California San Francisco, San Francisco, California; and
| | - Joanna L. Hart
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
- Palliative and Advanced Illness Research
Center, and
- Department of Medical Ethics and Health
Policy, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael
J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia,
Pennsylvania
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Darville A, Rademacher K, Wiggins AT, Lenhof MG, Hahn EJ. Training Tobacco Treatment Specialists through Virtual Asynchronous Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3201. [PMID: 35328889 PMCID: PMC8955214 DOI: 10.3390/ijerph19063201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years.
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Affiliation(s)
- Audrey Darville
- College of Nursing, University of Kentucky, Lexington, KY 40504, USA; (K.R.); (A.T.W.); (M.G.L.); (E.J.H.)
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Thomson R, Cooper S, Waldron J, Mamuzo E, McDaid L, Emery J, Phillips L, Naughton F, Coleman T. Smoking Cessation Support for Pregnant Women Provided by English Stop Smoking Services and National Health Service Trusts: A Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031634. [PMID: 35162656 PMCID: PMC8835166 DOI: 10.3390/ijerph19031634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/05/2023]
Abstract
Reducing smoking rates in pregnancy continues to be a public health priority. Given a recent UK government policy change resulting in The National Health Service (NHS) making a significant new contribution to cessation support in pregnancy in England, in addition to that of Local Authorities (LA), an up-to-date assessment of national support offered to pregnant women is needed. LA Stop Smoking Service (SSS) managers and representatives from maternity services in NHS Trusts were invited to participate in an online survey in autumn 2020. Topics included service configuration, staffing, practitioner consultations and treatments offered. The survey response rate was 66% (99/151) of LAs and 68% (95/140) of Trusts. Most LAs provided smoking support for pregnant smokers (78%), whereas under half (43%) of NHS Trusts did. Combination nicotine replacement therapy, i.e., a combination of a patch and short-acting product, was offered by LAs (92%) and Trusts (95%) and most commonly for 12 weeks duration, at 53% and 50%, respectively. Similar national online training was undertaken by those supporting women, with the majority undertaking the specialist pregnancy-specific module: LAs 60% and Trusts 79%. However, clinicians were reported to deliver specialist stop smoking support in over 50% of Trusts, whereas this was reported in only 16% of LAs. In England, both LA and NHS Trusts are currently delivering similar stop smoking support to pregnant women. Having nationally recognised treatment programmes and training allows for the delivery of consistent, evidence-based smoking cessation to pregnant women in different healthcare settings.
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Affiliation(s)
- Ross Thomson
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
- Correspondence:
| | - Sue Cooper
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
| | - John Waldron
- Action on Smoking and Health, Unit 2.9, The Foundry, 17 Oval Way, London SE11 5RR, UK; (J.W.); (E.M.)
| | - Efe Mamuzo
- Action on Smoking and Health, Unit 2.9, The Foundry, 17 Oval Way, London SE11 5RR, UK; (J.W.); (E.M.)
| | - Lisa McDaid
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (L.M.); (J.E.); (F.N.)
| | - Joanne Emery
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (L.M.); (J.E.); (F.N.)
| | - Lucy Phillips
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (L.M.); (J.E.); (F.N.)
| | - Tim Coleman
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
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Sheffer CE, Al-Zalabani A, Aubrey A, Bader R, Beltrez C, Bennett S, Carl E, Cranos C, Darville A, Greyber J, Karam-Hage M, Hawari F, Hutcheson T, Hynes V, Kotsen C, Leone F, McConaha J, McCary H, Meade C, Messick C, Morgan SK, Morris CW, Payne T, Retzlaff J, Santis W, Short E, Shumaker T, Steinberg M, Wendling A. The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2416. [PMID: 33801227 PMCID: PMC7967787 DOI: 10.3390/ijerph18052416] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.
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Affiliation(s)
- Christine E. Sheffer
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abdulmohsen Al-Zalabani
- Tobacco Treatment Specialist Training and Certification Program at College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Andrée Aubrey
- Tobacco Treatment Specialist Course, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
| | - Rasha Bader
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Claribel Beltrez
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Susan Bennett
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Ellen Carl
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Caroline Cranos
- Tobacco Treatment Specialist Training Program, Center for Tobacco Treatment Research and Training, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Audrey Darville
- BREATHE Online Tobacco Treatment Specialist Training Program, College of Nursing, University of Kentucky, Lexington, KY 40504, USA;
| | - Jennifer Greyber
- Duke-UNC Tobacco Treatment Specialist Training Program, Duke Smoking Cessation Program, Duke Cancer Center, Durham, NC 27705, USA;
| | - Maher Karam-Hage
- Tobacco Treatment Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Feras Hawari
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Tresza Hutcheson
- Tobacco Treatment Specialist Training Program, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Victoria Hynes
- Tobacco Treatment Education & Training Program, MaineHealth Center for Tobacco Independence, Portland, ME 04101, USA;
| | - Chris Kotsen
- Tobacco Treatment Specialist Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA;
| | - Frank Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jamie McConaha
- Tobacco Treatment Specialist Training and Certificate Program, School of Pharmacy, Duquesne University, Pittsburg, PA 15282, USA;
| | - Heather McCary
- Tobacco Treatment Specialist Certification Program, The Breathing Association, Columbus, OH 43203, USA;
| | - Crystal Meade
- Tobacco Prevention and Control Program, Wellness and Prevention Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA;
| | | | - Susan K. Morgan
- Tobacco Treatment Training Program, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA;
| | - Cindy W. Morris
- Rocky Mountain Tobacco Treatment Specialist Training Program, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Thomas Payne
- ACT Center for Tobacco Treatment, Education and Research, University of Mississippi Medical Center Cancer Institute, Jackson, MS 39213, USA;
| | - Jessica Retzlaff
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Wendy Santis
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Etta Short
- Optum’s Quit for Life Program, Eden Prairie, MN 55344, USA;
| | - Therese Shumaker
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Michael Steinberg
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Ann Wendling
- Tobacco Cessation Program, Healthways, A Sharecare Company, Franklin, TN 37067, USA;
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Ramos-Morcillo AJ, Leal-Costa C, García-Moral AT, Del-Pino-Casado R, Ruzafa-Martínez M. Design and Validation of an Instrument to Evaluate the Learning Acquired by Nursing Students from a Brief Tobacco Intervention (BTI-St©). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203944. [PMID: 31623268 PMCID: PMC6843560 DOI: 10.3390/ijerph16203944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to design and validate an instrument, based on the WHO 5As+5Rs model, to test the acquisition by nursing students of a brief tobacco intervention (BTI) learning. A validation design of an instrument following the criterion referenced tests model using videos of simulated BTIs in the primary care setting was carried out. The study included 11 experts in smoking prevention/care and 260 second-year nursing students. The study was in two stages: (1) selection and recording of clinical simulations (settings), and (2) test construction. Content was validated by applying the Delphi consensus technique and calculating the Content Validity Ratio (CVR) and Content Validity Index (CVI). A pilot test was conducted for item analysis. Reliability was evaluated as internal consistency (Kuder-Richardson [KR-20]) and test-retest temporal stability (intraclass correlation coefficient [ICC]). Three simulation settings were recorded. An instrument (BTI-St®) was developed with 23 items for dichotomous (yes/no) response. CVR was >70% for all items, KR-20 of 0.81-0.88, and ICC between 0.68 and0.73 (p < 0.0001). The BTI-St® is a robust and reliable instrument that is easily and rapidly applied. It follows the WHO 5As+5Rs model and offers objective criterion-referenced evaluation of BTI learning in nursing students.
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Affiliation(s)
| | - César Leal-Costa
- Department of Nursing, Faculty of Nursing, University of Murcia, 30100 Espinardo, Spain.
| | - Ana Teresa García-Moral
- Jaén Nordeste Sanitary District, Regional Ministry of Health of the Andalusian Regional Government, Úbeda, 23400 Jaén, Spain.
| | - Rafael Del-Pino-Casado
- Department of Nursing, School of Health Sciences, University of Jaén, 23071 Jaén, Spain.
| | - María Ruzafa-Martínez
- Department of Nursing, Faculty of Nursing, University of Murcia, 30100 Espinardo, Spain.
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Herbec A, Brown J, Shahab L, West R, Raupach T. Pragmatic randomised trial of a smartphone app (NRT2Quit) to improve effectiveness of nicotine replacement therapy in a quit attempt by improving medication adherence: results of a prematurely terminated study. Trials 2019; 20:547. [PMID: 31477166 PMCID: PMC6720069 DOI: 10.1186/s13063-019-3645-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/09/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) bought over the counter (OTC) appears to be largely ineffective for smoking cessation, which may be partially explained by poor adherence. We developed and evaluated the NRT2Quit smartphone app (for iOS) designed to improve quit attempts with OTC NRT by improving adherence to the medications. METHODS This study was a pragmatic double-blind randomised controlled trial with remote recruitment through leaflets distributed to over 300 UK-based community pharmacies. The study recruited adult daily smokers (≥10 cigarettes per day) who bought NRT, wanted to quit smoking, downloaded NTR2Quit and completed the registration process within the app. Participants were automatically randomly assigned within the app to the intervention (full) version of NRT2Quit or to its control (minimal) versions. The primary outcome was biochemically verified 4-week abstinence assessed at 8-week follow-up using Russell Standard criteria and intention to treat. Bayes factors were calculated for the cessation outcome. Secondary outcomes were self-reported abstinence, NRT use, app use and satisfaction with the app. RESULTS The study under-recruited. Only 41 participants (3.5% of the target sample) were randomly assigned to NRT2Quit (n = 16) or the control (n = 25) app versions between March 2015 and September 2016. The follow-up rate was 51.2%. The intervention participants had numerically higher biochemically verified quit rates (25.0% versus 8.0%, P = 0.19, odds ratio = 3.83, 0.61-24.02). The calculated Bayes factor, 1.92, showed that the data were insensitive to test for the hypothesis that the intervention app version aided cessation. The intervention participants had higher median logins (2.5 versus 0, P = 0.01) and were more likely to use NRT at follow-up (100.0% versus 28.6%, P = 0.03) and recommend NRT2Quit to others (100.0% versus 28.6%, P = 0.01). CONCLUSIONS Despite very low recruitment, there was preliminary but inconclusive evidence that NRT2Quit may improve short-term abstinence and adherence among smokers using NRT. Well-powered studies on NRT2Quit are needed, but different recruitment methods will be required to engage smokers through community pharmacies or other channels. TRIAL REGISTRATION ISRCTN ISRCTN33423896 , prospectively registered on 22 March 2015.
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Affiliation(s)
- Aleksandra Herbec
- Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
- Centre for Behaviour Change, University College London, Room 353, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Jamie Brown
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Lion Shahab
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Robert West
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Tobias Raupach
- Centre for Behaviour Change, University College London, Room 353, 1-19 Torrington Place, London, WC1E 6BT UK
- National Centre for Smoking Cessation and Training, 1 Great Western Industrial Centre, Dorchester, DT1 1RD UK
- Clinic for Cardiology and Pneumology, University Medical Centre, Universitaetsmedizin Goettingen UBFT, Robert-Koch, Strasse 40, 37075 Goettingen, Germany
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