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Marciniak ET, LaRocco AM, Deepak J. Promoting Training and Education in Tobacco Dependence Treatment. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bostan P, Salepci B, Uysal MA. The effect of postgraduate training in smoking cessation care on the clinical practice of pulmonologists. Tob Induc Dis 2023; 21:35. [PMID: 36909815 PMCID: PMC9993234 DOI: 10.18332/tid/159795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/04/2023] [Accepted: 01/25/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Many studies have shown that training in smoking cessation care (SCC) is important for increasing the number and quality of delivered interventions by health professionals, and various training methods are available. The study aimed to identify the relationship between receiving training on SCC and the frequency of providing outpatient-based SCC among pulmonologists who were members of the Turkish Thoracic Society (TTS). METHODS For this cross-sectional study, a self-administered online questionnaire-based survey was conducted on a group of active pulmonologists who were members of the TTS, between April and October 2019. The survey included questions about demographics, smoking status, participation in SCC training, and providing outpatient-based SCC. RESULTS A total of 199 (53%) pulmonologists were actively taking part in outpatient-based SCC. Compared to those that were not providing outpatient-based SCC, median age, median time since graduation, and the number of non-academics, non-current smokers and recipients of smoking cessation care training were significantly higher in the group providing outpatient-based SCC (p<0.001, p<0.001, p=0.002, p=0.001, respectively). It was observed that having SCC training increased more than 6-fold the likelihood of providing outpatient-based SCC (AOR=6.45; 95% CI: 3.96-10.49; p<0.001). CONCLUSIONS The most crucial obstacle in providing smoking cessation is healthcare workers not providing smoking cessation to smokers. It is worthwhile to devote more tasks and resources to training physicians on smoking cessation care since this may increase their effective involvement in tobacco cessation.
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Affiliation(s)
- Pinar Bostan
- Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Banu Salepci
- Department of Chest Diseases, Yeditepe University Kozyatagi Hospital, Istanbul, Turkey
| | - Mehmet A Uysal
- Yedikule Chest Diseases and Thoracic Surgery Hospital, University of Health Sciences Turkey, Istanbul, Turkey
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Almeida R, Barbosa C, Pereira B, Diniz M, Baena A, Conde A. Tobacco Smoking during Pregnancy: Women's Perception about the Usefulness of Smoking Cessation Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6595. [PMID: 35682178 PMCID: PMC9180849 DOI: 10.3390/ijerph19116595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022]
Abstract
Tobacco consumption during pregnancy is a serious public health problem due to its negative effects on fetal development and on pregnant women's health and well-being. Thus, it is of utmost importance to plan and implement smoking cessation interventions, to prevent the negative impact of this risk factor, namely on children's health and development. This cross-sectional study aimed at exploring the perceptions and beliefs about the usefulness of smoking cessation interventions during pregnancy, in a sample of pregnant Portuguese women. The smoking use by pregnant women, as well as the risk factors associated with tobacco smoking during pregnancy, were also analyzed. The sample included 247 pregnant Portuguese women aged between 18-43-years-old (M = 30.30, SD = 5.02): 42.5% never smoked, 18.3% quit smoking before pregnancy, 19.0% quit smoking after getting pregnant and 20.2% were current smokers. The pregnant Portuguese women who smoked during pregnancy (current smokers or who quit smoking after getting pregnant) were mostly single or divorced, with lower education levels, showed a higher prevalence of clinically significant anxiety symptoms, and perceived smoking cessation interventions during pregnancy as less useful when compared to women who never smoked or quit smoking prior pregnancy. Daily or weekly smoking cessation interventions, implemented by health professionals such as doctors, nurses, or psychologists are the ones perceived as the most useful for pregnant women. These findings provide important clues for the planning of smoking cessation interventions during pregnancy, highlighting the domains that should be carefully monitored by health professionals. Specific strategies should also be used by health professionals to promote smoking cessation considering the demands of pregnancy and postpartum.
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Affiliation(s)
- Rita Almeida
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Carolina Barbosa
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Bruno Pereira
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Mateus Diniz
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Antoni Baena
- eHealth Center, Faculty of Health Sciences, Universitat Oberta de Catalunya, 08018 Barcelona, Spain;
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ana Conde
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
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Hyndman K, Thomas RE, Schira HR, Bradley J, Chachula K, Patterson SK, Compton SM. The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214158. [PMID: 31661922 PMCID: PMC6862178 DOI: 10.3390/ijerph16214158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 01/18/2023]
Abstract
The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers’ websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students’ counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I2 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I2 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I2 = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.
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Affiliation(s)
- Kathryn Hyndman
- Faculty of Health Studies, Brandon University, Brandon, Manitoba R7A 6A9, Canada.
| | - Roger E Thomas
- School of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada.
| | - H Rainer Schira
- John E. Robbins Library, Brandon University, Manitoba R7A 6A9, Canada.
| | - Jenifer Bradley
- Department of National Defence, Petawawa, Ontario K8H 2X3, Canada.
| | - Kathryn Chachula
- Faculty of Health Studies, Brandon University, Brandon, Manitoba R7A 6A9, Canada.
| | - Steven K Patterson
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
| | - Sharon M Compton
- Dental Hygiene Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
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Sreeramareddy CT, Ramakrishnareddy N, Rahman M, Mir IA. Prevalence of tobacco use and perceptions of student health professionals about cessation training: results from Global Health Professions Students Survey. BMJ Open 2018; 8:e017477. [PMID: 29804056 PMCID: PMC5988057 DOI: 10.1136/bmjopen-2017-017477] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Health professionals play an important role in providing advice to their patients about tobacco prevention and cessation. Health professionals who use tobacco may be deterred from providing cessation advice and counselling to their patients. We aimed to provide prevalence estimates of tobacco use among student health professionals and describe their attitudes towards tobacco cessation training. METHODS Country-wise aggregate data from the Global Health Professions Student Survey on 'current cigarette smoking' (smoking cigarettes on 1 or more days during the past 30 days), and 'current use of tobacco products other than cigarettes' (chewing tobacco, snuff, bidis, cigars or pipes, 1 or more days during the past 30 days) were analysed. For each WHO region, we estimated mean prevalence rates of tobacco use weighted by the population of the sampling frame and aggregate proportions for 'health professionals' role' and 'cessation training' indicators using 'metaprop' command on Stata V.11. RESULTS A total of 107 527 student health professionals participated in 236 surveys done in four health profession disciplines spanning 70 countries with response rates ranging from 40% to 100%. Overall, prevalence of smoking was highest in European countries (20% medical and 40% dental students) and the Americas (13% pharmacy to 23% dental students). Other tobacco use was higher in eastern Mediterranean (10%-23%) and European countries (7%-13%). In most WHO regions, ≥70% of the students agreed that health professionals are role models, and have a role in advising about smoking cessation to their patients and the public. Only ≤33% of all student health professionals in most WHO regions (except 80% dental students in the Eastern Mediterranean region) had received formal training on smoking cessation approaches and ≥80% of all students agreed that they should receive formal cessation training. CONCLUSIONS Tobacco control should take place together with medical educators to discourage tobacco use among student health professionals and implement an integrated smoking cessation training into health professions' curricula.
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Affiliation(s)
| | - N Ramakrishnareddy
- Department of Community Medicine, Bangalore Medical College and Research Institute, Fort, Bangalore, India
| | - Mahbubur Rahman
- Disease Control & Research (IEDCR), Institute of Epidemiology, Dhaka, Mohakali, Bangladesh
| | - Imtiyaz Ali Mir
- Physiotherapy, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, Selangor, Malaysia
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Ye L, Goldie C, Sharma T, John S, Bamford M, Smith PM, Selby P, Schultz ASH. Tobacco-Nicotine Education and Training for Health-Care Professional Students and Practitioners: A Systematic Review. Nicotine Tob Res 2018; 20:531-542. [PMID: 28371888 DOI: 10.1093/ntr/ntx072] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/28/2017] [Indexed: 11/12/2022]
Abstract
Introduction The objective of this systematic review was to investigate what education and training characteristics prepares and supports health-care professionals (HCPs) in the delivery of competent and effective care to clients who use tobacco-nicotine. Aims and Methods A search of eight bibliographic databases for English-language peer-reviewed publications from January 2006 to March 2015. Studies were included if they met the a priori inclusion criteria, which consisted of: (1) quantitative study design and (2) focus on tobacco-nicotine education or training for HCP students and practitioners. All studies were independently screened for inclusion by two reviewers. Data from included studies were extracted for study characteristics and key outcomes then critically appraised for methodological quality. Results Fifty-nine studies were included for narrative synthesis. Two categories emerged: (1) curriculum characteristics (n = 10) and (2) education and training interventions (n = 49). Included curriculum studies identified the following themes: content, intensity, competencies evaluation, and barriers. Study findings about education and training interventions were grouped by level of education (prelicensure, post-licensure, and faculty training), teaching modality, health discipline, and the associated HCP and client outcomes. Conclusions This comprehensive review suggests that there is a lack of consistency in HCP tobacco-nicotine education and training characteristics. This paper provides valuable categorization of the most frequently utilized components of academic curriculum and discusses the interventions in relation to HCP and client outcomes. Gaps in the literature are highlighted, and the need for standardization of tobacco-nicotine training competencies and evaluation is discussed. Future research investigating the most effective approaches to training is needed. Implications This systematic review summarizes existing tobacco-related curriculum components (content, intensity, competency evaluation, and barriers) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes (knowledge, attitudes, behaviors, and skills) and client outcomes (quit attempts and smoking abstinence).
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Affiliation(s)
- Lisa Ye
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Catherine Goldie
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, ON, Canada
| | - Tanvi Sharma
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Sheila John
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Megan Bamford
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Patricia M Smith
- Human Science Division, Northern Ontario School of Medicine, ON, Canada
| | - Peter Selby
- Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Asper Clinical Research Institute, Winnipeg, MB, Canada
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Influencing Readiness and Intentions to Offer Tobacco Dependence Treatment Through Training: King Hussein Cancer Center and Global Bridges Promoting an Underutilised Specialty in the Eastern Mediterranean Region. J Smok Cessat 2016. [DOI: 10.1017/jsc.2016.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Although tobacco dependence treatment (TDT) is key to tobacco control, there continues to be a shortage of services in the Eastern Mediterranean Region (EMR). Barriers to offering services include the lack of training and education.Aims: To create a network of healthcare providers (HCPs) capable of advancing TDT, King Hussein Cancer Center – the regional host for Global Bridges in the EMR – developed, implemented, and evaluated a regional TDT training programme.Methods: The programme employed a predisposing–enabling–reinforcing framework, and utilised a combination of learning techniques. The evidence-informed curriculum aimed to influence knowledge, confidence, and competence, and the evaluation mechanism was aligned with these aims.Results and discussion: Training produced a 37% and 23% gain in knowledge and TDT-specific competencies, respectively. The majority of participants reported that the workshops enhanced confidence, and 72% reported intentions for positive change. Participants rated the workshops highly, and anticipated value from joining Global Bridges network. Immediate outcomes indicate success in advancing participants’ self-efficacy and readiness to treat. Intentions for positive change may potentially be the first step in modifying practice.Conclusion: Capacity building in TDT could be the first step in meeting the need for trained HCPs through positively influencing knowledge, confidence, competence, and intentions.
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Polak R, Dacey ML, Keenan H, Phillips EM. Bridging the gap--planning Lifestyle Medicine fellowship curricula: A cross sectional study. BMC MEDICAL EDUCATION 2014; 14:1045. [PMID: 25551283 PMCID: PMC4318224 DOI: 10.1186/s12909-014-0271-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The emerging field, Lifestyle Medicine (LM), is the evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health. While competencies for LM education have been defined, and undergraduate curricula have been published, there are no published reports that address graduate level fellowship in LM. This paper describes the process of planning a LM fellowship curriculum at a major, academic teaching institution. METHODS In September 2012 Harvard Medical School Department of Physical Medicine and Rehabilitation approved a "Research Fellowship in Lifestyle Medicine". A Likert scale questionnaire was created and disseminated to forty LM stakeholders worldwide, which measured perceived relative importance of six domains and eight educational experiences to include in a one-year LM fellowship. Statistical procedures included analysis of variance and the Wilcoxon signed-rank test. RESULTS Thirty-five stakeholders (87.5%) completed the survey. All domains except smoking cessation were graded at 4 or 5 by at least 85% of the respondents. After excluding smoking cessation, nutrition, physical activity, behavioral change techniques, stress resiliency, and personal health behaviors were rated as equally important components of a LM fellowship curriculum (average M = 4.69, SD = 0.15, p = 0.12). All educational experiences, with the exception of completing certification programs, research experience and fund raising, were graded at 4 or 5 by at least 82% of the responders. The remaining educational experiences, i.e. clinical practice, teaching physicians and medical students, teaching other health care providers, developing lifestyle interventions and developing health promotion programs were ranked as equally important in a LM fellowship program (average M = 4.23, SD = 0.11, p = 0.07). CONCLUSIONS Lifestyle fellowship curricula components were defined based on LM stakeholders' input. These domains and educational experiences represent the range of competencies previously noted as important in the practice of LM. As the foundation of an inaugural physician fellowship, they inform the educational objectives and future evaluation of this fellowship.
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Affiliation(s)
- Rani Polak
- Institute of Lifestyle Medicine, Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, MA, USA.
| | - Marie L Dacey
- School of Arts & Sciences, MCPHS University, 179 Longwood Ave, Boston, MA, USA.
| | - Hillary Keenan
- Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, USA.
| | - Edward M Phillips
- Institute of Lifestyle Medicine, Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, MA, USA.
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Knowledge about health effects of cigarette smoking and quitting among Italian university students: the importance of teaching nicotine dependence and treatment in the medical curriculum. BIOMED RESEARCH INTERNATIONAL 2014; 2014:321657. [PMID: 24804212 PMCID: PMC3997155 DOI: 10.1155/2014/321657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/25/2014] [Indexed: 11/24/2022]
Abstract
Aims of the study were to compare medical students (MS) to non-MS with respect to their knowledge of smoking and to investigate the effect of a short educational intervention on MS knowledge. MS (n = 962) and students of architecture and law (n = 229) were asked to complete a 60-item questionnaire addressing knowledge of smoking epidemiology and health effects (“Score 1”), and effectiveness of cessation treatments (“Score 2”). Upon completion of questionnaire, fourth year MS received a lecture on tobacco dependence. These students were asked to complete the same questionnaire one and two years later. Mean values for Score 1 were 48.9 ± 11.5% in MS and 40.5 ± 11.4% in non-MS (P < 0.001; d = 0.69). Respective values for Score 2 were 48.1 ± 10.8% and 42.6 ± 10.6% (P < 0.001; d = 0.50). Fifth year students who had attended the lecture in year 4 scored higher than students who had not attended the lecture. Significant differences were noted one but not two years after the educational intervention. In conclusion, MS know slightly more about smoking-related diseases and methods to achieve cessation than nonmedical students; a short educational intervention was associated with better knowledge one year later, but the effect was moderate and short-lived.
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Peiffer G, Underner M, Perriot J, Paillot N, Renolleau F. Le sevrage tabagique. REVUE DES MALADIES RESPIRATOIRES ACTUALITÉS 2013. [DOI: 10.1016/s1877-1203(13)70495-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Carson KV, Usmani ZA, Robertson TA, Mysore S, Brinn MP. Smoking cessation interventions for lung cancer patients. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.12.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SUMMARY Worldwide, lung cancer contributes to over 1.4 million deaths per year. Smoking cessation is strongly recommended in clinical practice guidelines for lung cancer management, yet evidence suggests a translational gap between evidence and practice. There are significant health benefits following smoking cessation even after a short period of time. Long-term implications for lung cancer patients include improvements in quality of life, reductions in postoperative complications and reductions in 12-month mortality. Evidence suggests that combining pharmacotherapy, in particular varenicline tartrate (varenicline), with cognitive and behavioral interventions offers the best opportunity for successful long-term abstinence. This review summarizes the latest evidence for smoking cessation interventions in lung cancer patients, identifies gaps in current clinical practice and highlights priority areas for future research.
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Affiliation(s)
- Kristin V Carson
- The Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
| | - Zafar A Usmani
- Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Thomas A Robertson
- Therapeutics Research Centre, School of Pharmacy & Biomedical Sciences, University of South Australia & The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
| | - Satya Mysore
- Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Malcolm P Brinn
- The Clinical Practice Unit, The Basil Hetzel Institute for Translational Health Research, Adelaide, Australia
- Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
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Carson KV, Brinn MP, Labiszewski NA, Peters M, Chang AB, Veale A, Esterman AJ, Smith BJ. Interventions for tobacco use prevention in Indigenous youth. Cochrane Database Syst Rev 2012; 2012:CD009325. [PMID: 22895988 PMCID: PMC6486186 DOI: 10.1002/14651858.cd009325.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that in the non-Indigenous population. Addiction to nicotine usually begins during early adolescence and young people who reach the age of 18 as non-smokers are unlikely to become smokers thereafter. Indigenous youth in particular commence smoking at an early age, and a disproportionate burden of substance-related morbidity and mortality exists as a result. OBJECTIVES To evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. SEARCH METHODS The Cochrane Tobacco Addiction Group Specialised Register was searched in November 2011, with additional searches run in MEDLINE. Online clinical trial databases and publication references were also searched for potential studies. SELECTION CRITERIA We included randomized and non-randomized controlled trials aiming to prevent tobacco use initiation or progression from experimentation to regular tobacco use in Indigenous youth. Interventions could include school-based initiatives, mass media, multi-component community level interventions, family-based programmes or public policy. DATA COLLECTION AND ANALYSIS Data pertaining to methodology, participants, interventions and outcomes were extracted by one reviewer and checked by a second, whilst information on risk of bias was extracted independently by a combination of two reviewers. Studies were assessed by qualitative narrative synthesis, as insufficient data were available to conduct a meta-analysis. The review process was examined by an Indigenous (Aboriginal) Australian for applicability, acceptability and content. MAIN RESULTS Two studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi-component community-based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow-up in the one study assessing this outcome (skills-community group versus control: risk ratio [RR] 0.95, 95% CI 0.78 to 1.14; skills-only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills-community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills-only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow-up (change score -0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10). AUTHORS' CONCLUSIONS Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth. This review highlights the paucity of data and the need for more research in this area. Smoking prevalence in Indigenous youth is twice that of the non-Indigenous population, with tobacco experimentation commencing at an early age. As such, a significant health disparity exists where Indigenous populations, a minority, are over-represented in the burden of smoking-related morbidity and mortality. Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco-related health disparities in Indigenous and non-Indigenous populations.
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Affiliation(s)
- Kristin V Carson
- Clinical Practice Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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Richmond R, Zwar N, Taylor R, Hunnisett J, Hyslop F. Teaching about tobacco in medical schools: a worldwide study. Drug Alcohol Rev 2010; 28:484-97. [PMID: 19737207 DOI: 10.1111/j.1465-3362.2009.00105.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS As medical practitioners of the future, medical students should be taught about tobacco control strategies and smoking cessation interventions. By including education about tobacco in the medical curricula, they can be informed about the health effects of tobacco use and learn to assist smokers to quit. Our study aimed to estimate the extent of teaching about tobacco and smoking cessation techniques in medical schools worldwide and compare with results we reported 10 years ago, to determine the content of curricula and range of teaching formats and to identify barriers to teaching about tobacco in medical schools and solutions. DESIGN AND METHODS A cross-sectional survey of all existing medical schools (n = 2090) in 171 countries was conducted. A questionnaire was designed, translated and sent to all medical schools. Main outcome measures included whether and how tobacco is taught; comparisons with the survey conducted 10 years ago; tobacco content in the curriculum; format of teaching; and barriers to teaching and solutions. RESULTS 665 medical schools from 109 countries completed the full questionnaire, with a response rate of 31.8% from medical schools and 64% of countries and consisting of 39% of medical schools in developed and 28% in less developed countries. A further 67 medical schools responded to a single question on whether they taught about tobacco. The total response rate was 35%. Of 561 medical schools responding to questions on teaching options, 27% of medical schools taught a specific module on tobacco compared with only 11% in our survey of medical schools conducted a decade ago; 77% integrated teaching on tobacco with other topics compared with 40% 10 years ago; 31% taught about tobacco informally as the topic arose (vs. 58%) and 4% did not teach about tobacco (vs. 12%). Most common topics taught were: health effects of smoking (94%), health effects of passive smoking (84.5%), epidemiology of tobacco use (81%), nicotine dependence (78%) and taking a smoking history (75%). Most popular method of teaching was by lectures (78%), case study discussions and problem-based learning exercises (51%), class readings 46%, in the clinical setting with real patients (45%), special projects and assignments (45%) and patient-centred teaching approaches, such as role plays (31%). Significantly, more barriers to teaching were identified by less developed countries (>60%) including: lack of available teaching time in the medical program, limited organisational ability to include new subjects, lack of staff resources to teach, lack of current plans to introduce a tobacco curriculum, lack of a key person to champion and organise teaching, lack of financial resources and lack of incentives or advantages to teach. A majority described solutions to these problems. A case study of education on tobacco throughout the medical curriculum is presented. DISCUSSION AND CONCLUSIONS We found an encouraging increase in the extent of teaching on tobacco in medical schools over 10 years. We report that although progress has been made to address the teaching of tobacco in medical schools worldwide, there is a great deal more effort required so that education on tobacco is an ongoing part of medical curricula. The teaching content is generally based on evidence-based smoking cessation guidelines
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Affiliation(s)
- Robyn Richmond
- School of Public Health and Community Medicine, University of NSW, Kensington, Australia.
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Muramoto ML, Lando H. Faculty development in tobacco cessation: training health professionals and promoting tobacco control in developing countries. Drug Alcohol Rev 2010; 28:498-506. [PMID: 19737208 DOI: 10.1111/j.1465-3362.2009.00106.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ISSUES Cessation programs are essential components of comprehensive tobacco control. Health-care providers, especially physicians, have major responsibility for role modeling and promoting cessation. For successful, sustainable cessation training programs, countries need health-care professionals with knowledge and skills to deliver and teach tobacco cessation. APPROACH Review literature relevant to faculty development in tobacco cessation and discuss its strategic potential in tobacco control. KEY FINDINGS Faculty development is essential for sustainable tobacco cessation training programs, and a potentially powerful strategy to shift professional and societal norms towards cessation and support of comprehensive tobacco control in countries with normative tobacco use and underdeveloped tobacco control programs. IMPLICATIONS Medical faculty are in a key position to influence tobacco cessation and control programs because of their roles as educators and researchers, receptivity to innovation and, influence on competencies and standards for medical education and practice. Faculty development programs must consider the number and type of faculty, and tobacco cessation curricula needed. Faculty development fosters the ability to institutionalise cessation education for students and community practitioners. Academic faculty are often leaders in their professional disciplines, influential in establishing clinical practice standards, and technical experts for government and other key health organisations. CONCLUSION Training health-care professional faculty to become knowledgeable and committed to tobacco cessation opens opportunities to promote cessation and shift professional and societal norms away from tobacco use.
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Affiliation(s)
- Myra L Muramoto
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ 85719, USA.
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Williams DM. Preparing pharmacy students and pharmacists to provide tobacco cessation counselling. Drug Alcohol Rev 2010; 28:533-40. [PMID: 19737211 DOI: 10.1111/j.1465-3362.2009.00109.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ISSUES Tobacco use and abuse is a major health risk for people across the world and is responsible for nearly 500 000 deaths in the USA annually. Currently, the accepted role of pharmacists is the provision of pharmaceutical care, which includes health promotion and prevention of disease. Pharmacists should work collaboratively with other health-care professionals to provide tobacco-cessation counselling to smokers. APPROACH Recently, in the USA, a curriculum has been developed by faculty at a school of pharmacy and distributed to pharmacy schools across the nation in a train-the-trainer format. This curriculum has been implemented in varying degrees in schools across the USA. In addition, there are national efforts to increase the involvement of practising pharmacists in promoting tobacco cessation by offering comprehensive programs or by increasing awareness and referrals. KEY FINDINGS The acceptance of the Rx for Change programs by schools of pharmacy has been high and the education and skills are being taught to most current pharmacy graduates. There is an increased emphasis on the role of pharmacists to assist in meeting national health goals including reducing tobacco-related risks. IMPLICATIONS Numerous opportunities exist for pharmacists to provide tobacco cessation counselling. Barriers to implementation of programs include lack of confidence by pharmacists and a perceived lack of demand by patients. CONCLUSION The consequences of tobacco use are well known. Pharmacists should enhance their involvement in health promotion and disease prevention and actively develop tobacco cessation counselling programs using available resources for the benefit of their patients.
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Affiliation(s)
- Dennis M Williams
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC 27599, USA.
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BOTELHO RICK, WASSUM KEN, BENZIAN HABIB, SELBY PETER, CHAN SOPHIA. Address the gaps in tobacco cessation training and services: Developing professional organisational alliances to create social movements. Drug Alcohol Rev 2009; 28:558-66. [DOI: 10.1111/j.1465-3362.2009.00112.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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ROCHE ANNM, PIDD KEN, FREEMAN TOBY. Achieving professional practice change: From training to workforce development. Drug Alcohol Rev 2009; 28:550-7. [DOI: 10.1111/j.1465-3362.2009.00111.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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ANDERSON PETER. Overview of interventions to enhance primary-care provider management of patients with substance-use disorders. Drug Alcohol Rev 2009; 28:567-74. [DOI: 10.1111/j.1465-3362.2009.00113.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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KRALIKOVA EVA, BONEVSKI BILLIE, STEPANKOVA LENKA, POHLOVA LUDMILA, MLADKOVA NIKOL. Postgraduate medical education on tobacco and smoking cessation in Europe. Drug Alcohol Rev 2009; 28:474-83. [DOI: 10.1111/j.1465-3362.2009.00104.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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GORDON JUDITHS, ALBERT DAVIDA, CREWS KARENM, FRIED JACQUELYN. Tobacco education in dentistry and dental hygiene. Drug Alcohol Rev 2009; 28:517-32. [DOI: 10.1111/j.1465-3362.2009.00108.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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