The role of academic pharmacy in tobacco cessation and control

Tobacco Education in Doctor of Pharmacy Programs in the United States (2021-2022)

OBJECTIVE

To characterize (1) tobacco cessation content, delivery, and assessment methods, (2) faculty perceptions of content adequacy, and (3) faculty interest in enhancing curricular content as a result of pharmacists' new, expanding role in prescribing tobacco cessation medications.

METHODS

One faculty member responsible for teaching tobacco cessation-related content at each college and school of pharmacy was invited to participate in a national, web-based survey. Survey items assessed various aspects of tobacco education and gauged faculty interest in attending a train-the-trainer program and integrating Tobacco Treatment Specialist training as part of the curriculum at their institution.

RESULTS

Of 132 survey respondents (93.0% response), 98.5% reported integrating tobacco cessation into the required curriculum, and 15.2% integrated the content into an elective course. The median number of formal educational hours was 5.0 (range, 1.0-18.0). One-third (33.3%) assessed students' tobacco cessation competency using objective structured clinical examinations. Most (83.8%) felt that their institution has adequate faculty expertise to teach comprehensive tobacco cessation, and 98.5% were interested in attending a train-the-trainer program for pharmacy faculty to learn to educate students on the latest developments of pharmacist-provided tobacco cessation. Similarly, 95.4% were interested in incorporating Tobacco Treatment Specialist training into their Doctor of Pharmacy curriculum.

CONCLUSION

Given the expanding scope of pharmacists' practice for prescribing tobacco cessation medications, there is a need to enhance curricular content in Doctor of Pharmacy programs. Current faculty expressed interest in expanding coursework to enable their graduates to work at the top of their license when treating tobacco use and dependence.

Opioid Use Disorder Curricular Content in US-Based Doctor of Pharmacy Programs

OBJECTIVES

To characterize the instructional settings, delivery methods, and assessment methods of opioid use disorder (OUD) content in Doctor of Pharmacy (PharmD) programs; assess faculty perceptions of OUD content; and assess faculty perceptions of a shared OUD curriculum.

METHODS

This national, cross-sectional, descriptive survey study was designed to characterize OUD content, faculty perceptions, and faculty and institutional demographics. A contact list was developed for accredited, US-based PharmD programs with publicly-accessible online faculty directories (n = 137). Recruitment and telephone survey administration occurred between August and December 2021. Descriptive statistics were computed for all items. Open-ended items were reviewed to identify common themes.

RESULTS

A faculty member from 67 (48.9%) of 137 institutions contacted completed the survey. All programs incorporated OUD content into required coursework. Didactic lectures were the most common delivery method (98.5%). Programs delivered a median of 7.0 h (range, 1.5-33.0) of OUD content in required coursework, with 85.1% achieving the 4-hour minimum for substance use disorder-related content recommended by the American Association of Colleges of Pharmacy. Just over half (56.8%) of faculty agreed or strongly agreed that their students were adequately prepared to provide opioid interventions; however, 50.0% or fewer perceived topics such as prescription interventions, screening and assessment interventions, resource referral interventions, and stigma to be covered adequately. Almost all (97.0%) indicated moderate, high, or extremely high interest in a shared OUD curriculum.

CONCLUSION

Enhanced OUD education is needed in PharmD programs. A shared OUD curriculum was of interest to faculty and should be explored as a potentially viable solution for addressing this need.

Community pharmacy technicians' engagement in the delivery of brief tobacco cessation interventions: Results of a randomized trial

BACKGROUND

In recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described.

OBJECTIVE

To compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation.

METHODS

Twenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training.

RESULTS

Over the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p < 0.001). The number of individual technicians who reported at least one intervention was 16 (of 26; 61.5%) in the minimal group and 24 (of 24; 100%) in the intensive group (p < 0.001). At the conclusion of the study, 100% of technicians in the intensive group self-rated their ability to interact with patients about quitting smoking as good, very good, or excellent compared to 73.9% in the minimal group (p = 0.10).

CONCLUSION

In both study arms, technicians documented high numbers of tobacco cessation interventions. The higher proportion of technicians providing one or more interventions in the intensive group suggests a greater overall engagement in the process, relative to those receiving minimal training. Technicians can play a key role in the delivery of tobacco cessation interventions in community pharmacies.

Implementing Brief Tobacco Cessation Interventions in Community Pharmacies: An Application of Rogers’ Diffusion of Innovations Theory

Pharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists’ perceptions of factors associated with the implementation of “Ask-Advise-Refer”, a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers’ Diffusion of Innovations Theory, assessed pharmacists’ perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.

Knowledge, attitude, practice and perceived barriers towards smoking cessation services among community pharmacists

Introduction

With more than one billion current smokers, 80% of them living in low and middle-income countries, tobacco smoking is considered a global public health problem. Jordan has one of the highest estimate rates of tobacco use in the region and world. Still, tobacco use interventions, that could significantly reduce the number of smoking-related diseases and reduce health care costs, are scarce. While such interventions could be carried out by community pharmacists, given their unique position to counsel patients and provide effective cessation interventions, the role of community pharmacists in tobacco control services in Jordan has never been fully investigated.

Objective

This study aimed at assessing the community pharmacists' knowledge, attitudes, and practice towards smoking cessation and identifying their perceived barriers for smoking cessation counselling utilizing a sample of community pharmacists in Northern Jordan.

Method

A cross-sectional study was conducted among community pharmacies in Irbid city, North of Jordan, between April and August 2018. A random sample of 95 pharmacies was selected using the multistage random sampling technique. A structured English questionnaire, consisting of 5 parts, was used. The Survey assessed pharmacists' socio-demographics, knowledge, attitude, practice and perceived barriers related to tobacco use cessation services.

Results

One hundred and fifty pharmacists completed the survey. Their mean age was 30.71±10.10 years. The mean of pharmacists' knowledge score was 3.74±0.38, while their positive and negative attitude were 3.87±0.43 and 3.18±0.66 respectively. Pharmacists' mean smoking cessation practice was 2.01+0.64. Barriers to providing cessation interventions included the lack of training on nicotine replacement therapy products (86%), the lack of smoking cessation programs (84%) and low demands from smokers (83.3%).

Conclusion

While knowledge related to tobacco use cessation services among the community pharmacists was sub-optimal, a good positive attitude and a low practice levels were observed. The lack of educational materials, low patients' demand, knowledge deficits, low training and the lack of cessation programs have been identified as barriers hindering the provision of smoking cessation services. Furthermore, the study identified factors that will increase community pharmacists' participation in smoking cessation, help in raising pharmacists' awareness of smoking as a public health problem and the importance of their role.

Smoking Cessation at the Community Pharmacy: Determinants of Success from a Real-Life Practice

The objectives of this study are to report the contribution of pharmacists to smoking cessation and study the determinants of smoking cessation success in eight pharmacies in Portugal (south) between 2009 and 2019. A real-life study was conducted with a sample of smokers who participated in pharmacist consultations. The sample included 135 smokers (average age of 47.9 ± 1.21 years), 79 (58.5%) of whom were male. In parallel with the motivation and behavioral approach, 116 (85.9%) smokers received pharmacological therapies: 108 (80.0%) were treated with nicotine replacement products and eight (5.9%) with non-nicotine medications. The interventions resulted in 70 (51.9%) smokers complying with the quit day, of whom 59 (43.7%) were smoking-abstinent at the end of the first month. Success rates were reduced to 32.6%, 28.1%, and 20.7% at the end of the 3rd, 6th, and 12th months, respectively. Smoking cessation was more successful for the participants receiving pharmacological therapies (Fisher’s exact test, p < 0.001) and those who participated in more pharmacist consultations (χ² = 59.994, p < 0.001) and more telephone sessions (χ² = 17.845, p < 0.001). Pharmacists can contribute significantly to the promotion of smoking cessation. Smokers who are more thoroughly followed up by pharmacists showed increased success rates when compared with smokers having fewer sessions with pharmacists.

Evaluation of an Interprofessional Tobacco Cessation Train-the-Trainer Program for Respiratory Therapy Faculty

BACKGROUND

Although tobacco use is the leading cause of numerous preventable diseases, including respiratory illnesses, respiratory therapy students historically have received inadequate education for treating tobacco use and dependence. To address this gap, a respiratory-specific tobacco cessation training program was created and disseminated via a train-the-trainer approach for faculty in respiratory therapy and respiratory care programs across the United States. The purpose of this study was to estimate the impact of the live, web-based, train-the-trainer programs on participating faculty, and to assess changes in the extent of adoption of tobacco cessation content in respiratory therapy curricula across institutions in the United States.

METHODS

Five live, 2.5-h web-based train-the-trainer programs for respiratory therapy faculty were conducted. To characterize impact of this national initiative, surveys were administered at baseline, immediately after training, and then at the end of the subsequent academic year.

RESULTS

A total of 270 respiratory therapy faculty members participated in a live webinar training, representing 248 of the 402 (61.7%) respiratory therapy schools in the United States. At the end of the subsequent academic year, faculty reported significant improvement in their overall ability to teach tobacco cessation (P < .001). Nearly all (97.4%) agreed that the webinar train-the-trainer format was conducive to learning, and high self-ratings were reported for skills to teach the tobacco cessation content. During the 2016-2017 academic year, 1,248 respiratory therapy students received training. Faculty anticipated teaching a median of 3 h of tobacco cessation in the subsequent academic year.

CONCLUSIONS

Training respiratory therapy faculty using a train-the-trainer approach had a positive impact on faculty's perceived confidence and ability to teach tobacco cessation at their institutions.

Long-term evaluation of a train-the-trainer workshop for pharmacy faculty using the RE-AIM framework

BACKGROUND

Although two thirds of tobacco users express interest in quitting, few pharmacists address tobacco use as part of routine practice. Historically, pharmacy schools provided inadequate tobacco cessation training for students. To address this educational gap, train-the-trainer workshops were conducted between 2003 and 2005 to train pharmacy faculty (n = 191) to teach a shared, national tobacco cessation curriculum at their academic institutions.

OBJECTIVE

To characterize faculty perceptions of the train-the-trainer workshops and estimate the long-term reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of the shared curriculum at pharmacy schools.

METHODS

This study is the second phase of a sequential mixed methods study. Results from Phase 1, a qualitative study, informed the development of survey items for Phase 2. Applying the RE-AIM framework, a web-based survey was developed and administered to train-the-trainer participants.

RESULTS

Of 191 trainees, 137 were locatable; of these, 111 completed a survey (81.0%). Most (n = 87; 78.4%) reported current employment in academia. The most highly rated reason for attending a workshop was to improve teaching of tobacco cessation content, and 98.1% reported moderate or high confidence for teaching tobacco cessation. Among those who practice in a clinical setting, 70.6% reported asking their patients about tobacco use all or almost all the time. Just over three fourths of faculty respondents who work in academia believe that shared curricula should be more broadly considered for use in pharmacy schools, and 79.0% agreed that shared curricula are a cost-effective approach to teaching.

CONCLUSION

Evidence is provided for long-term reach, effectiveness, adoption, implementation, and maintenance of the Rx for Change shared tobacco cessation training program. Participants perceived that the workshop resulted in long-term, positive effects on their careers as well as their teaching and clinical practice.

Attitudes and Perceptions of Tobacco-Related Products in College Students

BACKGROUND

Despite the highly publicized health consequences, some college students do not perceive tobacco consumption as harmful. Historically-Black College and Universities (HBCUs) have the lowest rates of tobacco-free policies compared to other colleges, universities, and minority-serving institutions, making their students at higher risk for tobacco abuse. A campus Alcohol, Tobacco, and Other Drug Prevention Committee (ATDP) was formed and led by a pharmacist to develop all tobacco cessation policies at the HBCU.

OBJECTIVES

(1) To determine the knowledge and attitudes of cigarettes, cigars, smokeless tobacco, electronic cigarettes, and hookah among college students in a rural area with high tobacco usage; (2) To assess perceptions on the effectiveness of smoking cessation resources on the college campus led by the ATDP committee.

METHODS

A cross-sectional study was conducted on 99 students between 18 - 26 years attending a HBCU in Maryland. The online survey was disseminated to assess student's health behaviors and attitudes towards tobacco products and their successfulness in abstinence using campus resources with the Health Belief Model.

RESULTS

Participants had more perceived harms with smoking tobacco (cigarettes and cigars) and smokeless tobacco, and greater perceived benefits with using electronic cigarettes and hookah (P < 0.001). Most students had limited knowledge of the four tobacco categories (5.8 ± 2.6 on a 10-point Likert scale). Self-efficacy to quit was 4.2 ± 1.7 on a 10-point Likert scale despite the current resources at the HBCU.

CONCLUSION

Students had a perceived benefits sequential rank order with hookah, e-cigarettes, smokeless tobacco, followed by smoking tobacco. Campuses should investigate barriers for abstinence, raise awareness about the dangers of tobacco, and create programs that enhance self-efficacy when quitting.

INNOVATION AND PRACTICE IMPLICATION

This is the first study of its kind that compares all major tobacco products head-to-head in a rural and underrepresented population. Additionally, the development of a campus-wide tobacco policy was novel as it was pharmacist-led. The results show this population has limited knowledge of tobacco products with more perceived benefits among newer nicotine delivery systems. Targeted education and public health programs should be implemented to prevent this susceptible group from initiating and continuing tobacco products.

Pharmacy: Addressing substance use in the 21st century

Across all care environments, pharmacists play an essential role in the care of people who use and misuse psychoactive substances, including those diagnosed with substance use disorders. To optimize, sustain, and expand these independent and collaborative roles, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) has developed core competencies for pharmacists to address substance use in the 21st century. Key concepts, skills, and attitudes are outlined, with links to entrustable professional activities to assist with integration into a variety of ideally interdisciplinary curricular activities.

Tobacco cessation training in 6-year pharmacy schools in Japan: a cross-sectional survey

OBJECTIVES

This study aimed to identify the extent of tobacco cessation training content, including the introduction of a comprehensive programme; and the presence of tobacco-related topics, including new tobacco products, school years and course of training, educators, and attitudes and policies relevant to tobacco education in pharmacy schools in Japan.

DESIGN

A cross-sectional survey.

SETTING

All pharmacy schools in Japan with a 6-year course of training were invited to participate.

METHODS

Pharmacy schools in Japan that agreed to participate in a web-based survey asking about tobacco cessation training, and attitudes and policies relevant to tobacco education.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the number of pharmacy schools that introduced comprehensive tobacco cessation training in their curriculum. The secondary outcome was to clarify the curriculum coverage of 9 basic knowledge and 10 tobacco cessation-specific topics, including new tobacco products.

RESULTS

Of the 75 pharmacy schools with a 6-year course in Japan, 52 (74%) responded to the survey. While 27 (52%) schools reported that comprehensive tobacco cessation training would be beneficial, only 1 school had introduced it as a one-credit elective course in the fifth year. Basic knowledge topics for tobacco cessation listed in or related to the Model Core Curriculum were covered by 44%-65% of the schools, while practical skills were covered in 10%-19% of the schools. Only seven schools (14%) introduced the topic of new tobacco products in their curriculum.

CONCLUSIONS

This study revealed that comprehensive tobacco cessation training is not generally offered in pharmacy schools in Japan. The Model Core Curriculum should revise its standards to implement updated tobacco cessation training programmes to keep up with new tobacco products and to train pharmacy students on counselling users of such products.

TRIAL REGISTRATION NUMBER

Tokyo University of Pharmacy and Life Sciences No. 17 - 14.

Faculty perceptions of a tobacco cessation train-the-trainer workshop and experiences with implementation: A qualitative follow-up study

BACKGROUND

Between 2003 and 2005, pharmacy faculty members (n = 191) participated in a national train-the-trainer workshop designed to equip faculty with the necessary knowledge and skills to implement a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, at pharmacy schools across the United States.

OBJECTIVE

To conduct a long-term, qualitative follow-up study of faculty participants to describe (a) perceptions of the train-the-trainer workshop, and (b) subsequent experiences with curricular implementation. Results of this investigation will inform a national survey of all train-the-trainer participants.

METHODS

Participants were selected via random sampling from the group of 191 faculty members who participated in the workshop. Semi-structured telephone interviews with participants were audio-recorded and transcribed, and qualitative thematic analysis was conducted.

RESULTS

Eighteen (62%) of 29 invited individuals participated in the interviews. All participants reported implementing components of Rx for Change at their institution. The analysis yielded eight major themes pertaining to faculty perceptions and experiences with implementation: (1) accessibility to tools for teaching, (2) increased confidence and skills, (3) flexibility delivering the curriculum, (4) factors facilitating implementation and challenges encountered by faculty, (5) enhancement in treating tobacco users in clinical practice, (6) students' confidence and cognizance of the pharmacists' role as a public health advocate, (7) networking and career development opportunities, and (8) useful background for research.

CONCLUSION

Participation in the train-the-trainer workshop increased self-reported confidence for teaching tobacco cessation, and faculty valued access to useful, updated tools for teaching. Furthermore, their newly acquired counseling skills were deemed helpful for treating patients' tobacco use and dependence in clinical practice. Participants also perceived improved pharmacy students' confidence and beneficial networking opportunities. Results can help future trainers understand faculty experiences with implementing a shared, national curriculum and inform faculty participants of some of the potential long-term outcomes as a result of participation.

Impact of a Shared Tobacco Cessation Curriculum in California Schools of Pharmacy

Purpose: To characterize the long-term impact of a shared, evidence-based tobacco cessation curriculum (Rx for Change) on tobacco-related education in California schools of pharmacy (n=8). Methods: Faculty members responsible for teaching tobacco-related content completed a survey assessing implementation of tobacco education, curricular time devoted to tobacco, and teaching and assessment methods utilized. Using historical data, the total number of students trained since 2000 was estimated. Results: All schools utilized the shared curriculum, and in 2012–2013, a median of 435 minutes (range: 240–600 minutes) was devoted to tobacco-related content within required curricula. Between 2000 and 2013, an estimated 10,616 pharmacy students in California received Rx for Change training. Conclusion: After more than a decade, a shared tobacco cessation curriculum continues to be widely utilized and provides a strong foundation for legislative efforts to enhance pharmacists' scope of practice related to prescriptive authority for tobacco cessation.

Comparison of pharmacy students' self-efficacy to address cessation counseling needs for traditional and electronic cigarette use

BACKGROUND AND PURPOSE

This study assessed pharmacy students' self-rated ability to provide cessation counseling for e-cigarette use and traditional cigarette smoking.

EDUCATIONAL ACTIVITY AND SETTING

A cross-sectional study was conducted in spring 2014 at The University of Texas at Austin. Participants included first through fourth year (P1-P4) doctor of pharmacy (PharmD) students. Perceived confidence and knowledge to counsel on cigarette smoking cessation and e-cigarette cessation were self-rated and based on the Ask-Advise-Assess-Assist-and Arrange (5 A's) follow-up model as well as general counseling skills for recreational nicotine product use cessation. Comparisons were made between students' confidence to counsel patients on traditional cigarette smoking cessation and e-cigarette cessation and by class level.

FINDINGS

Compared to cigarette smoking cessation counseling, students were less confident in their ability to counsel on e-cigarette cessation using the 5 A's model and general counseling skills. Students perceived themselves to be less knowledgeable about the harmful effects of e-cigarettes, pharmacists' role in counseling on e-cigarette cessation, and how patients can benefit from e-cigarette cessation counseling. A higher proportion of students reported having no training on e-cigarette cessation compared to cigarette smoking cessation (59% vs 9%).

SUMMARY

Targeted training on how to counsel patients on e-cigarette cessation should be included in pharmacy curricula. Such training is expected to increase the confidence of pharmacists-in-training to address the needs of patients who use e-cigarettes.

Linking pharmacists to the delivery of public health services

OBJECTIVE

To describe components fundamental to the process of linking pharmacy to the delivery of public health services in a sustainable way.

SUMMARY

Pharmacists deliver public health services with varying frequency. A literature review was conducted to create a set of fundamental links necessary for pharmacists to deliver public health services in a sustainable way. The service needed to be in alignment with public health priorities, be incorporated in the pharmacy curriculum, have postgraduate training opportunities, have a policy or legal platform supporting the service, and have a business model for financial sustainability. Immunization delivery was identified as an exemplary public health service delivered by pharmacists. Additional services evaluated were tobacco cessation counseling, transitions of care, hypertension screening, and substance abuse counseling.

CONCLUSION

Pharmacists are well positioned to provide public health services. Although pharmacists can offer these services, their delivery is variable because of unclearly defined links in the process necessary for their implementation. This article identifies actionable steps to establish sustainable methods for community pharmacists to deliver public health services.

Delivering Tobacco Cessation Content in the Middle East Through Interprofessional Learning

Objective. To explore the attitudes of pharmacy, pharmacy technician, medical, and public health students before and after an IPE activity that focused on smoking cessation in the Middle East. Methods. A pre-post intervention research design using the Readiness for Interprofessional Learning Scale (RIPLS) was used for this study. The tool contained 20 items, categorized under the following subscales: teamwork and collaboration, professional identity, and patient-centeredness. Results. A total of 47 out of 50 students from four different health disciplines in Qatar (medicine, pharmacy, pharmacy technician, and public health) who participated in the activity completed a pre- and post-intervention pre-validated questionnaire (94% response rate). Total attitude scores were calculated for all the 20 items along with attitudinal scores of the three domains. Most of the students reported having a positive attitude toward IPE; the number of students having a positive attitude toward IPE increased after the IPE session. The overall median (IQR) score increased from 82 (16) before the session to 84 (15) after the session. Students from different disciplines did not vary in their attitude scores. Conclusion. Health care professional students in Qatar perceived IPE positively, believing that it enhanced their communication skills, collaboration and appreciation of professional roles. This study has implication on developing effective methods to implement IPE in various health professional education curricula.

Global sale of tobacco products and electronic nicotine delivery systems in community pharmacies

OBJECTIVE

To estimate the proportion of countries/territories that allow sales of tobacco products and electronic nicotine delivery systems (ENDS) in community pharmacies.

METHODS

International Pharmaceutical Federation (FIP) member organisations were contacted by email and asked to respond to a two-item survey assessing whether their country/territory allowed sales of (a) tobacco products and (b) ENDS in community pharmacies.

RESULTS

Of 95 countries/territories contacted, responses were received from 60 (63.2%). Seven countries (11.7%) reported that tobacco products were sold in community pharmacies, and 11 countries (18.3%) reported that ENDS were sold in community pharmacies.

CONCLUSIONS

Among the FIP member organisations, there are few countries that allow the sale of tobacco products and ENDS in community pharmacies, with ENDS being more likely than tobacco products to be sold.

Comparison of pharmacy students' knowledge and self-efficacy to provide cessation counseling for hookah and cigarette use

OBJECTIVES

We aimed to assess pharmacy students' self-efficacy to provide cessation counseling for commercial cigarette and hookah tobacco use.

METHODS

A cross-sectional study including PharmD students at a College of Pharmacy was conducted in Spring 2014. Confidence in counseling and perception of knowledge were self-rated and based on the Ask-Advise-Assess-Assist-Arrange follow-up (5A's) model and general tobacco cessation counseling skills. Comparisons were made between cigarettes and hookahs and by program level using t-tests, Wilcoxon signed-rank test, analyses of variance, and Tukey-Kramer tests.

RESULTS

Overall, 82% and 16% of the students, respectively, reported receiving training on cigarette smoking and hookah tobacco use cessation. Students were moderately confident in their ability to counsel. Compared to hookah tobacco use cessation counseling, students were more confident in their general counseling skills and ability to counsel on cigarette smoking cessation using the 5A's (p < 0.001 in each case). Students perceived themselves to be more knowledgeable about cigarette smoking cessation than about hookah tobacco use cessation. Almost half of the students (42.0%) thought hookah tobacco was less harmful than traditional cigarettes.

CONCLUSIONS

Pharmacy students need further training to address hookah and other alternative tobacco products to support patients' cessation needs, decrease risks for tobacco-related morbidity and mortality, and increase medication effectiveness.

The impact of tobacco-free pharmacy policies on smoking prevalence

OBJECTIVES

California and Massachusetts are the only 2 states in the United States with municipalities that have local laws prohibiting the sale of tobacco products by pharmacies. The impacts of the tobacco-free pharmacy laws remain understudied. This study aims to fill this gap by examining the association between tobacco-free pharmacy laws and smoking prevalence among adults over time in California and Massachusetts.

DESIGN

This study used a series of cross-sectional surveys. The data source for this study was the Behavioral Risk Factor Surveillance Survey for each year from 2005 to 2013.

SETTING

The longitudinal changes in smoking prevalence at the city or county level were estimated and comparisons were made between cities or counties with tobacco-free pharmacy laws and those without the laws.

PARTICIPANTS

The participants used to estimate smoking prevalence were representative of adults within California and Massachusetts.

INTERVENTION

The implementation of tobacco-free pharmacy laws was considered to be the intervention in this study.

MAIN OUTCOME MEASURES

The outcome measures were smoking prevalence among adults. Mixed-effects negative binomial models were performed primarily to examine longitudinal changes in outcome measures.

RESULTS

The prevalence of smoking decreased in both states over time. In Massachusetts, there was a statistically significant decrease in smoking prevalence among cities with tobacco-free pharmacy laws compared with those without such laws. Despite the presence of an 8.6% decrease in prevalence after the implementation of tobacco-free pharmacy laws, this reduction was not statistically significant after controlling for the negative trend in smoking rates overall and other factors.

CONCLUSION

This study evaluated tobacco-free pharmacy laws with regard to the real-world impacts. Our findings highlight the need for future research on the effects of tobacco-free pharmacy laws with a prolonged time span and a comprehensive understanding of the law's implementation and enforcement.

Trends in Smoking Status and Utilization of Smoking Cessation Agents Among Females with Cardiovascular Diseases

BACKGROUND

In the United States, cigarette smoking accounts for almost 20% of all deaths attributed to heart disease. More women than men die each year of cardiovascular diseases (CVDs). Women who smoke have shown to be at a higher risk of cardiac deaths. The current study aims to determine the trend in smoking prevalence among women with CVD and their utilization of smoking cessation agents from 2004 to 2011.

MATERIALS AND METHODS

This was a retrospective exploratory study using Medical Expenditure Panel Survey data from 2004 to 2011. All female respondents with any one cardiovascular condition were identified. Descriptive statistics were carried out to obtain the number of female patients with CVD, their smoking status, and their use of smoking cessation agents. Furthermore, disparities in smoking status and smoking cessation agent utilization with respect to race and ethnicity were studied.

RESULTS

Among total CVD patients, 53% were females, which corresponded to 25.3 million females in the United States. Around 12.3% among them were current smokers. Only 6.9% among these females used smoking cessation agents. Smoking trends in females were inconsistent throughout the 8 years. Overall, the trend showed a decrease in the percentage of female smokers, while use of smoking cessation agents remained low from 2004 to 2011. Whites and non-Hispanics had more current smokers and women using smoking cessation agents.

CONCLUSION

The eight-year trend shows that the use of smoking cessation agents among females is very low, particularly among non-whites and Hispanics. This is of great concern and future efforts could focus on increasing the utilization of smoking cessation agents and collectively decreasing the risk of smoking in CVD by healthcare professionals.

Attitudes of experiential education directors regarding tobacco sales in pharmacies in the USA

OBJECTIVES

Accreditation guidelines in the USA suggest that experiential sites for pharmacy students should demonstrate 'a strong commitment to health promotion and illness prevention'; however, most community pharmacies sell tobacco products. This study aimed to determine the proportion of students rotating through advanced pharmacy practice experience (APPE) sites where tobacco is sold and experiential education directors' perception regarding the sales of tobacco in APPE sites.

METHODS

A brief survey was distributed by mail to experiential education directors at US pharmacy schools. The survey characterized the proportion of students who rotate at practice sites where tobacco is sold, directors' perceptions of tobacco sales in experiential sites, and the number of hours of tobacco education in their pharmacy curricula.

KEY FINDINGS

Directors (n = 81; 63%) estimated that 69% of students rotate through sites where tobacco is sold. If given the opportunity to choose between two potential sites, where one sells tobacco and the other does not, 40% of directors would be unlikely to choose a site that sold tobacco.

CONCLUSIONS

With respect to tobacco sales, pharmacy schools are largely noncompliant with guidelines and resolutions of professional organizations.

Pharmacy and public health: a pathway forward

OBJECTIVE To identify a pathway forward for practicing pharmacists in supporting public health initiatives by applying the five core competencies of public health. SUMMARY The pharmacist is well positioned to improve population health. Until now, increased impact of pharmacists has been based on the expansion of patient services rather than guided by a population approach to health. To increase their effectiveness and breadth of impact, pharmacists would benefit from applying the five core competencies of public health (social and behavioral science, health policy and administration, epidemiology, biostatistics, and environmental health sciences) to the practice of pharmacy. This article aims to explain how each of the core competencies applies to pharmacy practice and how pharmacists might apply public health skills in a more specific manner. CONCLUSION With increased clarity of the role of public health, and mastery of the five core competencies of public health, pharmacists can make unique and valuable contributions to the health of the public.

Tobacco education in U.S. respiratory care programs

INTRODUCTION

Exposure to tobacco smoke impacts the onset or exacerbation of most respiratory disorders, and respiratory therapists are well positioned to identify tobacco use and provide cessation assistance. The purpose of this study was to characterize the level of tobacco cessation education provided to students in U.S. respiratory care training programs.

METHODS

A national survey of 387 respiratory care programs assessed the extent to which tobacco is addressed in required coursework, methods of instruction, perceived importance, and adequacy of current levels of tobacco education in curricula and perceived barriers to enhancing the tobacco-related education.

RESULTS

A total of 244 surveys (63.0% response) revealed a median of 165 min (IQR, 88-283) of tobacco education throughout the degree program. Pathophysiology of tobacco-related disease (median, 45 min) is the most extensively covered content area followed by aids for cessation (median, 20 min), assisting patients with quitting (median, 15 min), and nicotine pharmacology and principles of addiction (median, 15 min). More than 40% of respondents believed that latter 3 content areas are inadequately covered in the curriculum. Key barriers to enhancing tobacco training are lack of available curriculum time, lack of faculty expertise, and lack of access to comprehensive evidence-based resources. Nearly three-fourths of the respondents expressed interest in participating in a nationwide effort to enhance tobacco cessation training.

CONCLUSIONS

Similar to other disciplines, enhanced tobacco cessation education is needed in respiratory care programs to equip graduates with the knowledge and the skills necessary to treat tobacco use and dependence.

Tobacco and alcohol sales in community pharmacies: policy statements from U.S. professional pharmacy associations

OBJECTIVE

To characterize the extent to which state and national professional pharmacy associations have implemented formal policies addressing the sale of tobacco and alcohol products in community pharmacies.

METHODS

To determine existence of tobacco and alcohol policies, national professional pharmacy associations (n = 10) and state-level pharmacy associations (n = 86) affiliated with the American Pharmacists Association (APhA) and/or the American Society of Health-System Pharmacists (ASHP) were contacted via telephone and/or e-mail, and a search of the association websites was conducted.

RESULTS

Of 95 responding associations (99%), 14% have a formal policy opposing the sale of tobacco products in pharmacies and 5% have a formal policy opposing the sale of alcohol in pharmacies. Of the associations representing major tobacco-producing states, 40% have a formal policy against tobacco sales in pharmacies, significantly more than the 8% of non-tobacco state associations with such policies.

CONCLUSION

Among national professional pharmacy associations, only APhA and ASHP have formal policy statements opposing the sale of both tobacco and alcohol in pharmacies. Most state-level professional pharmacy associations affiliated with these two national organizations have no formal policy statement or position.

Tobacco cessation education for pharmacists: Face-to-face presentations versus live webinars

OBJECTIVE To assess the perceived effectiveness of tobacco cessation continuing education for pharmacists in face-to-face presentation versus live webinar modalities. METHODS A continuing pharmacy education (CPE) activity, Do Ask, Do Tell: A Practical Approach to Smoking Cessation, was offered in face-to-face and live webinar modalities. Following the activity, participants completed a brief questionnaire that assessed the anticipated impact of the activity on their smoking cessation counseling practices. RESULTS Of the 1,088 CPE participants, 819 (75%) attended a face-to-face presentation and 269 (25%) participated in a live webinar. Posttraining self-rated ability to address tobacco use was similar between groups ( P = 0.38), and both the face-to-face and live webinar groups reported a significant difference between pre- and posttraining abilities ( P &lt; 0.05 for both groups). Attendees of the face-to-face presentation reported higher likelihoods of providing each of the individual tasks required to provide an effective, brief tobacco cessation intervention ( P &lt; 0.05 for each task). CONCLUSION These data suggest that more value exists in face-to-face education than live webinars when personal and interactive skills are the focus of the activity.

Promoting Pharmacy-Based Referrals to the Tobacco Quitline

Objective:

To conduct a pilot study of a student-delivered academic detailing initiative to promote brief, pharmacy-based tobacco cessation interventions, and referrals to the tobacco quitline.

Methods:

Pharmacy students (n = 11) received training and delivered academic detailing sessions for promoting brief tobacco cessation interventions at community pharmacies (n = 37). Six months after the session, a survey was faxed to each pharmacy to assess (1) the quality and acceptance of the academic detailing session and the materials provided during the session and (2) tobacco cessation counseling perceptions and practices.

Results:

Pharmacists from 30 (81%) sites responded to the survey; of these, 37% reported that they increased the number of patients asked about smoking since the academic detailing session, 70% reported an increase in the number of participants advised to quit smoking, 57% reported an increase in the number of patients counseled, and 50% reported routinely providing referrals to the tobacco quitline.

Conclusion:

pharmacy students are capable of providing academic detailing for brief tobacco cessation interventions in community pharmacies. Results of this pilot study suggest a positive impact of this service on pharmacists’ counseling behavior for tobacco cessation.