ob

acy

Results. A total of 493 students (82.3%) completed linkable pre- and post-training evaluations. Self-reported abilities, measured on a five-

currently smoke cigarettes or other forms of tobacco [1]. If

current usage patterns remain unchanged, this number will

and effective tobacco control interventions on a global scale

[3]. Because even brief interventions from clinicians

positively impact the cessation rates of tobacco users

effective tobacco

Preventive Medicine 40 (20increase to 1.7 billion smokers by the year 2025 [1].point scale, increased significantly from 1.89 F 0.89 to 3.53 F 0.72 (P b 0.001). Twenty-two percent of students rated their overallcounseling abilities as good, very good, or excellent before the training versus 94% of students after the training. Eighty-seven percent of

students indicated the training will increase the number of patients that they counsel; 97% believed it will increase the quality of their

cessation counseling.

Conclusions. Comprehensive training significantly improved pharmacy students perceived confidence and ability to provide tobacco

cessation counseling. The curriculum is applicable to other health professional training programs and currently is being used to train

pharmacy, medical, nursing, and dental students.

D 2004 Elsevier Inc. All rights reserved.

Keywords: Tobacco dependence; Curriculum; Education, pharmacy; Schools, pharmacy; Smoking cessation; Health personnel, education

Introduction

Tobacco use is a major cause of morbidity and mortality

worldwide. Globally, an estimated 1.3 billion individuals

Tobacco-attributable diseases are responsible for an esti-

mated 4.8 million premature deaths worldwide [2]. The

World Health Organization (WHO) predicts this figure will

double within the next 20 years in the absence of aggressiveRobin L. Corelli, Pharm.D.a, Lisa A. Kroon, Pharm.D.a, Eunice P. Chung, Pharm.D.b,

Leanne M. Sakamoto, Pharm.D.c, Berit Gundersen, Pharm.D.d, Christine M. Fenlon, B.F.A.e,

Karen Suchanek Hudmon, Dr.P.H., M.S., R.Ph.a,e,*

aDepartment of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, USAbDepartment of Pharmacy Practice, Western University of Health Sciences College of Pharmacy, USA

cDepartment of Clinical Pharmacy, University of Southern California School of Pharmacy, USAdDepartment of Pharmacy Practice, University of the Pacific Thomas J. Long School of Pharmacy and Health Sciences, USA

eDepartment of Epidemiology and Public Health, Yale University School of Medicine,

60 College Street, 4th Floor, New Haven, CT 06520, USA

Available online 8 December 2004

Abstract

Background. Previous studies suggest that healthcare professionals are inadequately trained to treat tobacco use and dependence. Because

even brief interventions from clinicians improve patient quit rates, widespread implementation of effective tobacco cessation training

programs for health professional students is needed.

Methods. Pharmacy students received 78 h of comprehensive tobacco cessation training. Participants completed pre- and post-program

surveys assessing perceived overall abilities for cessation counseling, skills for key facets of cessation counseling (Ask, Advise, Assess,

Assist, Arrange), and self-efficacy for counseling.Statewide evaluation of a t

for pharm0091-7435/$ - see front matter D 2004 Elsevier Inc. All rights reserved.

doi:10.1016/j.ypmed.2004.10.003

* Corresponding author. Fax: +1 203 785 6279.

E-mail address: karen.hudmon@yale.edu (K.S. Hudmon).acco cessation curriculum

students

05) 888895

www.elsevier.com/locate/ypmed[4,5], widespread implementation ofcessation training programs for current and future health

care providers should be an international priority.

not trained. Guidelines issued by the WHO and the United

States Public Health Service (USPHS) recommend that all

ive Mhealthcare professionals, including students in healthcare

professional training programs, receive education in the

treatment of tobacco use and dependence [4,7]. Despite

these recommendations and the knowledge that tobacco use

is a significant public health problem affecting persons of all

ages, numerous studies have shown that students in the

health professions receive inadequate training for treating

tobacco use and dependence [819]. In an international

survey assessing the tobacco-related content in medical

school curricula, Richmond et al. [13] found that only 34%

of schools provided smoking cessation training. Similarly,

in a survey of medical schools conducted between 1996 and

1998 in the United States, Ferry et al. [14] reported that

nearly 70% of schools did not require any clinical training

for tobacco cessation. Nearly one third of the programs

averaged fewer than 1 h of tobacco cessation instruction per

year of medical school. More recently, Wewers et al. [18]

surveyed 631 U.S. nursing programs and estimated that only

46% of baccalaureate and 67% of graduate nursing

programs include tobacco cessation skills training as a part

of required coursework.

In response to this documented need for tobacco

intervention training, a comprehensive tobacco cessation

curriculum was developed for students in the health

professions. Originally designed to train pharmacy students,

the Rx for Change: Clinician-Assisted Tobacco Cessation

program has been integrated into the required curricula of

each school of pharmacy in California since 2000. Because

Rx for Change adheres to recommendations outlined in the

USPHS Clinical Practice Guideline for Treating Tobacco

Use and Dependence [4], its applicability is broad and

adapted versions of the program have been incorporated into

the required coursework in the schools of medicine,

dentistry, and nursing at the University of California, San

Francisco. Recently, through grants funded by the National

Cancer Institute and the American Legacy Foundation, the

Rx for Change curriculum is being disseminated through

train-the-trainer programs to schools of pharmacy and

schools of nursing, respectively, in the U.S. [20,21]. Here,

we present the initial statewide evaluation results of the Rx

for Change curriculum obtained during the third year of

implementation for pharmacy students in California.

Methods

Participants and curriculum contentIn a meta-analysis of 10 studies, Lancaster et al. [6]

concluded that healthcare providers who have received

smoking cessation training are significantly more likely to

intervene with patients who use tobacco than those who are

R.L. Corelli et al. / PreventStudy participants were Doctor of Pharmacy (Pharm.D.)

students attending the University of California San Fran-cisco (UCSF), the University of the Pacific (UOP), the

University of Southern California (USC), or Western Uni-

versity of Health Sciences (WU) who received comprehen-

sive tobacco cessation training (the Rx for Change

curriculum) as part of their required pharmacy coursework.

Students were either in their first or second year of pro-

fessional school.

The Rx for Change curriculum, which has been described

in greater detail elsewhere, [22] and is available to registered

users at http://rxforchange.ucsf.edu, is a series of independ-

ent, but complementary modules that equip students with

the skills necessary to treat tobacco use and dependence. Six

core modules considered essential include: epidemiology of

tobacco use, nicotine pharmacology and principles of

addiction, drug interactions with smoking, assisting patients

with quitting, aids for cessation, and role playing with case

scenarios. Optional modules include: forms of tobacco,

pathophysiology of tobacco-related disease, genes and

smoking, post-cessation weight maintenance, how to get

involved, and a history of tobacco control.

At a minimum, the core modules can be administered in

6 h. Seven to 8 h provide a more desirable pace and allows

more time for hands-on pharmacotherapy counseling and

role-playing exercises. The materials heavily emphasize

methods for behavior modification that can be applied in a

wide range of clinical settings. Students are trained to apply

the 5 As (ask, advise, assess, assist, arrange) [4,23] when

delivering patient-specific behavioral interventions that,

when appropriate, also include pharmacotherapy. As part

of the aids for cessation module, students are given the

opportunity to handle nonprescription nicotine replacement

therapy formulations and placebo samples of the nicotine

nasal spray and the nicotine oral inhaler. Participants learn

key counseling points for each medication, as well as proper

dosing regimens and drug administration techniques. Non-

pharmacologic cessation aids also are discussed and

students gain hands-on experience with a hand-held com-

puter for scheduled, gradual reduction of smoking. A

minimum of 2 h of role-playing with case studies enable

students to gain first-hand experience in applying their

newly acquired knowledge and skills. Case studies illustrate

a wide variety of realistic counseling interactions; these vary

by practice environment (ambulatory or acute care setting)

and patient characteristics (demographics, stage of readiness

to quit, history of tobacco use, preferences for methods of

cessation, coping difficulties, etc.).

During the study period, students were exposed to the six

core modules and the optional forms of tobacco module

from the Rx for Change curriculum. While the modules

presented during the trainings were standardized, the format

and total hours of instruction varied by school: University of

California San Francisco, 8 h taught over 2 days (Spring

2002); Western University of Health Sciences, 8 h taught

over 2 days (Spring 2002); University of Southern Cali-

edicine 40 (2005) 888895 889fornia, 7 h taught over 4 days (Spring 2002); and University

of the Pacific, 7 h taught over 5 days (Fall 2002).

Program evaluation results

ive MStudy measures

To assess the effects of the training program, a 2-page

anonymous pre-training survey was administered immedi-

ately prior to the first Rx for Change module, and a three-

page anonymous post-training survey was administered

immediately following the final module.

The surveys, which included mostly parallel measures,

were linked using the following information: the last three

digits of the students home telephone number, the

numerical day of the month the student was born, and the

first two letters of the high school from which the student

graduated. Participation was voluntary, and because of the

anonymous nature of the data, a waiver of written informed

consent was obtained. Students were provided with a one-

page information sheet describing the study and its

procedures, risks, and benefits. The survey instruments

and study procedures were approved by the institutional

review board for the protection of human research subjects

at each study site.

Prior to this study, all measures were extensively pilot

tested with more than 1,100 pharmacy students who

participated in Rx for Change trainings during 2000 and

2001. The measures focused on assessing student percep-

tions of the training and its impact on confidence for

counseling and perceived counseling abilities. Students

were asked to estimate the percentage of the curriculum

that (1) was completely new, (2) they had been taught before

but needed to review, and (3) had been taught before and

was an unnecessary review (summing to 100%). Students

also estimated the percentage of the material that would be

used when working with patients and indicated whether they

had previously counseled any patients for tobacco cessation.

Both surveys evaluated students self-rated abilities for

cessation counseling, including (a) overall ability, (b) five

key competency facets of tobacco cessation counseling (the

5 As), and (c) self-efficacy (i.e., confidence) for counseling,

using a 12-item scale. Responses for assessments of overall

ability and the 5 As were scored using a five-point scale

(1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent).

Self-efficacy items also were scored using a 5-point scale

(1 = not at all confident, 2 = not very confident, 3 =

moderately confident, 4 = very confident, 5 = extremely

confident). Sociodemographic variables (assessed post-

training) included sex, age, race/ethnicity, and tobacco use

status. Finally, we assessed impressions of curriculum

content and its applicability, general attitudes concerning

the role of the pharmacy profession in tobacco control

activities, and opinions about tobacco sales in pharmacies

(1 = strongly against it, 2 = against it, 3 = neither for it nor

against it, 4 = in favor of it, 5 = strongly in favor of it).

Analysis

R.L. Corelli et al. / Prevent890Responses were summarized using standard descriptive

statistics. Scale scores were computed as the average ofOn average, students reported that 77.4% of the material

was completely new, 16.2% had been taught before but

needed to be reviewed, and 6.4% was an unnecessary

review. Students estimated that 80.8% of the material would

be used when providing patient care.

The self-reported pre- and post-training overall ability to

help patients quit using tobacco (Fig. 1) increased signifi-

cantly (P b 0.001), from an average of 1.89 (SD, 0.89) to3.53 (SD, 0.72). Post-training assessments of pre-training

abilities (mean, 1.50; SD, 0.71; bBefore attending this class,how would you have rated your overall ability to helpconstituent items for (a) a tobacco cessation counseling

competency scale, composed of the 5 As items, and (b)

self-efficacy for counseling, composed of 12 items. The

statistical significance of change scores were assessed

using paired t tests. Because our evaluation was designed

to assess program impact, our analyses included only

students who completed linkable pre- and post-training

surveys. As such, because the surveys were administered

in class, immediately prior to the first session and

immediately following the last session, students who

were absent from class on either day were unable to

provide linkable surveys.

Results

Student population

During the study period (March 2002 to November

2002), a total of 599 Pharm.D. students were enrolled in the

classes participating in the program. Of these students, 493

(82.3%) had linkable pre- and post-training surveys.

Participants at UCSF (n = 118; 96.7% participation),

UOP (n = 164; 80.4% participation), and USC (n = 120;

66.3% participation) were in their first-year of profes-

sional school; participants at WU (n = 91, 98.9%

participation) were second-year students. For two of these

schools (UCSF and WU), class attendance was manda-

tory, thus participation rates were higher. Seventy-four

percent were female, and ethnicity was distributed as

follows: 65.1% Asian or Pacific Islander, 22.4% Cauca-

sian, 6.1% Hispanic or Latino, 0.6% African American

and 5.8% other. The average age was 24.3 years (standard

deviation, 3.4; range 1941), and 11.0% disclosed that

they had smoked 100 or more cigarettes in their life.

Overall, 2.5% of students used tobacco (cigarettes, cigars,

pipes, snuff, or chew) every day, 4.3% used tobacco some

days, and 4.9% previously used tobacco but had quit.

Eight percent had previously counseled one or more

patients for tobacco cessation.

edicine 40 (2005) 888895patients quit using tobacco?Q) were significantly lower thanwere pre-training assessments of the same ability (P b

0.001). The proportion of students who rated their overall

ability to help patients quit tobacco as good, very good or

tency scale (Cronbach alpha estimate of internal consistency

in this sample, 0.85; one factor accounting for 63.2% of the

Fig. 1. Students self-ratings of overall ability a to help patients quit using tobacco (n = 493). P b 0.001 for all comparisons. abHow do you rate your overallability to help patients quit using tobacco? Q bbBefore the training, how would you have rated your overall ability to help patients quit using tobacco?QcResponses were scored using a five-point scale (1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent).

R.L. Corelli et al. / Preventive Medicine 40 (2005) 888895 891excellent increased from 22.1% (assessed pre-training) to

94.1% (assessed post-training). Post-training assessments of

pre-training abilities were lower, with 9.5% of students

rating their overall ability to help patients quit using tobacco

as good, very good or excellent.

Students pre- and post-training ratings of the 5 As are

shown in Fig. 2; for each of these, at least 92.3% described

their post-training skills as good, very good, or excellent.

For the post-training tobacco cessation counseling compe-Fig. 2. Students pre- and post-training self-ratings for five components of comp

Arrange (n = 493). aAll P values for paired t tests comparing pre- and post-trainvariance), the mean score was 3.74 (SD, 0.65) and this

differed significantly (P b 0.001) from the pre-trainingscores (mean, 2.10; SD, 0.81).

For the 12-item self-efficacy for counseling scale

(Cronbach alpha estimate of internal consistency in this

sample, 0.92; one factor accounting for 52.9% of the

variance), the post-training overall scale scores (mean, 3.62;

SD, 0.57) were significantly higher (P b 0.001) than werepre-training scores (mean, 1.94; SD, 0.74). Post-trainingrehensive tobacco cessation counseling: Ask, Advise, Assess, Assist, and

ing ratings b 0.001.

responses to the 12 scale items are presented in Table 1; for

each constituent item, we observed a significant difference

from pre- to post-training (P b 0.001).Eighty-seven percent of students indicated that partic-

ipating in the training would increase the number of patients

whom they counsel in the future; 97% believed it would

increase the quality of the counseling that they provide.

Approximately 96% and 89% of students believe the

pharmacy profession should be more active in helping

patients to quit using tobacco and in preventing the onset of

tobacco use, respectively. Ninety-nine percent believed that

students at other schools of pharmacy in the United States

would benefit from receiving the same, or similar tobacco

cessation training. On the issue of tobacco sales in

pharmacies, post-training assessments indicated that 53.4%

of students were strongly against it, 28.5% were against it,

16.9% were neutral, 0.8% were in favor of it, and 0.4% were

strongly in favor of it. Exposure to the Rx for Change

training strengthened opposition toward tobacco sales in

pharmacies, from an average score of 1.89 (SD, 1.29) pre-

training to 1.67 (SD, 0.82) post-training (P b 0.001).

observed a significant improvement in pharmacy students

self-rated confidence and ability for providing cessation

counseling following exposure to a 7- to 8-h comprehensive

tobacco cessation training program. The vast majority

(N94%) of students rated their overall tobacco cessationcounseling abilities as good, very good, or excellent

following completion of the training. Students self-efficacy

for providing counseling was similarly high, with more than

84% of students reporting being moderately, very, or

extremely confident for each of the 12 facets of counseling

embedded within the self-efficacy scale. This finding is

notable given that most (81.5%) of the participants were

first-year students with limited professional training or direct

patient care experience. Students felt most confident in their

abilities to motivate patients who are trying to quit, intervene

in the bask,Q bassess,Q and bassistQ facets of cessationcounseling, and recognize the need for referral. Students

were less likely to feel confident in their abilities to provide

cessation counseling when patients were not interested in

quitting or when there were time constraints. Although the

format for program implementation varied among the

schools, we observed no between-school differences for

the pre- versus post-training scores for overall ability or the

espon

ining

ll

t

R.L. Corelli et al. / Preventive Medicine 40 (2005) 888895892Table 1

Post-training self-efficacy for tobacco cessation counseling: distribution of r

ITEM Post-tra

Not at a

confiden

Can provide motivation to patients who are trying to quit 0.0

Know when a referral to a physician is appropriate 0.4

Have sufficient therapeutic knowledge of the pharmaceutical

products for tobacco cessation

0.2

Can sensitively suggest tobacco cessation to patients

who use tobacco

0.6

Can create consumer awareness of why pharmacists

should ask questions about tobacco use

0.4

Have the skills to monitor and assist patients throughout

their quit attempt

0.0

Know the appropriate questions to ask patients when

providing counseling

0.0

Can help recent quitters learn how to cope with situations

or triggers that might lead them to relapse back to smoking

0.4

Have the skills needed to counsel for an addiction 0.6

Are able to provide adequate counseling when time is limited 0.6

Can counsel patients who are not interested in quitting 1.8

Have the skills to assist patients who seem to be in a hurry 1.8

Average item score (post-training)bDiscussion

Previous studies of tobacco cessation curricula in health

professional schools have been evaluations of programs

developed and implemented at a single institution [2432].

To our knowledge, this is the first multi-site evaluation of a

standardized tobacco cessation training program for health

professional students. In this state-wide evaluation, wea All P values for paired t tests comparing pre- and post-training item responseb Computed as average of constituent items; significantly different than pre-traintobacco cessation counseling competency scale (the 5 As).

As the Rx for Change program is disseminated across the

United States, a larger sampling of pharmacy schools and

formats for implementation (e.g., the total number of hours

taught, the amount of time elapsed between the first and last

modules, and the year of pharmacy school in which the

students receive the training) will be examined in an attempt

to determine the most effective methods for implementation.

ses (n = 493)

student responses (%) Meana

(SD)Not very

confident

Moderately

confident

Very

confident

Extremely

confident

3.9 27.0 50.5 18.7 3.84 (0.77)

4.3 35.5 41.0 18.8 3.73 (0.83)

5.1 32.9 45.2 16.6 3.73 (0.80)

2.4 35.3 46.2 15.4 3.73 (0.77)

5.1 34.9 42.4 17.2 3.71 (0.82)

3.3 34.8 50.3 11.6 3.70 (0.71)

3.0 34.5 52.5 9.9 3.69 (0.69)

3.0 38.1 45.4 13.0 3.68 (0.75)

6.5 44.4 40.0 8.5 3.49 (0.77)

11.8 42.8 36.9 7.9 3.40 (0.82)

13.2 41.2 34.3 9.5 3.37 (0.89)

14.8 43.3 31.7 8.3 3.30 (0.89)

3.62 (0.57)s b 0.001.ing overall scale score (mean, 1.94; SD, 0.74), P b 0.001.

ive MAn interesting finding from our study was the difference

between students pre-training versus post-training (retro-

spective) assessments of their baseline ability to help

patients quit using tobacco. While standard evaluations of

educational interventions include a pre- and post-training

design, we included this additional retrospective measure

because we hypothesized that untrained students generally

underestimate the level of skills required to provide tobacco

cessation counseling. Prior to the training, one of every five

pharmacy students rated their overall ability to help patients

quit using tobacco as good (17.5%), very good (3.5%), or

excellent (1.1%). After exposure to the Rx for Change

curriculum, fewer than one of every 10 students rated their

baseline counseling abilities as good (8.1%) or very good

(1.4%), and none rated their pre-training skills as excellent.

This change suggests that the training itself leads students to

gain an enhanced understanding and appreciation for the

diverse set of skills necessary to provide comprehensive

tobacco cessation counseling, but further studies in this area

are warranted.

Although many schools of pharmacy across the country

are in the process of enhancing the tobacco education

component of their curricula, it is paradoxical that the

majority of community pharmacies, particularly chain

pharmacies, sell tobacco. As part of the Rx for Change

program, students are challenged to consider the ethical

dilemma imposed by the sales of tobacco in a practice

environment that otherwise is bmarketedQ to promote health.While our evaluations over the past several years have

consistently demonstrated that very few future pharmacists

are in favor of tobacco sales in pharmacies, the impact of a

tobacco education program on these perceptions has never

been evaluated. The Rx for Change program significantly

strengthened opposition to tobacco sales in pharmacies. As

we continue to raise awareness of this issue within the

profession, we can only hope that owners and employees of

pharmacies that sell tobacco products will revisit the ethics

of a practice that is incongruent with the pharmacists code

of ethics (http://www.aphanet.org/pharmcare/ethics.html).

Although our findings suggest that the Rx for Change

curriculum improves student confidence and ability to

provide tobacco cessation counseling, our study is not

without limitations. Our study was conducted in schools of

pharmacy in California, which tend to have a disproportion-

ately high number of students of Asian/Pacific Islander

descent; as such, our results might not be generalizable to

other training programs throughout the U.S. Although we

did include a 10-item post-training knowledge assessment in

our surveys, we do not report these data because the items

were changed throughout the period of study and varied

across the sites (e.g., different items and response options

were tested), in preparation for our nationwide dissem-

ination study (currently ongoing). Our short-term pre-post

design does not afford the opportunity to estimate the

R.L. Corelli et al. / Preventsustainability of the programs effects on student confidence

or its impact on actual counseling activities during clinicalrotations or after graduation. Additionally, our study did not

include a control group, and our measures relied on

students self-report of abilities. Evaluations of student

performance using an objective structured clinical exami-

nation (OSCE) would better assess the participants tobacco

cessation counseling competencies. We were unable to

incorporate OSCE measures because this examination

format was not used in the courses in which the Rx for

Change program was taught, and we lacked funding to

develop and implement an OSCE specifically designed to

evaluate the curriculum outside of the scheduled class time.

In the future, we hope to incorporate OSCE evaluations, as

others have done [2429], to further evaluate the impact of

Rx for Change on counseling skills. Finally, while our

program is applicable to students in all health professions,

our study evaluated the impact of the Rx for Change

curriculum only on students enrolled in a doctor of

pharmacy program. While formal evaluations of the impact

of the Rx for Change program on other disciplines have not

been conducted, the program has been adapted and

disseminated to 84 nursing programs, one dental school,

and one medical school in the US [21]. The program also

has been used to train licensed providers including tobacco

cessation counselors in a research study of smoking

cessation in patients with schizophrenia (Michael Smith,

Principal Investigator) and community pharmacists in a

large National Cancer Institute-funded smoking cessation

program in sixteen communities Texas (Alexander Pro-

khorov, Principal Investigator). Because the Rx for Change

curriculum is based on the USPHS Clinical Practice

Guideline and incorporates enhanced instructional techni-

ques (e.g., role playing and hands-on demonstration

exercises; our more recent additions to the program include

the viewing of videotaped counseling sessions and engaging

students in trigger tape discussions) that have been found in

previous studies to be effective in training medical students,

[33] residents, [34], and practicing physicians [35], we

anticipate that our results would be applicable to students in

other disciplines.

Our data suggest that students completing the training

attain a high degree of self-confidence for providing

comprehensive tobacco cessation assistance. Moreover, the

vast majority of students perceive that participation in the

training will increase both the frequency and quality of their

intervention efforts with tobacco users. Given the preva-

lence of tobacco-related morbidity and mortality, it is

imperative that practicing clinicians and students in health

professional schools receive evidence-based training in the

treatment of tobacco use and dependence. Ideally, compre-

hensive tobacco cessation training would be a core require-

ment in the curricula of all health care professional schools,

and this training would be further augmented through

continuing education and certification programs for licensed

providers. While further studies are necessary to document

edicine 40 (2005) 888895 893the impact of these training programs on long-term cessation

rates with tobacco users, it is logical to conclude that

health professional schools work together in sharing

The hands-on portion of the aids for cessation module

was made possible in part through product donations to the

ive Mschools from Pharmacia Corporation (now Pfizer, Inc.) and

PICS Inc.

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Acknowledgments

We would like to thank the pharmacy students at UCSF,

USC, UOP, and WU who completed our surveys and have

provided thoughtful feedback toward the refinement of the

Rx for Change curriculum since 2000.

The evaluation of this program was made possible

through funding from the University of California

Tobacco-Related Disease Research Program (grant 10ST-

0339 to K Hudmon). Preparation of the manuscript was

supported in part by the National Cancer Institute (grant

R25 90720 to K Hudmon).providing patients with widespread access to a multi-

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R.L. Corelli et al. / Preventive Medicine 40 (2005) 888895 895

Statewide evaluation of a tobacco cessation curriculum for pharmacy studentsIntroductionMethodsParticipants and curriculum contentStudy measuresAnalysis

ResultsStudent populationProgram evaluation results

DiscussionAcknowledgmentsReferences