statewide evaluation of a tobacco cessation curriculum for pharmacy students

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    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


    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


    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.


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

    E-mail address: (K.S. Hudmon).acco cessation curriculum


    05) 888895[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.


    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, 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