Tobacco Dependence Education Research Articles

The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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.

Tobacco dependence among people with mental illness: a facility-based cross sectional study from Southwest Ethiopia

BackgroundTobacco smoking is a health care issue in developed as well as in developing countries. Tobacco smoking among people with mental illness is significantly higher than in the general population. Tobacco smoking has negative effects on physical, mental and financial well-being of people with mental illness but little is known about tobacco dependence among mental health service users in sub-Saharan African countries, including Ethiopia. Therefore, this study attempted to assess the prevalence of tobacco dependence and associated factors among mental health service users at Jimma University teaching hospital.MethodsA cross-sectional study was conducted among 305 male and 117 female mental health service users at Jimma University teaching Hospital in 2014. The Fagerstrom Test for Nicotine Dependence (FTND) was used to assess tobacco dependence. Logistic regression analysis was used for bivariate and multivariate analysis. Variables with a P value of <0.05 were considered to be associated with tobacco dependence in the final model.ResultsThe prevalence of current tobacco dependence among the study participants was 18.5%. Amongst people with tobacco dependence, 57.7, 29.5 and 12.8% had moderate, high and very high level of tobacco dependence respectively. All mental health service users with tobacco dependence were males. There was a significant association between tobacco dependence and high school education (AOR 3.02, 95% CI 1.07, 8. 48), alcohol use disorder (AOR 4.14, 95% CI = 1.54, 11.11), daily khat chewing (AOR 13.51, 95% CI = 4.27, 42.74), chewing khat 2–3 times per week (AOR 5.09, 95% CI = 1.37,18.95), chewing khat once a week (AOR 4.31, 95%CI = 1.04,17.78), having friends who smoke tobacco (AOR 4.88, 95% CI = 2.12, 11.25) and being diagnosed with schizophrenia compared to a diagnosis of major depression (AOR 5.26, 95% CI = 2.07, 13.37). However, daily attendance at a place of worship (AOR 0.46, 95% CI = 0.22, 0.95) was associated negatively with tobacco dependence.ConclusionIn this study, there was a high prevalence of tobacco dependence among mental health services users. There is a pressing need to increase availability of psychological and pharmacological interventions to reduce tobacco dependence and tobacco-related medical illness in this vulnerable group.

Effectiveness of tobacco intervention education in health professional students' practice: a systematic review protocol.

The objective of this review is to examine the effectiveness of entry-level education on smoking cessation or prevention and tobacco-dependence interventions on health professional student practice in promoting client health and on client smoking cessation behaviors.The specific review question to be addressed: what is the effect of entry-level tobacco dependence education on: (1) health professional students' knowledge and skills and self-efficacy, (2) performance of tobacco prevention and cessation interventions, and (3) client smoking cessation behaviors?

Developing, Managing, and Sustaining an Effective International Tobacco Dependence Treatment Partnership

Introduction: Global Bridges, hosted at Mayo Clinic since 2010, is the only international network of healthcare professionals dedicated to tobacco dependence treatment. Globally, fewer resources have been dedicated to treatment than to other evidence-based tobacco control policies. The Global Bridges network seeks to aid in filling this gap in tobacco control.Aims: This paper identifies ways to advance tobacco dependence treatment, as well as tobacco control, through efficient and effective use of a global health care provider network.Methods: Observation and critical analysis of lessons learned, project outcomes to date, and network analysis.Results/Findings: The initiative has built a strong global foundation, with training curricula developed and delivered in a number of countries, including low- and middle-income countries. While basic evaluation of content mastery and learner satisfaction has been conducted, more intensive evaluation and follow-up to confirm public health impact are essential needs. Finally, program analysis and application of management theory can be used in aiding future activities aimed at providing support for health care providers in the delivery of tobacco dependence treatment and in similar global public health endeavors.Conclusions: The Global Bridges healthcare professional network, now in its sixth year, has developed training curricula and expanded evidence-based tobacco dependence education among healthcare professionals. Global Bridges comprises a unique and important component of the broader tobacco control community, and can play an integral role in furthering global tobacco control progress.

Tobacco dependence education: A survey of US and Canadian dental schools

BackgroundTobacco use is the leading preventable cause of morbidity and premature mortality and is a significant factor in the development of oral disease. Tobacco dependence education (TDE) has not, however, been consistently integrated into predoctoral education. The authors conducted a study assessing the content and extent of TDE and intervention skills in US and Canadian dental schools. MethodsIn 2013, the authors contacted the academic deans of the 74 accredited US and Canadian dental schools to identify the educator who would be most appropriately described as the tobacco-use cessation “champion” at their institution. The authors e-mailed an introductory letter to each school’s champion with a hyperlink to a 45-item survey; 2 follow-up emails were sent with links to the survey. ResultsThe response rate was 66% (N = 49). TDE was taught at 92% of dental schools; 90% of respondents indicated that faculty members were confident to extremely confident in teaching tobacco-related pathology. Only 49% reported this level of confidence in teaching students how to help patients quit tobacco. TDE is taught in periodontics (82%), oral pathology (77%), clinic (66%), oral diagnosis (59%), public health dentistry (55%), pharmacology (55%), oral medicine (52%), and other disciplines (less than 50%). ConclusionsThe survey responses revealed that TDE is not a curricular component in all US and Canadian dental schools. Faculty members were most confident in teaching tobacco-related pathology but may lack the interest and skills needed to integrate TDE as part of patient care. Practice ImplicationsPatients who use tobacco in any form are at an increased risk of developing periodontitis, developing oral cancer, and having poorer surgical outcomes, emphasizing the need for the dental team to be well-prepared through predoctoral dental education.

Dental Hygiene Students’ Perceptions of a Cultural Competence Component in a Tobacco Dependence Education Curriculum: A Pilot Study

First Nations and Inuit peoples have tobacco use rates three times that of the Canadian national average. Providing tobacco dependence education (TDE) requires an understanding of the factors surrounding tobacco use that are culturally specific to this population. The aim of this pilot study was to evaluate the effectiveness of a new cultural competence component for Canadian First Nations and Inuit peoples in a TDE curriculum at Dalhousie University School of Dental Hygiene, Halifax, Nova Scotia, Canada. In 2011, the TDE curriculum was revised to include a First Nations and Inuit people's cultural component. A 32-question survey was developed for the study, with questions divided into four subscales regarding students' perceived knowledge, skills, comfort level, and attitudes about working with this population. Responses from students in two succeeding years were compared: the first cohort had not participated in the revised curriculum (56% response rate), and the second cohort had (63% response rate). The results showed an overall improvement in the subscales evaluated and a significant (p=0.002) improvement in the knowledge subscale of the students who received the new TDE curriculum, specifically regarding knowledge about sociocultural characteristics, health risks, and cultural healing traditions of First Nations and Inuit people. Although the results indicated an increase in the knowledge of the culture of First Nations and Inuit peoples, it is unclear whether the students felt better prepared to provide TDE to this population. For future research, the investigators would examine what learning experiences and further changes to the curriculum could be provided to facilitate the level of preparedness to successfully deliver TDE.

Tobacco Dependence Education in U.S. Dental Assisting Programs’ Curricula

The aim of this study was to assess the level of tobacco dependence education (TDE) in the curricula of U.S. dental assisting programs and to compare the findings to those from a similar assessment of dental hygiene curricula. In the 2012-13 academic year, a 51-item survey was sent to directors of all 298 accredited dental assisting programs. Assessed were curricular TDE content, time spent on each topic, expected levels of clinical competence, and resources used. Of the 298 potential participants, 89 programs returned completed surveys, for a response rate of 30%. Of the 13 TDE-related content areas, those most often covered were oral disease related to tobacco use (100%) and general diseases related to tobacco use (93%); those least often covered were stages of (behavior) change (29%), how to develop a comprehensive tobacco intervention program in a private office setting (23%), and strategies for community-based tobacco control (22%). Responding program directors indicated the following levels of tobacco cessation intervention at which students should demonstrate competence: brief, 44%; moderate, 55%; intensive, 8%. Less than half of the reporting programs conducted a formal assessment of clinical competence in any TDE-related skills; however, skills in assessing patient tobacco use and associating head and neck findings to tobacco use were formally or informally assessed by 74% and 61%, respectively. Compared to dental hygiene programs, TDE appeared to play a smaller role in the curricula of dental assisting programs, and dental assisting programs were less likely to formally assess clinical competence in TDE.

Using Experiential Learning and OSCEs to Teach and Assess Tobacco Dependence Education with First‐Year Dental Students

Previous research has indicated that dentists do not routinely engage in tobacco cessation interventions with their patients due, in part, to a lack of training in the predoctoral curriculum. From 2010 to 2012, this study at one U.S. dental school evaluated the effectiveness of experiential learning and objective structured clinical examinations (OSCEs) to improve first-year dental students' knowledge and beliefs about tobacco dependence and cessation interventions. Analysis indicated acceptable reliability and student performance for the OSCE. In all three years, there were statistically significant increases in student knowledge (p<0.001). In each year, there were also statistically significant shifts in student perceptions of preparedness (p<0.001 to p=0.034) and willingness (p<0.001 to p=0.005) to provide tobacco dependence treatment to patients. Results suggest that OSCEs utilizing standardized patients may be an effective method for assessing tobacco dependence education. Preparing for and participating in an OSCE with a standardized patient may help increase student knowledge and shape the beliefs of early dental students about engaging in patient tobacco cessation interventions. Findings were mixed on the impact of experiential learning on OSCE performance, suggesting further research is needed.

Tobacco Dependence Curricula in US Osteopathic Medical Schools: A Follow-up Study

Tobacco use is the leading preventable cause of illness and death in the United States. A 1998 survey of US osteopathic medical schools identified deficiencies in tobacco dependence curricula. To assess the current content and extent of tobacco dependence education and intervention skills in US osteopathic medical school curricula. An electronic survey. Osteopathic medical schools with students enrolled for the 2009-2010 academic year. Twenty-seven osteopathic medical school deans or their designated administrators. Reported instruction in 7 basic science and 6 clinical science content areas (elective or required) and hours of tobacco dependence education were assessed and compared with the 1998 data. The mean (standard deviation) number of content areas reported as covered in 2010 was 10.6 (2.3) (6.1 [1.2] basic science areas, 4.6 [1.3] clinical science areas). Seventeen of 27 respondents (63%) reported that smokeless tobacco content was covered at their school, and 9 of 27 (33%) reported that the stages of change counseling technique was covered. Compared with 1998, a significant increase was noted in the percentage of schools covering tobacco dependence (92.6% in 2010 compared with 57.9% in 1998, P=.0002). Reported hours of tobacco dependence instruction were also significantly higher in 2010 compared with those in 1998 (Fisher exact test, P<.05). No statistically significant changes were found in the proportion of schools covering all 13 content areas (15.7% vs 22.2%), the proportion covering motivational interviewing in detail (26.3% vs 33.3%), or the proportion requiring curricula on smokeless tobacco (57.9% vs 59.3%). Osteopathic medical school respondents reported more instruction on tobacco dependence in 2010 compared with those in 1998. However, some important basic science and clinical science content areas are not being adequately taught in US osteopathic medical schools.

Assessment of Tobacco Dependence Curricula in Italian Dental Hygiene Schools

The aim of this study was to assess the level of tobacco dependence education offered by Italian dental hygiene programs. A fifty-question survey was mailed to the thirty-one active public and private dental hygiene programs in Italy during the 2008-09 academic year. The survey assessed faculty confidence in teaching tobacco treatment, which courses contained tobacco dependence content, the number of minutes spent on specific content areas, and the level of clinical competence that dental hygiene graduates should be able to demonstrate. Surveys were returned by sixteen programs for a response rate of 52 percent. Respondents indicated tobacco dependence education was included in clinic or clinic seminar (56 percent), periodontics (44 percent), oral pathology (31 percent), and prevention (19 percent). All programs reported including the effects of tobacco on general and oral diseases in courses. However, more in-depth topics received less curriculum time; these included tobacco treatment strategies (63 percent) and discussion of cessation medications (31 percent). Interestingly, 62 percent of the respondents indicated they expected dental hygiene graduates to demonstrate a tobacco treatment competency level of a moderate intervention or higher (counseling, discussion of medications, follow-up) rather than a brief intervention in which patients are advised to quit then referred to a quitline. The results of this study indicated that Italian dental hygiene students are not currently receiving adequate instruction in tobacco treatment techniques nor are they being adequately assessed. This unique overview of Italian dental hygiene tobacco dependence education provides a basis for further discussion towards a national competency-based curriculum.

The implementation of a tobacco dependence education curriculum in a Swiss Dental Hygiene School – an 8‐year review

The aim of our investigation was to review the implementation of a comprehensive tobacco dependence education (TDE) curriculum at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland, 2001-2008. In 2001, new forms to record patients' tobacco use history and willingness to quit were created for all the MSDH patients. In 2002, a new theoretically based tobacco dependence treatment protocol was implemented into the MSDH curriculum. Students received instruction on how to provide brief tobacco use dependence interventions as well as maintain detailed records of patient tobacco use and cessation interventions for every smoker at all dental hygiene visits. In 2002, 17 lecture hours were added to the following subjects: pathology, periodontology, preventive dentistry, pharmacology and psychology. During the same time period, 2213 patients (56.9% women) have visited the MSDH. Smoking status was recorded in 85.7% of all the patients (30.2% smokers). Brief tobacco use interventions were recorded in 36.8% of all smokers while 7.6% of these have reported to quit smoking. Overall, the new TDE curriculum was successfully implemented and accepted by the MSDH faculty. Applications in the clinical practice, however, may still be improved to better identify smokers and increase initial and follow-up interventions potentially leading to higher quit rates.

Improving Tobacco Dependence Education for Dental and Dental Hygiene Students at Loma Linda University School of Dentistry

In a general effort to facilitate dental professionals' effective tobacco-dependence education (TDE), the student part of the project reported here had three purposes: 1) to promote tobacco cessation activities in the dental school clinic, 2) to evaluate dental and dental hygiene students' confidence level in treating tobacco-dependent patients, and 3) to determine the frequency, duration, and depth with which the students assisted tobacco-dependent patients. Surveys of senior dental and dental hygiene students at the Loma Linda University School of Dentistry were conducted in 2008. Of the twenty-seven questions on the survey, nineteen related to the procedures students performed and questions asked of patients, one question asked how many minutes students spent counseling patients, and seven questions related to barriers to incorporating TDE activities. Only 56.5 percent of the responding dental students reported they routinely "asked and advised" about their patients' smoking behaviors, but 87.5 percent of the responding dental hygiene students reported they routinely did so. After the curricular intervention, the follow-up survey found that the dental students more frequently showed their patients the effects of tobacco on the oral mucosa and more frequently discussed pharmacotherapy options and made referrals during routine care. Until all dental and dental hygiene students are required to meet written board and clinical competencies in TDE and given adequate mentoring by clinical faculty to treat tobacco-dependent patients, the likelihood of seeing major improvements in tobacco-cessation treatment in dental practices is low.

Improving Tobacco Dependence Education Among the Loma Linda University School of Dentistry Faculty

Tobacco-related health problems are among the most preventable forms of illness. By assuming proactive tobacco use counseling roles, dental professionals can help reduce the number of people who use tobacco. Minimum standards for intervention by dental care providers were established more than a decade ago by the American Dental Association and the American Dental Hygienists' Association. The goal of Loma Linda University School of Dentistry in its tobacco-cessation efforts is to move beyond those standards towards more effective interventions. The school conducted a study to determine the formal education of the faculty, evaluate the current state of tobacco dependence education (TDE) delivered to students, identify topics that dental faculty members wanted to further their education, promote tobacco dependence education among the dental faculty, and enhance teaching moments on the clinic floor. A fifty-seven question survey was e-mailed to all faculty members with >0.4 FTE (full-time equivalent) during the 2007-08 school year. The response rate was 80 percent (101 out of 126). The results revealed that faculty members have limited formal training; however, 73.1 percent agreed that TDE would be beneficial to them. They also believed that, upon graduation, dental professionals should be able to perform at least a ten-minute moderate intervention program and discuss options for tobacco dependence treatments with patients. This project was designed to establish a 2008-09 baseline of TDE clinical practices, knowledge, and attitudes and to assess the effects of faculty development, curricular didactic, and clinical changes.

Assessing the Current Status of Tobacco Dependence Education Curricula in US Physician Assistant Programs

Tobacco use continues to be the single most preventable cause of death and disease in the United States. A paradigm shift is needed in physician assistant (PA) education to address tobacco dependence as a chronic, relapsing disease requiring patient education, counseling, treatment, and follow-up. A national study was conducted to assess the existing tobacco dependence education currently offered in U.S. PA programs. An established tobacco dependence curriculum survey was revised and mailed to the 141 accredited PA programs in the United States during the 2008-2009 academic year. The survey asked respondents to report the following with regard to tobacco dependence education content in their PA program; (1) Perceived self-efficacy and barriers; (2) Medical topics covered and minutes spent; (3) Evaluation of students' competency level; (4) Tobacco courses, topics, and resources used; and (5) Level of tobacco-cessation competency expected upon graduation. A total of 79 surveys were returned (56% response rate). Though, on average, over 827 minutes (14 hours) were devoted to tobacco dependence education curriculum, most minutes (223 minutes) were spent on the health effects of tobacco use, with only 42 minutes spent on cessation counseling, 55 minutes on medications, and 13 minutes on integrating tobacco-cessation into clinical practice. PA educators have the unique opportunity to affect tobacco-related morbidity and mortality. The present study demonstrates that PA instructors are more than adequately teaching students about tobacco use. However, it is not clear if students are being adequately taught how to assist patients to quit using tobacco.

Assessment of Tobacco Dependence Curricula in U.S. Dental Hygiene Programs

Tobacco dependence education (TDE) continues to be a vital component of dental hygiene curricula-made even more important by the fact that tobacco cessation in adults in the United States has stagnated over the past ten years. This study was undertaken to assess the salient characteristics of TDE in U.S. dental hygiene programs. A fifty-one question survey was mailed to the program directors of all 283 accredited dental hygiene programs during the 2007-08 school year (this number does not include the programs in Illinois, which were excluded since they had participated in a previous study). A total of 187 schools returned the survey for a return rate of 66 percent. Curricular content, minutes spent on each topic, existing level of clinical competence measured, expected level of clinical competence, and resources used were assessed. Respondents reported an average of 6.7 hours spent on all identified components of tobacco education. While 77 percent of respondents reported formally assessing whether a student asked if a patient used tobacco, only 26 percent indicated having a formal competency utilizing all of the U.S. Public Health Service's Clinical Practice Guideline 5 As and 5 Rs. In contrast, 72 percent of program directors reported expecting their graduates to be competent in a moderate intervention that included all 5 As. Though there is a clear commitment to TDE among dental hygiene programs in the United States, we recommend training to a more intensive level of TDE in order to facilitate broader adoption of comprehensive, evidence-based guidelines.

The Effectiveness of Tobacco Intervention Education for Health Professional Students' Health Promotion Practice: A Systematic Review

Review Question/Objective The Review objective is to examine the effectiveness of entry level programme education regarding smoking prevention and tobacco use interventions on health professional student practice in promoting client health. The specific review question to be addressed is: What is the effect of entry level tobacco dependence education on health professional students’ knowledge and skills, selfefficacy, and performance of tobacco prevention and cessation interventions? Inclusion Criteria Types of Participants The participants are health professional students undertaking the following programs of study: nursing (registered nurses, registered psychiatric nurses, advanced practice nurses, licensed practical nurses); midwifery ; medicine; dentistry; dental hygiene; dental therapy; pharmacy; respiratory therapy; occupational therapy; physical therapy; speech language therapy; optometry; social work; psychology; chiropractic therapy; and naturopathic medicine. Studies that evaluate practicing healthcare providers who are not students in entry level educational programs will be excluded. Health profession student programs whose graduates can practice without qualifying for a license (non regulated disciplines) will be excluded. Programs where graduates do not have daily, direct interactions with clients will be excluded. Advanced practice nurses and medical residents provide specialised care to patients with health concerns commonly linked to tobacco use. Studies reporting evaluations of curricula among the following post graduate medical speciality programs will be included in the review: Anesthesia; Cardiac Surgery; Cardiology; Community Medicine; Critical Care Medicine; Dermatology; Endocrinology and Metabolism; Family Medicine; General Medicine; Emergency Medicine; Medical Oncology; Nephrology; Neurology; Obstetrics /Gynaecology; Ophthalmology; Orthopaedic Surgery; Otolaryngology; Paediatrics; Plastic Surgery; Psychiatry, Radiation Oncology; Respiratory Medicine; Surgery and Vascular Surgery. Types of Intervention(s) This review will consider all studies that report the implementation and evaluation of an entry level program, curricular activity or component in smoking prevention and treating tobacco use and dependence, and its impact on student practice in promoting client health. Comparisons of different approaches to the educational intervention (including pre- and post-training results) to usual or no training will be included. The settings will include post-secondary institutions such as universities or colleges, and will include undergraduate or pre-licensure training, postgraduate medical speciality training, and advanced practice nursing programmes at the master’s level.TRUNCATED AT 350 WORDS