MEDICALLY ILL SMOKERS AND PLANNING TO QUIT

Cigarette smoking is the leading cause of preventable disease and is the cause of nearly 1 in 5 deaths in the United States. The prevalence of smoking has had a leveling off effect after many years of significant decline. Certain subgroups of the population, such as those with low income and certain illnesses, continue to smoke at disproportionately high rates. Reasons for these disparities in smoking rates are complex. Developing a better understanding of the issues related to persistent smoking particularly for those with medical illness and limited access to cessation resources can help focus interventions to help these high risk smokers quit. This dissertation includes a systematic review of the literature associated with hardcore smoking; an analysis of the reliability and validity of a self-efficacy instrument in a sample of low-SES, medically ill smokers; and the results of a cross-sectional, non-experimental study exploring the relationship between smoking-related factors and planning to quit in a sample of medically ill smokers. A sample of 70 current and recent smokers was surveyed at a free clinic. Quitting self-efficacy was measured using an instrument not previously tested in a rural, medically ill sample. Modifications to the survey were made based on qualitative interviews with smokers and a single question measuring self-efficacy was also tested. There was a high correlation among the self-efficacy measures (Spearman’s rho .99, p \u3c .001) and between the longer instrument and the single question (Spearman’s rho .65, p \u3c .001). Each measure demonstrated acceptable reliability and validity. In the study exploring potential factors associated with planning to quit, the number of prior quit attempts and confidence to quit explained 43% of the variance in those planning versus not planning to quit. Providing interventions focused on increasing confidence and experience with quit attempts can be effective in promoting a plan to quit in this group of smokers who, because of their medical illness, can benefit significantly from cessation. Research is needed to explore cessation outcomes when employing these targeted interventions with medically ill smokers in rural areas

Special Ops: Vulnerable Populations and Tobacco Treatment

Reasons for Smoking among individuals with co-morbid substance use (SUD)and/or psychiatric disorders (PD) Smoking cessation treatment for individuals with co-morbid substance use (SUD) and/or psychiatric disorders (PD) Smoking among the Homeless populatio

Tobacco Use Dependence and Approaches to Treatment

Counseling Demonstrates a Dose-Response Effect/Comes in Many Forms Brief advice during a “window of opportunity” can increase quit attempts by 40% Medication combined with counseling doubles the success rate Quitlines: proactive fax to quitline most effective Online (becomeanex.org, smokefree.gov, mylastdip.com) Cooper Clayton Classes at many local health departments; schedules and provision of medication varies I-Phone apps/text to quit Tailoring NRT to the tobacco user Studies show efficacy in smokers and smokeless tobacco users (Ebbert, et al, 2010) Combining patch with shorter acting form of NRT has been shown to be safe and effective (Stead, et al, Cochrane Review, 2008; Kozlowski, et al, 2007) Extended use of NRT or other medications is being shown to reduce relapse rates (Schnoll, et al, 2010) High dose NRT is safe and effective for heavy smokers (Fredrickson, et al, 1995

The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities

Process and outcome evaluation of a novel online-only Tobacco Treatment Specialist (TTS) training program

Background Competency standards for tobacco treatment specialists and training have been formalized by the Association for Treating Tobacco Use and Dependence (ATTUD). To increase access to formalized TTS training in remote regions, we developed a novel online-only format incorporating video technologies. The purposes of the study were to: 1) evaluate and compare knowledge and skill acquisition using synchronous video-conferencing versus uploaded video content reviewed asynchronously; and 2) assess the fidelity of evaluating tobacco treatment specialist trainee knowledge and skills using standardized case presentations. Methods An observational pilot study design was used to evaluate the effectiveness of synchronous versus asynchronous online evaluation strategies. Twenty trainees were randomly assigned to synchronous (Zoom; n = 11) and asynchronous (YouTube; n = 9) groups to demonstrate skills using a standardized case scenario. All trainees then completed a written case study. Two independent raters evaluated the groups using a rubric and checklist. Results There were no significant differences in total mean scores between the two groups using the rubric. Intra-class correlation coefficient (ICC) between raters for total rubric scores were 0.68 in the synchronous group and 0.33 in the asynchronous group. For the checklist, trainees in the synchronous group had higher mean scores (19.1) than the asynchronous group (16.6; p=.03). Checklist ICC scores differed significantly between groups; 0.80 for synchronous and 0.41 for asynchronous. For the written case, there was a larger, but non-significant, increase in scores for the asynchronous group (1.5 versus 0.3 points). All participants achieved a passing written case score. Conclusions There was moderate to strong agreement between raters when using the synchronous method while the asynchronous method yielded weak agreement. Synchronous (Zoom) evaluation yielded higher mean assessment skill scores than asynchronous (YouTube) assessment. The synchronous evaluation trended toward lower variability in scores when compared to the written case; the standard evaluation used for all participants

Training Tobacco Treatment Specialists through Virtual Asynchronous Learning

Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years

Pharmacological Transdifferentiation of Human Nasal Olfactory Stem Cells into Dopaminergic Neurons

International audienc