Elsevier

Preventive Medicine

Volume 40, Issue 6, June 2005, Pages 888-895
Preventive Medicine

Statewide evaluation of a tobacco cessation curriculum for pharmacy students

https://doi.org/10.1016/j.ypmed.2004.10.003Get rights and content

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 7–8 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.

Results

A total of 493 students (82.3%) completed linkable pre- and post-training evaluations. Self-reported abilities, measured on a five-point scale, increased significantly from 1.89 ± 0.89 to 3.53 ± 0.72 (P < 0.001). Twenty-two percent of students rated their overall counseling 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.

Introduction

Tobacco use is a major cause of morbidity and mortality worldwide. Globally, an estimated 1.3 billion individuals currently smoke cigarettes or other forms of tobacco [1]. If current usage patterns remain unchanged, this number will increase to 1.7 billion smokers by the year 2025 [1]. Tobacco-attributable diseases are responsible for an estimated 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 aggressive and effective tobacco control interventions on a global scale [3]. Because even brief interventions from clinicians positively impact the cessation rates of tobacco users [4], [5], widespread implementation of effective tobacco cessation training programs for current and future health care providers should be an international priority.

In 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 not trained. Guidelines issued by the WHO and the United States Public Health Service (USPHS) recommend that all healthcare 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 [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. 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.

Section snippets

Participants and curriculum content

Study participants were Doctor of Pharmacy (Pharm.D.) students attending the University of California San Francisco (UCSF), the University of the Pacific (UOP), the University of Southern California (USC), or Western University of Health Sciences (WU) who received comprehensive 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 professional school.

The Rx for Change curriculum, which has

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 professional school; participants at WU (n = 91, 98.9% participation) were second-year students. For two of these schools

Discussion

Previous studies of tobacco cessation curricula in health professional schools have been evaluations of programs developed and implemented at a single institution [24], [25], [26], [27], [28], [29], [30], [31], [32]. 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, we observed a significant improvement in pharmacy students' self-rated confidence and ability for

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).

The hands-on

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