This activity is designed to change: Competence, Performance, Patient Outcome.8.25hr(s)
Activity Format:

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Overview

Goal: To educate students and providers in AHEC activities on tobacco cessation and prevention.

Professional Practice GapsHealthcare providers have the opportunity to provide tobacco interventions: 70% of smokers see a primary care clinician each year (CDC, 1993), and 70% of smokers report an interest in quitting (CDC, 2002b). However, despite the opportunity, patient interest, and evidence of treatment effectiveness, physicians still are not fully implementing guidelines in their practices.
Centers for Disease Control and Prevention. Smoking-attributable mortality, morbidity, and economic costs (SAMMEC). Adult SAMMEC and maternal and child health (MCH). 2002b. Available at: https://chronicdata.cdc.gov/Health-Consequences-and-Costs/Smoking-Attributable-Mortality-Morbidity-and-Econo/3kjq-j5dm Accessed on: 2010-06-15.
Centers for Disease Control. Use of smokeless tobacco among adults -- United States, 1991. MMWR Morb Mortal Wkly Rep. 1993; 42: 263-266.

Educational Objectives:

After completing this activity participants will be able to:
  • Discuss with patients the prevalence of tobacco use and tobacco-associated mortality

  • Apply motivational interviewing techniques in typical circumstances encountered in primary care with patients who have alcohol, tobacco, or other substance use problems

  • Consider the indications and contraindications, special precautions, and warnings for use of first-line smoking deterrent pharmacotherapies when providing tobacco interventions

  • Determine a patient's stage of quitting, and use it to choose the appropriate tobacco cessation intervention

  • Use an evidence-based, developmentally appropriate tobacco use prevention activity with children patients in a primary care practice

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.complies with the Standards for Commercial Support issued by the ACCME and requires disclosure of and resolution of any conflicts of interest for those in control of content.
Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.
Disclosure: Has disclosed no relevant financial relationships.
Mary P Metcalf, PhD, MPH (Vice President, Clinical Tools, Inc.)Mary Metcalf has had an interest in education since she first volunteer for the Insect Zoo at the Smithsonian in 1980. Since then, she has expanded her repertoire to include the development and assessment of medical and science education projects. She completed her undergraduate work at New College of Florida with a double major in Math and Anthropology, and graduate studies at the University of Virginia, in Anthropology. She worked in archaeology for 10 years, and is a Registered Professional Archaeologist. After her work in archaeology began to focus on education, she moved into health and medical education at Clinical Tools, Inc. in Pittsburgh, PA, where she also taught at Carnegie Mellon University from 1996-1998. Since relocating to Chapel Hill, NC, Dr. Metcalf has pursued additional education in public health, with an MPH from UNC-CH, and becoming a Certified Health Education Specialist (CHES). Dr. Metcalf brings her diverse background to Clinical Tools' project by concentrating on adult learning, and qualitative and quantitative assessment. She served as Principal Investigator for 3 SBIR Phase//Phase II projects, leading to EndingSuicide.com, and TobaccoCME.com, as well as BrainTrain4Kids.com. Dr. Metcalf enjoys doing yoga, anything that involves being outdoors, reading F/SF, and drinking black tea. Most of all, she enjoys spending time with her family, which includes three amazing and confusing children, and cleaning up the messes they leave behind.
Disclosure: Has disclosed no relevant financial relationships.
Charlie Mahan, MD (Dean Emeritus of the University of South Florida College of Public Health , On Behalf of the University of South Florida Area Health Education Center (AHEC))Dr. Charlie Mahan is Dean and Professor Emeritus in the College of Public Health at the University of South Florida and The Lawton and Rhea Chiles Center for Healthy Mothers and Babies. He holds a joint appointment as Professor, Department of Obstetrics and Gynecology in the USF College of Medicine. He serves as Interim President of the National Board of Public Health Examiners. A West Virginian, he received his MD degree from Northwestern University and did his residency training at the University of Minnesota where he returned to join the faculty. He moved to Florida in 1974 to be Professor of Obstetrics and Gynecology and Director of Ambulatory Services for Women at the University of Florida and Director of the North Central Florida Maternal and Infant Care Program and Florida Midwifery Resource center. He was Director of the Robert Wood Johnson Healthy Futures Program to Improve Infant Mortality in the southern states. He chaired the American College of Obstetrics and Gynecology (ACOG) Committee on Health Care for Underserved Women that developed U.S. Maternacare, a universal health coverage plan for all American women. In the early 1990s he also chaired a committee that developed the National Fetal and Infant Mortality Review program. He directed the State Health Department in Florida from 1988 to 1995 and was Dean of the College of Public Health at the University of South Florida from 1995 to 2002. He was elected to the Academy of Distinguished Alumni of West Virginia University and presented the Byford Outstanding Alumnus Award by Northwestern University Medical School. He has also been presented the Irwin Chabon Award by Lamaze International and the 2004 Martha May Eliot Award by the American Public Health Association for exceptional achievements in maternal and child health. He is Past President of the Association of State and Territorial Health Officials and was Chair of the Advisory Committee to the Director of the Centers for Disease Control and Prevention from 1997-2003. He is on the Board of Directors of the Frontier Nursing Service, and The Ounce of Prevention Fund of Florida. He also serves as statewide chairperson for the March of Dimes Florida Prematurity Prevention Campaign. He chairs the selection committee for the Blue Foundation's annual Sapphire Award.
Disclosure: Has disclosed no relevant financial relationships.
Carolyn Schlede, MD (Internal Medicine Attending and Director of the Smoking Cessation Clinic James A. Haley Veterans' Hospital, University of South Florida College of Medicine)Dr. Carolyn Schlede is an Attending physician with experience and expertise in smoking cessation. She graduated from Cornell and then received her medical degree from the University of Rochester School of Medicine and Dentistry. She did her residency in Internal Medicine at the University of South Florida. She is certified by the American Board of Internal Medicine and Geriatric Medicine. She has been active in smoking cessation since establishing the Smoking Cessation Clinic at the James A. Haley Veterans' Hospital in 1984. Since that time she has been instrumental in establishing and expanding smoking cessation programs at VA hospitals and clinics throughout Florida and Puerto Rico, as well as many hospitals and clinics in the private sector. She has given numerous Grand Rounds, train-the-trainer workshops, seminars, and other CME programs on smoking cessation throughout the United States. She has been invited to participate in planning committees for tobacco cessation programs for the VA, Department of Defense, American Cancer Society, American Lung Association, and AHEC. Dr. Schlede has presented her research results at national meetings as well as international meetings, including the World Conference on Tobacco or Health.
Disclosure: Has disclosed no relevant financial relationships.
David J Drobes, PhD (Associate Director of the Tobacco Research and Intervention Program, University of South Florida)David J Drobes, PhD., is Associate Director of the Tobacco Research and Intervention Program, and Senior Member in the Department of Health Outcomes and Behavior at the Moffitt Cancer Center, and he is Professor of Oncologic Sciences and Psychology at the University of South Florida. He received his doctorate in clinical psychology from Purdue University (1993). He completed post-doctoral fellowships at the University of Florida (1993-95) and the Medical university of South Carolina (1995-96), where he remained on the faculty in the Department of Psychiatry and Behavioral Sciences (1996-2002). Dr. Drobes' research program encompasses a biobehavioral perspective toward addictive behaviors, with a primary focus on genetic and environmental influences on nicotine/tobacco use, alcohol use, and their interactions. His current research is concerned with understanding tobacco craving and cue-elicited reactions using psychophysiological and neurocognitive paradigms, and translating basic laboratory findings into improved smoking cessation treatments. He has authored over 45 journal articles, and has been supported by approximately $3 million in federal research funding as Principal Investigator, and another $5 million as Co-Investigator Dr. Drobes is an active grant and manuscript reviewer, and currently serves as Associate Editor for the journal Nicotine and Tobacco Research.
Disclosure: Has disclosed no relevant financial relationships.
Clinical Tools, MD, MD (Company, CTI)Clinical Tools, Inc. (CTI) is a small, physician-run business dedicated to harnessing the potential of the Internet to create scalable, usable, and broadly available tools to improve the ability of physicians and other health care providers to care for patients. We achieve this goal by providing education and training to students and professionals and creating Web-based support tools for clinicians, researchers, and consumers. Information technology can and should serve as a stable framework that supports researchers and clinicians in their roles. We provide dissemination and management tools that empower clinicians and consumers to understand and control the vast amount of information related to making individual health choices. We serve our clients creatively, effectively, and with the highest quality of service.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Carolyn Schlede, MD (Internal Medicine Attending and Director of the Smoking Cessation Clinic James A. Haley Veterans' Hospital, University of South Florida College of Medicine)Dr. Carolyn Schlede is an Attending physician with experience and expertise in smoking cessation. She graduated from Cornell and then received her medical degree from the University of Rochester School of Medicine and Dentistry. She did her residency in Internal Medicine at the University of South Florida. She is certified by the American Board of Internal Medicine and Geriatric Medicine. She has been active in smoking cessation since establishing the Smoking Cessation Clinic at the James A. Haley Veterans' Hospital in 1984. Since that time she has been instrumental in establishing and expanding smoking cessation programs at VA hospitals and clinics throughout Florida and Puerto Rico, as well as many hospitals and clinics in the private sector. She has given numerous Grand Rounds, train-the-trainer workshops, seminars, and other CME programs on smoking cessation throughout the United States. She has been invited to participate in planning committees for tobacco cessation programs for the VA, Department of Defense, American Cancer Society, American Lung Association, and AHEC. Dr. Schlede has presented her research results at national meetings as well as international meetings, including the World Conference on Tobacco or Health.
Disclosure: Has disclosed no relevant financial relationships.
Peter Friedmann, MD (Associate Professor of Medicine and Community Health, Brown Medical School)Dr. Friedmann is a primary care physician, ASAM-certified addictionist, and substance abuse researcher. He is a nationally recognized expert on screening for substance use disorders in medical settings, the organization of care for patients with addictive disorders, and the role of the primary care physician in the diagnosis and treatment of substance problems. He has given several invited presentations on buprenorphine in primary care and on substance abuse treatment in primary care. He is a course director for ASAM's buprenorphine training series, a member of ASAM's Buprenorphine Training Subcommittee and a mentor in the SAMHSA-funded Physician Clinical Support System (www.pcssmentor.org). He is also president-elect for the Association for Medical Education and Research in Substance Abuse (www.amersa.org).
Disclosure: Has disclosed no relevant financial relationships.
Timothy John McGrath, MD, MBA (Family Physician, Private Practice )Dr. McGrath is currently in private practice in Mebane, North Carolina. He earned his undergraduate degree at Drew University and his medical degree at the Medical College of Georgia. He completed his residency at the University of North Carolina at Chapel Hill, where he served as Chief Resident in the Department of Family Medicine. His interests include preventive medicine and disease modifying lifestyles, medical delivery systems, and medical economics. He is currently enrolled in the Kenan Flagler executive master of business administration program at UNC. Dr. McGrath is an active member of the NCAFP, AAFP, and AMA.
Disclosure: Has disclosed no relevant financial relationships.
Ted Diedrich, MSc (SBIRT Progarm Coordinator; PhD Student, Denver Health and Hospital Authority, Denver, CO University of Colorado at Denver)
Disclosure: Has disclosed no relevant financial relationships.
Charlie Mahan, MD (Dean Emeritus of the University of South Florida College of Public Health , On Behalf of the University of South Florida Area Health Education Center (AHEC))Dr. Charlie Mahan is Dean and Professor Emeritus in the College of Public Health at the University of South Florida and The Lawton and Rhea Chiles Center for Healthy Mothers and Babies. He holds a joint appointment as Professor, Department of Obstetrics and Gynecology in the USF College of Medicine. He serves as Interim President of the National Board of Public Health Examiners. A West Virginian, he received his MD degree from Northwestern University and did his residency training at the University of Minnesota where he returned to join the faculty. He moved to Florida in 1974 to be Professor of Obstetrics and Gynecology and Director of Ambulatory Services for Women at the University of Florida and Director of the North Central Florida Maternal and Infant Care Program and Florida Midwifery Resource center. He was Director of the Robert Wood Johnson Healthy Futures Program to Improve Infant Mortality in the southern states. He chaired the American College of Obstetrics and Gynecology (ACOG) Committee on Health Care for Underserved Women that developed U.S. Maternacare, a universal health coverage plan for all American women. In the early 1990s he also chaired a committee that developed the National Fetal and Infant Mortality Review program. He directed the State Health Department in Florida from 1988 to 1995 and was Dean of the College of Public Health at the University of South Florida from 1995 to 2002. He was elected to the Academy of Distinguished Alumni of West Virginia University and presented the Byford Outstanding Alumnus Award by Northwestern University Medical School. He has also been presented the Irwin Chabon Award by Lamaze International and the 2004 Martha May Eliot Award by the American Public Health Association for exceptional achievements in maternal and child health. He is Past President of the Association of State and Territorial Health Officials and was Chair of the Advisory Committee to the Director of the Centers for Disease Control and Prevention from 1997-2003. He is on the Board of Directors of the Frontier Nursing Service, and The Ounce of Prevention Fund of Florida. He also serves as statewide chairperson for the March of Dimes Florida Prematurity Prevention Campaign. He chairs the selection committee for the Blue Foundation's annual Sapphire Award.
Disclosure: Has disclosed no relevant financial relationships.
David J Drobes, PhD (Associate Director of the Tobacco Research and Intervention Program, University of South Florida)David J Drobes, PhD., is Associate Director of the Tobacco Research and Intervention Program, and Senior Member in the Department of Health Outcomes and Behavior at the Moffitt Cancer Center, and he is Professor of Oncologic Sciences and Psychology at the University of South Florida. He received his doctorate in clinical psychology from Purdue University (1993). He completed post-doctoral fellowships at the University of Florida (1993-95) and the Medical university of South Carolina (1995-96), where he remained on the faculty in the Department of Psychiatry and Behavioral Sciences (1996-2002). Dr. Drobes' research program encompasses a biobehavioral perspective toward addictive behaviors, with a primary focus on genetic and environmental influences on nicotine/tobacco use, alcohol use, and their interactions. His current research is concerned with understanding tobacco craving and cue-elicited reactions using psychophysiological and neurocognitive paradigms, and translating basic laboratory findings into improved smoking cessation treatments. He has authored over 45 journal articles, and has been supported by approximately $3 million in federal research funding as Principal Investigator, and another $5 million as Co-Investigator Dr. Drobes is an active grant and manuscript reviewer, and currently serves as Associate Editor for the journal Nicotine and Tobacco Research.
Disclosure: Has disclosed no relevant financial relationships.
Clinical Tools, MD, MD (Company, CTI)Clinical Tools, Inc. (CTI) is a small, physician-run business dedicated to harnessing the potential of the Internet to create scalable, usable, and broadly available tools to improve the ability of physicians and other health care providers to care for patients. We achieve this goal by providing education and training to students and professionals and creating Web-based support tools for clinicians, researchers, and consumers. Information technology can and should serve as a stable framework that supports researchers and clinicians in their roles. We provide dissemination and management tools that empower clinicians and consumers to understand and control the vast amount of information related to making individual health choices. We serve our clients creatively, effectively, and with the highest quality of service.
Disclosure: Has disclosed no relevant financial relationships.

Review Dates

Content Review:Editorial Review:
Fri, 4/30/2010Fri, 4/30/2010

Modules in this Training Activity

  • Tobacco Cessation

  • Motivational Interviewing for Primary Care

  • Tobacco Cessation Pharmacotherapy

  • Tobacco: Children and Tobacco: Three Cases

  • SP: Julie: Pregnancy and Smoking

  • Tobacco in Older Adults

  • Tobacco: Smokeless Tobacco

  • Tobacco: Five Cases: Basic Tobacco Cessation Interventions

  • Tobacco: History of Florida's Tobacco Settlement

  • Tobacco Interventions With Tobacco Dependent Patients

  • Tobacco Medical Complications

  • Tobacco Addiction Neurobiology

  • SWAT (Students Working Against Tobacco)

  • Tobacco Cessation Pharmacotherapies

Module Practice Gap References
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Bricker JB, Leroux BG, Peterson AV Jr, Kealey KA, Sarason IG, Andersen MR, Marek PM.. Nine-year prospective relationship between parental smoking cessation and children's daily smoking. Addiction. 2003 ; 98(5): 585-93. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12751972
Brogan and Partners. Tobacco program research. Focus group research report . The Center for Social Gerontology Web site. 2001. Available at: http://www.tcsg.org/tobacco/BPCSG-Report_01.pdf
Burns DM. Cigarette smoking among the elderly: disease consequences and the benefits of cessation. Am J Health Promotion. 2000; 14(6): 357-61.
Butler C, Rollnick S, Cohen D, Russell I, Bachmann M, Stott N. Motivational counseling versus brief advice for smokers in general practice: a randomized trial. Br J Gen Pract. 1999; 49: 611-616.
Caraballo RS, Giovino GA, Pechacek TF, et al. Racial and ethnic differences in serum cotinine levels of cigarette smokers. JAMA. 1998; 280: 135-139.
Carey KB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Mental Health Journal. 1996; 32: 291-306.
Carlsson CM, Stein JH. Cardiovascular disease and the aging woman: overcoming barriers to lifestyle changes. Current Women's Health Reports. 2002; 2(5): 366-372.
Center for Tobacco Research and Intervention. Record number of Wisconsin senior smokers quit through Wisconsin Tobacco Quit Line Program . Press Release. 2003.
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Centers for Disease Control and Prevention. Cigarette smoking among adults -- United States, 2003. Morbidity and Mortality Weekly Report. 2005; 54(20): 509-513.
Centers for Disease Control and Prevention. Cigarette smoking among adults -- United States, 2005. Morbidity and Mortality Weekly Report. 2006; 55(42): 1145-1148.
Centers for Disease Control and Prevention. Cigarette smoking among adults -- United States, 2005–2014. Morbidity and Mortality Weekly Report. 2007; 65(44): 1233-1240.
Centers for Disease Control and Prevention. Cigarette smoking among adults -- United States, 2007. Morbidity and Mortality Weekly Report. 2008; 57(45): 1221-1226.
Centers for Disease Control and Prevention. Cigarette smoking-attributable morbidity -- United States. MMWR Morb Mortal Wkly Rep. 2003; 52(35): 842-4.
Centers for Disease Control and Prevention. Cigarette use among high school students -- United States, 1991-2003. MMWR Morb Mortal Wkly Rep. 2004; 53(23): 499-502.
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Centers for Disease Control and Prevention. Smoking & Tobacco Use. CDC Website. 2003. Available at: http://www.cdc.gov/tobacco/ Accessed on: 2010-06-15.
Centers for Disease Control and Prevention. Smoking-attributable mortality, morbidity, and economic costs (SAMMEC). Adult SAMMEC and maternal and child health (MCH). 2002b. Available at: https://chronicdata.cdc.gov/Health-Consequences-and-Costs/Smoking-Attributable-Mortality-Morbidity-and-Econo/3kjq-j5dm Accessed on: 2010-06-15.
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US Dept of Health and Human Services. Women and Smoking: A Report of the Surgeon General -- 2001. Atlanta, Ga: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 2001.
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Audience and Accreditation

Audience:

Students and providers in the Florida AHEC network

A letter of completion for up to 8.25 hour(s) is available for non-physicians.
A score of 70% on the post-test is required to complete the activity.
Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

Training Activity References
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Agency for Healthcare Research and Quality. Screening for abdominal aortic aneurysm. What's new from the USPSTF?. AHRQ Website. AHRQ Publication 05-IP002. February 2005. Available at: http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/abdominal-aortic-aneurysm-screening Accessed on: 2004-04-04.
Ahijevych KL, Tyndale RF, Dhatt RK, Weed HG, Browning KK. Factors influencing cotinine half-life during smoking abstinence in African American and Caucasian women. Nicotine Tob Res. 2002; 4(4): 423-431.
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FundingInitial development of this activity was supported by a grant from the National Heart, Lung, and Blood Institute (#R44HL65885).