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Curriculum for treating nicotine dependence in psychiatry

Institution: University of California, San Francisco
Investigator(s): Judith Prochaska, Ph.D., M.P.H.
Award Cycle: 2004 (Cycle 13) Grant #: 13KT-0152 Award: $269,500
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: New Investigator Awards

Initial Award Abstract
The overall goal of this line of research is to develop and evaluate a curriculum for psychiatry residency programs focused on identifying and treating tobacco dependence among one of the largest and most vulnerable yet understudied groups of smokers – individuals with mental illness. Smokers with mental illness and addictive disorders are estimated to account for 44% of cigarettes sold in the US and are at high risk for smoking-related deaths and disability, yet their tobacco use has been largely ignored by the mental health, addictions, and tobacco control communities. Psychiatry residency programs provide a unique arena for disseminating clinical treatment guidelines, impacting professional norms, and increasing access to tobacco cessation services among mentally ill smokers.

The specific aims of the proposed research are to evaluate, using a quasi-experimental design, a series of key hypotheses addressing the measured efficacy of a tobacco cessation curriculum for delivery in psychiatry residency training programs. The curriculum will be built upon an existing resource – Rx for Change, a tobacco cessation curriculum initially developed and evaluated in California Schools of Pharmacy, funded by the California Tobacco-Related Disease Research Program – and informed by comprehensive literature review, consultation with an Expert Advisory Group, and focus groups with psychiatry residents. To our knowledge, this would be the first curriculum specifically tailored to the clinical issues unique to treating smoking in psychiatry. We hypothesize that the curriculum will be associated with increases in psychiatry residents’ (N = 36) competence, confidence, and counseling behaviors for supporting cessation among their patients who use tobacco, with initial changes from pre- to post-training sustained at 3-months follow up. Residents’ tobacco cessation practices will be operationalized in terms of the National Cancer Institute’s “5 A’s” intervention for physicians to Ask about tobacco use, Advise tobacco users to quit, Assess readiness to quit, Assist with cessation, and Arrange follow up. A 6-month chart review of residents’ documented tobacco cessation practices will provide data on clinical contacts with approximately 900 patients over multiple visits. The costs associated with curriculum implementation will be determined, and portability of the training will be evaluated in a second psychiatry residency program.

Psychiatric treatment encounters provide an ideal but, as yet, untapped opportunity for treating this deadly addiction. Ultimately, this research could lead to a model tobacco cessation curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching this vulnerable and costly population of smokers.

Medical students' use of the stages of change model in tobacco cessation counseling.
Periodical: Journal of General Internal Medicine Index Medicus:
Authors: Prochaska, J.J., Teherani, A., & Hauer, K.E. ART
Yr: 2007 Vol: Nbr: 22 Abs: Pg: 223-227

Methods of quantifying change in multiple risk factor interventions.
Periodical: Preventive Medicine Index Medicus:
Authors: Prochaska, J.J., Velicer, W.F., Nigg, C.R., & Prochaska, J.O. ART
Yr: 2008 Vol: Nbr: 46 Abs: Pg: 260-265

Treating tobacco dependence in clinically depressed smokers: Effect of smoking cessation on mental health functioning.
Periodical: American Journal of Public Health Index Medicus:
Authors: Prochaska, J.J., Hall, S.M., Tsoh, J., Eisendrath, S., Rossi, J.S., Redding, C.A., Rosen, ART
Yr: 2008 Vol: Nbr: 98 Abs: Pg: 446-448

Multiple health behavior change research: An introduction and overview.
Periodical: Preventive Medicine Index Medicus:
Authors: Prochaska, J.J., Spring, B., Nigg, C.N. ART
Yr: 2008 Vol: Nbr: 46 Abs: Pg: 181-188

Changes in psychiatric patients' thoughts about quitting smoking during a smoke free hospitalization.
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Shmuelil, D., Fletcher, L., Hall, S.E., Hall, S.M., Prochaska, J.J. ART
Yr: 2008 Vol: 10 Nbr: Abs: Pg: 875-881

Tobacco use among individuals with schizophrenia: what role has the tobacco industry played?
Periodical: Schizophrenia Bulletin Index Medicus:
Authors: Prochaska, J.J., Hall, S.M., & Bero, L. ART
Yr: 2008 Vol: 34 Nbr: Abs: Pg: 555-567

Evaluating the validities of different DSM-IV based conceptual constructs of tobacco dependence.
Periodical: Addiction Index Medicus:
Authors: Hendricks, P.S., Prochaska, J.J., Humfleet, G. & Hall, S.M. ART
Yr: 2008 Vol: 103 Nbr: Abs: Pg: 1215-1223

Physical activity as a strategy for maintaining tobacco abstinence.
Periodical: Preventive Medicine Index Medicus:
Authors: Prochaska, J.J., Hall, S.M., Humfleet, G., Munoz, R., Reus, V., Gorecki, J., & Hu, D. ART
Yr: Vol: 47 Nbr: Abs: Pg: 215-220

Evaluation of an evidence-based tobacco treatment curriculum for psychiatry residency training programs.
Periodical: Academic Psychiatry Index Medicus:
Authors: Prochaska, J.J., Fromont, S.C., Leek, D., Hudmon, K., Louie, A.K., Jacobs, M.H., & Hall, S ART
Yr: Vol: Nbr: Abs: Pg:

Treatment of smokers with co-occuring disorders: emphasis on integration in mental health and addiction treatment settings.
Periodical: Annual Review of Clinical Psychology Index Medicus:
Authors: Hall, S.M., & Prochaska, J.J. ART
Yr: Vol: Nbr: Abs: Pg:

Resisting tempting foods and smoking behavior: implications from a self-control theory perspective.
Periodical: Health Psychology Index Medicus:
Authors: Shmueli, D., & Prochaska, J.J. ART
Yr: Vol: Nbr: Abs: Pg: