This research is designed to disseminate and evaluate adoption, implementation, and maintenance of an evidence-based tobacco treatment curriculum for psychiatry training programs focused on treating smokers with co-occurring psychiatric and addictive disorders. Individuals with mental illness and addictive disorders account for 44% to 46% of cigarettes sold in the US, equating to 175 billion cigarettes annually. Smokers with mental illness experience great difficulty with quitting 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. Prioritization of mental health treatment, lack of appreciation of the negative health effects of tobacco use, and beliefs that persons with mental illness are not able or willing to quit have contributed to the development of a culture in many treatment settings that accepts and normalizes tobacco use. Psychiatry training programs provide a unique arena for impacting professional norms and increasing access to tobacco cessation services among mentally ill smokers. Our curriculum can be viewed as a vehicle for systematic, dissemination of the clinical practice guidelines for treating tobacco dependence in psychiatric patients. The proposed research is responsive to TRDRP’s research priority on prevention and cessation of tobacco use and tobacco-related health disparities in California’s diverse populations, which include populations with co-addictions or mental disorders.
With TRDRP funding, we developed a 4-hour tobacco treatment curriculum for psychiatry residency training programs, called Rx for Change in Psychiatry. To our knowledge, our curriculum is the first specifically tailored to the clinical issues unique to treating tobacco dependence in smokers with co-occurring disorders. Evaluation of the curriculum in three psychiatry residency training programs in Northern California with 55 residents demonstrated significant changes in residents’ knowledge, attitudes, confidence, and counseling behaviors from pre- to post-training, with changes sustained at 3-months follow up.
The main objectives of the proposed dissemination research study are to evaluate, using a quasi-experimental design, statewide adoption, implementation, and maintenance of our evidence-based tobacco cessation curriculum in California and Arizona psychiatry residency training programs as well as extension of the curriculum to graduate psychiatric nursing programs. The dissemination plan follows Roger’s Diffusion of Innovations theory and Glasgow’s RE-AIM framework and uses a train-the-trainer model and innovative adherence and performance measures. The study’s primary aims are to: 1) Recruit two faculty members from each of the 20 California adult psychiatry residency training programs and 10 graduate psychiatric mental health nurse practitioner and clinical specialist programs to attend a full-day train-the-trainer event in San Francisco, CA, and provide faculty participants with sufficient knowledge and skills to implement the Rx for Change in Psychiatry curriculum at their training programs; 2) Attain a high level of curriculum adoption, implementation, and maintenance; 3) Evaluate curriculum adoption, delivery, maintenance, and efficacy, using a 5-tiered evaluation approach incorporating both process and outcome measures, and examining moderator/mediator effects; 4) Publicize and avail the curriculum materials to other allied mental health training programs; and 5) Develop a training system and online distribution portal for national dissemination of the Rx for Change in Psychiatry curriculum. The primary hypotheses of interest concern changes in resident/student knowledge, confidence, attitudes, behaviors, and skills following the curriculum and at 6-months follow up. Repeated measures analyses will be conducted, including relevant covariates and a clustering effect for training program. Ultimately, this research could lead to a model tobacco cessation curriculum that can be disseminated and implemented nationally and thereby effectively reach this vulnerable and costly population of smokers. |