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Dissemination of the Rx for Change in Psychiatry Curriculum

Institution: University of California, San Francisco
Investigator(s): Judith Prochaska, Ph.D., M.P.H.
Award Cycle: 2008 (Cycle 17) Grant #: 17RT-0077 Award: $409,106
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Research Project Awards
Abstracts

Initial Award Abstract
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.
Publications

Designing for dissemination: Development of an evidence-based tobacco treatment curriculum for psychiatry training programs.
Periodical: Journal of the American Psychiatric Nurses Association Index Medicus:
Authors: Prochaska JJ; Fromont SC; Hudmon K Cataldo JK ART
Yr: 2009 Vol: Nbr: 15 Abs: Pg: 24-31

Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and_x000d_ addiction treatment settings
Periodical: Annual Review of Clinical Psychology Index Medicus:
Authors: Hall, S.M., & Prochaska, J.J. ART
Yr: 2009 Vol: 5 Nbr: Abs: Pg: 409-431

Ten critical reasons for treating tobacco dependence in inpatient psychiatry
Periodical: Journal of the American Psychiatric Nurses Association Index Medicus:
Authors: Prochaska, J.J. ART
Yr: 2009 Vol: 15 Nbr: Abs: Pg: 404-409

Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction?
Periodical: Drug and Alcohol Dependence Index Medicus:
Authors: Prochaska, J.J. ART
Yr: 2010 Vol: 110 Nbr: Abs: Pg: 177-182

Integrating tobacco treatment into mental health settings
Periodical: JAMA: Journal of the American Medical Association Index Medicus:
Authors: Prochaska, J.J. ART
Yr: 2010 Vol: 304 Nbr: Abs: Pg: 2534-2535

Smoking cessation: an integral part of lung cancer treatment
Periodical: Oncology Index Medicus:
Authors: Cataldo, J.K., Dubey, S., Prochaska, J.J. ART
Yr: 2010 Vol: 78 Nbr: Abs: Pg: 289-301

Cigarette smoking is a risk factor for Alzheimer's disease: an analysis controlling for tobacco industry affiliation
Periodical: Journal of Alzheimer's Disease Index Medicus:
Authors: Cataldo, J.K., Prochaska, J.J., & Glantz, S.A. ART
Yr: 2010 Vol: 19 Nbr: Abs: Pg: 465-480

The effect of exposure to smoking scenes in films on immediate smoking: a controlled laboratory study
Periodical: American Journal of Preventative Medicine Index Medicus:
Authors: Shmueli, D., Prochaska, J.J., & Glantz, S.A. ART
Yr: 2010 Vol: 38 Nbr: Abs: Pg: 351-358

Reaching young adult smokers through the internet: comparison of three recruitment_x000d_ mechanisms
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Ramo, D., Hall, S.M., & Prochaska, J.J. ART
Yr: 2010 Vol: 12 Nbr: Abs: Pg: 768-775

A population-based examination of cigarette smoking and mental illness for_x000d_ African Americans
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Hickman, N.J., Delucchi, K, & Prochaska, J.J. ART
Yr: 2010 Vol: 12 Nbr: Abs: Pg: 1125-1132

Smoking and mental illness: Breaking the link
Periodical: New England Journal of Medicine Index Medicus:
Authors: Prochaska, J.J. ART
Yr: 2011 Vol: 365 Nbr: Abs: Pg: 196-198

A review of multiple health behavior change interventions for primary prevention.
Periodical: American Journal of Lifestyle Medicine Index Medicus:
Authors: Prochaska, J.J. & Prochaska, J.O. ART
Yr: 2011 Vol: 5 Nbr: Abs: Pg: 208-221

Screening for research consent capacity in the inpatient psychiatry setting
Periodical: Journal of Empirical Research on Human Research Ethics Index Medicus:
Authors: Hickman NJ, Prochaska JJ, Dunn LB. ART
Yr: 2011 Vol: 6 Nbr: Abs: Pg: 65-72

An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder
Periodical: Bipolar Disorder Index Medicus:
Authors: Prochaska, J.J., Reyes, R.S., Schroeder, S.A., Doederlein, A., Daniels, A.S., Bergeson, B. ART
Yr: 2011 Vol: 13 Nbr: Abs: Pg: 466-473

Treatment of dependent smokers with extended cognitive behavioral and medication treatment
Periodical: American Journal of Public Health Index Medicus:
Authors: Hall, S.M., Humfleet, G.L., Muòoz, R.F., Reus, V.I., Prochaska, J.J., Robbins, J.A. ART
Yr: 2011 Vol: 101 Nbr: Abs: Pg: 2349-2356

Reliability and validity of self-reported smoking in an anonymous online survey with_x000d_ young adults
Periodical: Health Psychology Index Medicus:
Authors: Ramo, D., Hall, S.M., & Prochaska, J.J. ART
Yr: 2011 Vol: 30 Nbr: Abs: Pg: 693-701

Cardiology Rx for Change: improving clinical attention to tobacco use and secondhand smoke exposure in cardiology
Periodical: Clinical Cardiology Index Medicus:
Authors: Prochaska, J.J., Benowitz, N.L., Glantz, S.A., Hudmon, K., & Grossman, W. ART
Yr: 2011 Vol: 34 Nbr: Abs: Pg: 738-743

Cigarette smoking and serious psychological distress: A population-based study of California adults
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Sung, H-Y, Prochaka, J.J., Max, W., Shi, Y., Ong, M., Hu, T-W. ART
Yr: 2011 Vol: 13 Nbr: Abs: Pg: 1183-1192

A test of positive affect induction for countering self-control depletion in cigarette smokers.
Periodical: Psychology of Addictive Behaviors Index Medicus:
Authors: Shmueli, D., & Prochaska, J.J. ART
Yr: 2011 Vol: 26 Nbr: Abs: Pg: 157-161

Tobacco and marijuana use among adolescents and young adults: A systematic review_x000d_ of their co-use.
Periodical: Clinical Psychology Review Index Medicus:
Authors: Ramo, D.E., Liu, H., & Prochaska, J.J. ART
Yr: 2012 Vol: 32 Nbr: Abs: Pg: 105-121

Prevalence and co-use of marijuana among young adult cigarette smokers: an anonymous_x000d_ online national survey
Periodical: Addiction Science and Clinical Practice Index Medicus:
Authors: Ramo, D.E., & Prochaska, J.J. ART
Yr: 2012 Vol: 7 Nbr: Abs: Pg: 5

Broad reach and targeted recruitment using Facebook for an online survey of young adult_x000d_ substance use.
Periodical: Journal of Medical Internet Research Protocols Index Medicus:
Authors: Ramo, D.E., & Prochaska, J.J. ART
Yr: 2012 Vol: 14 Nbr: Abs: Pg: e28

Medical students' attention to multiple risk behaviors: a randomized standardized patient examination
Periodical: Journal of General Internal Medicine Index Medicus:
Authors: Prochaska, J.J., Gali, K., Miller, B., & Hauer, K.E. ART
Yr: 2012 Vol: 27 Nbr: Abs: Pg: 700-707

Validation study of the K6 scale as an indicator of subthreshold mental distress.
Periodical: International Journal of Methods in Psychiatric Research Index Medicus:
Authors: Prochaka, J.J., Sung, H-Y, Max, W., Shi, Y., Ong, M., Hu, T-W. ART
Yr: 2012 Vol: 21 Nbr: Abs: Pg: 88-97

Meta-analysis of varenicline use and treatment-emergent cardiovascular events
Periodical: British Medical Journal Index Medicus:
Authors: Prochaska, J.J., & Hilton, J.F. ART
Yr: 2012 Vol: 344 Nbr: Abs: Pg: e2856

Twitter = Quitter? An analysis of Twitter quit smoking social networks.
Periodical: Tobacco Control Index Medicus:
Authors: Prochaska, J.J., Pechmann, C., Kim, R., & Leonhardt, J.M. ART
Yr: 2012 Vol: 21 Nbr: Abs: Pg: 447e449

Counseling nondaily smokers about secondhand smoke as a cessation message:_x000d_ a pilot randomized trial
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Schane, R.M., Prochaska, J.J., & Glantz, S.A. ART
Yr: 2013 Vol: 15 Nbr: Abs: Pg: 334-342

Correlates of tobacco dependence and motivation to quit among emerging adults in mental health treatment.
Periodical: Drug and Alcohol Dependence Index Medicus:
Authors: Grana, R.A., Ramo, D.E., Fromont, S.C., Hall, S.M., & Prochaska, J.J. ART
Yr: 2012 Vol: 125 Nbr: Abs: Pg: 127-31