Evaluation of an Evidence-Based Tobacco Treatment Curriculum for Psychiatry Residency Training Programs

Abstract

Objective-Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness.Methods-The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in [2005][2006], using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California.Results-The curriculum was associated with improvements in psychiatry residents' knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre-to posttraining sustained at 3-months' follow-up. Residents' self-reported changes in treating patients' tobacco use were substantiated through systematic chart review.Conclusion-The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers.Nicotine dependence is the most prevalent substance abuse disorder among individuals with mental illness, with the prevalence of tobacco use two to four times that reported in the general population (1,2). Individuals with mental illness and addictive disorders are estimated to account for 44% to 46% of cigarettes sold in the United States (1,3), equating to the consumption of 187 billion cigarettes annually (4). Tobacco use adversely affects the duration and quality of life for patients with mental illness, is predictive of future suicidal behavior, and can reduce the therapeutic blood levels of some psychiatric medications (5-11). In terms of Address correspondence to Judith J. Prochaska, Ph.D., M.P.H., University of California, San Francisco, 401 Parnassus Ave -TRC 0984, San Francisco, CA 94143-0984; E-mail: JProchaska@ucsf.edu (e-mail). Manuscripts authored by an editor of Academic Psychiatry or by a member of its editorial board undergo the same editorial review process, including blinded peer review, applied to all manuscripts. Additionally, the Editor is recused from any editorial decision-making. lives saved, quality of life, and cost efficacy, treating smoking is considered one of the most important act...

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