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Academic Strategies to Influence Evidence-Based Tobacco Cessation Practices

Academic Strategies to Influence Evidence-Based Tobacco Cessation Practices. Janie Heath PhD, APRN-BC, FAAN Associate Dean Academic Programs & Professor of Nursing University of Virginia, School of Nursing

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Academic Strategies to Influence Evidence-Based Tobacco Cessation Practices

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  1. Academic Strategies to Influence Evidence-Based Tobacco Cessation Practices Janie Heath PhD, APRN-BC, FAAN Associate Dean Academic Programs & Professor of Nursing University of Virginia, School of Nursing Former Associate Dean of Academics College of Nursing & Director, Tobacco Cessation Nursing Faculty Practice Group Georgia Health Sciences University

  2. Why Make Tobacco Control an Academic Initiative • 46 million adults smoke (18.4% of population) • GEORGIA = 19.5% prevalence • VIRGINIA = 16.4% • 1200 individuals DIE every day in U.S. because of tobacco use (450,000 / yr) • GEORGIA = 10,000 / yr • VIRGINIA = 9200 / yr • Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years—United States, 2005–2010. Morbidity and Mortality Weekly Report 2011;60(33):1207–12 [accessed 2012 June 3].

  3. Why Make Tobacco Control an Academic Initiative • It’s our MISSION • Improve health and reduce the burden of illness in society by discovering,disseminating,andapplying knowledgeof human health and disease • It’s our EXPERTISE • It’s our PASSION

  4. Why Make Tobacco Control an Academic Initiative It’s all about OPPORTUNITY to promote health! Major Responsibilities • Chief Academic Officer (CAO) for Accreditation and Outcomes Assessment • CAO, Curriculum/Program development • CAO, Regulation of Academic/Student Affairs & Contracts Academic/Enterprise-wide Engagement • Strategic Planning • New Financial Model: Responsibility Based Budget • University Assessment • Recent Funding • PI, HRSA DNP Acute Care APN Grant ($950,000) – 3 year • Ntl Panel, AHA, Effects of Smokeless Tobacco; Circulation 9/10 • Co-I, NIH, AA Family Intervention for Smoking Cessation – 5 year

  5. Student Reach with Tobacco Control – Rx for Change EDU • BSN - 361 students • Traditional • RN-BSN • MSN - 244 students • Clinical Nurse Leader • Primary Care NP • Acute Care NP and CNS • PMH NP and CNS • Health Mgmt Systems • Public Health Nursing Leadership • Post MS Certificate - 21 students • NP, CNS, Wound Ostomy Care • DNP - 38 students • PhD - 48 students • Doctoral exchange – 11 students • TOTAL Projected UVA Tobacco Control Reach: 2012 Fall Enrollment = 723 students

  6. Our MODEL for Optimal EBP Tobacco Cessation Outcomes Provide Research Funding: Organizations Federal Raise Awareness: Grassroots State National International Cessation Interventions= Standard of Nsg Practice Ensure Accountability: Licensure Certification Provide Training: Nsg EDU Nsg CE Provide Systems Support: Priority in Organizations Heath, J., Andrews, J. (2006). Translation of tobacco cessation interventions into clinical practice. Nursing Research, 55(4): S44-S50.

  7. The REAP Framework • National coalition of nurse educators established to help disseminate resources and information through a REAP framework for tobacco control • R = RESEARCH • E = EDUCATION • A = ADVOCACY • P= PRACTICE • Founder: Dr. Janie Heath (MCG) • Co-Founders: Dr. Jeannette Andrews, Medical University of South Carolina and Dr. Claudia Barone, University of Arkansas Medical Sciences • www.nurses4tobaccocontrol.org

  8. Application of REAPthrough Academic Partnerships • Georgetown University • Medical College of Georgia • University of Arkansas • Vanderbilt University • Medical University of South Carolina • University of Virginia Research Education Advocacy Practice

  9. Research: Workforce Development • To evaluate the effect of an advanced practice nurse driven EDU INTERVENTION to improve the effectiveness of tobacco cessation interventions among… • Acute Care Cardiology & Pulmonary Providers • PMH APRN Providers • Maternal Child Providers

  10. Application of the Theory of Reasoned Action Schematic drawing of Theory of Reasoned Action’s relationship to tobacco cessation interventions (TCI) adapted from Fishbein and Ajzen (2010)

  11. Overview of Studies • Pretest – Posttest; Descriptive Correlational Designs • Convenience Samples in large academic medical centers with healthcare providers • Fishbein-Azjen Theory of Reasoned Action Framework • INTERVENTION- Rx for Change Clinician Assisted Tobacco Cessation* (www.rxforchange.edu) a 1 Hour Interactive DVD Education Session • 43 item survey

  12. Overview of Selected Findings Self- Confidence Correlations Intention Scores TRA Beliefs Change Knowledge Scores Heath, J., Kelley, J., Andrews, J., Crowell, N., Corelli, R., Hudmon, K.S. (2007). Evaluation of a tobacco cessation curricular intervention among acute care nurse practitioner faculty member. American Journal of Critical Care, 16(3):284-289. Heath, J. & Amole, J. (podium). Tobacco Control and Mental Illness: Breaking Barriers through NP Education, Practice and Research. The 36th Annual Meeting of National Organization of Nurse Practitioner Faculties, Washington, DC; 4/17/10 Alices, M, Manghram, D, Heath, J., Bennett, S. & Joshua, T ( poster). Tobacco Cessation Interventions among Acute-Care Providers in Respiratory Units. The National Teaching Institute and Critical Care Exhibition Conference, Chicago, IL; 5/4/11. Amole, J., Heath, J., McLear, B,, & Thomas, J. (2012). Optimizing tobacco cessation strategies through an online continuing education program. Nursing Clinics of North America. 47: 71-79

  13. Education Research • To evaluate the effect of the Rx for Change Clinician Assisted Tobacco Cessation Curriculum Intervention among pre-licensure interdisciplinary healthcare students • Nursing, Dental Hygiene & Respiratory Therapy • COMMIT - CNLs

  14. Education Intervention: Rx For Change Clinician Assisted Tobacco Cessation Curriculum – • Based on USPHS Guideline and extensively reviewed by experts in tobacco control • Comprehensive > 350 CD-slides, ancillary handouts, evaluation measures, case studies • Selected Modules • Epidemiology • Forms of tobacco • Genes & tobacco use • Pathophysiology • Nicotine addiction • Pharmacotherapy • Counseling techniques • Access at www.rxforchange.ucsf.edu Rxfor change Authors: Karen Hudmon RPh, DrPH Robin Corelli PharmD

  15. Overview of Studies • Pretest – Posttest; Descriptive Correlational Designs • Convenience Samples in large academic medical centers with students • Fishbein-Azjen Theory of Reasoned Action Framework • INTERVENTION- Rx for Change Clinician Assisted Tobacco Cessation* (www.rxforchange.edu) a 3 Hour Interactive Education Sessions • 43 item survey

  16. Overview of Selected Findings Self- Confidence Correlations Intention Scores TRA Beliefs Change Knowledge Scores Inglett, S, Heath, J. (podium). Factors Influencing Undergraduate Nursing Students Intentions to Integrate Tobacco Cessation in Daily Practice. 5th Annual Uniting Practice, Education, and Research Conference, Beta Omicron & Pi Lambda Chapters, Sigma Theta Tau International, Augusta, GA; 2/23/10 Inglett, S., Schumacher, A., Kiernan, B., & Heath, J. (poster). The Effect of a Service Learning Project on CNL Student’s Knowledge, Confidence, Beliefs, & Intentions to Intervene with Tobacco Dependent Women. 26thAnnual SNRS Conf, New Orleans, LA, 2/18/12 Inglett, S., Schumacher, A., Kiernan, B., & Heath, J. (poster). Predictors for Intentions to Intervene with Tobacco Dependent Women: A CNL Student Learning Project. 16thAnnual Graduate Research Day, Georgia Health Sciences University, Augusta, GA 4/18/12 Kelley, J., Heath, J., Crowell, N. (2006). Using the Rx for change tobacco curriculum in advanced practice nursing education. Critical Care Nursing Clinics of North America,18(1): 131-138.

  17. Advocacy Outcomes • Tobacco Free Campus Initiative • College of Nursing faculty leadership • Student leadership • Service learning activities for students • March of Dimes project • Media coverage • The Augusta Chronicle • Local TV Stations

  18. Service Learning Outcomes for Students Great American Smoke Out • ~30 pre-licensure /yr • ~5 post-licensure /yr • ~ 4 faculty / yr Kick Butts Campaign • ~18 pre-licensure / yr • ~ 3 post-licensure / yr • ~ 2 faculty /yr Employee Wellness Health Fair • ~22 pre-licensure / yr • ~ 4 post-licensure / yr • ~ 2 faculty / yr GHSU NSG, Respiratory Therapy & Dental Hygiene

  19. Service Learning Outcomes for Students Circle Of Motivated MOMs for Infants to be Tobacco-free (COMMIT) • March of Dimes 12 mth funding • Recruit 24 tobacco dependent women of child bearing age to participate in a 6 wk evidence based tobacco cessation program & follow up GHSU NSG and 3rd yr Pharmacy Students

  20. Practice Outcomes To evaluate the effect of an advanced practice nurse driven tobacco cessation clinic on health and cessation outcomes among • GHSU employees, staff, faculty and students • Heath et al (2012). The impact of the Georgia Health Sciences University Nursing Faculty Practice on Tobacco Cessation Rates, NursClin N Am (47) 1-12. • PMH participants Funding per Tobacco Free Campus Initiative: University, Health System & Physician Practice Group

  21. Nursing Faculty Practice Group (NFPG) and Tobacco Control @ GHSU • How We Got There… • Administrative support • Dean Lucy Marion has long history of promoting faculty practice • All GHSU SON faculty receive 0.2 work effort for practice • New Facility • 3700 Square foot; full services from laboratory space to 5 exam rooms

  22. NFPG and Tobacco Control @ GHSU • How We Got There… • Faculty interest and expertise • 22 members (33%) of NFPG in active practice • 7 members (10%) of NFPG with tobacco control expertise • Financial incentive • 9% Dean’s fund, 9% Chair’s fund, 37% practice, 45% faculty

  23. NFPG and Tobacco Control @ GHSU How We Got There… Nov 29th, 2006 Town Hall Announcement; Nov 15th, 2007 Tobacco Free Campus

  24. The NFPG Tobacco Cessation Clinic GHSU Tobacco Cessation Program ~ weekly group sessions for 6 wks x 2 hours each ~ individual sessions for 4 wks x 2 hours each ~ telephone follow up 3mths, 6mths & 12mths • Our Providers • Medical Evaluation and Management • Janie Heath PhD, NP; Margo Henderson DNP, NP; Lovoria Williams MSN, NP; Pam Cromer MSN, NP • Collaborating Physician: Dr. Sara Young –MCG-HI Family Medicine • Behavioral Counseling • Nursing - Sharon Bennett DNP, CNS; Margaret Tuck MSN, CNS: Jack Amole DNP, CNS; • Allied Health – Susan Whiddon MS, RT • Our Staff • Jim Hawkins, NFPG Manager • Nita Sakovitz & Candice Yates, Clinic Coordinator • Plus STUDENTS!

  25. NFPG Tobacco Cessation Clinic • CLINICAL MEASURES: Objective: • Weight • Blood Pressure • Heart Rate • Carbon Monoxide (CO) Subjective (Self Report): • Medical & Tobacco History • Average Daily Cigarettes • Fagerstrom Level of Dependence Scale • CES-D Depression Scale • Readiness to Quit Ladder • Motivation to Quit Scale • Confidence to Quit Scale • Medication Tolerance

  26. EBP Treatment for Tobacco Dependence Counseling + Pharmacotherapy = Best Outcomes

  27. EBP Treatment for Tobacco Dependence A Successful Approach to Break the Cycle of Tobacco Dependence The PHYSICAL The BEHAVIOR The EMOTIONAL Automatic learned behavior with cigarettes Physical addiction of cravings & withdrawals Role of cigarettes in life—pleasure, stress, social Adapted from Legacy’s GSD&M Presentation 12/5/03 27

  28. NFPG Tobacco Cessation Clinic Outcomes N = 160 completed program; 2007 - 2009 Female n = 88 (55%) Male n = 72 (45%) • Heath et al (2012). NursClin N Am (47) 1-12.

  29. NFPG Tobacco Cessation Clinic Outcomes Married 53% Single 29% Divorced 15% Other 5% Demographic findings: n = 160 completed program; 2007-2009 • Heath et al (2012). NursClin N Am (47) 1-12.

  30. NFPG Tobacco Cessation Clinic Outcomes Caucasian 79% African American 18% Asian 3% Other 1% Demographic findings: n = 160 completed program; 2007-2009 • Heath et al (2012). NursClin N Am (47) 1-12.

  31. NFPG Tobacco Cessation Clinic Outcomes H&Ps x178 Evaluated Completed Program x160 Completed Start and Completion of Program: 2007 - 2009 • Heath et al (2012). NursClin N Am (47) 1-12.

  32. NFPG Tobacco Cessation Clinic Outcomes 123/178 (93.89%) attempted to quit before n = 160 completed program; 2007-2009 151 (85%) received Chantix as part of treatment at the NFPG Tobacco Cessation Clinic • Heath et al (2012). NursClin N Am (47) 1-12.

  33. NFPG Tobacco Cessation Pharmacotherapy Outcomes 95% Chantix Start Pack Chantix Continuation Pack NRT Zyban Chantix 75% 11% 3% 91% treated with medication (145/160) as mono-therapy or combination therapy: x6 NRT patch, x3 NRT gum, x5 NRT lozenge, x2 NRT inhaler; x4 Zyban; x138 Chantix; x15 No meds • Heath et al (2012). NursClin N Am (47) 1-12.

  34. NFPG Tobacco Cessation Clinic Outcomes HA 3% Constipation 3% Flatulence 5% Other 8% Sleeplessness 13% Vivid Dreams 34% Nausea 34% Comparison to Pfizer’s Phase 2 Trials of Chantix: Nausea = 30%; Insomnia = 18% Chantix Prescribing Information 2008 Insert, Pfizer, New York, NY Pharmacotherapy Outcomes: Chantix Side Effect Profile

  35. NFPG Tobacco Cessation Clinic Outcomes Group Session Quit Rate Individual Session Quit Rate 66% 64% 55% Collective Quit Rates Tobacco QUIT Rates @ End of 6 wk / 4 wk Treatment per Self Report & Carbon Monoxide Validation

  36. NFPG Tobacco Cessation Clinic Outcomes Follow Up Self- Report 3 mths 36% Follow Up Self- Report 6 mths 22% 16% Follow Up Self- Report 12 mths Collective Tobacco QUIT Rates (no response = lost to follow up and/or assumed to relapse)

  37. NFPG Tobacco Cessation Clinic Outcomes Analysis QUIT RATES at End of Tx, 3, 6 and 12 mths compared to… If Married p = .0312 Readiness to Quit Score p = .0034 Number of Group Sessions p = .0001 Number of Individual Sessions p = .0001

  38. Quit Rates for Mental Illness and/or Substance Abuse Substance Abuse 2/2 (100% - QUIT at 6 wktx) Bipolar 0/2 (0% - QUIT at 6 wk tx) Anxiety 5/6 (83% - QUIT at 6 wk tx) Multiple PMH Disorders 3/9 (33%) Depression 17/22 (77% - QUIT at 6 wktx) PMH Tobacco Cessation Outcomes: 27 of 39 (69%) QUIT Demographics: n = 39 with PMH Disorders (0.8%)

  39. NFPG Tobacco Cessation Clinic Outcomes for Mental Illness and/or Substance Abuse 39/39 (100%) attempted to quit before Demographics: n = 39

  40. NFPG Tobacco Cessation Clinic Outcomes for Mental Illness and/or Substance Abuse 79% on Chantix (31/39) 81% on Chantix (25/31) 85% Group Session (33/39) QUIT Rates: EOT 69%, 3mths 10%; 6mths 12%; 12mths 7%

  41. Academic Strategies to Influence Evidence-Based Tobacco Cessation Practices WORK!!! REAP into action for… Happy & Healthy EMPLOYEES/Patients! …and COUPLES..!

  42. THANK YOU Janie Heath PhD, APRN-BC, FAAN Janie.heath@virginia.edu

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