8:00 a.m. – 8:30 a.m Registration
8:30 am – 8:35 am Introduction and Objectives Lorinda L. Coan, LDH, MS
8:35 am – 9:35 am Nicotine Dependence 101 Dr. Arden Christen
9:35 am - 9:45 am Break
9:45 am – 10:15 am Oral health and Tobacco Dr. Arden Christen L. Coan
10:15 am – 11: 15 am Systemic Health and Tobacco Dr. Stephen Jay 
11:15 am – 11:30 am Molecular Biology of Tobacco Dr. Jack Windsor
11:30 am – 12:15 pm Pharmacotherapy and Cessation Aids Dr. Laura Romito
12:15 pm – 1:15 pm Lunch
1:15 pm – 2:45 pm Behavioral Interventions Lorinda L. Coan, LDH, MS
2:45 pm – 3:00 pm Break
3:00 pm– 3:45 pm The Office Model for Implementing  a Tobacco Cessation Program   Lorinda L. Coan, LDH, MS 
3:45 pm – 4:15 pm   Community Partners and Resources   Department of Health County   Representatives
4:15 pm – 4:30 pm Course Wrap Up Lorinda L. Coan, LDH, MS
4:30 PM Adjournment  

Table 1. Agenda for the Continuing Education Course, “Tobacco Cessation in Clinical Practice-A Team Approach”

CE Location

County

Smoking Rate (2011)

Goshen

Elkhart

21%

Lafayette

Tippecanoe

17%

Madison

Jefferson

28%

Richmond

Wayne

28%

Tell City

Perry

26%

Vincennes

Knox

31%

Indiana (overall)

 

25.6%

Table 2: Tobacco Use Rates by Location of Continuing Education Course

 

Question

Total N

Great (1)

Moderate (2)

Slight (3)

None (4)

Mean (SD)

Before

Q1: Knowledge of oral effects of tobacco

248

46 (19%)

165 (67%)

37 (15%)

0 (0%)

2.0 (0.6)

 

Q2: Clear understanding nicotine addiction

248

23 (9%)

126 (51%)

98 (40%)

1 (0%)

2.3 (0.6)

 

Q3: Knowledge of pharm of NRT, bupropion and varenicline

247

7 (3%)

49 (20%)

158 (64%)

33 (13%)

2.9 (0.7)

 

Q4: Knowledge of NRT, bupropion, varenicline dosing requirements

248

6 (2%)

27 (11%)

86 (35%)

129 (52%)

3.4 (0.8)

 

Q5: Knowledge of adverse effects of NRT, Bupropion, varenicline

246

7 (3%)

30 (12%)

116 (47%)

93 (38%)

3.2 (0.8)

 

Q6: Knowledge of communication techniques for tobacco cessation

247

10 (4%)

85 (34%)

135 (55%)

17 (7%)

2.6 (0.7)

 

Q7: Knowledge of selection of community and state resources

247

9 (4%)

35 (14%)

143 (58%)

60 (24%)

3.0 (0.7)

 

Q8: Clear understanding ISDH local community resources services

246

5 (2%)

25 (10%)

126 (51%)

90 (37%)

3.2 (0.7)

 

Q9: Clear understanding of Quitline service

246

12 (5%)

26 (11%)

101 (41%)

107 (43%)

3.2 (0.8)

Immediate

Q1: Knowledge of oral effects of tobacco

247

211 (85%)

35 (14%)

1 (0%)

0 (0%)

1.1 (0.4)

 

Q2: Clear understanding nicotine addiction

248

203 (82%)

44 (18%)

1 (0%)

0 (0%)

1.2 (0.4)

 

Q3: Knowledge of pharm of NRT, bupropion and varenicline

247

149 (60%)

91 (37%)

7 (3%)

0 (0%)

1.4 (0.5)

 

Q4: Knowledge of NRT, bupropion, varenicline dosing requirements

247

129 (52%)

106 (43%)

12 (5%)

0 (0%)

1.5 (0.6)

 

Q5: Knowledge of adverse effects of NRT, Bupropion, varenicline

247

135 (55%)

103 (42%)

9 (4%)

0 (0%)

1.5 (0.6)

 

Q6: Knowledge of communication techniques for tobacco cessation

246

183 (74%)

60 (24%)

3 (1%)

0 (0%)

1.3 (0.5)

 

Q7: Knowledge of selection of community and state resources

247

148 (60%)

91 (37%)

8 (3%)

0 (0%)

1.4 (0.6)

 

Q8: Clear understanding ISDH local community resources services

244

120 (49%)

105 (43%)

18 (7%)

1 (0%)

1.6 (0.6)

 

Q9: Clear understanding of Quitline service

245

170 (69%)

67 (27%)

8 (3%)

0 (0%)

1.3 (0.5)

3 month

Q1: Knowledge of oral effects of tobacco

136

90 (66%)

44 (32%)

2 (1%)

0 (0%)

1.4 (0.5)

 

Q2: Clear understanding nicotine addiction

135

75 (56%)

58 (43%)

2 (1%)

0 (0%)

1.5 (0.5)

 

Q3: Knowledge of pharm of NRT, bupropion and varenicline

136

21 (15%)

83 (61%)

32 (24%)

0 (0%)

2.1 (0.6)

 

Q4: Knowledge of NRT, bupropion, varenicline dosing requirements

136

17 (13%)

60 (44%)

49 (36%)

10 (7%)

2.4 (0.8)

 

Q5: Knowledge of adverse effects of NRT, Bupropion, varenicline

136

18 (13%)

73 (54%)

40 (29%)

5 (4%)

2.2 (0.7)

 

Q6: Knowledge of communication techniques for tobacco cessation

136

71 (52%)

55 (40%)

10 (7%)

0 (0%)

1.6 (0.6)

 

Q7: Knowledge of selection of community and state resources

136

56 (41%)

60 (44%)

20 (15%)

0 (0%)

1.7 (0.7)

 

Q8: Clear understanding ISDH local community resources services

135

56 (41%)

56 (41%)

20 (15%)

3 (2%)

1.8 (0.8)

 

Q9: Clear understanding of Quitline service

134

76 (57%)

42 (31%)

14 (10%)

2 (1%)

1.6 (0.7)

Table 3: Clinicians’ Self-Reported Tobacco Dependence and Treatment Knowledge Before, Immediately After, and 3 Months After the Tobacco CE Program

Time

Question

Total N

Strongly Agree (1)

Agree (2)

Undecided (3)

Disagree (4)

Strongly Disagree (5)

Mean (SD)

Immediate

Q10: will improve ability to play active role in team plan

247

92 (37%)

142 (57%)

12 (5%)

0 (0%)

1 (0%)

1.7 (0.6)

 

Q11: will improve ability to use communication strategies

247

115 (47%)

128 (52%)

3 (1%)

0 (0%)

1 (0%)

1.6 (0.6)

 

Q12: will implement the brief tobacco intervention strategies

246

69 (28%)

139 (57%)

36 (15%)

2 (1%)

0 (0%)

1.9 (0.7)

 

Q13: will refer interested patients to local resources

246

102 (41%)

132 (54%)

10 (4%)

2 (1%)

0 (0%)

1.6 (0.6)

 

Q14: will refer interested patients to the Indiana Quitline

244

129 (53%)

104 (43%)

9 (4%)

1 (0%)

1 (0%)

1.5 (0.6)

3 month

Q10: currently play active role in team based tobacco cessation

130

10 (8%)

68 (52%)

22 (17%)

22 (17%)

8 (6%)

2.6 (1.1)

 

Q11: applying the communication strategies learned in the course

129

23 (18%)

86 (67%)

13 (10%)

4 (3%)

3 (2%)

2.1 (0.8)

 

Q12: implemented brief tobacco intervention strategies

128

15 (12%)

75 (59%)

18 (14%)

15 (12%)

5 (4%)

2.4 (1.0)

Table 4: Clinicians’ Self-Reported Intention to Implement Tobacco Intervention Behaviors and Actual Implementation 3 Months Post-CE

Time

Question

Total N

0

1-5

6-10

11-15

16 or more

3 month

Q14: #pts referred to local counselors since CE program

130

62 (48%)

58 (45%)

8 (6%)

0 (0%)

2 (2%)

3 month

Q15: # pts referred to Indiana Quitline since CE program

133

50 (38%)

64 (48%)

12 (9%)

3 (2%)

4 (3%)

Table 5: Clinicians’ Self-Reported Referrals to Local Cessation Resources and Indiana Tobacco Quitline 3 Months Post-CE

 

 

 

3 month

 

 

 

 

 

 

 

Referral

Immediate

Total N

0

1-5

6-10

11-15

16 or more

Mean (SD)

p-value

Correlation

Local

Strongly Agree (1)

58

32 (55%)

22 (38%)

4 (7%)

0 (0%)

0 (0%)

1.5 (0.6)

0.0700

0.16

 

Agree (2)

65

28 (43%)

31 (48%)

4 (6%)

0 (0%)

2 (3%)

1.7 (0.8)

 

 

 

Undecided (3)

3

0 (0%)

3 (100%)

0 (0%)

0 (0%)

0 (0%)

2.0 (0.0)

 

 

 

Disagree (4)

1

0 (0%)

1 (100%)

0 (0%)

0 (0%)

0 (0%)

2.0 (.)

 

 

Quitline

Strongly Agree (1)

77

30 (39%)

36 (47%)

7 (9%)

1 (1%)

3 (4%)

1.8 (0.9)

0.7427

0.02

 

Agree (2)

49

16 (33%)

26 (53%)

4 (8%)

2 (4%)

1 (2%)

1.9 (0.9)

 

 

 

Undecided (3)

4

2 (50%)

1 (25%)

1 (25%)

0 (0%)

0 (0%)

1.8 (1.0)

 

 

 

Strongly Disagree (5)

1

1 (100%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

1.0 (.)

 

 

Table 6: Numbers of Patients Referred to Local Cessation Resources and Indiana Tobacco Quitline Reported by Clinicians’ 3 Months Post-CE

 Time

Immediate

3 Month

p-value

Survey Question

Total N

Yes

Total N

Yes

 

Q15: Tobacco cessation resources are currently provided

241

85 (35%)

NA

NA

 

Q16: Resources-Literature display in reception area

245

47 (19%)

133

32 (24%)

 

Q16: Resources-Literature display in treatment area

245

50 (20%)

133

44 (33%)

p=0.0173

Q16: Resources-Video in treatment area

245

4 (2%)

133

4 (3%)

 

Q16: Resources-Distributed directly to patient

245

53 (22%)

132

66 (50%)

p<.0001

Q16: Resources-Practice website

245

4 (2%)

133

4 (3%)

 

Q16: Resources-Other

245

11 (4%)

133

13 (10%)

 

Q17: Barrier-Lack of time to distribute resources

240

29 (12%)

133

27 (20%)

 

Q17: Barrier-Lack of time to discuss resources

240

48 (20%)

132

16 (12%)

 

Q17: Barrier-Patient acceptance

240

30 (13%)

132

39 (30%)

p=0.0004

Q17: Barrier-Lack of referral agencies in area

240

19 (8%)

132

49 (37%)

 

Q17: Barrier-Locating and obtaining resources

240

49 (20%)

132

9 (7%)

p=0.0003

Q17: Barrier-Space for resource materials

240

23 (10%)

132

10 (8%)

 

Q17: Barrier-Cost of resource materials

240

28 (12%)

132

17 (13%)

 

Q17: Barrier-Other

240

30 (13%)

132

11 (8%)

 

Q18: Prescribe/Recommend NRT gum

245

51 (21%)

132

17 (13%)

p=0.0082

Q18: Prescribe/Recommend NRT lozenge

245

20 (8%)

132

30 (23%)

p=0.0009

Q18: Prescribe/Recommend NRT patch

245

45 (18%)

132

55 (42%)

p=0.0431

Q18: Prescribe/Recommend NRT inhaler

245

7 (3%)

132

30 (23%)

 

Q18: Prescribe/Recommend NRT nasal spray

245

5 (2%)

132

46 (35%)

 

Q18: Prescribe/Recommend NRT bupropion

245

13 (5%)

132

9 (7%)

 

Q18: Prescribe/Recommend NRT varenicline

245

30 (12%)

132

4 (3%)

p=0.0330

Q18: Prescribe/Recommend no pharmacotherapy

245

135 (55%)

132

16 (12%)

 

Table 7: Clinician’s Self-Reported Tobacco Cessation Resources and Perceived Barriers Before and 3 Months Post-CE