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Post-certification training increases the likelihood of healthcare professionals intervening with smokers, which is likely to improve treatment outcomes.



Health professionals who have received training are significantly more likely to intervene with smokers than those who have not been trained. However, reviews of medical education both in the UK and the United States indicate continuing gaps in on tobacco cessation in curricula (Roddy et al., 2004; Spangler et al., 2002). For example, one cross-sectional survey study found that tobacco and smoking cessation education had increased in recent years in medical schools worldwide (N=561) with 27% reported including a specific module on tobacco in medical school curricula compared to only 11% of medical schools reporting on the same outcome 10 years prior (Richmond et al., 2009).  However, despite this increase in education over time, there is much room for improvement given that less than one third of surveyed schools included such training. The poor use of pharmacotherapies for cessation in the UK reflects the need for training and increased use of smoking cessation guidelines.  A survey reported in 2006 found relatively few British GPs and practice nurses initiating prescriptions for cessation pharmacotherapy: many more patients requested these drugs than were prescribed them on the advice of the clinician (Wilson et al., 2006). Stillman et al. (2006) emphasize the need for schools of public health to create comprehensive tobacco control education curricula, and the ASPH/Legacy Foundation Scholarship, Training, and Education Program for Tobacco Use Prevention (STEP UP) program has made a set of recommendations for such education, research, and training needs (Sheffer et al., 2006) However, no evidence shows that these interventions changed patient smoking behavior (Lancaster et al., 2002). Trials evaluating training by measuring patient outcomes are complex and costly to implement and there are few of them.

Medical education systems should support training in tobacco cessation to ensure health professionals have appropriate knowledge of tobacco use epidemiology, the health damage from tobacco use, evidence-based treatment options, and community/policy interventions, and to support them in continuing to update their knowledge and skills in tobacco control. Such educational efforts require proper funding, provisions that allow health professionals to attend continuing educational opportunities, and follow up (Raw et al., 1998).



Lancaster T, Fowler G. Training health professionals in smoking cessation. Cochrane Database of Systematic Reviews 2000, Issue 3.

Raw M, McNeill A, West R. Smoking cessation guidelines and their cost-effectiveness. Thorax. 1998; 53(Suppl.5, Part1): S1-S19.

Richmond R, Zwar N, Taylor R, Hunnisett J, Hyslop F. Teaching about tobacco in medical schools: A worldwide study. Drug Alcohol Rev. 2009; 28: 484–497.

Roddy E, Rubin P, J Britton, on behalf of the Tobacco Advisory Group of the Royal College of Physicians. A study of smoking and smoking cessation on the curricula of UK medical schools. Tobacco Control. 2004; 13: 74-77.

Sheffer C, Green L, Ramiah K, Raczynski J. Recommendations from the ASPH/Legacy Scholarship, Training, and Education Program for Tobacco Use Prevention (STEP UP) strategy planning meeting Chicago, May 3, 2005. Public Health Rep. 2006; 121(5): 629-633.

Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: current efforts and gaps in US medical schools. JAMA. 2002; 288(9): 1102-1109.

Stillman F, Wipfli H, Samet J. Reaching and educating the global tobacco control community: innovative approaches to tobacco control training. Public Health Rep. 2006; 121(5): 521-528.

Wilson A, Sinfield P, Rodgers S, Hammersley V, Coleman T
. Drugs to support smoking cessation in UK general practice: are evidence-based guidelines being followed? Qual Saf Health Care. 2006; 15(4): 284-288.

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