North Carolina AHEC Program
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Counseling for Change: An Online Tobacco Cessation Course

In 1998, Forsyth County in North Carolina had an exceedingly high infant mortality rate of 12.5 per 1000 live births. That rate exceeded the North Carolina rate of 10.2 and was the highest of the five metropolitan counties in the state.

With the help of a grant from The Duke Endowment, an initiative was launched by Northwest AHEC. The overarching goal was to improve the smoking cessation services offered to women of childbearing age in order to reduce their risk of having a low birth weight or premature infant. In partnership with many agencies, a variety of approaches - including didactic education for health care providers and referrals to a local tobacco counseling telephone service - was implemented in an effort to help women stop smoking.

Tobacco continues to be one of the leading causes of preventable disease and premature mortality in the United States today. Health care providers can have a tremendous impact on reducing the rates of tobacco use and preventing unnecessary disease and death through tobacco cessation counseling offered to patients. An online course was developed at the end of The Duke Endowment grant to sustain the educational efforts. The current online course was expanded to include tools to enhance the skills of health care providers working with both men and women across the lifespan.

At the conclusion of the course, the participant will apply skills in counseling patients in tobacco cessation, explain the stages of change for use in tobacco cessation counseling, state the 5 A's used in counseling, and utilize the brief intervention model when counseling patients to quit.

The online course includes counseling for smoking cessation, exposure to second hand smoke (SHS), and the use of smokeless tobacco. The target audience consists of physicians, nurses, dentists, pharmacists, mental, public and allied health professionals. Formal continuing education credit of five contact hours is available. Topics in the five course modules include a behavior change model, the 5 A’s “gold standard” for counseling, nicotine withdrawal symptoms/treatment, and resources. The course consists of several case studies; two scenarios are presented involving women – a pregnant female and a school-age girl with asthma related to SHS. Other cases studies involve a teenage boy using smokeless tobacco and an older man who is a chronic smoker.

The course has been completed by 474 participants since its inception in 2005. Participants represent all disciplines in 18 states, including North Carolina. As a result of the initial grant, the course was expanded from the targeted focus on infant mortality to currently addressing global issues related to tobacco use. Physician advice and encouragement have been shown to increase the number of patients who will attempt and succeed in quitting smoking. Recent studies suggest that physician interventions have the potential to increase long-term abstinence rates to 30% from only 7% among adult smokers attempting to quit on their own.

Northwest AHEC's Mona Brown Ketner, RN, MSN, C-EFM, and Nedra Edwards Hines, MHA, lead this effort.