title: Cardiology Rx for Change: improving clinical attention to tobacco use and secondhand smoke exposure in cardiology.
abstract: BACKGROUND
  Heart disease is the leading cause of tobacco-related death in smokers and of deaths due to secondhand smoke (SHS) exposure in nonsmokers. This study centers on the development and evaluation of an evidence-based model curriculum for improving clinical attention to tobacco use and SHS exposure in cardiology.
  
  
  OBJECTIVE
  We hypothesized that the curriculum would be associated with improvements in clinician tobacco-related knowledge, attitudes, confidence, and counseling behaviors from pre-to post-training and at the 3-month follow-up.
  
  
  METHODS
  The 1-hour Cardiology Rx for Change curriculum was evaluated with 22 cardiology fellows and 77 medical residents with consistent training effects observed between the 2 groups.
  
  
  RESULTS
  Trainees' tobacco treatment knowledge increased significantly from pre- to post-training (t[81] = 6.51, P<0.001), and perceived barriers to providing cessation treatment decreased significantly (t[81] = -3.97, P<0.001). The changes, however, were not sustained at the 3-month follow-up, suggesting the need for booster training efforts. From pretraining to 3-month follow-up, the training was associated with significant sustained gains in clinician confidence for treating tobacco dependence (t[61] = 3.69, P = 0.001) and with improvements in clinicians assessing patients' readiness to quit smoking (from 61% to 79%, t[59] = 3.69,P<0.001) and providing assistance with quitting (from 47% to 59%, t[59] = 2.12, P = 0.038). Asking patients about tobacco use, advising cessation, and arranging follow-up also increased over time, but not significantly. All participants (100%) recommended the curriculum for dissemination to other training programs.
  
  
  CONCLUSIONS
  Available online via http://rxforchange.ucsf.edu, Cardiology Rx for Change offers a packaged training tool for improving treatment of tobacco use and SHS exposure in cardiology care.
authors: Center for Tobacco Control, Research, and Education, University of California, San Francisco, San Francisco, California 94143-0984, USA. jprochaska@ucsf.edu
authors: Judith J
authors: JJ
authors: Prochaska
authors: Neal L
authors: NL
authors: Benowitz
authors: Stanton A
authors: SA
authors: Glantz
authors: Karen Suchanek
authors: KS
authors: Hudmon
authors: William
authors: W
authors: Grossman
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D012495:San Francisco; D012907:Smoking / Q000009:adverse effects; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000517:prevention & control
chemical_list: D014028:Tobacco Smoke Pollution