Fourth-year UW medical students learned about tobacco treatment when they recently completed a public-health elective class led by UW-CTRI Researchers Drs. Megan Piper and Jessica Cook.
In past years, the students would get to shadow UW-CTRI experts in person but, due to the pandemic, this year that wasn’t possible.
So Kay Lera, Assistant to the UW-CTRI Directors / Research Administrative Assistant, used her extensive teaching background to help bring the course to life online.
“I think it went exceptionally well overall,” Cook said. “Kay developed an innovative new class website that helped instructors and students navigate the new virtual format. The website included the course schedule, embedded WebEx links for each lecture, and all course materials. Kay’s experience as an educator and passion for teaching was an important part of the success of the new virtual format.”
Thanks to the portal, students got to discuss such topics as:
- An overview of tobacco treatment and electronic medical records by UW-CTRI Director Dr. Michael Fiore.
- Special populations and smoking with Dr. Adrienne Johnson.
- Understanding withdrawal with Dr. Danielle McCarthy.
- Dealing with smoking relapse with Dr. Tanya Schlam.
- Clinical role plays with Health Counselor Chris Ripley.
- Alternative tobacco products with Dr. Doug Jorenby.
- Motivating smokers to quit with Cook.
- The Wisconsin Tobacco Quit Line with Coordinator Kate Kobinsky.
- Medical systems and electronic medical records with UW-CTRI Outreach Director Rob Adsit.
- Learning and practicing evidence-based treatment for smokers who do and don’t want to quit with Piper and Cook.
- Electronic cigarettes with Dr. Brian Williams.
- Behavioral health and health equity with Dr. Bruce Christiansen.
The course, offered once a year for two weeks, has instructed 35 medical students during the last seven years. Many have gone on to help family, friends, and patients quit smoking.
“Thank you so much for a great course!” said student Ninah Divine.
The 2021 students, fourth-year medical students Brittany Anderson, Katherine Mooney, Helen Zukin-O’Callaghan, Michael Wakely and Divine, said they especially valued learning about evidence-based treatment and the “5 A’s,” which encourage clinicians to ask about tobacco use, advise patients to quit, assess willingness, assist with quitting or motivation to quit, and then arrange for follow-up.
The students examined existing research on tobacco use treatment among specific populations and presented online to UW-CTRI staff. Students also reviewed smoking cessation websites and apps as part of this class.
1. Divine said she took the course to support patients and prevent diseases as a primary care physician. “I am Cherokee, and bring this perspective to tobacco as a sacred medicine, in contrast to its commercial use, which disproportionately harms Native/Indigenous communities and other marginalized groups,” she said. From her research and personal experiences, she has discovered that:
- Thirty-eight percent of high school kids from tribes smoke (vs 20% of all high schoolers).
- Seventy-eight percent were exposed to secondhand smoke within the last week.
- Commercial tobacco is wrapped in a history of colonization of tribal lands, near genocide of tribal people, and appropriation of tribal culture in the name of marketing commercial tobacco products.
- Marketing programs to help tribal people quit commercial tobacco use seems to work best when the marketing is specific and meaningful to each individual tribe.
2. Wakely said he’s interested in how to best utilize his brief time with patients in the ER to discuss smoking cessation. “I’ll see many patients who will have life-changing pathologies that are directly related to their smoking habits,” he said, “and I believe this would be a very motivating time for them where an intervention could be crucial.” His research on low-income smokers showed that:
- Forty million Americans live in poverty, 29 million without health insurance.
- Studies show they want to quit but face barriers to evidence-based treatment.
- There’s a common belief that willpower is the most important key to quitting—more common than a belief in evidence-based treatments being most important.
- There is a need to ensure more people have insurance and/or access to evidence-based treatments.
3. Anderson said she is interested in helping patients quit, especially those struggling with behavioral health challenges. She found that:
- Those with schizophrenia smoke at the highest rates and tend to start at a younger age, right around the time when symptoms tend to kick in.
- Those with schizophrenia tend to have decreased dopamine levels, and smoking activates the dopaminergic system.
- Researchers estimate about 28 years of lost life for people with schizophrenia vs. peers without the disease. This may be due, at least in part, to high smoking rates.
- People with schizophrenia are often left out of treatment trials.
- Many recovery providers are reluctant to treat them for tobacco use.
- Most patients with schizophrenia want to quit smoking.
- Varenicline is most effective at helping people with schizophrenia to quit smoking.
- Group behavioral therapy can also help.
4. Zukin-O’Callaghan said she is eager support mothers quitting tobacco during pregnancy and postpartum. She found:
- Smoking has significant adverse effects for both mother and child.
- The earlier moms quit, the better, but there’s a benefit at any point, including after birth.
- Counseling is recommended, but medications have insufficient evidence and aren’t recommended.
5. Katherine Mooney said she is eager to use what she learned in her practice, particularly with patients who have comorbidities in addition to tobacco use disorder. She found:
- 16 million have COPD and millions more may have it and don’t realize it.
- The Lung Health Study found that, among 2,818 US smokers, after one year those who quit had improved lung function.
- After five years, all had lung decline, but those who quit smoking had half the decline of smokers.
- Some have suggested discussing with smokers how their individual lung health could improve as a way to motivate them to quit. Results have been mixed across all studies but, in England, one study that shared the individual’s “lung age” showed a positive effect in quitting motivation.
“The outstanding group of students engaged deeply in the course material,” Cook said, “and completed the course eager and well prepared to treat tobacco dependence in their patients.”
“I really am looking forward to using these skills to make an impact from the emergency department side of things,” said Wakely.
“The new UW-CTRI Treating Tobacco Dependency Spring Elective Website is a demonstration of how our UW-CTRI team consistently works to adopt efficient methods of collaboration,” Lera said. “Without hesitation, the amazing instructors took a positive risk and went out of their comfort zone to try a new way of running the online UW-CTRI spring elective course. I absolutely love working with the scientists at UW-CTRI!”