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BACKGROUND: Training medical students in tobacco prevention and treatment skills is critical if we are to have competent physicians prepared to address the grave levels of morbidity and mortality associated with tobacco use. Tobacco Prevention and Cessation Education at US Medical Schools (PACE), a National Cancer Institute funded project, was launched to assess and improve curriculum content and teaching at 12 US medical schools. METHODS: The 2003 survey was completed by faculty and administrators. The survey was divided into four main sections: tobacco content and skills, curricular evaluation, faculty perceptions of barriers and promoters, and educational vision. RESULTS: Thirty-six percent of all medical school courses had some tobacco-related content. Five schools provided a total of between 4 and 8 hours of teaching, 5 schools provided 10-13 hours, and 2 schools provided 17 and 18 hours of teaching. Of the 12 schools, 8 had fewer hours devoted to tobacco teaching in the clerkships than during the 1st-year courses. Only 2 schools noted any tobacco content for Obstetrics/Gynecology clerkships, and only 4 schools provided teaching in the pediatric setting (range 5-201 minutes). CONCLUSION: In comparison to earlier studies, it appears that more tobacco content is now integrated into medical school courses. More improvement is necessary, however, particularly in tobacco use prevention. Institutions need to examine the role of faculty in prioritizing tobacco information and promoting a culture that builds competency in tobacco control and treatment. [ABSTRACT FROM AUTHOR]

Introduction: The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD., Materials and Methods: The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar., Results: Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise., Conclusions: This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers., (© The Association of Military Surgeons of the United States 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To estimate the extent of environmental tobacco smoke (ETS) exposure among nonsmokers in the adult population of Cambodia., Methods: A cross-sectional survey was conducted on a nationally representative sample of 13,988 Cambodian adults in 2005. Information on smoking and exposure to ETS was obtained by trained interviewers using a standard questionnaire., Results: Overall, 37.4% of the 10,263 nonsmoking responders, or an estimated 1,629,700 nonsmoking Cambodians, were exposed to ETS. One third of pregnant women (31.4%) were exposed to ETS at home. In both unadjusted and adjusted models, men were less likely to be exposed to ETS at home (OR=0.34; 95% CI=0.29-0.41) and more likely to be exposed to ETS at work and in public places (OR=3.08; 95% CI=2.14-4.43 and OR=2.17; 95% CI=1.82-2.59, respectively). Education was inversely related to ETS exposure at home (OR=0.51; 95% CI=0.27-0.96 for 10 years of education vs 5 years or less). Legislators, senior officials, and managers were less likely to be exposed to ETS at home than professionals (OR=0.13; 95% CI=0.04-0.46), but more likely to be exposed at work or in public places. Rural residence was associated with higher ETS exposure in the home (OR=2.52; 95% CI=1.71-3.71) and lower ETS exposure at work (OR=0.42; 95% CI=0.24-0.76) compared to urban residence., Conclusions: The high prevalence of ETS exposure among adult Cambodians indicates an urgent need for specific measures such as public awareness campaigns, policies, and regulations to protect nonsmokers in Cambodia.

Design: The aim of the programme was to ultimately affect public health practice and policy in the Kingdom of Cambodia and Lao People's Democratic Republic (Lao PDR) by training key health professionals to conduct tobacco control research., Setting: Encouraged by the World Health Organization's Framework Convention on Tobacco Control, a global partnership formed to build effective leadership to develop and guide national tobacco control agendas. The partners were the Ministries of Health (Cambodia and Lao PDR), non-government organisations (Adventist Development and Relief Agency in Cambodia and Laos) and an academic institution (Loma Linda University, Loma Linda, California, USA)., Subjects: 16 health professionals, 10 from Cambodia and 6 from Lao PDR, were selected by local advisory committees to enter a two-year, intensive tobacco research graduate certificate and research training programme., Intervention: We developed a "Global Tobacco Control Methods" (GTCM) 28 unit certificate programme that was offered in five sessions from September 2003 to September 2005 at the National Institute of Public Health, Phnom Penh, Cambodia. As part of their coursework, the 16 trainees actively participated in the development and implementation of two research projects. In the first project, "Healthy Doc Healthy Patient" (HDHP), trainees adapted an existing, self-administered questionnaire designed to assess health practices and beliefs of medical students in Cambodia and Lao PDR. The second project involved the design of a national prevalence of tobacco use and health beliefs study in Cambodia using a multi-stage, cluster sample method. Trainees were sponsored to attend and present at international tobacco control conferences to enhance their awareness of the tobacco epidemic., Results: As of September 2005, 14 trainees (8 from Cambodia and 6 from Lao PDR) completed the courses in the GTCM certificate programme. The HDHP study sampled four medical school classes (years 3, 4, 5 and 6) in both Cambodia (n = 330, 71.1% response rate) and Lao PDR (n = 386, 87.3% response rate). As part of the Cambodian adult tobacco prevalence study in Cambodia, 13,988 adults (ages > or = 18 years) were interviewed from all 22 provinces during the summer of 2005. Over the two years, more than half of the trainees participated substantially in local and regional tobacco control and research activities. Programme challenges included the trainees' limited English language and computer proficiency skills, both of which improved during the two years., Conclusions: With the successful completion of the certificate programme, the remaining two years of the grant will be used to prepare the trainees for positions of leadership within their Ministries of Health and other agencies to implement effective tobacco control policies based on locally-derived research findings.

Context: Tobacco use has been identified as the primary preventable cause of premature deaths and disability, yet results of a previous survey show that undergraduate allopathic medical schools do not adequately address this topic., Objective: To assess the content and extent of tobacco education and intervention skills in osteopathic medical schools' curricula., Design: A mailed survey with 19 questions similar to one used for allopathic medical schools., Setting: Nineteen osteopathic medical schools., Participants: Responses were obtained from each associate dean for medical education or representative., Main Outcome Measures: Curriculum in seven basic science and six clinical science content areas (elective or required), hours of tobacco use intervention education, and resource materials used to design curricula., Results: Average number of total content areas covered was 10.2 (6 +/- 1.6 basic science areas, 4.17 +/- 1.54 clinical areas) with a range of 2 to 13. Nine (47%) schools reported covering all seven basic science areas, and one school reported covering none. Eleven (64.7%) of seventeen schools reported less than 3 hours of training in tobacco dependence treatment techniques during all 4 years. Sixty percent of schools do not require clinical training in smoking cessation techniques. Thirty-six percent require clinical training in an artificial setting without patients. None of the schools require clinical training with live patients. The schools founded after 1920 covered an average of almost twice as many content areas as those founded before 1920 (11.1 vs 6.6; P = .018)., Conclusions: Most US osteopathic medical school graduates are not being adequately educated to treat nicotine dependence as recommended by the National Cancer Institute expert panel and the Public Health Service Clinical Practice Guideline. Specifically, osteopathic medical education is deficient in clinical nicotine dependence treatment during the third and fourth years.

Background: Many persons who attempt to quit smoking have made previous unsuccessful attempts to quit with pharmacologic aids. An understanding of the impact of these previous attempts to quit is vital for selecting medications that may be more successful in a future attempt to quit. In particular, the effect of repeated use of bupropion SR (Zyban; INN, amfebutamone) on abstinence rates has not been studied previously., Methods: This was a multicenter, randomized, double-blind, placebo-controlled study in 450 smokers who had previously used bupropion in a smoking cessation attempt. The study consisted of a screening phase, a 12-week treatment phase, and a follow-up at month 6. Participants made regular clinic visits throughout the treatment phase during which they received brief counseling sessions to encourage abstinence from smoking. The primary end point was continuous abstinence from smoking from weeks 4 through 7. Secondary efficacy end points were examined throughout the treatment phase and at follow-up after 6 months., Results: In participants receiving bupropion SR, 27% (61 of 226) remained abstinent throughout the period from weeks 4 through 7 compared with 5% (11 of 224) of participants receiving placebo (P <.001). Significantly (P <.001) more participants who received bupropion SR during the treatment phase remained continuously abstinent from the start of week 4 through month 6 (27 of 226; 12%) compared with participants who received placebo (5 of 224; 2%). Eleven participants receiving placebo (5%) and 19 participants receiving bupropion SR (8%) stopped taking the study medication because of an adverse event., Conclusions: Bupropion SR is an effective medication for retreatment of smokers who have used bupropion SR previously.

The selection of a non-nicotine treatment is based on the acceptability of various treatments with smokers, the ability to address the specific neurobiology of nicotine addiction, and the option to provide treatment for co-morbid conditions of nicotine-dependent patients. The search for effective treatments for nicotine dependence has generated a wide variety of non-nicotine approaches based on the neuropharmacologic and sensory basis for tobacco use. The only non-nicotine, FDA-approved medication is bupropion, an amino-ketone agent that is believed to work on the dopaminergic and noradrenergic neurotransmitters involved in perpetuating nicotine dependence. This article reviews other unapproved medications, mechanisms of action, and their effectiveness in clinical trials.

Context: Tobacco use is the leading preventable cause of death in the United States. And yet only 21% of practicing physicians claim they received adequate training to help their patients stop smoking., Objective: To assess the content and extent of tobacco education and intervention skills in US medical schools' curricula., Design: A survey with 13 multiple-response items on tobacco education. Survey questions were based on the recommendations of the Agency for Health Care Policy and Research and the National Cancer Institute Expert Panel. The Liaison Committee on Medical Education included 4 of these items in a modified form on the 1997 annual questionnaire., Setting: One hundred twenty-six US medical schools., Participants: Surveys were obtained from 122 associate deans for medical education (98.6%)., Main Outcome Measures: Curriculum content in basic science and clinical science, elective or required clinical experience, hours of instruction, and resource materials., Results: Inclusion of all 6 tobacco curricula content areas recommended by the National Cancer Institute and the Agency for Health Care Policy and Research was higher in basic science (63/115 [54.8%]) than in clinical science (5/115 [4.4%]). Most medical schools (83/120 [69.2%]) did not require clinical training in smoking cessation techniques, while 23.5% (27/115) offered additional experience as an elective course. Thirty-one percent (32/102) of schools averaged less than 1 hour of instruction per year in smoking cessation techniques during the 4 years of medical school. A minority of schools reported 3 or more hours of clinical smoking cessation instruction in the third (14.7%) and fourth (4.9%) years., Conclusions: A majority of US medical school graduates are not adequately trained to treat nicotine dependence. The major deficit is the lack of smoking cessation instruction and evaluation in the clinical years. A model core tobacco curricula that meets national recommendations should be developed and implemented in all US medical schools.

Tobacco dependence is the most overlooked and undertreated preventable cause of chronic disease in the developed world. Three barriers to effective treatment must be overcome: the reluctance of nicotine addicts to seek help; inadequate training of health professionals to treat hard core smokers; and a health care system that does not acknowledge the need for professional treatment of nicotine addiction. Effective physicians are equipped with the knowledge and skills to identify high-risk smokers who need more assistance to quit. All smokers should be engaged in a tailored office intervention based on their needs. Adoption of simple clinical protocols can eliminate the barriers that prevent effective counseling and treatment in the office setting.

Recent studies suggest that the prevalence of smoking among active duty military women is higher than that of active duty military men or civilians of either gender. No data have been published on cessation rates among female veterans. We wanted to report such rates in a group of female veterans at Pettis VAMC Preventive Medicine Clinic and to study predictive factors for smoking cessation and prevention. We identified female patients at Pettis VAMC Preventive Medicine Women's Clinic who had received services in the past 3 years or who enrolled as new patients during the study period; 529 received questionnaires by mail or at the clinic; 409 returned completed surveys. A high proportion (32.5%) of our sample of female veterans were current smokers, and 67% of female veteran smokers reported smoking at least one pack daily. More than one-third of ever-smokers began smoking during military service. Thirty-nine percent of the female veteran sample had CES-D scores of 16 or greater, and current smokers had significantly greater mean CES-D scores than former smokers. Twenty-three percent of current smokers had high nicotine dependence scores (> 7). The highest proportion of CES-D scores compatible with depressive symptoms (55%) was seen among current smokers who consumed a pack or more of cigarettes per day. Ever-smokers who screened as depressed were significantly less likely to have quit than those with lower CES-D scores; however, in multivariate models, CES-D scores were not significantly related to cessation. The prevalence of current, ever, and heavy smoking was high among this sample of female veterans attending a VAMC Preventive Medicine clinic. An unexpectedly high prevalence of screening scores compatible with depression was found among this sample, particularly among smokers. This warrants further investigation, particularly in light of the reported relationship between depression and smoking.